Eventide Lutheran Home
1405 7th Street South, Moorhead, MN 56560 · Clay County · 145 certified beds · avg 113 residents/day · certified since Apr 1, 1987
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★★☆☆3/5 · CMS overall rating: 4/5
The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.
Most serious findings (actual harm or immediate jeopardy)
▲ Immediate jeopardy, one-off · Apr 30, 2025 · F-0689 · triggered by a complaint
The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Why it matters: This is one of the most common citations and directly relates to falls and injuries, which can be devastating for older adults.
Severity (J): Inspectors found a situation that put a resident's life or safety in immediate danger, affecting one or a few residents. The facility must fix it immediately — these citations often come with large fines.
Corrected: Apr 22, 2025 (Past Non-Compliance)
▲ Actual harm, one-off · Jun 24, 2026 · F-0689 · triggered by a complaint
The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Why it matters: This is one of the most common citations and directly relates to falls and injuries, which can be devastating for older adults.
Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Jul 10, 2026 (Deficient, Provider has date of correction)
▲ Actual harm, one-off · Mar 12, 2025 · F-0689 · triggered by a complaint
The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Why it matters: This is one of the most common citations and directly relates to falls and injuries, which can be devastating for older adults.
Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Feb 20, 2025 (Past Non-Compliance)
▲ Actual harm, one-off · Dec 10, 2024 · F-0689 · triggered by a complaint
The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Why it matters: This is one of the most common citations and directly relates to falls and injuries, which can be devastating for older adults.
Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Dec 1, 2024 (Past Non-Compliance)
▲ Actual harm, one-off · Sep 15, 2023 · F-0689 · triggered by a complaint
The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Why it matters: This is one of the most common citations and directly relates to falls and injuries, which can be devastating for older adults.
Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Oct 4, 2023 (Deficient, Provider has date of correction)
All citations in the current public record (17)
CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.
| Date | Severity | What the facility was cited for |
|---|---|---|
| Jun 24, 2026 | ▲ G · Actual harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| Jun 24, 2026 | D · Potential for harm, one-off | The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint |
| Nov 13, 2025 | D · Potential for harm, one-off | The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint |
| Jun 25, 2025 | D · Potential for harm, one-off | The facility did not treat residents with dignity and respect, or did not honor their rights to make their own decisions and communicate freely. This is one of the most fundamental resident rights. |
| Jun 25, 2025 | D · Potential for harm, one-off | The facility did not allow residents to take their own medications when a clinical review showed they could do so safely. Residents have this right if their care team determines it's appropriate. |
| Jun 25, 2025 | D · Potential for harm, one-off | The facility did not make reasonable adjustments to fit each resident's individual needs and preferences — things like call buttons within reach, preferred wake-up times, or accessible room setups. |
| Jun 25, 2025 | D · Potential for harm, one-off | The facility did not honor residents' right to make their own choices about their daily lives, such as when to wake up, what to eat, or how to spend their time. |
| Jun 25, 2025 | D · Potential for harm, one-off | The facility did not reassess a resident after a significant change in their condition, such as a sudden decline in health. A full new assessment is required when a resident's condition changes in a major way. |
| Jun 25, 2025 | D · Potential for harm, one-off | The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving. |
| Apr 30, 2025 | ▲ J · Immediate jeopardy, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| Apr 2, 2025 | D · Potential for harm, one-off | The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. · from a complaint |
| Mar 12, 2025 | ▲ G · Actual harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| Dec 10, 2024 | ▲ G · Actual harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| Apr 10, 2024 | F · Potential for harm, facility-wide | The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. |
| Apr 10, 2024 | D · Potential for harm, one-off | The facility did not provide a safe, clean, comfortable, and homelike environment, including safe support for residents' daily living needs. |
| Apr 10, 2024 | D · Potential for harm, one-off | The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. |
| Sep 15, 2023 | ▲ G · Actual harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
Inspection trend by year
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 1 | 1 | G ▲ |
| 2024 | 4 | 1 | G ▲ |
| 2025 | 10 | 2 | J ▲ |
| 2026 | 2 | 1 | G ▲ |
Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.
Fines and enforcement (last 3 years)
2 fines totaling $24,128.
| Date | Type | Amount / length |
|---|---|---|
| Apr 30, 2025 | Fine | $14,508 |
| Mar 12, 2025 | Fine | $9,620 |
Nurse staffing (from payroll records, adjusted for how much care residents need)
| Measure | This facility | Minnesota avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 5.51 | 4.83 | 3.95 | top 18% in Minnesota; top 7% in the U.S. |
| Registered Nurse hours | 0.79 | 1.22 | 0.69 | bottom 13% in Minnesota; top 28% in the U.S. |
| Weekend total nurse staffing | 5.13 | 4.27 | 3.50 | top 11% in Minnesota; top 5% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.37 | 0.69 | 0.48 | bottom 14% in Minnesota; bottom 47% in the U.S. |
| Total nursing staff turnover (%) | 32.2 | 42.2 | 45.8 | top 28% in Minnesota; top 18% in the U.S. |
| RN turnover (%) | 30.0 | 38.6 | 42.9 | top 40% in Minnesota; top 29% in the U.S. |
Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 4.88, RN 0.70, weekend 4.54. Staffing rating: 5/5.
