Inspection Reports for
Serendipitous Living
7935 Upper 139Th Court West, Apple Valley, MN 55044, MN, 55044
Back to Facility ProfileDeficiencies (last 1 years)
Deficiencies (over 1 years)
26 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
567% worse than Minnesota average
Minnesota average: 3.9 deficiencies/yearDeficiencies per year
28
21
14
7
0
Inspection Report
Follow-Up
Census: 5
Capacity: 5
Deficiencies: 26
Date: Feb 28, 2024
Visit Reason
Follow-up survey to determine correction of orders found on the survey completed on October 4, 2023.
Findings
The facility corrected all state correction orders from the prior survey except for a violation related to resident record authentication. Additional violations were found related to resident record entries, fire safety, staffing plan, tuberculosis prevention, emergency preparedness, medication management, and other regulatory requirements.
Deficiencies (26)
Failed to ensure entries in four resident records were authenticated by the name and title of the person making the entry.
Failed to develop and implement a staffing plan to determine staffing levels to meet resident needs.
Failed to maintain a tuberculosis prevention program including documentation of health history and symptom screening for employees.
Failed to post an emergency disaster plan prominently and have a comprehensive emergency preparedness plan with all required content.
Failed to maintain resident records with documentation of all provided services and discharge summary.
Failed to comply with fire safety code requirements including interconnected smoke alarms and portable fire extinguisher maintenance.
Failed to provide required fire safety and evacuation plans, training, and drills.
Failed to provide uniform checklist disclosure of services to resident.
Failed to maintain complete employee records including background studies, training, competency evaluations, and performance reviews.
Failed to ensure annual training included all required topics for unlicensed personnel.
Failed to complete comprehensive resident assessments per regulatory requirements.
Failed to revise service plans to reflect current services provided including blood sugar checks.
Failed to conduct annual medication management reassessment including review of all medications and side effects.
Failed to develop individualized medication management plans with required content.
Failed to document medication setup with required details.
Failed to train unlicensed personnel on medication administration for unplanned time away when licensed nurse is not available.
Failed to renew prescriptions at least every 12 months.
Failed to securely store medications and restrict access to authorized personnel only.
Failed to post required notice of electronic monitoring devices at facility entrance.
Failed to authenticate resident record entries with name and title of person making entry.
Failed to ensure resident record included all required documentation of services and discharge summary.
Failed to ensure interconnected smoke alarms so that actuation of one alarm causes all alarms to operate.
Failed to maintain portable fire extinguishers as required by State Fire Code.
Failed to provide fire safety and evacuation plans with required elements, training, and drills.
Failed to develop individual abuse prevention plan with required content for resident.
Failed to provide care and services according to accepted health care standards for resident with hospital bed side rails, including required assessments and documentation.
Report Facts
Residents present: 5
Licensed capacity: 5
Fines assessed: 3000
Deficiencies cited: 29
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jodi Johnson | Supervisor, State Evaluation Team | Contact for questions and reconsideration process |
| Molly Dougherty | Public Health Sanitarian | Conducted food and beverage inspection |
| Salina Yann | Certified Food Protection Manager | Food safety manager at facility |
| LALD/RN-A | Licensed Assisted Living Director/Registered Nurse | Named in multiple findings related to staffing, medication management, and compliance |
| ULP-B | Unlicensed Personnel | Named in medication administration and training deficiencies |
| ULP-C | Unlicensed Personnel | Named in medication administration and training deficiencies |
| ULP-D | Unlicensed Personnel | Named in tuberculosis screening and medication administration deficiencies |
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