Inspection Reports for Presbyterian Homes of Bloomington
9889 Penn Ave S, Bloomington, MN 55431, United States, MN, 55431
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
7 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
79% worse than Minnesota average
Minnesota average: 3.9 deficiencies/yearDeficiencies per year
12
9
6
3
0
Inspection Report
Follow-Up
Census: 90
Deficiencies: 9
Date: Nov 20, 2025
Visit Reason
The Minnesota Department of Health completed a follow-up survey on November 20, 2025, to determine correction of orders from the survey completed on September 18, 2025.
Findings
The follow-up survey verified that the facility is in substantial compliance. The original survey on September 18, 2025, identified multiple deficiencies including infection control, fire safety, emergency relocation notification, dementia training, nursing assessments, medication storage, expired medications, and appropriate care related to bed rails.
Deficiencies (9)
Failed to ensure food was prepared and served according to the Minnesota Food Code, including bare hand contact with ready-to-eat foods.
Failed to establish and maintain an infection control program consistent with accepted standards, including hand hygiene and PPE use by unlicensed personnel.
Failed to comply with State Fire Code; smoke alarms were over 10 years old and controlled egress system failed to operate.
Failed to provide written notice with required content for emergency relocation for one resident.
Failed to ensure all employees received required dementia care training including problem solving with challenging behaviors within 160 working hours.
Failed to complete nursing reassessments and monitoring within required timeframes for three residents.
Failed to store medications securely and permit only authorized personnel access; medication left unsecured in resident's room.
Failed to dispose of expired medication found in resident's medication tote.
Failed to provide care and services according to accepted health care standards related to consumer bed rails; lacked individualized assessment and documentation.
Report Facts
Residents present: 90
Fines assessed: 2000
Hours worked: 346.75
Smoke alarms age: 10
Expired medication date: Jul 21, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jess Schoenecker | Supervisor, State Evaluation Team | Signed follow-up survey letter |
| Airiana Johanns | Certified Food Protection Manager | Named in Food and Beverage Inspection Report |
| ULP-A | Unlicensed Personnel | Named in infection control and medication storage deficiencies |
| ULP-B | Unlicensed Personnel | Named in infection control and dementia training deficiencies |
| CNS-D | Clinical Nurse Supervisor | Provided statements on infection control, emergency relocation, medication management, and bed rail assessment |
| LALD-C | Licensed Assisted Living Director | Provided statements on emergency relocation notification and dementia training |
| REM-F | Regional Engineer Manager | Accompanied surveyor during fire safety inspection |
| ESD-G | Environmental Services Director | Accompanied surveyor during fire safety inspection |
Inspection Report
Routine
Deficiencies: 3
Date: Apr 3, 2025
Visit Reason
The inspection was conducted to evaluate compliance with regulatory requirements related to mental health notifications, psychotropic medication use, and food safety standards in the nursing facility.
Findings
The facility failed to notify the designated State Mental Health Authority for a resident with new onset mental illness, did not limit PRN antipsychotic medication use to 14 days or ensure re-evaluation, and failed to properly monitor and remove expired or unlabeled food items in refrigerators and freezers, posing potential risks to residents.
Deficiencies (3)
Failed to notify the county (State Mental Health Authority) for 1 resident with new onset mental illness.
Failed to ensure PRN antipsychotic medications were limited to 14 days of use or re-evaluated by the medical provider for 1 resident.
Failed to ensure monitoring and timely removal of expired or unlabeled food in refrigerators and freezers, risking foodborne illness for many residents.
Report Facts
Residents affected: 1
Residents affected: 1
Residents affected: 20
PRN antipsychotic medication order start date: 2025
PRN antipsychotic medication doses administered: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| CP-A | Consulting Pharmacist | Reviewed resident's orders monthly and recommended end date for PRN antipsychotic |
| DON | Director of Nursing | Verified PRN quetiapine order lacked 14-day stop date and acknowledged policy |
| DA-A | Assistant Dietary Director | Conducted kitchen tours and audits, removed expired food, and confirmed food safety processes |
| DA-B | Crossway Server | Confirmed responsibility for checking snack cart and noted unlabeled food items |
| DA-D | Kitchen Supervisor | Confirmed removal of unlabeled food and lack of process for single use cream cheese and creamers |
| DA-C | Per-diem Crossway Server | Described food labeling and use process for unit food items |
Inspection Report
Routine
Deficiencies: 3
Date: Jan 11, 2024
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident care, medication management, and provision of adaptive equipment in the nursing home.
