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Inspection Reports for Martha House LLC

1861 Preserve Court, Shakopee, MN 55379, MN, 55379

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Inspection Report Summary

The most recent inspection on October 3, 2023, found the facility in substantial compliance but identified several deficiencies related to food safety, tuberculosis prevention, documentation, nursing assessments, service plans, and medication records. Earlier inspections were not provided for comparison, so broader patterns cannot be fully assessed. Inspectors cited issues mainly in regulatory compliance areas such as infection control, resident rights notices, and record-keeping. No complaint investigations or enforcement actions, including fines or license suspensions, were listed in the available reports. Without prior inspection data, it is unclear whether these findings represent a new or ongoing pattern.

Deficiencies (last 1 years)

Deficiencies (over 1 years) 8 deficiencies/year

Deficiencies are regulatory violations found during state inspections.

105% worse than Minnesota average
Minnesota average: 3.9 deficiencies/year

Deficiencies per year

8 6 4 2 0
2023
Severe (Immediate Jeopardy) High (Actual Harm)
State average

Inspection Report

Routine
Census: 3 Deficiencies: 8 Date: 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.
Deficiencies (8)
Failed to ensure food was prepared and served according to the Minnesota Food Code, resulting in a level two violation at widespread scope.
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.
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.
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.
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.
Failed to have all required content on the service plan for one resident, resulting in a level two violation at widespread scope.
Failed to document medication disposition including prescription numbers for one discharged resident, resulting in a level two violation at widespread scope.
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.
Report Facts
Residents present: 3 Correction order time period: 21 Correction order time period: 7 Correction order time period: 2
Employees mentioned
NameTitleContext
Jodi JohnsonSupervisor, State Evaluation TeamContact person for correction order reconsideration process
Shukri OsmanDirectorFacility director present during food and beverage inspection
Sarah ConboyPublic Health Sanitarian IIILead Health Regulation Division Nurse Evaluator for food and beverage inspection
ULP-BUnlicensed PersonnelEmployee with tuberculosis screening and background study deficiencies
ULP-CUnlicensed PersonnelEmployee with tuberculosis screening deficiency
LALDIR/RN-ALicensed Assisted Living Director in Residency/Registered NurseInterviewed regarding multiple deficiencies including TB screening, background study, nursing assessment, service plan, and Bill of Rights

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