Inspection Reports for Havenwood of Maple Grove
18695 73rd Ave N, Maple Grove, MN 55311, United States, MN, 55311
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Inspection Report
Routine
Census: 142
Deficiencies: 11
Jun 25, 2025
Visit Reason
The Minnesota Department of Health conducted a full survey to evaluate and assess compliance with state licensing statutes for Havenwood of Maple Grove.
Findings
The survey identified multiple deficiencies including failure to obtain accurate licensure due to lack of a two-hour fire barrier, food service violations per Minnesota Food Code, incomplete employee records and training, late nursing assessments, unsigned service plans, improper medication administration instructions, and medication storage issues.
Severity Breakdown
Level 2: 11
Deficiencies (11)
| Description | Severity |
|---|---|
| Failure to obtain accurate licensure due to lack of evidence of an approved two-hour fire barrier wall between assisted living facility and adjoining therapy gym. | Level 2 |
| Food was not prepared and served according to Minnesota Food Code; specific violations detailed in Food and Beverage Establishment Inspection Report. | Level 2 |
| Employee records lacked required content for two employees including missing competency evaluations and orientation documentation. | Level 2 |
| Training and competency evaluations for unlicensed personnel were incomplete for one employee. | Level 2 |
| Employee orientation lacked required content including principles of person-centered planning for one employee. | Level 2 |
| One employee failed to complete required dementia care training within required timeframe. | Level 2 |
| Registered nurse failed to conduct ongoing nursing assessments within required 90-day intervals for three residents. | Level 2 |
| Current service plans lacked signatures or authentication by residents or representatives for two residents. | Level 2 |
| Specific medication administration instructions were not documented in resident record for one resident, including timing between eye drops. | Level 2 |
| Prescription medications stored in refrigerator were kept at temperatures above manufacturer recommendations (above 41°F), with thermometer malfunction and no corrective action reported. | Level 2 |
| Time sensitive medications were not dated when opened for one resident. | Level 2 |
Report Facts
Residents present: 142
Residents receiving dementia care: 44
Temperature range: 45
Temperature range: 50
Medication refrigerator temperature range: 74.2
Medication refrigerator temperature range: 81.1
Dementia training hours completed: 5.5
Days between nursing assessments: 105
Days between nursing assessments: 97
Days between nursing assessments: 125
Days between nursing assessments: 119
Days between nursing assessments: 99
Days between nursing assessments: 92
Days between nursing assessments: 132
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| ULP-B | Unlicensed Personnel | Named in findings related to incomplete competency evaluations and medication administration |
| RN-F | Registered Nurse | Named in findings related to incomplete orientation documentation |
| ULP-E | Unlicensed Personnel | Named in findings related to incomplete training, orientation, dementia training, and medication administration |
| CNS-D | Clinical Nurse Supervisor | Provided interview information related to training and nursing assessments |
| RRN-A | Regional Registered Nurse | Provided interview information related to nursing assessments and medication refrigerator |
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