Deficiencies per Year
16
12
8
4
0
Severe
High
Moderate
Inspection Report
Follow-Up
Census: 17
Deficiencies: 14
Jan 22, 2025
Visit Reason
Follow-up survey conducted to determine if orders from the November 7, 2024 survey were corrected.
Findings
The follow-up survey verified that the facility is in substantial compliance with previous correction orders. The prior survey identified multiple deficiencies including background study issues, infection control, fire safety, contract language, emergency relocation notification, medication management, and bed rail safety.
Severity Breakdown
Level 1: 1
Level 2: 11
Level 3: 2
Deficiencies (14)
| Description | Severity |
|---|---|
| Background study was not current and eligible for one employee. | Level 3 |
| Failed to ensure food was prepared and served according to Minnesota Food Code. | Level 2 |
| Failed to establish and maintain an effective infection control program related to glove use during medication administration. | Level 2 |
| Failed to maintain smoke alarms, fire separation, and provide approved ashtrays. | Level 2 |
| Assisted living contract included language waiving licensee's liability for health, safety, or personal property of residents. | Level 1 |
| Failed to provide required written notice and notify Ombudsman for emergency relocation of resident. | Level 2 |
| Failed to complete resident reassessment within required 90-day timeframe. | Level 2 |
| Failed to include all required content in residents' service plans. | Level 2 |
| Failed to develop and implement individualized medication management plans with required content for residents. | Level 2 |
| Failed to ensure medications were administered as ordered, including incorrect application of eye ointment and lack of training on measuring gel medication. | Level 2 |
| Failed to ensure time sensitive medications had an opened date and accurate labeling during medication administration. | Level 2 |
| Failed to document disposition of medications upon resident discharge including prescription numbers. | Level 2 |
| Failed to develop and implement individualized treatment or therapy management plan with required content. | Level 2 |
| Failed to ensure care and services were provided according to acceptable health care standards for resident with bed rail; lacked assessment and documentation of bed rail use and recall checks. | Level 3 |
Report Facts
Fine amount: 6000
Residents present: 17
Assessment days late: 21
Assessment days late: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kelly Thorson | Supervisor, State Evaluation Team | Signed follow-up survey letter dated February 25, 2025. |
| Jodi Johnson | Supervisor, State Evaluation Team | Signed survey letter dated December 13, 2024. |
| Ryan Miller | Environmental Health Specialist | Signed food and beverage establishment inspection report dated November 5, 2024. |
| Kyle Willaert | Cook | Signed food and beverage establishment inspection report dated November 5, 2024. |
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