Deficiencies (last 1 years)
Deficiencies (over 1 years)
21 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
438% worse than Minnesota average
Minnesota average: 3.9 deficiencies/yearDeficiencies per year
24
18
12
6
0
Inspection Report
Follow-Up
Census: 75
Capacity: 80
Deficiencies: 21
Date: Mar 19, 2025
Visit Reason
Follow-up survey to determine correction of orders from the survey completed on December 20, 2024.
Findings
The follow-up survey verified that the facility is in substantial compliance with previous correction orders.
Deficiencies (21)
Failed to establish and maintain an infection control program consistent with accepted standards, including hand hygiene and glove use.
Failed to post the 911 emergency number in common areas and near telephones.
Employee records lacked required documentation including orientation, competency evaluations, and RN signatures.
Failed to post emergency preparedness plan and emergency exit diagrams prominently on each floor.
Failed to provide required training and conduct evacuation drills for fire safety and evacuation plans.
Assisted living contract included waiver of liability for resident personal property.
Failed to provide required written notice for emergency relocation and notify Ombudsman for Long-Term Care.
Training and competency evaluations for unlicensed personnel lacked required content.
Failed to ensure RN supervision of unlicensed personnel within 30 days of performing delegated tasks.
Staff providing services failed to complete orientation including review of policies and person-centered care principles.
Failed to ensure required annual training topics were completed for staff.
Failed to complete resident reassessments timely within 14 days of initiation and every 90 days thereafter.
Service plans lacked resident or facility signature documenting agreement on services to be provided.
RN failed to conduct individualized medication assessments with required content for residents.
Failed to document medication setup with required details including date, medication, dose, times, route, and preparer.
Failed to develop written procedures for unlicensed personnel providing medications during unplanned time away.
Failed to develop and maintain individualized treatment and therapy management plan with all required content.
Failed to document administration of treatments including reasons for not administering and follow-up.
Failed to provide required dementia care policies and procedures to residents and/or representatives at move-in.
Failed to provide care and services according to accepted health care standards for residents with assistive devices, including unsafe bedrails.
Resident was treated without dignity and respect, including sleeping on a soiled mattress pad without linens.
Report Facts
Residents present at survey: 75
Licensed bed capacity: 80
Fines assessed: 3500
Days late for reassessment: 29
Days between assessments: 96
Days between assessments: 146
Days between assessments: 275
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jessie Chenze | Supervisor, State Evaluation Team | Signed follow-up survey letter and correspondence |
| John Boettcher | Public Health Sanitarian 3 | Conducted food and beverage establishment inspection |
| Tony Zamora | Kitchen Manager | Food and beverage establishment inspection |
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