Nursing homeActive
Four Seasons Health Care Inc
483 4th St Sw, Forman, ND 58032701724621125 certified beds · 23 residentsNon profit - CorporationMedicare and Medicaid
Surveys on file
7
since 2023
Deficiencies
29
● 1● 26● 2
Penalties · 3 yrs
$107,746
2 fines
Last survey
2026-05-19
Complaint
CMS overall
1 / 5
stars as published by CMS
CMS overall 1/5
Health 1
Staffing 1
Quality 4
Star ratings as published by CMS · CMS’s caveats
Survey history
Source: CMS · North Dakota Department of Health · data as of 2026-08-01| Date | Kind | Deficiencies | Official record | Archived PDF |
|---|---|---|---|---|
| 2026-05-19 | Complaint | 020 | CMS-2567 (Care Compare) | — |
| 2026-02-19 | Standard | 050 | CMS-2567 (Care Compare) | — |
| 2025-12-29 | Complaint | 010 | CMS-2567 (Care Compare) | — |
| 2025-09-24 | Complaint | 010 | CMS-2567 (Care Compare) | — |
| 2024-10-30 | Standard | 1121 | CMS-2567 (Care Compare) | — |
| 2023-11-08 | Standard | 050 | CMS-2567 (Care Compare) | — |
| 2023-08-30 | Complaint | 001 | CMS-2567 (Care Compare) | — |
Counts by class: paperwork · standard · harm.
Deficiencies
CMS · North Dakota Department of Health publishes each citation’s tag, official description and scope/severity letter. The surveyor’s written findings are in the Statement of Deficiencies (CMS-2567) for each survey, linked above.
F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.Scope/severity DStandard
Dignity & rights
Isolated; no actual harm, potential for more than minimal harm.Corrected 2026-06-22Record 355103-20260519-F580
F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Scope/severity DStandard
Care planningFalls
Isolated; no actual harm, potential for more than minimal harm.Corrected 2026-06-22Record 355103-20260519-F689
F640Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment.Scope/severity FStandard
Care planningRecords
Widespread; no actual harm, potential for more than minimal harm.Corrected 2026-04-06Record 355103-20260219-F640
F641Ensure each resident receives an accurate assessment.Scope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2026-04-06Record 355103-20260219-F641
F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.Scope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2026-04-06Record 355103-20260219-F657
F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.Scope/severity DStandard
Care planning
Isolated; no actual harm, potential for more than minimal harm.Corrected 2026-04-06Record 355103-20260219-F684
F883Develop and implement policies and procedures for flu and pneumonia vaccinations.Scope/severity DStandard
Infection control
Isolated; no actual harm, potential for more than minimal harm.Corrected 2026-04-13Record 355103-20260219-F883
F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Scope/severity DStandard
Care planningFalls
Isolated; no actual harm, potential for more than minimal harm.Corrected 2026-01-28Record 355103-20251229-F689
F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.Scope/severity DStandard
Abuse & neglect
Isolated; no actual harm, potential for more than minimal harm.Corrected 2025-09-25Record 355103-20250924-F600
F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.Scope/severity GHarm
Care planning
Isolated; actual harm that is not immediate jeopardy.Corrected 2024-12-12Record 355103-20241030-F684
F584Honor 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.Scope/severity EStandard
Dignity & rights
Pattern; no actual harm, potential for more than minimal harm.Corrected 2024-12-12Record 355103-20241030-F584
F625Notify 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.Scope/severity DStandard
Dignity & rights
Isolated; no actual harm, potential for more than minimal harm.Corrected 2024-12-12Record 355103-20241030-F625
F641Ensure each resident receives an accurate assessment.Scope/severity EStandard
Care planningRecords
Pattern; no actual harm, potential for more than minimal harm.Corrected 2025-01-14Record 355103-20241030-F641
F644Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.Scope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2024-12-12Record 355103-20241030-F644
F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.Scope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2024-12-12Record 355103-20241030-F657
F658Ensure services provided by the nursing facility meet professional standards of quality.Scope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2024-12-12Record 355103-20241030-F658
F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Scope/severity DStandard
Care planningFalls
Isolated; no actual harm, potential for more than minimal harm.Corrected 2024-12-12Record 355103-20241030-F689
F725Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.Scope/severity EStandard
Staffing
Pattern; no actual harm, potential for more than minimal harm.Corrected 2024-12-12Record 355103-20241030-F725
F761Ensure 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.Scope/severity DStandard
Medication
Isolated; no actual harm, potential for more than minimal harm.Corrected 2024-12-12Record 355103-20241030-F761
F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Scope/severity EStandard
Food & nutrition
Pattern; no actual harm, potential for more than minimal harm.Corrected 2024-12-12Record 355103-20241030-F812