Self-reported quality measures
Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.
Quality measures rating: 3/5 · long-stay residents: 2/5 · short-stay residents: 3/5
Who owns this facility
Non profit - Corporation
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Anderson, Kelsey | Individual | Operational/Managerial Control | NOT APPLICABLE | 01/10/2021 |
| Berg, Brittni | Individual | Operational/Managerial Control | NOT APPLICABLE | 04/25/2022 |
| Blue Stone Therapy INC | Organization | Operational/Managerial Control | NOT APPLICABLE | 11/01/2020 |
| Blue Stone Therapy INC | Organization | ADP of the SNF | NOT APPLICABLE | 08/29/2025 |
| Bock, Jodee | Individual | Corporate Director | NOT APPLICABLE | 12/15/2022 |
| Brandt, Terry | Individual | Corporate Director | NOT APPLICABLE | 12/15/2022 |
| Bye, Robert | Individual | Corporate Director | NOT APPLICABLE | 12/15/2022 |
| Bye, Robert | Individual | Corporate Officer | NOT APPLICABLE | 12/15/2022 |
| Fischbach, Tyler | Individual | Corporate Director | NOT APPLICABLE | 12/15/2022 |
| Gulbranson, Patrick | Individual | Corporate Director | NOT APPLICABLE | 12/15/2022 |
| Hager, Jim | Individual | Operational/Managerial Control | NOT APPLICABLE | 12/13/2022 |
| Harms, Kaley | Individual | Operational/Managerial Control | NOT APPLICABLE | 11/28/2018 |
| Johnson, Vikki | Individual | Corporate Director | NOT APPLICABLE | 12/15/2022 |
| Johnson, Vikki | Individual | Corporate Officer | NOT APPLICABLE | 12/01/2023 |
| Kelly, Kayla | Individual | Operational/Managerial Control | NOT APPLICABLE | 11/26/2023 |
| Kollar, Emily | Individual | Operational/Managerial Control | NOT APPLICABLE | 05/14/2019 |
| Kollar, Emily | Individual | ADP of the SNF | NOT APPLICABLE | 03/21/2025 |
| Larson-Casselton, Cindy | Individual | Corporate Director | NOT APPLICABLE | 12/15/2022 |
| Lee, Judith | Individual | Corporate Director | NOT APPLICABLE | 12/15/2022 |
| Lunak, Brandon | Individual | Corporate Director | NOT APPLICABLE | 12/15/2022 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
- "How do you make sure each resident's care follows the doctor's orders, and what changed after this citation?"
- "Can you give me examples of how your staff protect residents' dignity in everyday care, like bathing and dressing?"
- "If my family member is able to manage their own medications, would you allow it, and how is that decided?"
- "Can you give me examples of how you adjust daily routines and room setups to fit each resident's preferences?"
- "What choices do residents have over their daily schedule, like meal times, bathing, and activities?"
- "If my family member's health suddenly changes, how quickly do you reassess them and update their care?"
- "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
- "Can I see the results and plan of correction from your most recent state inspection?"
Nearby facilities (within 20 miles)
| Facility | Distance | City | Overall | Inspection | Flags |
|---|---|---|---|---|---|
| The Meadows on University | 1.4 mi | Fargo, ND | ★☆☆☆☆ | 1/5 | |
| SMP Health - St Catherine South | 1.5 mi | Fargo, ND | ★★★★☆ | 5/5 | |
| Bethany on University | 1.6 mi | Fargo, ND | ★★★★★ | 4/5 | |
| SMP Health - St Catherine North | 2.6 mi | Fargo, ND | ★★★★☆ | 3/5 | |
| Fargo Elim Health Care Center | 2.9 mi | Fargo, ND | ★★★☆☆ | 2/5 | |
| Bethany on 42nd | 4.1 mi | Fargo, ND | ★★★★★ | 5/5 | |
| Eventide Fargo | 4.8 mi | Fargo, ND | ★★★☆☆ | 3/5 | |
| Sheyenne Crossings Care Center/Tcu | 6.2 mi | West Fargo, ND | ★★★★★ | 4/5 |
Compare this facility with the 3 closest →
Facility data as of CMS processing date 2026-08-01. CCN 245461.