Findings
The facility was found deficient in maintaining a sanitary environment for a resident with feeding tube residue, ensuring proper clarification and documentation of narcotic medication orders and administration for a resident post-hospitalization, and providing appropriate adaptive eating equipment and assistance to a resident with physical impairments.
Deficiencies (3)
Failed to ensure a sanitary and homelike environment for 1 of 1 residents (R34) with dried feeding tube-like substance on feeding tube pole, dresser, bed, and floor.
Failed to ensure post-hospitalization narcotic medication orders were clarified and/or obtained and non-pharmacological interventions were documented prior to administration of PRN narcotic medication for 1 of 5 residents (R33).
Failed to provide adaptive eating equipment and appropriate assistance for 1 of 1 resident (R3) observed with difficulty eating.
Report Facts
Doses of as-needed narcotic medication provided: 11
Pain ratings recorded: 3
Pain ratings recorded: 4
Pain rating recorded: 6
Medication doses: 650
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN-D | Registered Nurse | Acknowledged presence of tube feeding residue and responsibility for cleaning feeding pump and pole |
| Director of Nursing | Director of Nursing (DON) | Stated expectations for cleaning, reviewed medication records, and verified lack of non-pharmacological intervention documentation |
| RN-F | Registered Nurse | Explained administration of PRN narcotic medication and documentation requirements |
| RN-C | Nurse Manager/Registered Nurse | Verified nursing assistants needed to read RA Group Sheet and provide proper adaptive equipment |
| NA-B | Nursing Assistant | Observed bringing lunch tray and noted lack of adaptive silverware |
| DA-A | Dietary Assistant | Responsible for setting up trays with proper silverware and plates |
Inspection Report
Deficiencies: 6
Date: May 4, 2023
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident care, including activities of daily living assistance, skin integrity, pain management, nurse staffing, and vaccination policies.
Findings
The facility was found deficient in multiple areas including failure to provide adequate bathing and personal hygiene for a resident unable to perform ADLs, inadequate assessment and treatment of significant bruising, failure to reassess and manage pressure ulcers, insufficient pain management for a resident with chronic pain and recent medication changes, failure to post nurse staffing information daily, and failure to offer influenza vaccination to a resident according to CDC guidelines.
Deficiencies (6)
Failed to ensure baths were provided to maintain personal hygiene for a resident unable to perform ADLs.
Failed to ensure significant bruising was comprehensively assessed and acted upon to promote healing and reduce risk of complications.
Failed to comprehensively reassess and develop interventions for an in-house acquired deep tissue injury and pressure ulcer.
Failed to comprehensively reassess, create, and implement pain interventions for a resident whose pain medications were decreased resulting in worsening pain.
Failed to post required nurse staffing information on a daily basis.
Failed to offer influenza vaccine to a resident according to CDC guidelines.
Report Facts
Residents affected: 1
Residents affected: 1
Residents affected: 1
Residents affected: 1
Residents affected: 79
Residents affected: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN-A | Registered Nurse | Interviewed regarding bathing documentation and resident R4's care |
| RN-B | Registered Nurse | Interviewed regarding bathing schedule and documentation for resident R4 |
| DON | Director of Nursing | Interviewed regarding bathing audits and documentation for resident R4 |
| NA-G | Nursing Assistant | Interviewed regarding bath documentation for resident R4 |
| NA-A | Nursing Assistant | Interviewed regarding bath documentation and refusal for resident R4 |
| NA-F | Nursing Assistant | Interviewed regarding bruising and pressure ulcer care for residents R38 and R24 |
| RN-C | Registered Nurse | Interviewed regarding bruising and pressure ulcer care for residents R38 and R24 |
| RN-D | Registered Nurse Clinical Coordinator | Interviewed regarding bruising and pressure ulcer care for residents R38 and R24 |
| PT-A | Physical Therapist | Interviewed regarding pain management and therapy for resident R17 |
| OT-A | Certified Occupational Therapy Assistant | Interviewed regarding use of palm guards for resident R17 |
| LPN-A | Licensed Practical Nurse | Interviewed regarding pain management and medication administration for resident R17 |
| NA-B | Nursing Assistant | Interviewed regarding palm guards and care for resident R17 |
| MD | Facility Medical Doctor | Interviewed regarding pain management and medication changes for resident R17 |
| LTCCC-A | Long-Term Care Clinical Coordinator | Interviewed regarding nurse staffing posting |
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