FOUR SEASONS HEALTH CARE INC
483 4TH ST SW, FORMAN, ND 58032 · CCN 355103
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Ratings
- Overall
- ★☆☆☆☆ 1
- Health inspection
- ★☆☆☆☆ 1
- Quality measures
- ★★☆☆☆ 2
- Staffing
- ★★★☆☆ 3
Facility
- Ownership type
- Non profit - Other
- Certified beds
- 33
- Avg residents/day
- 22.8
- Phone
- 7017246211
Inspection history vs North Dakota & national averages
Cycle 1 is the most recent standard health inspection. Lower total deficiency counts are better.
| Cycle | Inspection date | This facility | North Dakota avg | National avg | vs state |
|---|---|---|---|---|---|
| 1 | 2024-10-30 | 16 | 5.4 | 9.5 | +10.6 worse |
| 2 | 2023-11-08 | 5 | 6.3 | 9.8 | -1.3 better |
| 3 | 2022-09-14 | 13 | 5.1 | 9.3 | +7.9 worse |
Cycle 1 deficiencies by category
| Category | Deficiencies |
|---|---|
| Abuse, neglect, exploitation | 1 |
| Quality of life and care | 3 |
| Resident assessment and care planning | 4 |
| Nursing and physician services | 2 |
| Resident rights | 2 |
| Nutrition and dietary | 1 |
| Pharmacy service | 1 |
| Administration | 1 |
| Infection control | 1 |
Staffing (hours per resident per day)
| Metric | This facility | Turnover |
|---|---|---|
| Total nurse staffing (reported) | 3.89 | 57.7% |
| RN staffing (reported) | 0.78 | 100.0% |
| Total nurse staffing (adjusted) | 4.16 | — |
Fines & penalties
- Total fines
- $319,259
- Number of fines
- 5
- Number of penalties
- 5
- Payment denials
- 0
Inspection citations (34)1 immediate jeopardy4 actual harm
- DF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2025-12-29 · Health · corrected 2026-01-28
Potential for more than minimal harm
- JF0600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.2025-09-24 · Health · corrected 2025-09-25
Immediate jeopardy
- EF0584Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.2024-10-30 · Health · corrected 2024-12-12
Potential for more than minimal harm
- DF0625Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.2024-10-30 · Health · corrected 2024-12-12
Potential for more than minimal harm
- EF0641Ensure each resident receives an accurate assessment.2024-10-30 · Health · corrected 2025-01-14
Potential for more than minimal harm
- DF0644Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.2024-10-30 · Health · corrected 2024-12-12
Potential for more than minimal harm
- DF0657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.2024-10-30 · Health · corrected 2024-12-12
Potential for more than minimal harm
- DF0658Ensure services provided by the nursing facility meet professional standards of quality.2024-10-30 · Health · corrected 2024-12-12
Potential for more than minimal harm
- GF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2024-10-30 · Health · corrected 2024-12-12
Actual harm
- DF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2024-10-30 · Health · corrected 2024-12-12
Potential for more than minimal harm
- EF0725Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.2024-10-30 · Health · corrected 2024-12-12
Potential for more than minimal harm
- CF0732Post nurse staffing information every day.2024-10-30 · Health · corrected 2024-12-12
Potential for minimal harm
- DF0761Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.2024-10-30 · Health · corrected 2024-12-12
Potential for more than minimal harm
- EF0812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.2024-10-30 · Health · corrected 2024-12-12
Potential for more than minimal harm
- FF0865Have a plan that describes the process for conducting QAPI and QAA activities.2024-10-30 · Health · corrected 2024-12-12
Potential for more than minimal harm
- DF0880Provide and implement an infection prevention and control program.2024-10-30 · Health · corrected 2025-01-14
Potential for more than minimal harm
- DF0655Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted2023-11-08 · Health · corrected 2023-12-19
Potential for more than minimal harm
- DF0657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.2023-11-08 · Health · corrected 2023-12-13
Potential for more than minimal harm
- DF0658Ensure services provided by the nursing facility meet professional standards of quality.2023-11-08 · Health · corrected 2023-12-13
Potential for more than minimal harm
- DF0679Provide activities to meet all resident's needs.2023-11-08 · Health · corrected 2023-12-13
Potential for more than minimal harm
- DF0684Provide appropriate treatment and care according to orders, resident’s preferences and goals.2023-11-08 · Health · corrected 2023-12-13
Potential for more than minimal harm
- GF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2023-08-30 · Health · corrected 2023-08-15
Actual harm
- DF0609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.2023-03-27 · Health · corrected 2023-04-25
Potential for more than minimal harm
- GF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2023-03-27 · Health · corrected 2023-04-25
Actual harm
- DF0554Allow residents to self-administer drugs if determined clinically appropriate.2022-09-14 · Health · corrected 2022-10-25
Potential for more than minimal harm
- DF0578Honor 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.2022-09-14 · Health · corrected 2022-10-25
Potential for more than minimal harm
- BF0582Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.2022-09-14 · Health · corrected 2022-10-25
Potential for minimal harm
- DF0644Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.2022-09-14 · Health · corrected 2022-10-25
Potential for more than minimal harm
- GF0689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.2022-09-14 · Health · corrected 2022-10-25
Actual harm
- DF0759Ensure medication error rates are not 5 percent or greater.2022-09-14 · Health · corrected 2022-10-25
Potential for more than minimal harm
- DF0761Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.2022-09-14 · Health · corrected 2022-10-25
Potential for more than minimal harm
- EF0880Provide and implement an infection prevention and control program.2022-09-14 · Health · corrected 2022-10-25
Potential for more than minimal harm
- DF0887Educate 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.2022-09-14 · Health · corrected 2022-10-25
Potential for more than minimal harm
- EF0921Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.2022-09-14 · Health · corrected 2022-10-19
Potential for more than minimal harm
Ownership
| Owner | Type | Role | Percent | Since |
|---|---|---|---|---|
| ELLEFSON, PATTY | Individual | CORPORATE OFFICER | — | 2014-07-01 |
| JOHNSON, DEBORAH | Individual | CORPORATE OFFICER | — | 2014-07-01 |
| MARTINSON, DAVID | Individual | CORPORATE OFFICER | — | 2014-07-01 |
| MCLEAN, STEVEN | Individual | CORPORATE OFFICER | — | 2014-07-01 |
| ROCKSWOLD, JASON | Individual | CORPORATE OFFICER | — | 2014-07-01 |
| SCHLECHT, NATHAN | Individual | CORPORATE OFFICER | — | 2014-07-01 |
| WOYTASSEK, MARY KAY | Individual | CORPORATE OFFICER | — | 2014-07-01 |
| KLEINGARTNER, ANDREA | Individual | W-2 MANAGING EMPLOYEE | — | 2014-12-02 |
| LANG, SONYA | Individual | W-2 MANAGING EMPLOYEE | — | 2014-12-02 |
Other facilities in FORMAN
| Name | Overall | Beds |
|---|
Source: CMS Provider Data Catalog, Nursing Home Care Compare files (processed 2026-03-01). Citations show the 3 most recent inspection cycles.