Good Samaritan - Saint Ansgar — nursing home in Saint Ansgar, IA

Facility type: Nursing home · SNF / NF
CMS provider type: Medicare and Medicaid
Certified beds: 42 CMS-certified beds (not state-licensed beds)
Licensed beds: State licensure is issued by the state survey agency. State license records are not yet ingested for this facility; the federal CMS certification is shown instead.
Average residents per day: 38.0 CMS, MDS-derived
CMS Certification Number: 165210
Certification status: Active CMS certification Verified
First approved (Medicare/Medicaid): Apr 1, 1994
Ownership type: For profit - Corporation
Operator (legal business name): The Evangelical Lutheran Good Samaritan Society
CMS chain: Good Samaritan Society 92 facilities
Phone: (641) 713-4912
Resident & family council: Resident
Sprinklers in all required areas: Yes
Official profile: Medicare Care Compare ↗

Inspection record · CMS window

Verified

Inspections

6

latest Jun 18, 2026

Citations

12

2 health · 10 fire

Harm or worse

0

no immediate jeopardy

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J·	K·	L·
Actual harm	G·	H·	I·
Potential harm	D5	E1	F6
Minimal	A·	B·	C·

CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.

CMS Five-Star ratings

Federal · CMS

Overall

Health inspections

Staffing

Quality measures

Penalties · about the last 3 years

Fines

0

$0

Payment denials

0

Latest

—

Federal certification

Federal · CMS

Authority: Centers for Medicare & Medicaid Services (CMS), surveyed by the state survey agency
CCN: 165210
Program: Medicare and Medicaid
Medicare (SNF): Certified
Medicaid (NF): Certified
Certified beds: 42
First approved: Apr 1, 1994
Located in a hospital: No
Status: Active CMS certification as of CMS release Oct 1, 2026
Evidence: Verified

State license

State licensure is issued by the state survey agency. State license records are not yet ingested for this facility; the federal CMS certification is shown instead. State coverage for Iowa.

Federal certification and the state license are different records. A nursing home is licensed by the state and, separately, certified by CMS to bill Medicare and/or Medicaid. We link them by the CCN when the state publishes it; otherwise by exact address, house number and street, or exact name within the same ZIP, and label that link as inferred. Never by name alone.

CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.

Date	Domain	Survey types	Citations	Most severe	Open
Jun 18, 2026	Fire safety	Fire Safety Standard	3	Potential harm	—	Open →
Jun 18, 2026	Health	Health Standard	2	Potential harm	—	Open →
Apr 24, 2025	Fire safety	Fire Safety Standard	4	Potential harm	—	Open →
Apr 24, 2025	Health	Health Standard	0	No citations	—	Open →
Jul 21, 2024	Fire safety	Fire Safety Standard	3	Potential harm	—	Open →
Jul 21, 2024	Health	Health Standard	0	No citations	—	Open →

Enforcement

Penalties

Civil money penalties and denials of payment for new admissions, as published by CMS (about the last three years). Amounts may change on appeal.

No fines or payment denials in the CMS Penalties file for this CCN.

Scope × severity

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J·	K·	L·
Actual harm	G·	H·	I·
Potential harm	D5	E1	F6
Minimal	A·	B·	C·

By concept

Date	Tag	Deficiency	Scope / severity	Correction
Jun 18, 2026	K-0345	Have approved installation, maintenance and testing program for fire alarm systems. Smoke Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Jun 17, 2026
Jun 18, 2026	K-0761	To conduct inspection, testing and maintenance of fire doors by qualified individuals. Miscellaneous Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Jun 17, 2026
Jun 18, 2026	K-0923	Have proper medical gas storage and administration areas. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	E · Potential harm Pattern	Corrected Jun 17, 2026
Jun 18, 2026	F-0727	Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Nursing and Physician Services Deficiencies · Staffing & supervision	F · Potential harm Widespread	Corrected Jul 15, 2026
Jun 18, 2026	F-0880	Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention	D · Potential harm Isolated	Corrected Jul 15, 2026
Apr 24, 2025	K-0511	Have properly installed electrical wiring and gas equipment. Services Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Apr 28, 2025
Apr 24, 2025	K-0753	Have restrictions on the use of highly flammable decorations. Miscellaneous Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Apr 28, 2025
Apr 24, 2025	K-0761	To conduct inspection, testing and maintenance of fire doors by qualified individuals. Miscellaneous Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Apr 24, 2025
Apr 24, 2025	K-0918	Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Apr 22, 2025
Jul 21, 2024	K-0223	Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector. Egress Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Aug 2, 2024
Jul 21, 2024	K-0363	Install corridor and hallway doors that block smoke. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Jul 30, 2024
Jul 21, 2024	K-0918	Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Aug 7, 2024

“Corrected” does not erase a citation: the historical finding stays listed with its disposition. Narrative statements of deficiencies are not part of the CMS dataset; see Care Compare for the official inspection report.

