Inspection Reports for Nova Ewing Home
5152 Ewing Avenue North, Brooklyn Center, MN 55429, MN, 55429
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Inspection Report
Follow-Up
Census: 4
Deficiencies: 10
Sep 24, 2024
Visit Reason
Follow-up survey conducted on September 24, 2024, to determine if orders from the July 11, 2024 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: 6
Level 3: 1
Deficiencies (10)
| Description | Severity |
|---|---|
| Food was not prepared and served according to the Minnesota Food Code, resulting in a level two violation at a widespread scope. | Level 2 |
| Failed to ensure one employee had evidence of completing orientation to assisted living facility licensing requirements before providing services. | Level 2 |
| Failed to have a written emergency preparedness plan with all required content, and failed to post emergency exit diagrams on each floor. | Level 2 |
| Failed to maintain physical environment in good repair including exposed light bulbs, holes in walls, broken door trim, and holes in doors. | Level 2 |
| Failed to develop fire safety and evacuation plan with required content, provide required training and drills. | Level 2 |
| Failed to ensure resident bedrooms had minimum window opening meeting state standard for egress, constituting a distinct hazard to life. | Level 3 |
| Failed to execute written contracts with required content including Health Facility Identification number. | Level 1 |
| Assisted living contract included language waiving licensee's liability for resident health, safety, or personal property. | Level 1 |
| Failed to ensure one employee received required initial dementia care training within first 160 working hours. | Level 2 |
| Service plan lacked required content including action to be taken if scheduled service cannot be provided. | Level 2 |
Report Facts
Residents present: 4
Window measurements: 550
Window measurements: 573.5
Window measurements: 792
Correction order compliance dates: 7
Correction order compliance dates: 21
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| ULP-C | Unlicensed Personnel | Named in findings for lack of orientation documentation and incomplete dementia care training. |
| Jess Schoenecker | Supervisor, State Evaluation Team | Signed follow-up survey letter dated October 18, 2024. |
| Casey DeVries | Supervisor, State Evaluation Team | Signed correction order letters and correspondence related to July 11, 2024 survey. |
| AD-B | Assistant Director | Interviewed regarding orientation documentation, emergency preparedness, fire safety, and window egress deficiencies. |
| CNS-A | Clinical Nurse Supervisor | Provided resident contract and assisted living contract documents during survey. |
| Dheeraj Karki | Certified Food Protection Manager | Named on Food and Beverage Establishment Inspection Report dated July 8, 2024. |
| Casey Kipping | Public Health Sanitarian III | Signed Food and Beverage Establishment Inspection Report dated July 8, 2024. |
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