Blaine Wp II

Last evaluation

March 2, 2022

Evaluations on record

1

Investigations substantiated

4 kept 7 years

Inconclusive

0 kept 4 years

Unsubstantiated

4 kept 3 years

Most recent evaluation (March 2, 2022, state report PZSH11)

MDH: “On May 9, 2022, the Minnesota Department of Health conducted a revisit at the above provider to follow-up on orders issued pursuant to a survey completed on March 2, 2022.”

Survey completed May 9, 2022: 6 correction orders

• Tag 480: 144G.41 Subd 1 (13) (i) (B) Minimum requirements (re-issued) scope/level letter F
  Details

  MDH’s finding, as written: “No further action needed”

  Rule cited: “(13) offer to provide or make available at least the following services to residents: (i) at least three nutritious meals daily with snacks available seven days per week, according to the recommended dietary allowances in the United States Department of [...]”

• Tag 680: 144G.42 Subd. 10 Disaster planning and emergency preparedness (re-issued) Level 2, widespread scope, scope/level letter F
  Details

  MDH’s finding, as written: “Based on interview and record review the licensee failed to have a written emergency disaster preparedness plan with all the required content. This had the potential to affect all 38 residents receiving services under the assisted living license. [...]”

  Rule cited: “(a) The facility must meet the following requirements: (1) have a written emergency disaster plan that contains a plan for evacuation, addresses elements of sheltering in place, identifies temporary relocation sites, and details staff assignments in the event [...]”

• Tag 800: 144G.45 Subd. 2 (a) (4) Fire protection and physical environment (re-issued) scope/level letter E
  Details

  MDH’s finding, as written: “No further action needed”

  Rule cited: “(4) keep the physical environment, including walls, floors, ceiling, all furnishings, grounds, systems, and equipment in a continuous state of good repair and operation with regard to the health, safety, comfort, and well-being of the residents in accordance [...]”

• Tag 810: 144G.45 Subd. 2 (b)-(f) Fire protection and physical environment (re-issued) scope/level letter F
  Details

  MDH’s finding, as written: “No further action needed”

  Rule cited: “(b) Each assisted living facility shall develop and maintain fire safety and evacuation plans. [...]”

• Tag 1890: 144G.71 Subd. 20 Prescription drugs (re-issued) Level 2, isolated scope, scope/level letter D
  Details

  Summary: MDH found the licensee failed to discard expired medication and failed to keep the original prescription label with legible information for one of three residents (R2) with medication storage reviewed.

  MDH’s finding, as written: “Based on observation, interview and record review, the licensee failed to discard expired medication and failed to keep the original prescription label with legible information for one of three residents (R2) with medication storage reviewed. [...]”

  Rule cited: “A prescription drug, prior to being set up for immediate or later administration, must be kept in the original container in which it was dispensed by the pharmacy bearing the original prescription label with legible information including the expiration or [...]”

• Tag 2040: 144G.81 Subdivision 1 Fire protection and physical environment (re-issued) scope/level letter F
  Details

  MDH’s finding, as written: “No further action needed”

  Rule cited: “An assisted living facility with dementia care that has a secured dementia care unit must meet the requirements of section 144G.45 and the following additional requirements: (1) a hazard vulnerability assessment or safety risk must be performed on and around [...]”

Survey completed March 2, 2022: 23 correction orders

• Tag 110: 144G.10 Subdivision 1a Assisted living director license required Level 2, widespread scope, scope/level letter F · correction period: Two (2) days
  Details

  Summary: MDH found the licensee failed to ensure the licensed assisted living director (LALD) was listed as the Director of Record for the licensee.

  MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure the licensed assisted living director (LALD) was listed as the Director of Record for the licensee. This had the potential to affect all the licensee's residents, staff, and visitors. [...]”

  Rule cited: “Each assisted living facility must employ an assisted living director licensed or permitted by the Board of Executives for Long Term Services and Supports.”

• Tag 250: 144G.20 Subdivision 1. Conditions Level 2, widespread scope, scope/level letter F · correction period: Twenty-One (21) days
  Details

  Summary: MDH found the licensee failed to ensure the management officials who were in charge of the day-to-day operations, and responsible for the resident's assisted living services, understood all of the assisted living facility with dementia care regulations.

  MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure the management officials who were in charge of the day-to-day operations, and responsible for the resident's assisted living services, understood all of the assisted living facility with dementia care regulations. This has the potential to affect all residents, staff and visitors. [...]”

  Rule cited: “(a) The commissioner may refuse to grant a provisional license, refuse to grant a license as a result of a change in ownership, refuse to renew a license, suspend or revoke a license, or impose a conditional license if the owner, controlling individual, or [...]”

• Tag 430: 144G.40 Subd. 2 Uniform checklist disclosure of services Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
  Details

  Summary: MDH found the licensee failed to provide a copy of the uniform checklist disclosure of services with the required content for two of three residents (R1, R2) with records reviewed.

  MDH’s finding, as written: “Based on interview and record review, the licensee failed to provide a copy of the uniform checklist disclosure of services with the required content for two of three residents (R1, R2) with records reviewed. [...]”

  Rule cited: “(a) All assisted living facilities must provide to prospective residents: (1) a disclosure of the categories of assisted living licenses available and the category of license held by the facility; (2) a written checklist listing all services permitted under [...]”

• Tag 480: 144G.41 Subd 1 (13) (i) (B) Minimum requirements Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
  Details

  Summary: MDH found the licensee failed to ensure food was prepared according to the Minnesota Food Code.

  MDH’s finding, as written: “Based on observation, interview and record review, the licensee failed to ensure food was prepared according to the Minnesota Food Code. This had the potential to affect all 38 current residents of the facility. [...]”

  Rule cited: “(13) offer to provide or make available at least the following services to residents: (i) at least three nutritious meals daily with snacks available seven days per week, according to the recommended dietary allowances in the United States Department of [...]”

• Tag 485: 144G.41 Subd 1. (13) (i) (A) and (C) Minimum Requirements Level 1, widespread scope, scope/level letter C · correction period: Twenty-one (21) days
  Details

  Summary: MDH found the licensee failed to have a menu prepared at least one week in advance and made available to all residents.

  MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to have a menu prepared at least one week in advance and made available to all residents. This had the potential to affect all the 38 residents of the facility. [...]”

  Rule cited: “(13) offer to provide or make available at least the following services to residents: (i) at least three nutritious meals daily with snacks available seven days per week, according to the recommended dietary allowances in the United States Department of [...]”

Fines assessed by MDH

• Tag 2310 (144g.91 Subd. 4 - Appropriate Care And Services): $3,000.00

Total fines assessed, as printed in the letter: $500.00.

Total fines assessed, as printed in the letter: $3,000.00.

Substantiated investigations (state reports)

• December 12, 2023 · report HL316757166M · MDH finding: Substantiated, individual responsibility
  Details

  Allegation, as written: “The alleged perpetrator (AP) financially exploited resident #1 and resident #2 when the AP diverted their narcotic medications.”

  “The Minnesota Department of Health determined financial exploitation was substantiated.”

  “The AP was responsible for the maltreatment.”

  Summary: MDH looked into an allegation and found: financial exploitation substantiated (individual responsibility).

  MDH’s conclusion, as written: “The Minnesota Department of Health determined financial exploitation was substantiated. The AP was responsible for the maltreatment. The investigation identified a consistent discrepancy of the AP signing out oxycodone in resident #1 and resident #2's handwritten narcotic book and each resident's electronic medical record (EMAR). Additionally, multiple unlicensed caregivers, the AP's co-workers, identified handwritten entries of their names they identified as forgeries for both resident #1 and #2. A review of the documents identified a pattern indicating the AP had access to resident #1 and resident #2's narcotic book at times consistent with when forgeries occurred. An equal opportunity employer.”

  Action taken by facility: “Completed internal investigation and terminated employment for AP. The facility established an audit system to ensure the documentation of the EMAR and the narcotic books were reconciled. The facility reviewed the residents with narcotic and/or other controlled substances and reduced the number of such medications in use in the facility. [...]”

  Action taken by MDH: “The facility was issued a correction order regarding the vulnerable adult's right to be free from maltreatment.”

