Inspection Report
Original Licensing
Census: 23
Deficiencies: 11
Nov 8, 2023
Visit Reason
The Minnesota Department of Health conducted an initial survey to assess compliance with state licensing statutes for assisted living with dementia care.
Findings
The licensee was found in substantial compliance but had several deficiencies including failure to prominently post an emergency disaster plan, maintain physical environment and fire safety, update service plans, delegate medication administration properly, monitor medication refrigerator temperatures, document medication disposition, develop individualized treatment plans, document oxygen treatment, and provide dementia care policies to residents or representatives.
Severity Breakdown
Level 1: 2
Level 2: 9
Deficiencies (11)
| Description | Severity |
|---|---|
| Failed to prominently post an emergency disaster plan. | Level 1 |
| Failed to maintain the facility's physical environment in good repair including missing door closer on fire door, lack of guardrail on stairway, non-operating exhaust fan, and missing ceiling tiles. | Level 2 |
| Failed to maintain fire safety and evacuation plans with required elements including detailed fire protection procedures, unique resident needs, and employee training. | Level 2 |
| Failed to update service plans for residents to reflect current care needs. | Level 2 |
| Service plans lacked required content including monitoring schedules and contingency plans. | Level 2 |
| Registered nurse failed to provide written, resident-specific medication administration instructions for unlicensed personnel. | Level 2 |
| Failed to monitor and document medication refrigerator temperatures according to manufacturer recommendations. | Level 2 |
| Failed to document disposition of medications upon resident discharge. | Level 2 |
| Failed to develop individualized treatment and therapy management plan with required content for resident receiving treatments. | Level 2 |
| Failed to document oxygen treatment administration and effectiveness for resident. | Level 2 |
| Failed to provide dementia care policies and procedures to residents or their representatives at move-in. | Level 1 |
Report Facts
Residents present: 23
Medication refrigerator temperature: 41
Medication refrigerator temperature missing logs: 10
Oxygen flow rate: 2
Oxygen flow rate max: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jessie Chenze | Supervisor, State Evaluation Team | Signed licensing letter and contact for reconsideration requests |
| Denese Kopnick | Kitchen Manager | Accompanied food establishment inspection |
| Jeremiah J. Valentine | Certified Food Protection Manager | Certified food protection manager for food establishment |
| Callie Harrison | Health Inspector | Signed food establishment inspection report |
| ULP-C | Unlicensed Personnel | Observed administering medications and oxygen to residents |
| CNS-B | Clinical Nurse Supervisor | Interviewed regarding deficiencies and documentation |
| LALD-A | Licensed Assisted Living Director | Interviewed and verified facility conditions and policies |
| LPN-D | Licensed Practical Nurse | Observed medication refrigerator temperature and discussed monitoring |
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