Inspection Reports for Holistic Health Care Services
1544 Roundhouse Circle, Shakopee, MN 55379, MN, 55379
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Inspection Report
Follow-Up
Census: 1
Deficiencies: 18
Sep 18, 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 manage the entire building as an assisted living facility, inadequate staffing plan and schedule posting, food safety violations, missing grievance procedure postings, incomplete tuberculosis prevention program, deficient emergency preparedness plan, incomplete resident records, fire safety code violations including lack of interconnected smoke alarms, and medication storage and disposition issues.
Severity Breakdown
Level 1: 1
Level 2: 15
Level 3: 1
Deficiencies (18)
| Description | Severity |
|---|---|
| Licensee failed to manage, control, and operate the entire building as an assisted living facility; non-assisted living occupants reside on one side of the duplex without proper fire separation. | Level 2 |
| Failed to develop and implement a staffing plan including biannual evaluation and failed to have a daily work schedule posted in a central location accessible to staff, residents, volunteers, and the public. | Level 2 |
| Food was not prepared and served according to Minnesota Food Code; specific violations detailed in Food and Beverage Establishment Inspection Report dated September 15, 2025. | Level 2 |
| Failed to post required grievance procedure information and contact information for ombudsman and maltreatment reporting. | Level 2 |
| Failed to post the original current license at the main entrance of the facility. | Level 1 |
| Failed to post 911 emergency number and information for reporting suspected maltreatment in common areas and near telephones. | Level 2 |
| Failed to establish and maintain a tuberculosis infection control program including timely TB screening for employees. | Level 2 |
| Failed to maintain a comprehensive emergency preparedness plan with all required content and failed to post the emergency plan. | Level 2 |
| Resident records lacked required documentation including service documentation and discharge summary content. | Level 2 |
| Failed to maintain facility in compliance with Minnesota State Fire Code including cigarette butt disposal, obstructed emergency exits, use of extension cords, and damaged power cords. | Level 3 |
| Failed to provide interconnected smoke alarms throughout the facility; hardwired alarms were not interconnected with wireless battery-operated alarms. | Level 2 |
| Physical environment not maintained in good repair; deck and railing off kitchen were rotten, damaged, and loose. | Level 2 |
| Failed to develop fire safety and evacuation plan with required content including employee and resident training and readily available plan. | Level 2 |
| Failed to ensure registered nurse conducted direct supervision of staff performing delegated nursing tasks within 30 days of first providing those services. | Level 2 |
| Failed to ensure direct care staff received required initial training on mental illness and de-escalation topics. | Level 2 |
| Failed to complete comprehensive resident assessment at least every 90 days. | Level 2 |
| Failed to store prescription medications in securely locked compartments; medication closet key was left in the lock. | Level 2 |
| Failed to document all required information on disposition of medications for discharged resident including prescription numbers. | Level 2 |
Report Facts
Resident count: 1
Fine amount: 1000
Days late: 5
Days late: 15
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jodi Johnson | Supervisor, State Evaluation Team | Contact person for survey and correction orders |
| Ridwan A. Mohamed | Certified Food Protection Manager | Named in food safety inspection report |
| Jijo Ahmed | Owner | Named in food safety inspection report |
| Sarah Conboy | Public Health Sanitarian Supervisor | Named in food safety inspection report |
| Unlicensed Personnel C | Named in multiple findings including medication administration and training | |
| Clinical Nurse Supervisor B | Named in multiple findings including assessments, training, and fire safety | |
| Owner D | Named in fire safety and physical environment findings | |
| Licensed Assisted Living Director/Registered Nurse A | Named in multiple findings including postings and medication storage |
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