Inspection Report
Follow-Up
Census: 119
Deficiencies: 4
Jun 3, 2025
Visit Reason
Follow-up survey conducted on June 3, 2025, to determine correction of orders from the survey completed on March 12, 2025.
Findings
The follow-up survey verified that the facility is in substantial compliance. The initial survey on March 12, 2025, found multiple deficiencies including food service violations, incomplete background studies for staff, failure to conduct comprehensive resident reassessments, and medication administration errors.
Severity Breakdown
Level 2: 3
Level 3: 1
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to ensure food was prepared and served according to the Minnesota Food Code, including encrusted food debris in convection oven. | Level 2 |
| Failed to ensure a background study was current and eligible for one employee providing direct care without supervision. | Level 3 |
| Failed to conduct a comprehensive reassessment with a change of condition for one resident who started hospice services. | Level 2 |
| Failed to ensure nurse delegated procedures were followed by unlicensed personnel during medication administration, including failure to check medication labels against MAR. | Level 2 |
Report Facts
Residents present: 119
Employees: 59
Fine amount: 3000
Certification expiration: 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| ULP-F | Unlicensed Personnel | Provided direct care without completed background study and failed to follow medication administration procedures |
| Jodi Johnson | Supervisor, State Evaluation Team | Signed follow-up survey letter |
| LALD-A | Licensed Assisted Living Director | Reviewed employee background study issues |
| RVPO-I | Regional Vice President of Operations | Reviewed employee background study issues |
| CNS-B | Clinical Nurse Supervisor | Interviewed regarding resident reassessment and medication administration |
| Jonathan P. Tormoen | Certified Food Protection Manager | Signed Food and Beverage Establishment Inspection Report |
| Chris Foster | Public Health Sanitarian III | Signed Food and Beverage Establishment Inspection Report |
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