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Nursing homesMinnesota › Neilson Place

Neilson Place

1000 Anne Street Northwest, Bemidji, MN 56601 · 2187510220 · 78 certified beds

Overall★☆☆☆☆ 1/5
Health inspections★☆☆☆☆ 1/5
Staffing★★★★☆ 4/5
Quality measures★★☆☆☆ 2/5
Abuse icon: CMS flags this facility for an abuse citation in recent inspections.

Ownership group

Per CMS filings, this facility is affiliated with Sanford Health, a group operating 4 facilities in 3 states. Group record: average rating 2.5/5, 1 abuse citation icons, 0 facilities on the Special Focus list, $316,298 in federal fines. This facility rates below its group average (2.5/5).

See all 4 facilities in this group →

Staffing (hours per resident per day)

Total nurse staffing: 3.80 (Minnesota median: 4.16). RN hours: 0.89. Weekend total: 3.27. Nursing staff turnover: 55%.

Inspection deficiencies

All-time on record: 47 deficiency citations, including 1 at immediate-jeopardy level. Below: citations from 2023 onward (severity letters explained in methodology).

Survey dateDeficiencySev.TypeStatus
2026-03-05Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. EHealthcorrected 2026-04-17
2026-03-05Provide and implement an infection prevention and control program. EHealthcorrected 2026-04-17
2026-03-05Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. DHealthcorrected 2026-04-17
2026-03-05Assess the resident when there is a significant change in condition Dcomplaintcorrected 2026-04-17
2026-03-05Ensure services provided by the nursing facility meet professional standards of quality. DHealthcorrected 2026-04-17
2026-03-05Provide care and assistance to perform activities of daily living for any resident who is unable. DHealthcorrected 2026-04-17
2026-03-05Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. DHealthcorrected 2026-04-17
2026-03-05Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. DHealthcorrected 2026-04-17
2025-12-09Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Gcomplaintcorrected 2025-11-12
2025-07-02Protect each resident from separation (from other residents, his/her room, or confinement to his/her room). Gcomplaintcorrected 2025-07-28
2025-07-02Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. Dcomplaintcorrected 2025-07-28
2025-04-04Provide and implement an infection prevention and control program. Dcomplaintcorrected 2025-04-25
2025-02-25Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Dcomplaintcorrected 2025-02-28
2025-02-25Provide appropriate treatment and care according to orders, resident’s preferences and goals. Dcomplaintcorrected 2025-02-28
2024-12-20Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Gcomplaintcorrected 2024-12-19
2024-12-05Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. FHealthcorrected 2025-01-17
2024-12-05Provide and implement an infection prevention and control program. FHealthcorrected 2025-01-17
2024-12-05Provide care and assistance to perform activities of daily living for any resident who is unable. DHealthcorrected 2025-01-17
2024-12-05Provide enough food/fluids to maintain a resident's health. DHealthcorrected 2025-01-17
2024-12-05Post nurse staffing information every day. DHealthcorrected 2025-01-17
2024-12-05Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. DHealthcorrected 2025-01-17
2024-12-05Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. DHealthcorrected 2025-01-17
2024-12-05Ensure medication error rates are not 5 percent or greater. DHealthcorrected 2025-01-17
2024-12-05Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. DHealthcorrected 2025-01-17
2024-12-05Develop and implement policies and procedures for flu and pneumonia vaccinations. DHealthcorrected 2025-01-17
2024-09-27Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. Jcomplaintcorrected 2024-09-20
2024-07-02Ensure each resident must receive and the facility must provide necessary behavioral health care and services. Dcomplaintcorrected 2024-08-02
2024-07-02Ensure that residents are free from significant medication errors. Dcomplaintcorrected 2024-08-02
2024-02-29Provide appropriate pressure ulcer care and prevent new ulcers from developing. Gcomplaintcorrected 2024-03-22
2024-02-29Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Gcomplaintcorrected 2024-03-22
2024-02-29Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. Dcomplaintcorrected 2024-03-22
2024-02-29Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Dcomplaintcorrected 2024-03-22
2024-02-29Respond appropriately to all alleged violations. Dcomplaintcorrected 2024-03-22
2023-11-09Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Dcomplaintcorrected 2023-12-06
2023-11-09Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Dcomplaintcorrected 2023-12-06
2023-11-09Respond appropriately to all alleged violations. Dcomplaintcorrected 2023-12-06
2023-10-25Provide and implement an infection prevention and control program. FHealthcorrected 2023-11-29
2023-10-25Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. EHealthcorrected 2023-11-29
2023-10-25Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. DHealthcorrected 2023-11-29
2023-10-25Honor 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. DHealthcorrected 2023-11-29

Federal penalties

DateTypeAmount
2025-12-09Fine$17,345
2024-09-27Fine$14,433
2024-02-29Fine$14,137

Ownership & control records (CMS filings)

NameRoleType%Since
SANFORD NORTH5% Or Greater Direct Ownership InterestOrganization100%since 05/01/2014
SANFORD5% Or Greater Indirect Ownership InterestOrganization100%since 05/01/2014
CAIN, JAMESCorporate DirectorIndividualNOT APPLICABLEsince 11/19/2015
ENGBRECHT, WESLEYCorporate DirectorIndividualNOT APPLICABLEsince 01/01/2021
GASSEN, WILLIAMCorporate DirectorIndividualNOT APPLICABLEsince 11/24/2020
GULSVIG, NEILCorporate DirectorIndividualNOT APPLICABLEsince 03/28/2019
JACOBS, DONALDCorporate DirectorIndividualNOT APPLICABLEsince 01/01/2014
LUNDEEN, MARKCorporate DirectorIndividualNOT APPLICABLEsince 01/01/2014
MOLBERT, LAURISCorporate DirectorIndividualNOT APPLICABLEsince 01/01/2021
NORTH, ANDREWCorporate DirectorIndividualNOT APPLICABLEsince 01/01/2017
TEIKEN, BRENTCorporate DirectorIndividualNOT APPLICABLEsince 05/01/2014
VENTLING-HERRMANN, MARNIECorporate DirectorIndividualNOT APPLICABLEsince 01/01/2022
GASSEN, WILLIAMCorporate OfficerIndividualNOT APPLICABLEsince 11/24/2020
MARLETTE, WILLIAMCorporate OfficerIndividualNOT APPLICABLEsince 06/16/2023
MORRISON, TONYCorporate OfficerIndividualNOT APPLICABLEsince 02/01/1991

Compare nearby (Beltrami County)

Source: CMS Provider Data Catalog (July 2026 release) — provider file, deficiency file, ownership file, penalty file. CCN 245039. Corrections: data@carerecords.org.