  Survey completed September 5, 2023: 1 correction order

  • Tag 2360: 144G.91 Subd. 8 Freedom from maltreatment
    Details

    Summary: MDH found the facility failed to ensure two of two resident(s) reviewed (R1 and R2) was free from maltreatment.

    MDH’s finding, as written: “The facility failed to ensure two of two resident(s) reviewed (R1 and R2) was free from maltreatment. Findings include: The Minnesota Department of Health (MDH) issued a determination maltreatment occurred, and an individual person was responsible for the maltreatment, in connection with incidents which occurred at the facility. Please refer to the public maltreatment report for details.”

    Rule cited: “Residents have the right to be free from physical, sexual, and emotional abuse; neglect; financial exploitation; and all forms of maltreatment covered under the Vulnerable Adults Act.”

• June 5, 2023 · report HL316752509M · MDH finding: Substantiated, facility responsibility
  Details

  Allegation, as written: “The facility neglected the resident when multiple resident-to-resident altercations occurred and the facility failed to monitor, assess, and implement interventions to protect the health and safety of the residents.”

  “The Minnesota Department of Health determined neglect was substantiated.”

  “The facility was responsible for the maltreatment.”

  Summary: MDH looked into an allegation and found: neglect substantiated (facility responsibility).

  MDH’s conclusion, as written: “The Minnesota Department of Health determined neglect was substantiated. The facility was responsible for the maltreatment. The facility failed to provide supervision to protect the resident's health and safety following multiple resident-to-resident altercations. The facility was aware several residents exhibited aggressive behavior and failed to identify and implement interventions to mitigate future incidents.”

  Action taken by facility: “Procedures for addressing resident-to-resident altercations were updated.”

  Action taken by MDH: “The responsible party will be notified of their right to appeal the maltreatment finding. The facility was found to be in noncompliance.”

  Survey completed March 15, 2023: 2 correction orders

  • Tag 630: 144G.42 Subd. 6 (b) Compliance with requirements for reporting ma Level 3, widespread scope, scope/level letter I · correction period: Seven (7) days
    Details

    Summary: MDH found the facility failed to update the individual abuse prevention plan (IAPP) with noted incidents for two of two residents (R1 and R2) with records reviewed.

    MDH’s finding, as written: “Based on interview and record review, the facility failed to update the individual abuse prevention plan (IAPP) with noted incidents for two of two residents (R1 and R2) with records reviewed. Both residents were involved in multiple instances of resident-to-resident aggression and the facility failed to update R1 and R2's IAPPs to reflect the incidents, R1 and R2's vulnerabilities when interacting with other residents, and specific measures to minimize risk to R1, R2, and the other residents. [...]”

    Rule cited: “(b) The facility must develop and implement an individual abuse prevention plan for each vulnerable adult. [...]”

  • Tag 2360: 144G.91 Subd. 8 Freedom from maltreatment
    Details

    Summary: MDH found the facility failed to ensure two of two residents reviewed (R1 and R2) were free from maltreatment.

    MDH’s finding, as written: “The facility failed to ensure two of two residents reviewed (R1 and R2) were free from maltreatment. The findings include: The Minnesota Department of Health (MDH) issued a determination maltreatment occurred, and the facility was responsible for the maltreatment, in connection with incidents which occurred at the facility. Please refer to the public maltreatment report for details.”

    Rule cited: “Residents have the right to be free from physical, sexual, and emotional abuse; neglect; financial exploitation; and all forms of maltreatment covered under the Vulnerable Adults Act.”

• June 5, 2023 · report HL316755765M · MDH finding: Substantiated, facility responsibility
  Details

  Allegation, as written: “The facility neglected the resident when multiple resident-to-resident altercations occurred and the facility failed to monitor, assess, and implement interventions to protect the health and safety of the residents.”

  “The Minnesota Department of Health determined neglect was substantiated.”

  “The facility was responsible for the maltreatment.”

  Summary: MDH looked into an allegation and found: neglect substantiated (facility responsibility).

