Deficiencies per Year
8
6
4
2
0
Severe
High
Inspection Report
Annual Inspection
Census: 60
Deficiencies: 5
Oct 1, 2025
Visit Reason
The Minnesota Department of Health conducted a full survey to evaluate and assess compliance with state licensing statutes for the assisted living facility with dementia care license.
Findings
The facility was found in substantial compliance but had several deficiencies including failure to comply with Minnesota Food Code, infection control program deficiencies, fire protection and physical environment issues, and incomplete resident service plan documentation. The facility was assessed fines totaling $1,000 for infection control and fire protection violations.
Severity Breakdown
Level 2: 4
Level 1: 1
Deficiencies (5)
| Description | Severity |
|---|---|
| Food was not prepared and served according to the Minnesota Food Code, resulting in a level two violation at a widespread scope. | Level 2 |
| Failed to establish and maintain an infection control program consistent with accepted health care standards, resulting in a level two violation at a widespread scope. | Level 2 |
| Failed to comply with Minnesota State Fire Code; multiple fire doors would not close and latch automatically, missing fire rated door, and delayed egress locking system lacked approved release switch, resulting in a level two violation at a widespread scope. | Level 2 |
| Failed to provide functioning and interconnected smoke alarms in resident rooms as required by State Fire Code, resulting in a level one violation at a widespread scope. | Level 1 |
| Failed to ensure revisions to the service plan included signatures documenting agreement by the facility and resident for one resident, resulting in a level two violation at an isolated scope. | Level 2 |
Report Facts
Fines assessed: 1000
Residents present: 60
Priority 1 orders: 1
Priority 3 orders: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Mark R. Dejarlais | Certified Food Protection Manager, Kitchen Supervisor | Named in Food and Beverage Inspection Report and employee illness policy discussion |
| Renee L. Anderson | Supervisor, State Evaluation Team | Signed cover letter for the state survey report |
| Jenna Kilawee | Licensed Assisted Living Director | Mentioned in Food and Beverage Inspection Report discussion |
| Melissa Ramos | Public Health Sanitarian 3 | Signed Food and Beverage Inspection Report |
| Susan Winkelmann | Contact for questionnaire | Contact person for provider feedback questionnaire |
| Angel Woehler | Health Regulation Division Nurse Evaluator | Mentioned in Food and Beverage Inspection Report discussion |
| Unlicensed Personnel G | Observed assisting resident with personal cares and hand hygiene deficiencies | |
| Clinical Nurse Supervisor B | Provided interview on handwashing standards | |
| Maintenance Manager C | Interviewed regarding fire door and smoke alarm deficiencies | |
| Licensed Assisted Living Director A | Interviewed regarding service plan deficiencies |
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