Inspection Reports for Martha House LLC
1861 Preserve Court, Shakopee, MN 55379, MN, 55379
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Inspection Report
Routine
Census: 3
Deficiencies: 8
Oct 3, 2023
Visit Reason
The Minnesota Department of Health conducted a full survey to evaluate and assess compliance with state licensing statutes for Martha House LLC.
Findings
The facility was found in substantial compliance but had several deficiencies including food safety violations, tuberculosis prevention program gaps, missing required notices and documentation, incomplete nursing assessments, incomplete service plans, and medication disposition documentation issues.
Severity Breakdown
Level 1: 1
Level 2: 7
Deficiencies (8)
| 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 establish and maintain a tuberculosis infection control program including required TB screening documentation for employees, resulting in a level two violation at widespread scope. | Level 2 |
| Failed to provide required notice for right to designated representative on a document separate from the contract for one resident, resulting in a level one violation at widespread scope. | Level 1 |
| Failed to ensure a background study was submitted and received in affiliation with the assisted living license for one employee, resulting in a level two violation at widespread scope. | Level 2 |
| Failed to ensure the registered nurse completed an initial assessment prior to contract execution or move-in date for one resident, resulting in a level two violation at isolated scope. | Level 2 |
| Failed to have all required content on the service plan for one resident, resulting in a level two violation at widespread scope. | Level 2 |
| Failed to document medication disposition including prescription numbers for one discharged resident, resulting in a level two violation at widespread scope. | Level 2 |
| Failed to provide the correct Minnesota Bill of Rights for Assisted Living Residents including required complaint reporting statement for one resident, resulting in a level two violation at widespread scope. | Level 2 |
Report Facts
Residents present: 3
Correction order time period: 21
Correction order time period: 7
Correction order time period: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jodi Johnson | Supervisor, State Evaluation Team | Contact person for correction order reconsideration process |
| Shukri Osman | Director | Facility director present during food and beverage inspection |
| Sarah Conboy | Public Health Sanitarian III | Lead Health Regulation Division Nurse Evaluator for food and beverage inspection |
| ULP-B | Unlicensed Personnel | Employee with tuberculosis screening and background study deficiencies |
| ULP-C | Unlicensed Personnel | Employee with tuberculosis screening deficiency |
| LALDIR/RN-A | Licensed Assisted Living Director in Residency/Registered Nurse | Interviewed regarding multiple deficiencies including TB screening, background study, nursing assessment, service plan, and Bill of Rights |
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