Inspection Reports for Good Samaritan Society-Heritage Grove
2122 River Rd NW, East Grand Forks, MN 56721, United States, MN, 56721
Back to Facility ProfileDeficiencies per Year
12
9
6
3
0
High
Inspection Report
Follow-Up
Census: 84
Deficiencies: 11
Apr 16, 2025
Visit Reason
Follow-up survey conducted to determine correction of orders issued pursuant to a survey completed on December 6, 2024.
Findings
The facility was found to be in substantial compliance but had not corrected all state correction orders from the prior survey. Specific deficiencies included failure to submit a plan review application for a renovation project, failure to report an unaccounted narcotic loss, incomplete staff records, fire safety code violations including smoke alarm and fire door issues, incomplete fire safety training, background study affiliation errors, medication management and storage issues, and expired medications in storage.
Severity Breakdown
Level 2: 11
Deficiencies (11)
| Description | Severity |
|---|---|
| Failed to submit a plan review application for a facility renovation project. | Level 2 |
| Failed to immediately report to the Minnesota Adult Abuse Reporting Center an unaccounted narcotic loss from one resident. | Level 2 |
| Employee records lacked required training and competency documentation for unlicensed personnel. | Level 2 |
| Failed to comply with smoke alarm requirements including lack of interconnection and missing door closers on fire doors. | Level 2 |
| Failed to provide required fire safety and evacuation training to staff and residents. | Level 2 |
| Failed to submit a plan review application for a renovation project involving a tub room conversion. | Level 2 |
| Background study for one employee was not affiliated with the correct health facility identification. | Level 2 |
| Failed to reassess a resident for medication management services when resident status changed. | Level 2 |
| Failed to maintain a current individualized medication management plan with all required content for one resident. | Level 2 |
| Failed to store prescription medications in securely locked compartments and permit access only to authorized personnel for one resident. | Level 2 |
| Failed to maintain time sensitive medications with legible opened and expiration dates and failed to monitor for expired medications in medication storage rooms. | Level 2 |
Report Facts
Residents present: 84
Residents receiving assisted living services: 36
Medication count discrepancy: 1
Expired medications: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Benjamin J. Zwart | Supervisor, State Engineering Services Section | Contact for correction order reconsideration process |
| Jessie Chenze | Supervisor, State Evaluation Team | Contact for informal conference and survey questions |
| LALD-A | Licensed Assisted Living Director | Named in multiple findings including renovation project, medication loss, staff training, background study affiliation, fire safety |
| CNS-H | Clinical Nurse Supervisor | Named in medication loss investigation and staff training findings |
| ULP-E | Unlicensed Personnel | Named in medication administration and staff record findings |
| ULP-C | Unlicensed Personnel | Named in medication administration and staff record findings |
| ULP-G | Unlicensed Personnel | Named in medication storage and administration findings |
| DM-D | Director of Maintenance | Named in fire safety and smoke alarm findings |
| RN-B | Registered Nurse | Named in background study affiliation finding |
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