Deficiencies (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: 51
Deficiencies: 26
Date: Sep 8, 2023
Visit Reason
Follow-up survey to determine correction of orders found on the survey completed on June 30, 2023.
Findings
The facility was found not to have corrected all state correction orders issued on June 30, 2023, including infection control program deficiencies, resident record issues, service plan implementation, and medication storage. Additional violations were also identified during the follow-up survey.
Deficiencies (26)
Failed to establish and maintain an infection control program during medication and treatment administration by unlicensed personnel.
Failed to ensure employee tuberculosis symptom and history screenings and a two-step tuberculin skin test were completed and documented for one employee.
Failed to protect resident records against unauthorized disclosure; staff left laptop screens with resident information visible.
Failed to ensure food was prepared and served according to the Minnesota Food Code.
Failed to ensure medication administration was performed according to accepted standards; staff failed to wash hands between residents and tasks.
Failed to ensure tuberculosis prevention program was established and maintained according to CDC guidelines; lacked current TB screening for employees.
Failed to post emergency numbers for 911 and Minnesota Adult Abuse Reporting Center in common areas and near telephones.
Failed to post emergency disaster plan prominently and failed to conduct required evacuation drills.
Space heater found in dementia care resident's sleeping room, constituting a distinct hazard to life.
Failed to ensure background studies were completed and cleared prior to staff providing services for multiple employees.
Failed to ensure orientation and training for agency and unlicensed staff prior to providing services.
Failed to ensure training and competency evaluations for unlicensed personnel were conducted by a registered nurse.
Failed to ensure orientation included all required topics for unlicensed personnel.
Failed to ensure staff were oriented specifically to each individual resident and the services to be provided.
Failed to ensure service plans included signatures documenting agreement by resident and facility for multiple residents.
Failed to ensure medication setup documentation included dates, medication name, dosage, times, route, and person completing setup.
Failed to ensure time sensitive medications were dated when opened for multiple residents.
Failed to ensure medication cart was securely locked and accessible only to authorized personnel.
Failed to ensure disposition of medications was documented in resident record upon discharge.
Failed to ensure training and competency evaluations for medication administration were completed by a registered nurse for unlicensed personnel.
Failed to ensure documentation of medication administration included signature, medication name, dosage, date, time, route, and reason for missed doses.
Failed to ensure training and competency evaluations for blood glucose testing were completed by a registered nurse for unlicensed personnel.
Failed to ensure service plan included required content such as service description, fees, staff providing services, monitoring schedules, and contingency plans for two residents.
Failed to conduct activity evaluation addressing all required elements and develop individualized activity plan for one resident.
Failed to provide care and assisted living services according to accepted health care and medical or nursing standards for two residents with siderails; lacked siderail assessments.
Failed to provide residents and their legal and designated representatives required dementia care policies at move-in.
Report Facts
Residents present at time of survey: 51
Fine amount: 500
Fine amount: 9000
Medication setup documentation missing: 1
Residents with siderails: 13
Temperature: 40
Temperature: 39
Temperature: 39
Temperature: -10
Temperature: -10
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jodi Johnson | Supervisor, State Evaluation Team | Contact for questions about orders and fines |
| Beau Bergmann | Certified Food Protection Manager | Signed food establishment inspection report |
| Rob Davis | Sanitarian 2 | Signed food establishment inspection report |
| RN-B | Registered Nurse | Named in multiple findings related to infection control, training, supervision, medication administration, and care planning |
| ULP-H | Unlicensed Personnel | Named in infection control, medication administration, training, and supervision findings |
| ULP-J | Unlicensed Personnel | Named in training, supervision, medication administration, and dementia care findings |
| ULP-D | Unlicensed Personnel | Named in training, supervision, orientation, and dementia care findings |
| ULP-I | Unlicensed Personnel | Named in tuberculosis screening and training findings |
| LPN-K | Licensed Practical Nurse | Named in background study findings |
| ULP-P | Unlicensed Personnel (Agency Staff) | Named in orientation findings |
| RN-C | Registered Nurse | Named in emergency preparedness findings |
| DES-G | Director of Environmental Services | Named in fire safety and hazard assessment findings |
| M-F | Maintenance | Named in fire safety and hazard assessment findings |
| HRM-L | Human Resources Manager | Named in background study and training findings |
| DSM-N | Director of Sales and Marketing | Named in contract and designated representative findings |
| LED-O | Life Enrichment Director | Named in activity plan findings |
| LALD-A | Licensed Assisted Living Director | Named in siderail assessment findings |
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