Five-Star ratings

Federal · CMS

Overallstate 3.1

Health inspectionsstate 2.8

Staffingstate 3.8

Quality measuresstate 3.4

Long-stay QM

Short-stay QM

CMS ratings apply to CMS-certified nursing homes only and are relative within each state. They are not a guarantee of any individual resident’s experience.

Nurse staffing · hours per resident per day

Total nurse staffing3.23

State avg 3.86US avg 3.90

Registered nurse (RN)0.79

State avg 0.74US avg 0.69

Licensed practical nurse0.32

State avg 0.56US avg 0.86

Nurse aide2.12

State avg 2.56US avg 2.35

Weekend total nurse2.68

State avg 3.38US avg 3.43

Reported from Payroll-Based Journal (PBJ) data, as published by CMS. Case-mix adjusted total: 4.28 (case-mix index 1.06).

Staff turnover

Total nursing staff turnover21.2%

State avg 44.1%US avg 45.3%

Registered nurse turnover12.5%

State avg 42.1%US avg 42.5%

Administrators who left0

State avg 0US avg 1

Health survey score

Cycle 1 standard survey: Jun 18, 2026
Cycle 1 health score: 20
Total weighted score: 15

Operating entity

The Evangelical Lutheran Good Samaritan Society

CMS legal business name of the certified provider. Operates 87 facilities.

VerifiedLinked by exact legal name

CMS chain

Good Samaritan Society

92 facilities in 9 states. CMS chain ID 726.

VerifiedAssigned by CMS

Chain average overall rating (CMS): 3

Ownership disclosures

Disclosures

28

Organizations

2

Individuals

26

Direct & indirect ownership

Owners of record

Name	Type	Role (Carefield group)	CMS role text	Share	Since
Sanford	Organization	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	not provided	Jan 1, 2019
The Evangelical Lutheran Good Samaritan Society	Organization	Indirect owner	5% OR GREATER INDIRECT OWNERSHIP INTEREST	100%	Jan 1, 2019

CMS Ownership file

All disclosed roles

Operator, owners, managers, officers and lenders are distinct roles and are never flattened into one entity. Organizations link across facilities by exact normalized legal name; individuals are listed per facility only.

Name	Type	Role (Carefield group)	CMS role text	Share	Since
Sanford	Organization	Direct owner	5% OR GREATER DIRECT OWNERSHIP INTEREST	not provided	Jan 1, 2019
The Evangelical Lutheran Good Samaritan Society	Organization	Indirect owner	5% OR GREATER INDIRECT OWNERSHIP INTEREST	100%	Jan 1, 2019
Kelsey Bundy	Individual	Operational / managerial control	OPERATIONAL/MANAGERIAL CONTROL	not provided	Apr 25, 2021
Tony Morrison	Individual	Operational / managerial control	OPERATIONAL/MANAGERIAL CONTROL	not provided	Jan 1, 2019
Kelly Ross	Individual	Operational / managerial control	OPERATIONAL/MANAGERIAL CONTROL	not provided	May 1, 2017
George Brown	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	Jan 1, 2025
Dana Dykhouse	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	May 30, 2024
Wesley Engbrecht	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	May 30, 2024
William Gassen	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	May 30, 2024
Neil Gulsvig	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	May 30, 2024
Stephanie Herseth Sandlin	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	May 30, 2024
Mark Lundeen	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	May 30, 2024
Maureen Mccausland	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	Jan 1, 2025
Lauris Molbert	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	May 30, 2024
Andrew North	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	May 30, 2024
Kevin Schieffer	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	Jan 10, 2025
David Shulkin	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	May 30, 2024
Brent Teiken	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	May 30, 2024
Marnie Ventling-Herrmann	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	May 30, 2024
Thomas Wenzel	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	Jan 1, 2025
Joel Fluit	Individual	Corporate officer / director	CORPORATE OFFICER	not provided	Oct 1, 2022
William Gassen	Individual	Corporate officer / director	CORPORATE OFFICER	not provided	May 30, 2024
Aimee Middleton	Individual	Corporate officer / director	CORPORATE OFFICER	not provided	Jan 27, 2022
Nicholas Olson	Individual	Corporate officer / director	CORPORATE OFFICER	not provided	Apr 8, 2024
Nathan Schema	Individual	Corporate officer / director	CORPORATE OFFICER	not provided	Jun 24, 2019
Kelsey Bundy	Individual	Additional disclosable party	ADP OF THE SNF	not provided	Apr 25, 2021
Tony Morrison	Individual	Additional disclosable party	ADP OF THE SNF	not provided	Jan 1, 2019
Kelly Ross	Individual	Additional disclosable party	ADP OF THE SNF	not provided	May 1, 2017

