Inspection Reports for Providence Villa LLC
200 Minnesota Ave, Sebeka, MN 56477, MN, 56477
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Inspection Report
Follow-Up
Census: 16
Deficiencies: 27
Sep 25, 2024
Visit Reason
Follow-up survey to determine correction of orders found on the survey completed July 3, 2024.
Findings
The follow-up survey found the facility to be in substantial compliance. The Department of Health removed the conditional license based on these findings.
Severity Breakdown
Level 1: 1
Level 2: 23
Level 3: 2
Deficiencies (27)
| Description | Severity |
|---|---|
| Licensee failed to ensure management officials understood all assisted living facility regulations. | Level 2 |
| Food was not prepared and served according to the Minnesota Food Code. | Level 2 |
| Infection control standards were not followed during medication administration and disinfecting shared equipment. | Level 2 |
| Failed to post required grievance procedure and contact information for Ombudsman and maltreatment reporting. | Level 2 |
| Failed to post required 911 emergency number in common areas. | Level 2 |
| Employee records lacked required documentation including annual performance reviews and competency evaluations. | Level 2 |
| Failed to maintain a tuberculosis infection control program with current facility risk assessment. | Level 2 |
| Failed to post and develop a written emergency preparedness plan with all required content and quarterly review of missing resident plan. | Level 2 |
| Resident records lacked current, legible, dated, and authenticated entries. | — |
| Resident record lacked a discharge summary for a discharged resident. | — |
| Failed to develop and maintain fire safety and evacuation plan with required elements. | Level 2 |
| Failed to develop and execute a written contract with required content prior to providing services for one resident. | Level 2 |
| Failed to provide written notice of emergency relocation and notify Ombudsman for resident hospitalized longer than four days. | Level 2 |
| Failed to ensure all employees had cleared background studies prior to independent resident contact. | Level 3 |
| Training and competency evaluations for unlicensed personnel lacked required content. | Level 2 |
| Failed to ensure direct supervision of staff performing delegated tasks within 30 days of hire. | Level 2 |
| Failed to complete required orientation topics for unlicensed personnel before providing services. | Level 2 |
| Failed to complete required annual training for employees performing direct services. | Level 2 |
| Failed to provide required dementia care training for unlicensed personnel and non-direct care staff. | Level 2 |
| Failed to complete comprehensive resident change of condition assessment following hospitalization and uniform assessment tool content for two residents. | Level 2 |
| Failed to develop and maintain individualized medication management record with all required content for two residents. | Level 2 |
| Failed to ensure specific instructions for medication administration were in resident record and communicated to unlicensed personnel. | Level 2 |
| Medications were not administered according to manufacturer's instructions for one resident receiving inhaler administration. | Level 2 |
| Failed to develop written procedures and train unlicensed personnel for providing medications for residents having unplanned time away. | Level 2 |
| Failed to ensure medications were maintained and monitored for expired dates when stored by the licensee. | Level 2 |
| Failed to provide care and services according to accepted health care standards for residents using bedrails and consumer bedrail, including lack of comprehensive assessment and documentation. | Level 3 |
| Failed to post required signage at facility entrance disclosing electronic monitoring devices. | Level 1 |
Report Facts
Residents present at survey: 16
Conditional license duration: 90
Potential fines: 6500
Certified Food Protection Manager certificate expiration: Jul 19, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Chelsea Olson | Certified Food Protection Manager | Named in food establishment inspection report |
| Rick Michals | Executive Regional Operations Manager | Signed regulatory letters |
| Jessie Chenze | Surveyor Supervisor | Contact for reports and conference calls |
| Stephanie Reynolds | Public Health Sanitarian | Food establishment inspector |
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