Inspection Reports for Peace Homecare Services LLC
5127 53rd Avenue, North Crystal, MN 55429, MN, 55429
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Inspection Report
Routine
Census: 4
Capacity: 4
Deficiencies: 8
Aug 13, 2024
Visit Reason
The Minnesota Department of Health conducted a full survey to evaluate and assess compliance with state licensing statutes for Peace Homecare Services LLC.
Findings
The facility was found in substantial compliance but had several level two violations including failure to prepare and serve food according to Minnesota Food Code, non-functioning and non-interconnected smoke alarms, incomplete resident reassessments, incomplete and unsigned service plans, medication administration errors, lack of treatment and therapy management plans, and inadequate documentation of treatments.
Severity Breakdown
Level 2: 8
Deficiencies (8)
| Description | Severity |
|---|---|
| Food was not prepared and served according to the Minnesota Food Code. | Level 2 |
| Smoke alarms did not function properly and were not interconnected as required. | Level 2 |
| Registered nurse failed to complete a comprehensive reassessment within 90 days for one resident. | Level 2 |
| Written service plan was not revised and signed by the resident to reflect current services provided. | Level 2 |
| Medication administration procedures were not followed for two residents. | Level 2 |
| Treatment or therapy management plan was incomplete and lacked required content for one resident. | Level 2 |
| Documentation of treatments was lacking for one resident. | Level 2 |
| Medications were not administered according to policy and accepted standards of practice by two staff members. | Level 2 |
Report Facts
Residents present: 4
Total licensed capacity: 4
Days late for reassessment: 7
Time period for correction: 7
Time period for correction: 21
Time period for correction: 7
Medication dosage: 10
Medication dosage: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jodi Johnson | Supervisor, State Evaluation Team | Signed the survey letter and provided contact information. |
| CNS-B | Clinical Nurse Supervisor | Interviewed regarding deficiencies including reassessment, medication administration, and treatment plans. |
| LALD-A | Licensed Assisted Living Director | Observed administering medication and treatment, interviewed about medication errors and service plan deficiencies. |
| ULP-C | Unlicensed Personnel | Observed administering medications and assisting with treatments; involved in medication administration errors. |
| Casey Kipping | Public Health Sanitarian III | Signed the Food and Beverage Establishment Inspection Report. |
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