Deficiencies per Year
12
9
6
3
0
High
Inspection Report
Routine
Census: 31
Deficiencies: 12
Jun 9, 2023
Visit Reason
The Minnesota Department of Health conducted a survey to evaluate and assess compliance with state licensing statutes for an assisted living facility with dementia care license.
Findings
The survey identified multiple deficiencies including failure to ensure food preparation and service according to Minnesota Food Code, inadequate infection control practices, incomplete individual abuse prevention plans, lack of tuberculosis prevention program compliance, incomplete emergency preparedness plan, missing documentation in resident records, failure to maintain physical environment in good repair, insufficient fire safety training, incomplete staff orientation and annual training, and incomplete service and treatment plans for residents.
Severity Breakdown
Level 2: 12
Deficiencies (12)
| Description | Severity |
|---|---|
| Failure to ensure food was prepared and served according to the Minnesota Food Code. | Level 2 |
| Failure to establish and maintain an effective infection control program including proper hand hygiene and cleaning of assistive devices. | Level 2 |
| Individual abuse prevention plans lacked statements of specific measures to minimize risk of abuse for residents R2, R3, and R6. | Level 2 |
| Failure to establish and maintain a tuberculosis prevention program including baseline testing and training for one employee. | Level 2 |
| Failure to post emergency preparedness plan prominently and lack of required content in the plan. | Level 2 |
| Failure to document all provided services in resident records for residents R3 and R6. | Level 2 |
| Failure to maintain physical environment in continuous state of good repair including fire door latches and sprinkler riser room wall. | Level 2 |
| Failure to provide required employee and resident training on fire safety and evacuation plans. | Level 2 |
| Failure to provide complete orientation to staff including required topics for one employee. | Level 2 |
| Failure to provide at least eight hours of annual training for one employee including required topics. | Level 2 |
| Failure to include required content in service plans for residents R2, R3, and R6 including frequency of services and monitoring methods. | Level 2 |
| Failure to develop and maintain individualized treatment or therapy management plans for residents R3 and R6 including wound care and TED stockings. | Level 2 |
Report Facts
Active residents: 31
Quaternary Ammonia concentration: 200
Food temperatures: 35
Food temperatures: 36
Food temperatures: 194
Food temperatures: 41
Food temperatures: 34
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| ULP-C | Unlicensed Personnel | Named in findings related to infection control, tuberculosis prevention, orientation, annual training, and dementia care training deficiencies. |
| Jonathan Hill | Supervisor, State Evaluation Team | Signed letter regarding correction order reconsideration process. |
| LPN-E | Licensed Practical Nurse | Interviewed regarding hand hygiene and infection control practices. |
| CNS-B | Clinical Nurse Supervisor | Interviewed regarding infection control, service plan deficiencies, and wound care. |
| LALD-A | Licensed Assisted Living Director | Interviewed regarding tuberculosis screening, emergency preparedness, training, and service plan updates. |
| ULP-D | Unlicensed Personnel | Observed assisting resident with wound care and interviewed about wound care instructions. |
| ULP-G | Unlicensed Personnel | Observed assisting resident with TED stockings. |
| Eric Dickerson | Kitchen Manager | Signed food establishment inspection report. |
| Jessica Davis | Public Health Sanitarian III | Signed food establishment inspection report. |
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