Inspection Reports for Evensong Manor
6264 Yukon Ave N, Brooklyn Park, MN 55428, MN, 55428
Back to Facility Profile
Inspection Report
Complaint Investigation
Census: 4
Capacity: 5
Deficiencies: 22
Mar 27, 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.
Findings
The survey identified multiple deficiencies including failure to provide accessible plans of correction, lack of means for residents to request assistance 24/7, inadequate staffing plan and schedule posting, failure to comply with Minnesota Food Code, lack of daily social and recreational activities, incomplete individual abuse prevention plans, incomplete tuberculosis prevention program, deficient emergency preparedness plan, incomplete resident records, non-functioning interconnected smoke alarms, unmaintained fire extinguishers, physical environment disrepair, incomplete fire safety and evacuation plans and training, incomplete training and competency evaluations for unlicensed personnel, incomplete orientation for registered nurse, incomplete annual training for staff, incomplete resident reassessments, failure to properly delegate and document medication administration, and failure to post required electronic monitoring notice.
Complaint Details
The visit was complaint-related as it was triggered by allegations and previous deficiencies. The follow-up survey verified substantial compliance but identified ongoing deficiencies.
Severity Breakdown
Level 1: 2
Level 2: 18
Level 3: 1
Deficiencies (22)
| Description | Severity |
|---|---|
| Failed to make available the most recent plan of correction in a manner readily accessible to residents and others. | Level 1 |
| Failed to provide a means for residents to request assistance for health and safety needs 24/7. | Level 2 |
| Failed to develop and implement a written staffing plan with required evaluations and post 24-hour staffing schedule. | Level 2 |
| Failed to ensure food was prepared and served according to Minnesota Food Code. | Level 2 |
| Failed to have a daily program of social and recreational activities based on resident needs. | Level 2 |
| Failed to develop individual abuse prevention plans for residents. | Level 2 |
| Failed to maintain a tuberculosis prevention and control program including screening and training for employees. | Level 2 |
| Failed to have a complete written emergency preparedness plan and failed to post it prominently. | Level 2 |
| Failed to ensure resident records included documentation of services provided. | Level 2 |
| Failed to provide functioning interconnected smoke alarms in all resident rooms. | Level 2 |
| Failed to maintain portable fire extinguishers with required inspections and mounting. | Level 2 |
| Failed to maintain physical environment in good repair including tack strips with nails, damaged doors, and missing light fixture. | Level 2 |
| Failed to develop fire safety and evacuation plan with required content and provide required training and drills. | Level 2 |
| Failed to ensure training and competency evaluations were completed for all required skill areas for unlicensed personnel. | Level 2 |
| Failed to ensure orientation to assisted living statutes was completed for registered nurse supervising direct services. | Level 2 |
| Failed to ensure employee received all required orientation topics before providing direct care services. | Level 2 |
| Failed to ensure employees received at least eight hours of annual training including required topics. | Level 2 |
| Failed to conduct resident reassessment within 14 days following initiation of services. | Level 2 |
| Failed to ensure registered nurse trained unlicensed personnel in medication administration and verified competency prior to delegation. | Level 3 |
| Failed to accurately document medication administration for a resident. | Level 2 |
| Failed to document disposition of medications for a discharged resident. | Level 2 |
| Failed to post required electronic monitoring notice at facility entrance. | Level 1 |
Report Facts
Residents present: 4
Total licensed capacity: 5
Fines assessed: 3500
Correction order timeframe: 21
Correction order timeframe: 7
Correction order timeframe: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Casey DeVries | Supervisor, State Evaluation Team | Named in letter correspondence regarding follow-up survey |
| LALD-D | Licensed Assisted Living Director | Named in multiple findings related to training, supervision, and compliance |
| CNS-A | Clinical Nurse Supervisor | Named in multiple findings related to training, supervision, and compliance |
| RN-E | Registered Nurse | Named in findings related to supervision and orientation |
| ULP-B | Unlicensed Personnel | Named in findings related to medication administration and training |
| ULP-H | Unlicensed Personnel | Named in findings related to medication administration and training |
Loading inspection reports...
