Inspection Report
Census: 91
Deficiencies: 4
Oct 18, 2024
Visit Reason
The Minnesota Department of Health conducted a change of ownership survey to evaluate and assess compliance with state licensing statutes.
Findings
The licensee was found in substantial compliance but had several deficiencies including failure to implement all services required by service plans, inadequate training and competency verification for unlicensed personnel administering medications, incomplete medication administration documentation, and failure to ensure resident privacy during care.
Severity Breakdown
Level 2: 4
Deficiencies (4)
| Description | Severity |
|---|---|
| Failed to implement and provide all services required by the current service plan for one resident (R11). | Level 2 |
| Failed to ensure registered nurse instructed unlicensed personnel in proper medication administration methods and verified competency for topical medication administration. | Level 2 |
| Failed to ensure medication administration documentation included signature and title of person administering medications for three residents (R1, R13, R12). | Level 2 |
| Failed to ensure resident privacy during confidential treatment and personal hygiene activities. | Level 2 |
Report Facts
Residents present: 91
Residents receiving dementia care: 46
Time period for correction: 21
Time period for correction: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Casey DeVries | Supervisor, State Evaluation Team | Contact person for the survey report |
| LPN-K | Licensed Practical Nurse | Documented medication administration and interacted with unlicensed personnel |
| CNS-A | Clinical Nurse Supervisor | Provided expectations and verification regarding medication administration and privacy |
| ULP-L | Unlicensed Personnel | Administered topical medications without documented training or competency |
| ULP-O | Unlicensed Personnel | Administered topical medications without documented training or competency |
| ULP-M | Unlicensed Personnel | Administered topical medications without documented training or competency |
| ULP-J | Unlicensed Personnel | Observed providing medication and care without ensuring resident privacy |
| RN-N | Registered Nurse | Observed providing nail care in dining room without privacy |
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