Deficiencies per Year
20
15
10
5
0
Severe
High
Moderate
Low
Unclassified
Inspection Report
Follow-Up
Census: 50
Deficiencies: 18
Sep 18, 2025
Visit Reason
The Minnesota Department of Health conducted a follow-up survey to determine correction of orders found on the survey completed on June 26, 2025.
Findings
The facility had not corrected all of the state correction orders issued pursuant to the June 25, 2025 survey. Deficiencies were found in staffing plan implementation, food service compliance, grievance posting, employee records, tuberculosis prevention, resident records, fire safety and evacuation plans, contracts, emergency relocation notices, background studies, annual training, resident assessments, service plans, medication management plans, medication administration documentation, treatment documentation, and dementia care policies.
Severity Breakdown
Level 1: 1
Level 2: 14
Level 3: 1
Deficiencies (18)
| Description | Severity |
|---|---|
| Failed to implement a staffing plan to determine staffing levels and evaluate it at least twice a year. | Level 2 |
| Failed to ensure food was prepared and served according to the Minnesota Food Code. | Level 2 |
| Failed to post grievance procedure and required contact information in conspicuous places. | Level 2 |
| Failed to maintain complete employee records including annual performance reviews and job descriptions. | Level 2 |
| Failed to establish and maintain a tuberculosis prevention program including baseline TB testing and symptom screening. | Level 2 |
| Failed to maintain discharge summaries and documentation of services provided in resident records. | Level 2 |
| Failed to maintain physical environment including walls in good repair. | Level 2 |
| Failed to develop and maintain fire safety and evacuation plans with required content and training. | Level 2 |
| Failed to develop and execute assisted living written contract with required content for residents. | Level 2 |
| Failed to provide written notice with required content for emergency relocation and notify Office of Ombudsman for Long-Term Care. | Level 2 |
| Failed to ensure cleared DHS background study for employees and proper affiliation with licensee's HFID. | Level 3 |
| Failed to ensure employees received required annual training including dementia related topics. | Level 2 |
| Failed to conduct nursing reassessments within required timeframes. | Level 2 |
| Failed to include required content in resident service plans. | Level 2 |
| Failed to develop individualized medication management plans with all required content. | Level 2 |
| Failed to document medication administration or reasons for non-administration and follow-up procedures. | Level 2 |
| Failed to document treatment administration or reasons for non-administration and follow-up procedures. | Level 2 |
| Failed to provide assisted living with dementia care policies and procedures to residents and their representatives at move-in. | Level 1 |
Report Facts
Census: 50
Fine amount: 1000
Fine amount: 3000
Deficiency counts: 1
Deficiency counts: 7
Sanitizer concentration: 0
Sanitizer concentration: 272
Temperature: 47
Temperature: 49
Temperature: 47
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| CNA-D | Certified Nursing Assistant | Missing annual performance reviews, tuberculosis screening, dementia training, and medication administration documentation |
| ULP-F | Unlicensed Personnel | Missing job description, annual performance reviews, background study clearance, annual training |
| ULP-G | Unlicensed Personnel | Background study affiliated with another HFID and expired COVID-19 study |
| ULP-H | Unlicensed Personnel | Background study affiliated with another HFID and expired COVID-19 study |
| ULP-J | Unlicensed Personnel | Background study affiliated with another HFID |
| ULP-K | Unlicensed Personnel | Background study affiliated with another HFID |
| ULP-L | Unlicensed Personnel | Background study affiliated with another HFID |
| ULP-M | Unlicensed Personnel | Background study affiliated with another HFID |
| ULP-N | Unlicensed Personnel | Background study affiliated with another HFID |
| RN-O | Registered Nurse | Background study affiliated with another HFID |
| H-P | Housekeeper | Background study affiliated with another HFID |
| SD-R | Sales Director | Background study affiliated with another HFID |
| ULP-S | Unlicensed Personnel | Background study affiliated with another HFID |
| ULP-T | Unlicensed Personnel | Background study affiliated with another HFID |
| ULP-U | Unlicensed Personnel | Background study affiliated with another HFID |
| LE-V | Life Enrichment Coordinator | Background study affiliated with another HFID until survey date |
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