F865Have a plan that describes the process for conducting QAPI and QAA activities.Scope/severity FStandard
Records
Widespread; no actual harm, potential for more than minimal harm.Corrected 2024-12-12Record 355103-20241030-F865
F880Provide and implement an infection prevention and control program.Scope/severity DStandard
Infection control
Isolated; no actual harm, potential for more than minimal harm.Corrected 2025-01-14Record 355103-20241030-F880
F732Post nurse staffing information every day.Scope/severity CPaperwork
Staffing
Widespread; potential for minimal harm.Corrected 2024-12-12Record 355103-20241030-F732
F655Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admittedScope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-12-19Record 355103-20231108-F655
F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.Scope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-12-13Record 355103-20231108-F657
F658Ensure services provided by the nursing facility meet professional standards of quality.Scope/severity DStandard
Care planningRecords
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-12-13Record 355103-20231108-F658
F679Provide activities to meet all resident's needs.Scope/severity DStandard
Care planning
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-12-13Record 355103-20231108-F679
F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.Scope/severity DStandard
Care planning
Isolated; no actual harm, potential for more than minimal harm.Corrected 2023-12-13Record 355103-20231108-F684
F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Scope/severity GHarm
Care planningFalls
Isolated; actual harm that is not immediate jeopardy.Corrected 2023-08-15Record 355103-20230830-F689
Penalties & enforcement
| Date | Action | Amount | Source |
|---|---|---|---|
| 2024-10-30 | Civil money penalty | $78,309 | CMS · Penalties |
| 2023-11-08 | Civil money penalty | $29,437 | CMS · Penalties |
| 2023-08-30 | Civil money penalty | $7,738 | CMS · Penalties |
Quality measures
CMS MDS quality measures · 2025Q2-2026Q1 · definitions| Measure | Facility | North Dakota | National |
|---|---|---|---|
| Percentage of long-stay residents with pressure ulcers lower is better | 0.0% | 4.9% | 4.6% |
| Percentage of long-stay residents experiencing one or more falls with major injury lower is better | 3.3% | 5.1% | 3.2% |
| Percentage of long-stay residents who received an antipsychotic medication lower is better | 53.5% | 22.7% | 15.4% |
| Percentage of long-stay residents with a urinary tract infection lower is better | 2.4% | 2.6% | 1.6% |
| Percentage of long-stay residents who were physically restrained lower is better | 0.0% | 0.2% | 0.1% |
| Percentage of long-stay residents whose need for help with daily activities has increased lower is better | 19.5% | 19.8% | 13.9% |
| Percentage of long-stay residents who lose too much weight lower is better | 0.0% | 5.8% | 5.2% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication lower is better | 14.3% | 17.4% | 19.5% |
Figures verbatim from CMS, with the state and national figures from the same release. The direction that counts as better is CMS’s own and is stated on every row.
Ownership
As reported to CMS (Provider Enrollment)| Entity | Role | Interest | Since | Registry |
|---|---|---|---|---|
| Ellefson, Patty Individual | CORPORATE OFFICER | NOT APPLICABLE | — | — |
| Johnson, Deborah Individual | CORPORATE OFFICER | NOT APPLICABLE | — | — |
| Kleingartner, Andrea Individual | W-2 MANAGING EMPLOYEE | NOT APPLICABLE | — | — |
| Lang, Sonya Individual | W-2 MANAGING EMPLOYEE | NOT APPLICABLE | — | — |
| Martinson, David Individual | CORPORATE OFFICER | NOT APPLICABLE | — | — |
| Mclean, Steven Individual | CORPORATE OFFICER | NOT APPLICABLE | — | — |
| Rockswold, Jason Individual | CORPORATE OFFICER | NOT APPLICABLE | — | — |
| Schlecht, Nathan Individual | CORPORATE OFFICER | NOT APPLICABLE | — | — |
| Woytassek, Mary Kay Individual | CORPORATE OFFICER | NOT APPLICABLE | — | — |
Ownership as reported to CMS/state. CMS ownership data has known gaps; merges between entities are published only after human review.
Cost context
County figures from public surveys. Not this facility’s price. Nursing-home rates are not published by CMS or North Dakota.
No county cost figures on file for Sargent.
Nearby nursing homes
| Facility | Distance | Last survey | Deficiencies · 3 yrs |
|---|---|---|---|
| North Dakota Veterans Home Lisbon | 21.5 mi | 2025-08-06 | 021 |
| Wheatcrest Hills Healthcare Center Britton | 22.4 mi | 2025-12-04 | 0103 |
| Parkside Lutheran Home Lisbon | 23.6 mi | 2025-12-11 | 0180 |
| Good Samaritan Society - Oakes Oakes | 21.7 mi | 2026-06-18 | 1171 |
| Smp Health - Maryhill Enderlin | 36.3 mi | 2025-11-21 | 1121 |
Watch this facility
One email when a new survey, harm-class deficiency, penalty, Special Focus change or ownership change is recorded. Nothing else, ever.
Sources & provenance
| Section | Agency · dataset | Retrieved |
|---|---|---|
| Facility, ratings | CMS Provider Data · Nursing Home Provider Information | 2026-08-01 |
| Surveys | CMS · Survey Summary | 2026-08-01 |
| Deficiencies | CMS · Health Deficiencies (CMS-2567 findings via Care Compare) | 2026-08-01 |
| Penalties | CMS · Penalties | 2026-08-01 |
| Quality measures | CMS · MDS Quality Measures | 2026-08-01 |
| Ownership | CMS · Ownership | 2026-08-01 |