Inspection Report
Follow-Up
Census: 94
Deficiencies: 15
Jun 30, 2025
Visit Reason
Follow-up survey to determine correction of orders from the survey completed on April 3, 2025.
Findings
The follow-up survey verified that the facility is in substantial compliance with previous correction orders.
Severity Breakdown
Level 2: 14
Deficiencies (15)
| Description | Severity |
|---|---|
| Licensee failed to demonstrate legal responsibility for control and operation of the facility when allowing use of facility space by a vendor to provide therapy services to residents and outside community members. | Level 2 |
| Failed to ensure food was prepared and served according to the Minnesota Food Code. | Level 2 |
| Failed to ensure infection control standards were followed by unlicensed personnel during health monitoring services. | Level 2 |
| Failed to establish and maintain a tuberculosis infection control program including baseline TB screenings for employees. | Level 2 |
| Failed to comply with Minnesota State Fire Code including non-operational exit door, locked exit doors requiring keys, lack of emergency unlocking device for controlled egress doors, fire doors held open, holes in fire-resistant walls, storage in exit paths, and use of extension cords as permanent power. | Level 2 |
| Failed to provide interconnected smoke alarms throughout the facility. | Level 2 |
| Failed to provide required fire safety and evacuation training to residents annually. | Level 2 |
| Failed to ensure direct care employee received required dementia care training within required timeframe. | Level 2 |
| Failed to ensure dementia training included all required content for direct care employee. | Level 2 |
| Failed to revise service plans to include provided services for residents R3, R4, and R5. | Level 2 |
| Failed to provide specific resident instructions related to medication administration for residents R3, R4, and R5. | Level 2 |
| Failed to document medication administration properly for residents R3, R4, R5, R9, and R10. | Level 2 |
| Failed to ensure medications were maintained with original prescription labels including expiration dates and failed to monitor for expired medications. | Level 2 |
| Failed to provide written specific instructions for blood glucose monitoring for residents R3, R5, and R6. | Level 2 |
| Failed to ensure privacy was maintained for resident R6 during blood glucose monitoring in a common dining area. | Level 2 |
Report Facts
Residents present: 94
Fines assessed: 500
Dementia training hours: 6.25
Dementia training hours: 1
Medication administration times: 5
Blood pressure monitoring frequency: 32
Blood pressure range: 172
Blood pressure range: 63
Medication expiration date: 2023
Temperature: 156
Temperature: 174
Temperature: 38
Temperature: 39
Temperature: 41
Temperature: 40
Temperature: 37
Temperature: 41
Sanitizer concentration: 200
Sanitizer concentration: 200
Dishwasher temperature: 160
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Benjamin J. Zwart | Supervisor, State Engineering Services Section | Signed follow-up survey letter dated June 30, 2025 |
| Jessie Chenze | Supervisor, State Evaluation Team | Signed letter dated April 30, 2025 regarding initial survey |
| Dennis Reif | Certified Food Protection Manager | Signed food and beverage establishment inspection report dated April 3, 2025 |
| Ryan Trenberth | SAN III, Bemidji District Office | Signed food and beverage establishment inspection report dated April 3, 2025 |
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