Inspection Reports for Jabez Customized Living Services
1417 Brookdale Drive, Brooklyn Park, MN 55444, MN, 55444
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Inspection Report
Original Licensing
Census: 4
Deficiencies: 6
Aug 27, 2024
Visit Reason
The Minnesota Department of Health conducted an initial survey to evaluate and assess compliance with state licensing statutes for Jabez Customized Living Services.
Findings
The licensee was found to be in substantial compliance but had several level two violations including failure to establish a tuberculosis prevention program at time of hire for an employee, incomplete emergency preparedness plan, lack of interconnected smoke alarms, incomplete fire safety and evacuation plan and training, inclusion of a waiver of liability in resident contracts, and failure to label opened medications with date opened.
Severity Breakdown
Level 2: 6
Deficiencies (6)
| Description | Severity |
|---|---|
| Failed to establish and maintain a tuberculosis infection control program including TB symptom screening and baseline testing at time of hire for one employee. | Level 2 |
| Failed to have a written emergency preparedness plan with all required content including evacuation plans, training, and exercises. | Level 2 |
| Failed to provide interconnected smoke alarms so that activation of one alarm causes all alarms to activate. | Level 2 |
| Failed to develop a complete fire safety and evacuation plan and failed to provide required training to residents and employees. | Level 2 |
| Assisted living contract included a waiver of facility liability for resident health, safety, or personal property. | Level 2 |
| Failed to label opened prescription medications with date opened for one resident's injectable medications. | Level 2 |
Report Facts
Residents present: 4
Time period for correction: 21
Time period for correction: 7
Medication dosage: 6
Medication dosage: 27
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Renee Anderson | Supervisor, State Evaluation Team | Signed the survey letter and contact for questions |
| LALD-A | Licensed Assisted Living Director | Interviewed regarding tuberculosis screening, emergency preparedness, fire safety, and contract issues |
| ULP-B | Unlicensed Personnel | Employee involved in tuberculosis screening deficiency and medication administration |
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