4 Reports
Inspection Report — Jun 5, 2025
Routine
Date: Jun 5, 2025
Visit Reason
MDH assisted living licensing survey
Findings
MDH assisted living licensing survey identified 10 state correction orders covering food service violations, failure to timely report suspected maltreatment, incomplete employee records and background study affiliation, fire protection and sprinkler/ventilation hazards, missing supervision/competency documentation for staff performing delegated nursing tasks, unsigned or undocumented service plan revisions, missing medication self-administration assessment, missing documentation that dementia-care policies were provided at move-in, and unsecured oxygen cylinders. No immediate fines were assessed for this survey.
Deficiencies (10)
0480 144G.41 Subdivision 1 Subd. 1a (a-b) Minimum requirements; required food services: Based on observation, interview, and record review, the licensee failed to ensure food was prepared and served according to the Minnesota Food Code (see Food & Beverage Establishment Inspection Report dated June 3, 2025).
0620 144G.42 Subd. 6 (a) / 626.557, Subd. 3 Compliance with requirements for reporting maltreatment: The licensee failed to immediately report suspected maltreatment of a resident (R5) to MAARC; the MAARC report was filed 72 hours after the fall.
0650 144G.42 Subd. 8 (a) Staff records: The licensee's employee record for unlicensed personnel (ULP-F) lacked documentation of a medication administration competency evaluation.
0775 144G.45 Subd. 2. (a) Fire protection and physical environment: The licensee failed to maintain fire-safety features (disconnected dryer ventilation with lint buildup, sprinkler heads obstructed or missing escutcheons, and use of extension cords/multiplug adapters as permanent wiring) creating a potential fire risk.
01290 144G.60 Subdivision 1 Background studies required: The licensee did not have a DHS background study affiliated with this facility's HFID for employee ULP-C until the affiliation was completed during the survey.
01440 144G.62 Subd. 4 Supervision of staff providing delegated nursing or therapy tasks: The licensee lacked documentation that a registered nurse provided the required direct supervision within 30 days for ULP-F and ULP-G performing delegated tasks.
01640 144G.70 Subd. 4 (a-e) Service plan, implementation and revisions to: An updated service plan for resident R2 lacked signature or other authentication by the facility and by the resident or representative documenting agreement to the revised services.
01870 144G.71 Subd. 18 Medications provided by resident or family member: The registered nurse did not assess and document self-administration for medications found at R3's bedside (topical preparations) and the medication management assessment did not document that R3 could self-administer those items.
02110 144G.82 Subd. 3 Policies: The licensee did not document that assisted living with dementia care policies and procedures were provided to resident R2 or R2's representative at the time of move-in or conversion to assisted living licensure.
02310 144G.91 Subd. 4 (a) Appropriate care and services: Oxygen cylinders in resident R6's apartment were not all secured (three cylinders found unsecured on the floor), creating a tipping and safety hazard.
Inspection Report — May 16, 2025
Complaint Investigation
Date: May 16, 2025
Visit Reason
MDH complaint investigation of alleged neglect.
Complaint Details
HL319498784M | Finding: Inconclusive | The facility neglected the resident when facility staff did not have the resident’s pressure relieving air mattress plugged in resulting in pressure sores on the resident’s heels.
Findings
Maltreatment inconclusive. One correction order was issued addressing individualized treatment and therapy management, specifically the lack of a treatment plan documenting the prescribed alternating pressure mattress, resident-specific instructions, and procedures for notifying licensed staff and documenting treatments.
Deficiencies (1)
01940 144G.72 Subd. 3 Individualized treatment or therapy management: The licensee failed to develop and maintain a current individualized treatment management plan for a resident with an ordered alternating pressure mattress, lacking documentation of resident-specific instructions, procedures for notifying a registered nurse or licensed professional, and requirements for documenting treatment and monitoring.
Report Facts
residents receiving services: 74
Inspection Report — Mar 11, 2025
Complaint Investigation
Date: Mar 11, 2025
Visit Reason
MDH complaint investigation of alleged neglect.
Complaint Details
HL319496708M | Finding: Not Substantiated | The alleged perpetrator, a facility staff member, neglected the resident by administering incorrect medication to the resident.
Findings
Maltreatment not substantiated. No correction orders were issued.
Inspection Report — Feb 3, 2023
Routine
Date: Feb 3, 2023
Visit Reason
MDH assisted living licensing survey.
Findings
Eight state licensing correction orders were issued covering food-service/Minnesota Food Code compliance; employee records and documentation of supervision; emergency preparedness and generator testing; fire protection (smoke alarm interconnection) and fire safety/evacuation planning; physical environment and maintenance issues; and dementia-care training documentation. No immediate fines were assessed for this evaluation.
Deficiencies (8)
0480 144G.41 Subd 1 (13) (i) (B) Minimum requirements: The licensee failed to ensure food was prepared and served according to the Minnesota Food Code, as documented in the Food and Beverage Establishment Inspection Report.
0650 144G.42 Subd. 8 Employee records: The licensee failed to maintain required employee records for multiple staff, including missing signed performance evaluations and lack of documented periodic supervision.
0680 144G.42 Subd. 10 Disaster planning and emergency preparedness: The emergency preparedness manual contained outdated contact names and the licensee did not document required weekly generator inspections, monthly load (test) runs, or monthly transfer switch tests.
0780 144G.45 Subd. 2 (a) (1) Fire protection and physical environment: Smoke alarms in apartment unit 224 and the combined unit 415/417 were not interconnected and did not sound throughout the unit when tested.
0800 144G.45 Subd. 2 (a) (4) Fire protection and physical environment: The physical environment was not maintained (dust-filled wall-unit filters, hazardous cleaning chemicals accessible under resident cabinets, a mattress stored in a bathroom covering the shower, a broken toilet paper holder, and a mop-sink soap dispenser lacking proper backflow protection).
0810 144G.45 Subd. 2 (b)-(f) Fire protection and physical environment: Fire safety and evacuation documentation and posted floor layouts lacked required content (missing location/number of sleeping rooms on posted layouts, no 4th-floor layout posted, and smoke barrier identification missing); employee evacuation drill frequency/documentation was incorrect.
01450 144G.62 Subd. 5 Documentation: The licensee failed to retain documentation of direct RN supervision of an unlicensed person (ULP-F) performing delegated tasks.
01540 144G.64 (a) TRAINING IN DEMENTIA CARE REQUIRED: The executive director (ED-A) and registered nurse (RN-E) lacked documentation showing completion of the required eight hours of initial dementia-care training within 80 working hours.
Report Facts
fines_assessed_total: 0
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