Inspection Report
Routine
Census: 35
Deficiencies: 7
May 15, 2025
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.
Findings
The licensee was found in substantial compliance but had several violations including food service not meeting Minnesota Food Code, missing annual performance evaluation for one unlicensed staff, fire protection and physical environment deficiencies including locked exit doors without emergency release, non-interconnected smoke alarms, physical environment damage, incomplete fire safety and evacuation plans, and unsecured medication storage.
Severity Breakdown
Level 2: 7
Deficiencies (7)
| Description | Severity |
|---|---|
| Food was not prepared and served according to the Minnesota Food Code, resulting in a level two violation at widespread scope. | Level 2 |
| Employee record lacked documentation of an annual performance evaluation for one unlicensed personnel. | Level 2 |
| Failed to comply with Minnesota State Fire Code due to exit doors secured with electromagnetic locks without emergency release and locked patio gates blocking exit paths. | Level 2 |
| Smoke alarms were not fully interconnected so that actuation of one alarm did not cause all alarms to sound. | Level 2 |
| Physical environment not maintained in good repair; tile base damaged and water damage behind tile in shower bath. | Level 2 |
| Fire safety and evacuation plan failed to include specific fire protection actions for residents. | Level 2 |
| Prescription medications were not securely locked; medication cart left unlocked and unattended during medication administration. | Level 2 |
Report Facts
Residents present: 35
Fine amount: 1000
Priority 1 Orders: 2
Priority 3 Orders: 2
Temperature: 44
Temperature: 50
Sanitizer concentration: 10
Sanitizer concentration: 50
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| ULP-B | Unlicensed Personnel | Observed administering medications and leaving medication cart unlocked. |
| CNS-A | Clinical Nurse Supervisor | Verified medication cart should be locked and stated staff would be retrained. |
| LALD-C | Licensed Assisted Living Director | Accompanied surveyor on facility tour and provided fire safety and evacuation documents. |
| MS-E | Maintenance Supervisor | Accompanied surveyor on facility tour and confirmed fire code deficiencies. |
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