Inspection Report
Follow-Up
Census: 130
Deficiencies: 9
Jan 14, 2025
Visit Reason
Follow-up survey conducted to determine if orders from the October 24, 2024 survey were corrected.
Findings
The follow-up survey verified that the facility is in substantial compliance with previous correction orders. The original survey identified multiple deficiencies including food safety violations, infection control issues, staff record deficiencies, emergency preparedness gaps, physical environment concerns, background study noncompliance, resident assessment delays, medication administration errors, and inappropriate use of consumer bed rails.
Severity Breakdown
Level 2: 7
Level 3: 2
Deficiencies (9)
| Description | Severity |
|---|---|
| Food was not prepared and served according to the Minnesota Food Code, including cross-contamination and cold holding violations. | Level 2 |
| Failed to establish and maintain an effective infection control program related to medication administration for one unlicensed personnel. | Level 2 |
| Employee records lacked required content including current professional licensure and job description for one registered nurse. | Level 2 |
| Failed to maintain a written emergency preparedness plan with required annual and quarterly reviews. | Level 2 |
| Failed to maintain physical environment in good repair; broken cabinet lock with chemicals accessible and residents wandering in kitchen. | Level 2 |
| Background studies were not submitted or received for three employees, resulting in an immediate correction order. | Level 3 |
| Registered nurse failed to conduct ongoing resident assessments and reassessments within required 90-day intervals for three residents. | Level 2 |
| Medication was not administered as prescribed for one resident; medication order confusion led to incorrect dosage administration. | Level 2 |
| Failed to provide care and services according to accepted health care standards for two residents with consumer bed rails; lacked assessments and documentation related to bed rail use and safety. | Level 3 |
Report Facts
Residents present: 130
Fines assessed: 6000
Medication dosage: 2.5
Temperature: 80
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Casey DeVries | Supervisor, State Evaluation Team | Signed follow-up survey letter |
| Matthew Jacobsen | Director of Culinary | Signed Food and Beverage Establishment Inspection Report |
| Sarah Conboy | Public Health Sanitation Supervisor | Signed Food and Beverage Establishment Inspection Report |
| ULP-A | Unlicensed Personnel | Named in medication administration error and infection control deficiency |
| RN-H | Registered Nurse | Named in staff record deficiency and physical environment observation |
| CNS-C | Clinical Nurse Supervisor | Named in medication administration and bed rail assessment deficiencies |
| LALD-D | Licensed Assisted Living Director | Named in staff record and background study deficiencies |
| ULP-I | Unlicensed Personnel | Named in bed rail use deficiency |
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