Inspection Reports for Maplewood Homes Of Faribault
428 Northwest 5Th Street, Faribault, MN 55021, MN, 55021
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Inspection Report
Follow-Up
Census: 8
Capacity: 10
Deficiencies: 17
Oct 1, 2024
Visit Reason
Follow-up survey to determine if orders from the April 4, 2024 survey and the July 16, 2024 follow-up survey were corrected.
Findings
The follow-up survey verified that the facility is in substantial compliance with previous correction orders.
Severity Breakdown
Level 1: 2
Level 2: 14
Level 3: 1
Deficiencies (17)
| Description | Severity |
|---|---|
| Failed to develop and implement a staffing plan for determining staffing levels that ensures sufficient staffing at all times to meet residents' needs and emergencies. | Level 2 |
| Food was not prepared and served according to the Minnesota Food Code; menu lacked inclusion of breakfast, lunch, and snacks. | Level 2 |
| Failed to maintain a comprehensive tuberculosis infection control program including documentation of completed health history and symptom screen for employees. | Level 2 |
| Failed to have a written emergency preparedness plan with all required content including hazard assessment, training, and exercises. | Level 2 |
| Failed to provide interconnected smoke alarms so that actuation of one alarm causes all alarms to sound. | Level 2 |
| Failed to maintain physical environment in good repair; resident bedroom obstructed egress window and contained electrical hazards; fire alarm system lacked required annual inspection. | Level 2 |
| Resident bedrooms did not have windows meeting minimum egress size requirements. | Level 3 |
| Failed to include required content related to medical assistance waivers and housing support program in resident contract. | Level 1 |
| Failed to offer resident the opportunity to identify a designated representative with required statutory language in contract. | Level 1 |
| Failed to provide required training and competency evaluations for unlicensed personnel including infection control, personal hygiene, fall prevention, communication skills, and emergency procedures. | Level 2 |
| Failed to provide required orientation to new unlicensed personnel including consumer advocacy and person-centered planning. | Level 2 |
| Failed to provide required annual training including maltreatment reporting, infection control, and person-centered planning. | Level 2 |
| Resident service plan lacked required content including schedule and methods of monitoring staff and contingency plans. | Level 2 |
| Failed to conduct face-to-face medication management assessment including review of all medications and interventions to prevent diversion. | Level 2 |
| Unlicensed personnel failed to prime insulin pens prior to administration as required. | Level 2 |
| Medications were not maintained in original containers with legible prescription labels and date opened for time-dated drugs. | Level 2 |
| Treatment or therapy management plan lacked required content including procedures for notifying nurse when problems arise. | Level 2 |
Report Facts
Residents present: 8
Total licensed capacity: 10
Fine amount: 3000
Insulin dosage: 65
Insulin pen open area: 475
Insulin pen open area: 462.5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Casey DeVries | Supervisor | Named as contact for follow-up survey and correction orders |
| Jodi Johnson | Supervisor | Named as contact for initial licensing survey and correction orders |
| Margaret Leigh Clendenin | Certified Food Protection Manager | Signed food establishment inspection report |
| Isaiah Armendariz | Environmental Health Specialist | Signed food establishment inspection report |
| ULP-C | Unlicensed Personnel | Named in medication administration and training deficiencies |
| ULP-D | Unlicensed Personnel | Named in training and orientation deficiencies |
| LALD-A | Licensed Assisted Living Director | Named in multiple findings including staffing plan, TB screening, emergency preparedness, fire safety, and contract deficiencies |
| MS-E | Maintenance Supervisor | Named in physical environment and fire safety deficiencies |
| MP-F | Maintenance Personnel | Named in physical environment and fire safety deficiencies |
| CNS-B | Clinical Nurse Supervisor | Named in medication management and training deficiencies |
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