Inspection Reports for Ibson Health Services LLC
4553 Hampshire Avenue, North Crystal, MN 55428, MN, 55428
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Inspection Report
Original Licensing
Capacity: 10
Deficiencies: 5
Sep 23, 2025
Visit Reason
The Minnesota Department of Health conducted an initial survey to assess compliance with state licensing statutes for an assisted living facility license.
Findings
The licensee was found in substantial compliance but had several violations including failure to ensure food was prepared according to Minnesota Food Code, failure to post required grievance and maltreatment reporting information, incomplete assisted living contracts, and incomplete medication setup documentation.
Severity Breakdown
Level 1: 1
Level 2: 4
Deficiencies (5)
| Description | Severity |
|---|---|
| Failed to ensure food was prepared and served according to the Minnesota Food Code. | Level 2 |
| Failed to post information about grievance procedures and contact information for ombudsman and maltreatment reporting. | Level 2 |
| Failed to post 911 emergency number and Minnesota Adult Abuse Reporting Center information in common areas and near telephones. | Level 2 |
| Failed to execute a written assisted living contract with required content including licensee's telephone number, health facility ID, and disclosure of ability to provide specialized diets. | Level 1 |
| Failed to document medication setup including dates, medication name, dose, times, route, and person completing setup. | Level 2 |
Report Facts
Total residents at time of survey: 0
Licensed capacity: 10
Priority 1 Orders: 0
Priority 2 Orders: 1
Priority 3 Orders: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Orlumma S. Afonya | Certified Food Protection Manager | Named as CFPM on Food & Beverage Inspection Report |
| Renee Anderson | Supervisor, State Evaluation Team | Contact person for the inspection report |
| LALD/CNS-B | Licensed Assisted Living Director/Clinical Nurse Supervisor | Interviewed regarding deficiencies and policies |
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