Good Samaritan - Forest City
Forest City, Winnebago County, Iowa · CCN 165213 · Non-profit (Church related) · part of Good Samaritan Society (92 facilities, chain average 3 stars)
CMS rates Good Samaritan - Forest City 4 of 5 overall as of August 2026. 43 certified beds, 31 residents a day on average. 9 citations on record from the current inspection cycles, 1 at immediate jeopardy; 2 fines totalling $25,945 and 1 payment denial.
CMS’s ratings
The Five-Star Quality Rating System, as CMS publishes it. Where CMS gives no rating, the reason CMS gives is printed instead.
| Overall | ★★★★☆ 4 of 5 |
|---|---|
| Health inspections | ★★★★☆ 4 of 5 |
| Staffing | ★★★★☆ 4 of 5 |
| Quality measures | ★★☆☆☆ 2 of 5 |
| Quality: long-stay / short-stay | 3 / 2 of 5 |
Staffing
| Total nurse staffing | 3.491 hours per resident per day |
|---|---|
| Registered nurses | 0.87621 hours per resident per day |
| Weekend total | 3.19401 hours per resident per day |
| Nursing staff turnover | 31% (registered nurses 33.3%) |
| Administrators who left | 0 |
Citations from health inspections
Each is a finding by a state surveyor on the date shown, in CMS’s words. The severity is CMS’s scope-and-severity grid, spelled out: harm on the left, how widespread on the right.
| Survey | Finding | Severity | Status |
|---|---|---|---|
| 2025-08-07 complaint survey |
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Freedom from Abuse, Neglect, and Exploitation Deficiencies · tag F0600 |
D No actual harm, with potential for more than minimal harm; isolated | Past Non-Compliance 2025-07-15 |
| 2025-08-07 | Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Quality of Life and Care Deficiencies · tag F0690 |
D No actual harm, with potential for more than minimal harm; isolated | Deficient, Provider has date of correction 2025-08-22 |
| 2024-09-05 complaint survey |
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · tag F0689 |
G Actual harm that is not immediate jeopardy; isolated | Past Non-Compliance 2024-04-22 |
| 2024-09-05 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Resident Assessment and Care Planning Deficiencies · tag F0656 |
D No actual harm, with potential for more than minimal harm; isolated | Deficient, Provider has date of correction 2024-09-19 |
| 2024-09-05 complaint survey |
Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · tag F0684 |
D No actual harm, with potential for more than minimal harm; isolated | Deficient, Provider has date of correction 2024-09-19 |
| 2024-09-05 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · tag F0812 |
D No actual harm, with potential for more than minimal harm; isolated | Deficient, Provider has date of correction 2024-09-19 |
| 2023-10-19 | Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Nutrition and Dietary Deficiencies · tag F0805 |
K Immediate jeopardy to resident health or safety; pattern | Deficient, Provider has date of correction 2023-11-02 |
| 2023-10-19 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Resident Rights Deficiencies · tag F0580 |
D No actual harm, with potential for more than minimal harm; isolated | Deficient, Provider has date of correction 2023-11-08 |
| 2023-10-19 | Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · tag F0684 |
D No actual harm, with potential for more than minimal harm; isolated | Deficient, Provider has date of correction 2023-11-08 |
Fines and payment denials
| Date | Penalty | Amount |
|---|---|---|
| 2024-09-05 | Fine | $8,824 |
| 2023-10-19 | Payment denial for 4 days from 2023-11-17 | — |
| 2023-10-19 | Fine | $17,121 |
Who owns and runs it
Every owner, officer and manager CMS lists, as filed. These are the names in CMS’s ownership record; anyone named in the ownership record can ask about it on the about page.
| Name | Role | Share | Since |
|---|---|---|---|
| The Evangelical Lutheran Good Samaritan Society Organization | operational/managerial control | — | 2019-01-01 |
| Carlson, Byron Individual | contracted managing employee | — | 2023-05-01 |
| Cain, James Individual | corporate director | — | 2024-05-30 |
| Dykhouse, Dana Individual | corporate director | — | 2024-05-30 |
| Engbrecht, Wesley Individual | corporate director | — | 2024-05-30 |
| Gassen, William Individual | corporate director | — | 2024-05-30 |
| Gulsvig, Neil Individual | corporate director | — | 2024-05-30 |
| Herseth Sandlin, Stephanie Individual | corporate director | — | 2024-05-30 |
| Lundeen, Mark Individual | corporate director | — | 2024-05-30 |
| Molbert, Lauris Individual | corporate director | — | 2024-05-30 |
| North, Andrew Individual | corporate director | — | 2024-05-30 |
| Shulkin, David Individual | corporate director | — | 2024-05-30 |
| Teiken, Brent Individual | corporate director | — | 2024-05-30 |
| Ventling-Herrmann, Marnie Individual | corporate director | — | 2024-05-30 |
| Fluit, Joel Individual | corporate officer | — | 2022-10-01 |
| Gassen, William Individual | corporate officer | — | 2024-05-30 |
| Middleton, Aimee Individual | corporate officer | — | 2022-01-27 |
| Olson, Nicholas Individual | corporate officer | — | 2024-04-08 |
| Rogers, Michael Individual | corporate officer | — | 2022-06-13 |
| Schema, Nathan Individual | corporate officer | — | 2022-01-01 |
| Brink, Holly Individual | w-2 managing employee | — | 2022-11-20 |
| Middleton, Aimee Individual | w-2 managing employee | — | 2022-01-27 |
| Morrison, Tony Individual | w-2 managing employee | — | 2019-01-01 |
What changed
Nothing has changed in this record since it was first loaded. The next CMS refresh is the next chance.
Tell me when this record changes
One email when the monthly CMS refresh brings a new citation, a fine or payment denial, a rating change, a flag, or a change of ownership for Good Samaritan - Forest City.
Source: Centers for Medicare & Medicaid Services, Provider Data Catalog (public domain), files dated 2026-08-01. Ratings are CMS’s; citations are state surveyors’ findings; nothing here is estimated or a recommendation. Every nursing home in Winnebago County.