01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-02-12 | 22 | 2026-02-12 | 1 |
| Cycle 2 | 2024-12-11 | 4 | 2024-12-11 | 4 |
| Cycle 3 | 2023-11-02 | 9 | 2023-11-02 | 2 |
CMS CCN 2455582026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Good Samaritan Society - Windom
705 Sixth Street · Windom, MN 56101 · Cottonwood County
Certified beds63CMS provider file
Recent citation rows42current CMS citation release
Penalty rows2current 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
42 rows in the current release
1 rows carry G–L scope/severity codes; 1 carry J–L. 5 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-02-12 · HEALTHF0578Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Correction field: Deficient, Provider has date of correction · 2026-03-182026-02-12 · HEALTHF0582Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Correction field: Deficient, Provider has date of correction · 2026-03-182026-02-12 · HEALTHF0605Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Correction field: Deficient, Provider has date of correction · 2026-03-182026-02-12 · HEALTHF0609Severity E · pattern; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2026-03-18 · complaint2026-02-12 · HEALTHF0610Severity E · pattern; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Correction field: Deficient, Provider has date of correction · 2026-03-18 · complaint2026-02-12 · HEALTHF0628Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Correction field: Deficient, Provider has date of correction · 2026-03-182026-02-12 · HEALTHF0638Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Assure that each resident’s assessment is updated at least once every 3 months.
Correction field: Deficient, Provider has date of correction · 2026-03-182026-02-12 · HEALTHF0645Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
PASARR screening for Mental disorders or Intellectual Disabilities
Correction field: Deficient, Provider has date of correction · 2026-03-182026-02-12 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2026-03-182026-02-12 · HEALTHF0685Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Assist a resident in gaining access to vision and hearing services.
Correction field: Deficient, Provider has date of correction · 2026-03-182026-02-12 · HEALTHF0695Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2026-03-182026-02-12 · 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 · 2026-03-182026-02-12 · HEALTHF0756Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Correction field: Deficient, Provider has date of correction · 2026-03-182026-02-12 · HEALTHF0759Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Correction field: Deficient, Provider has date of correction · 2026-03-182026-02-12 · HEALTHF0868Severity F · widespread; potential for more than minimal harm
Administration Deficiencies
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Correction field: Deficient, Provider has date of correction · 2026-03-182026-02-12 · HEALTHF0880Severity F · widespread; 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 · 2026-03-182026-02-12 · FIREK0324Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2026-03-182026-01-27 · HEALTHF0550Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2026-02-25 · complaint2026-01-27 · HEALTHF0580Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Correction field: Deficient, Provider has date of correction · 2026-02-25 · complaint2026-01-27 · HEALTHF0657Severity E · pattern; 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 · 2026-02-25 · complaint2026-01-27 · HEALTHF0686Severity K · pattern of immediate jeopardy
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2026-02-25 · complaint2026-01-27 · HEALTHF0791Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide or obtain dental services for each resident.
Correction field: Deficient, Provider has date of correction · 2026-02-25 · complaint2026-01-27 · 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 · 2026-02-25 · complaint2024-12-11 · HEALTHF0550Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2025-01-1703 / 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 |
|---|---|---|---|
| 2026-01-27 | Fine | $194,680 | 0 |
| 2026-01-27 | Payment Denial | $0 | 20 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- SANFORDOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 01/01/2019
- THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETYOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTEREST100% · since 01/01/2019
- BROWN, GEORGEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2025
- DYKHOUSE, DANAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- ENGBRECHT, WESLEYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- GASSEN, WILLIAMIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- GULSVIG, NEILIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- HERSETH SANDLIN, STEPHANIEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- LUNDEEN, MARKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- MCCAUSLAND, MAUREENIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2025
- MOLBERT, LAURISIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- NORTH, ANDREWIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- SCHIEFFER, KEVINIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2025
- SHULKIN, DAVIDIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- TEIKEN, BRENTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- VENTLING-HERRMANN, MARNIEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/30/2024
- WENZEL, THOMASIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2025
- FLUIT, JOELIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/01/2022
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 hours4.47per resident day
RN hours0.84per resident day
Weekend nurse hours3.91per resident day
Staff turnover40.7%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.