Other facilities operated by The Evangelical Lutheran Good Samaritan Society

All 86 →

Facility	Beds	Last inspection	Citations (window)	Fines
Good Samaritan - Loveland Village 2101 S Garfield Ave, Loveland, CO 80537 CCN 065139Abuse icon	104	Apr 2, 2026	271 IJ4 harm	$46k
Good Samaritan Society -- Fort Collins Village 508 W Trilby Rd, Fort Collins, CO 80525 CCN 065227	64	Dec 4, 2025	22	—
Creekstone Health and Wellness 1500 Southgate Drive, Kissimmee, FL 34746 CCN 105559	161	Dec 11, 2025	271 harm	$12k
Harry and Jeanette Weinberg Care Center 45-090 Namoku St, Kaneohe, HI 96744 CCN 125033	44	Jan 30, 2025	20	—
Good Samaritan - Davenport 700 Waverly Road, Davenport, IA 52804 CCN 165169	119	Jan 29, 2026	35	—
Good Samaritan - Indianola 708 South Jefferson, Indianola, IA 50125 CCN 165186	105	May 14, 2026	691 IJ3 harm	$20k
Good Samaritan - West Union 201 Hall Street, West Union, IA 52175 CCN 165187	52	May 20, 2026	32	—
Good Samaritan - Villisca 202 North Central Avenue, Villisca, IA 50864 CCN 165189	46	Jan 29, 2026	341 harm	—

Same chain in Iowa

All 91 in chain →

Facility	Beds	Last inspection	Citations (window)	Fines
Salem Lutheran Home 2027 College Avenue, Elk Horn, IA 51531 CCN 165155	64	Aug 13, 2026	521 harm	$15k
Good Samaritan - Davenport 700 Waverly Road, Davenport, IA 52804 CCN 165169	119	Jan 29, 2026	35	—
Good Samaritan - Indianola 708 South Jefferson, Indianola, IA 50125 CCN 165186	105	May 14, 2026	691 IJ3 harm	$20k
Good Samaritan - West Union 201 Hall Street, West Union, IA 52175 CCN 165187	52	May 20, 2026	32	—
Good Samaritan - Villisca 202 North Central Avenue, Villisca, IA 50864 CCN 165189	46	Jan 29, 2026	341 harm	—
Good Samaritan - Algona 412 West Kennedy Street, Algona, IA 50511 CCN 165190	72	Dec 4, 2025	413 harm	$7,070
Good Samaritan - Red Oak 201 Alix Avenue, Red Oak, IA 51566 CCN 165191	53	Apr 23, 2026	471 IJ2 harm	$68k
Good Samaritan - Estherville 1646 Fifth Avenue North, Estherville, IA 51334 CCN 165192	62	Jan 15, 2026	44	—

No building or property record is linked to this facility yet. Parcel, assessor and building-permit joins will be added only where a valid site match exists.

Coordinates as published by CMS.

Address: 701 East Fourth Street, Saint Ansgar, IA 50472
ZIP: 50472
County: Mitchell County FIPS 19131
State: Iowa
Urban / rural (CMS): Rural

Within ~25 km

Nearby nursing homes

Facility	Distance	Beds	Last inspection	Citations (window)	Fines
Stacyville Community Nursing Home 413 South Broad Street, Stacyville, IA 50476 CCN 165438	12 km	34	Aug 6, 2026	472 harm4 open	$22k
Osage Rehab and Health Care Center 830 South Fifth Street, Osage, IA 50461 CCN 165173	13.7 km	46	Apr 2, 2026	881 IJ1 harm	$14k
Faith Lutheran Home 914 Davidson Drive, Osage, IA 50461 CCN 165433	14.1 km	50	Jul 16, 2025	7	—

Source	Record	Facts	Evidence	Source release	Retrieved
CMS Provider Information US-CMS	165210	name, address, phone, certification, certified_beds, ownership_type, legal_business_name, chain	Verified	Oct 1, 2026	Nov 7, 2026
CMS Provider Information US-CMS	165210	ratings, staffing, health_survey_score Five-Star ratings and PBJ staffing apply to the CMS-certified universe only.	Verified	Oct 1, 2026	Nov 7, 2026

Record-level source links for CCN 165210

First seen by Carefield Nov 7, 2026 · last changed Nov 7, 2026. This record as JSON · Report a correction