Inspection Reports for Nevada Home
9019 Nevada Avenue, North Brooklyn Park, MN 55445, MN, 55445
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Inspection Report
Routine
Census: 3
Deficiencies: 8
Apr 11, 2025
Visit Reason
The Minnesota Department of Health conducted a full survey to evaluate and assess compliance with state licensing statutes for the assisted living facility.
Findings
The licensee was found in substantial compliance but had several violations including failure to list the licensed assisted living director as Director of Record, food service violations per Minnesota Food Code, lack of daily social and recreational activities, failure to post grievance procedures, non-functional and non-interconnected smoke alarms, lack of monthly fire extinguisher inspections, incomplete fire safety and evacuation plans and training, and incomplete resident service plans.
Severity Breakdown
Level 1: 2
Level 2: 6
Deficiencies (8)
| Description | Severity |
|---|---|
| Licensed assisted living director was not listed as Director of Record. | Level 1 |
| Food was not prepared and served according to Minnesota Food Code, including failure to date-mark opened food items. | Level 2 |
| Failed to provide a daily program of social and recreational activities based on resident needs. | Level 2 |
| Failed to post required grievance procedure information in a conspicuous place. | Level 2 |
| Smoke alarms were not interconnected and did not function properly. | Level 2 |
| Portable fire extinguishers lacked records of monthly visual inspections. | Level 1 |
| Fire safety and evacuation plan lacked specific employee actions, resident fire protection procedures, and required training and drills were not conducted as required. | Level 2 |
| Resident service plan lacked method of supervision and monitoring of staff and emergency contact authority information. | Level 2 |
Report Facts
Residents present: 3
Fine amount: 500
Food code violation compliance date: 0
Evacuation drills documented: 5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RN-A | Registered Nurse / Licensed Assisted Living Director | Identified as licensed assisted living director and involved in findings related to director of record, service plan, and grievance posting. |
| HM-C | House Manager | Assisted with smoke alarm testing, provided fire safety and evacuation documents, and involved in multiple interviews. |
| Jess Schoenecker | Supervisor, State Evaluation Team | Signed the cover letter for the inspection report. |
| Jessica Davis | Public Health Sanitarian III | Conducted Food and Beverage Establishment Inspection and signed the inspection report. |
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