Deficiencies per Year
8
6
4
2
0
High
Inspection Report
Follow-Up
Census: 14
Deficiencies: 5
Jul 16, 2025
Visit Reason
Follow-up survey to determine correction of orders from the survey completed on April 24, 2025.
Findings
The follow-up survey verified that the facility is in substantial compliance with previous correction orders.
Severity Breakdown
Level 2: 5
Deficiencies (5)
| Description | Severity |
|---|---|
| Fire sprinkler head coverage was blocked by curtains installed in resident rooms, violating Minnesota Fire Code provisions. | Level 2 |
| Fire safety and evacuation plan lacked required content including accurate evacuation maps, employee actions, and resident fire protection procedures; training was not provided to staff or residents as required. | Level 2 |
| Annual training for staff did not include all required topics, specifically review of facility policies and procedures for one licensed practical nurse. | Level 2 |
| Registered nurse failed to complete a follow-up assessment within 14 days of admission for one resident and failed to complete a comprehensive reassessment within 90 days for another resident. | Level 2 |
| Delegated medication administration procedures were not followed for one resident; unlicensed personnel applied medication cream without first washing and drying the affected areas as ordered. | Level 2 |
Report Facts
Residents present during survey: 14
Days late for 14-day assessment: 4
Days between assessments exceeding limit: 6
Time period for correction: 7
Time period for correction: 21
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Benjamin J. Zwart | Supervisor, State Engineering Services Section | Signed follow-up survey letter. |
| Jodi Johnson | Supervisor, State Evaluation Team | Signed letter regarding correction order reconsideration process. |
| LPN-D | Licensed Practical Nurse | Employee record lacked evidence of required annual training. |
| DM-I | Director of Maintenance | Interviewed regarding fire sprinkler and fire safety plan deficiencies. |
| CNS-B | Clinical Nurse Supervisor | Reviewed resident assessments and medication administration issues. |
| ULP-C | Unlicensed Personnel | Observed not following medication administration procedure for resident R2. |
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