Inspection Report
Routine
Census: 84
Deficiencies: 7
Nov 6, 2024
Visit Reason
The Minnesota Department of Health conducted a survey on November 6, 2024, to evaluate and assess compliance with state licensing statutes for Arbor Glen Senior Living, an assisted living facility.
Findings
The survey identified multiple violations including failure to prepare and serve food according to Minnesota Food Code, inadequate emergency preparedness plan, non-compliance with fire safety code including fire door issues and smoke alarm interconnection, failure to conduct required evacuation drills, non-compliance with local building permit requirements, incomplete resident reassessments, and improper medication labeling.
Severity Breakdown
Level 2: 7
Deficiencies (7)
| Description | Severity |
|---|---|
| Failed to ensure food was prepared and served according to the Minnesota Food Code. | Level 2 |
| Failed to maintain a written emergency preparedness plan with all required information. | Level 2 |
| Failed to comply with Minnesota State Fire Code requirements including fire resistant door closers removed, doors held open, slide bolt locks on exit doors, storage blocking exit, use of extension cords, non-interconnected smoke alarms, unsealed fire wall penetrations, and open electrical boxes. | Level 2 |
| Failed to provide evacuation drills in the required sequence and frequency. | Level 2 |
| Failed to comply with local building permit requirements for a greenhouse built in the underground parking garage. | Level 2 |
| Failed to ensure registered nurse conducted ongoing resident monitoring and reassessment within required timeframes for two residents. | Level 2 |
| Failed to date time-sensitive medications with opened or expiration dates for one resident's insulin pens. | Level 2 |
Report Facts
Residents present: 84
Residents receiving dementia care: 59
Evacuation drills documented: 5
Days late for resident reassessment: 49
Insulin pen discard timeframe: 28
Temperature of butter: 74
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Renee L. Anderson | Supervisor, State Evaluation Team | Signed cover letter for the inspection report |
| Patty M. Dzelak | Certified Food Protection Manager | Person in charge during food and beverage establishment inspections |
| Chris Foster | Public Health Sanitarian III | Signed food and beverage establishment inspection reports |
| Dede Hinnendael | Nurse Evaluator | On site nurse evaluator during inspection |
| Renee L. Anderson | Supervisor | State Evaluation Team contact for questions |
| CNS-B | Clinical Nurse Supervisor | Provided information on resident assessments and medication labeling |
| RN-F | Registered Nurse | Checked insulin pens and planned staff education |
| ULP-E | Unlicensed Personnel | Assisted resident R2 with mechanical lift transfer and toileting |
| ULP-J | Unlicensed Personnel | Assisted resident R3 with medication administration and administered insulin to R6 |
| ESD-G | Environmental Services Director | Accompanied surveyor during facility tour |
| LALD-A | Licensed Assisted Living Director | Provided fire safety and evacuation plan and training documentation |
| RDO-C | Regional Director of Operations | Provided emergency preparedness review document |
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