01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-05-28 | 4 | 2026-05-28 | 6 |
| Cycle 2 | 2025-07-30 | 6 | 2025-07-30 | 10 |
| Cycle 3 | 2024-06-06 | 3 | 2024-06-06 | 1 |
CMS CCN 2455122026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
First Care Living Center
900 Hilligoss Boulevard Southeast · Fosston, MN 56542 · Polk County
Certified beds36CMS provider file
Recent citation rows30current CMS citation release
Penalty rows1current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
30 rows in the current release
1 rows carry G–L scope/severity codes; 1 carry J–L. 4 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-05-28 · HEALTHF0585Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Correction field: Deficient, Provider has date of correction · 2026-06-302026-05-28 · HEALTHF0744Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
Correction field: Deficient, Provider has date of correction · 2026-06-302026-05-28 · HEALTHF0883Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Correction field: Deficient, Provider has date of correction · 2026-06-302026-05-28 · HEALTHF0887Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
Correction field: Deficient, Provider has date of correction · 2026-06-302026-05-28 · FIREK0232Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Have corridors or aisles that are unobstructed and are at least 8 feet in width.
Correction field: Deficient, Provider has date of correction · 2026-06-182026-05-28 · FIREK0291Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Install emergency lighting that can last at least 1 1/2 hours.
Correction field: Deficient, Provider has date of correction · 2026-06-232026-05-28 · FIREK0324Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2026-06-242026-05-28 · FIREK0355Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Properly select, install, inspect, or maintain portable fire extinguishes.
Correction field: Deficient, Provider has date of correction · 2026-06-232026-05-28 · FIREK0372Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Correction field: Deficient, Provider has date of correction · 2026-06-012026-05-28 · FIREK0761Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Correction field: Deficient, Provider has date of correction · 2026-07-072025-07-30 · HEALTHF0637Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Assess the resident when there is a significant change in condition
Correction field: Deficient, Provider has date of correction · 2025-08-102025-07-30 · HEALTHF0657Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Correction field: Deficient, Provider has date of correction · 2025-08-102025-07-30 · HEALTHF0676Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Correction field: Deficient, Provider has date of correction · 2025-08-012025-07-30 · HEALTHF0688Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Correction field: Deficient, Provider has date of correction · 2025-08-012025-07-30 · HEALTHF0755Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Correction field: Deficient, Provider has date of correction · 2025-08-052025-07-30 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-07-302025-07-30 · FIREK0321Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2025-08-252025-07-30 · FIREK0324Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2025-07-292025-07-30 · FIREK0345Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2025-09-152025-07-30 · FIREK0355Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Properly select, install, inspect, or maintain portable fire extinguishes.
Correction field: Deficient, Provider has date of correction · 2025-07-292025-07-30 · FIREK0363Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2025-07-292025-07-30 · FIREK0372Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Correction field: Deficient, Provider has date of correction · 2025-07-292025-07-30 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2025-08-202025-07-30 · FIREK0914Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Correction field: Deficient, Provider has date of correction · 2025-08-2903 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2024-04-26 | Fine | $14,433 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- CHRISTENSEN, JAMESIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2020
- HAUGEN, JOELIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2017
- HEILMAN, TIMIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2020
- HORN, BEVERLYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2017
- JACKSON, AARICKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2020
- LEWANDOWSKI, LAURIEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2017
- MERTZ, TAYLORIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/17/2022
- SMITH, BENJAMINIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/17/2022
- ARVIN, DOUGLASIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/18/2023
- GEFROH ELLISON, STEFANIEIndividual · CORPORATE OFFICERNOT APPLICABLE · since 08/12/2024
- HURLEY, ALANIndividual · CORPORATE OFFICERNOT APPLICABLE · since 05/18/2023
- WATTERS, MICHAELIndividual · CORPORATE OFFICERNOT APPLICABLE · since 07/01/2023
- INNOVIS HEALTH LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2017
- ARVIN, DOUGLASIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/08/2023
- CURTIS, MICHAELIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 07/08/2024
- GUPTA, PARULIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 09/02/2025
- HURLEY, ALANIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/18/2023
- ESSENTIA HEALTHOrganization · ADP OF THE SNFNOT APPLICABLE · since 01/29/2025
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours5.35per resident day
RN hours1.55per resident day
Weekend nurse hours4.45per resident day
Staff turnover41.7%CMS reported field
06 / LOCAL RECORDS
Open the Minnesota ledger →Other published facilities nearby
No second facility in the same city met the directory rule.