Inspection Report
Original Licensing
Census: 92
Deficiencies: 16
Nov 20, 2024
Visit Reason
The Minnesota Department of Health conducted a full survey for a change of ownership to evaluate and assess compliance with state licensing statutes.
Findings
The licensee was found in substantial compliance but had multiple deficiencies including food service violations, failure to post grievance and maltreatment reporting information, incomplete resident records, missing designated representative notices, contract issues, incomplete staff training and supervision, incomplete resident assessments and service plans, and medication management deficiencies.
Severity Breakdown
Level 2: 16
Deficiencies (16)
| Description | Severity |
|---|---|
| Failed to ensure food was prepared and served according to the Minnesota Food Code, resulting in a level two violation at widespread scope. | Level 2 |
| Failed to post grievance procedure information with required content in a conspicuous place, resulting in a level two violation at widespread scope. | Level 2 |
| Failed to post information and phone numbers for reporting suspected maltreatment to the Minnesota Adult Abuse Reporting Center, resulting in a level two violation at widespread scope. | Level 2 |
| Failed to include a discharge summary in one discharged resident's record, resulting in a level two violation at isolated scope. | Level 2 |
| Failed to provide required notice of right to designate a representative on a document separate from the contract for two residents, resulting in a level two violation at isolated scope. | Level 2 |
| Assisted living contracts included waiver of liability language for three residents, resulting in a level two violation at pattern scope. | Level 2 |
| Failed to ensure training and competency evaluations for one unlicensed personnel included all required content, resulting in a level two violation at isolated scope. | Level 2 |
| Failed to ensure training and competency evaluations for one unlicensed personnel included all required content related to observing, reporting, and documenting resident status, and other nursing tasks, resulting in a level two violation at isolated scope. | Level 2 |
| Failed to provide direct supervision of staff performing delegated tasks within 30 days of employment for two unlicensed personnel, resulting in a level two violation at isolated scope. | Level 2 |
| Failed to ensure two unlicensed personnel received the required eight hours of dementia care training within 80 working hours of employment, resulting in a level two violation at widespread scope. | Level 2 |
| Failed to conduct ongoing nursing assessments not to exceed 90 days for three residents, resulting in a level two violation at pattern scope. | Level 2 |
| Failed to revise written service plans to reflect current services for two residents, resulting in a level two violation at isolated scope. | Level 2 |
| Failed to develop an individualized medication management plan with required content for one resident, resulting in a level two violation at isolated scope. | Level 2 |
| Failed to ensure registered nurse documented resident-specific instructions for medication administration for one resident, resulting in a level two violation at isolated scope. | Level 2 |
| Failed to develop and implement a treatment or therapy management plan with required content for two residents, resulting in a level two violation at isolated scope. | Level 2 |
| Failed to develop and implement an individualized activity evaluation and plan addressing all required provisions for two residents in memory care, resulting in a level two violation at widespread scope. | Level 2 |
Report Facts
Residents present: 92
Residents receiving dementia care: 59
Dementia care training hours: 3.5
Dementia care training hours planned: 6.5
Days between nursing assessments: 91
Days between nursing assessments: 136
Days between nursing assessments: 112
Milk temperature: 50
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jodi Johnson | Supervisor, State Evaluation Team | Named as contact for questions regarding the survey |
| Cory Franzmeier | Director of Culinary Services | Named as person in charge during food service inspection |
| Blia Lor | Public Health Sanitarian I | Conducted food service inspection |
| Kassie Marking | Health Regulation Division Nurse Evaluator | Lead for food service inspection |
| Susan Winkelmann | Contact for provider feedback questionnaire | |
| Jodi Johnson | Supervisor, State Evaluation Team | Signed the state licensing survey letter |
| Cory Franzmeier | Director of Culinary Services | Signed the food service inspection report |
| Blia Lor | Public Health Sanitarian I | Signed the food service inspection report |
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