Deficiencies per Year
12
9
6
3
0
High
Moderate
Inspection Report
Follow-Up
Census: 78
Deficiencies: 11
Jul 6, 2023
Visit Reason
Follow-up survey conducted on July 6, 2023, to determine if orders from the May 24, 2023 survey were corrected.
Findings
The follow-up survey verified that the facility is in substantial compliance with previous correction orders.
Severity Breakdown
Level 2: 10
Level 3: 1
Deficiencies (11)
| 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 engage in and maintain documentation of quality management activities as stated in the licensee's Quality Management Program, resulting in a level two violation at a widespread scope. | Level 2 |
| Failed to ensure documentation of significant changes in resident status, documentation of services provided as identified in the service plan, and discharge summary completeness for residents R2, R4, and R6, resulting in a level two violation at a pattern scope. | Level 2 |
| Failed to provide required written notice for emergency relocation and notify the Office of Ombudsman for Long-Term Care for resident R2, resulting in a level two violation at an isolated scope. | Level 2 |
| Failed to ensure direct supervision of unlicensed personnel performing delegated nursing tasks by a registered nurse within 30 days for one employee, resulting in a level two violation at an isolated scope. | Level 2 |
| Failed to assess resident R1 for change of condition related to falls and failed to implement new interventions to prevent future falls, resulting in a level three violation at an isolated scope. | Level 3 |
| Service plans for residents R1, R2, R3, and R4 lacked required content including schedule and methods of monitoring assessments, monitoring staff providing services, and contingency plans, resulting in a level two violation at a widespread scope. | Level 2 |
| Medications were not stored according to manufacturer's recommendations; medication refrigerator temperatures were frequently out of range and not consistently monitored, resulting in a level two violation at a pattern scope. | Level 2 |
| Controlled medications (morphine syringes) were not individually labeled for residents R7 and R8, resulting in a level two violation at a pattern scope. | Level 2 |
| Time-sensitive medications (eye drops) for residents R9 and R10 were not dated with an expiration date after opening, resulting in a level two violation at a pattern scope. | Level 2 |
| Failed to document disposition of medications for resident R6 upon discharge, resulting in a level two violation at an isolated scope. | Level 2 |
Report Facts
Residents present: 78
Fines assessed: 3000
Falls: 20
Medication refrigerator temperature checks: 109
Medication refrigerator temperature checks: 119
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jessica Chenze | Supervisor, State Evaluation Team | Named in follow-up survey letter and reconsideration process |
| Jessie Chenze | Supervisor, State Evaluation Team | Named in follow-up survey letter and reconsideration process |
| LALD-A | Licensed Assisted Living Director | Interviewed regarding quality management, emergency relocation, and medication refrigerator temperature |
| CNS-C | Clinical Nurse Supervisor | Interviewed regarding quality management, falls, medication storage, and service plans |
| LPN-K | Licensed Practical Nurse | Completed incident investigation reports and supervised unlicensed personnel |
| ULP-I | Unlicensed Personnel | Performed delegated nursing tasks without documented direct supervision |
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