  MDH’s conclusion, as written: “The Minnesota Department of Health determined neglect was substantiated. The facility was responsible for the maltreatment. The facility failed to provide supervision to protect the resident's health and safety following multiple resident-to-resident altercations. The facility was aware several residents exhibited aggressive behavior and failed to identify and implement interventions to mitigate future incidents.”

  Action taken by facility: “Procedures for addressing resident-to-resident altercations were updated.”

  Action taken by MDH: “The responsible party will be notified of their right to appeal the maltreatment finding. The facility was found to be in noncompliance.”

  Survey completed March 15, 2023: 2 correction orders

  • Tag 630: 144G.42 Subd. 6 (b) Compliance with requirements for reporting ma Level 3, widespread scope, scope/level letter I · correction period: Seven (7) days
    Details

    Summary: MDH found the facility failed to update the individual abuse prevention plan (IAPP) with noted incidents for two of two residents (R1 and R2) with records reviewed.

    MDH’s finding, as written: “Based on interview and record review, the facility failed to update the individual abuse prevention plan (IAPP) with noted incidents for two of two residents (R1 and R2) with records reviewed. Both residents were involved in multiple instances of resident-to-resident aggression and the facility failed to update R1 and R2's IAPPs to reflect the incidents, R1 and R2's vulnerabilities when interacting with other residents, and specific measures to minimize risk to R1, R2, and the other residents. [...]”

    Rule cited: “(b) The facility must develop and implement an individual abuse prevention plan for each vulnerable adult. [...]”

  • Tag 2360: 144G.91 Subd. 8 Freedom from maltreatment
    Details

    Summary: MDH found the facility failed to ensure two of two residents reviewed (R1 and R2) were free from maltreatment.

    MDH’s finding, as written: “The facility failed to ensure two of two residents reviewed (R1 and R2) were free from maltreatment. The findings include: The Minnesota Department of Health (MDH) issued a determination maltreatment occurred, and the facility was responsible for the maltreatment, in connection with incidents which occurred at the facility. Please refer to the public maltreatment report for details.”

    Rule cited: “Residents have the right to be free from physical, sexual, and emotional abuse; neglect; financial exploitation; and all forms of maltreatment covered under the Vulnerable Adults Act.”

• May 23, 2023 · report HL316755564M · MDH finding: Substantiated, individual responsibility
  Details

  Allegation, as written: “The alleged perpetrator (AP) abused a resident when the AP slapped the resident's left foot and pushed the resident's legs into the resident's chest while being assisted to bed.”

  “The Minnesota Department of Health determined abuse was substantiated.”

  “The AP was responsible for the maltreatment.”

  Summary: MDH looked into an allegation and found: abuse substantiated (individual responsibility).

  MDH’s conclusion, as written: “The Minnesota Department of Health determined abuse was substantiated. The AP was responsible for the maltreatment. Recorded video of the resident's bed showed the AP assisting the resident into bed. With the resident lying flat on his back, the AP walked to the end of the bed and slapped the top of the resident's left foot and toes. Next, the AP picked up the resident's legs by his ankles, and with bent knees, pushed both legs into the resident's chest. The AP held the resident's bent legs with one hand, while he picked up the blankets and tossed the blankets over the resident.”

  Action taken by facility: “The facility educated all staff regarding vulnerable adult abuse and reporting. The AP is no longer employed by the facility.”

  Action taken by MDH: “The facility was issued a correction order regarding the vulnerable adult's right to be free from maltreatment.”

  Survey completed April 26, 2023: 1 correction order

  • Tag 2360: 144G.91 Subd. 8 Freedom from maltreatment
    Details

    Summary: MDH found the facility failed to ensure one of one residents reviewed (R1) was free from maltreatment.

    MDH’s finding, as written: “The facility failed to ensure one of one residents reviewed (R1) was free from maltreatment. Findings include: The Minnesota Department of Health (MDH) issued a determination maltreatment occurred, and the AP was responsible for the maltreatment, in connection with incidents which occurred at the facility. Please refer to the public maltreatment report for details.”

    Rule cited: “Residents have the right to be free from physical, sexual, and emotional abuse; neglect; financial exploitation; and all forms of maltreatment covered under the Vulnerable Adults Act.”

Summaries are ours and are marked “Summary”; quoted text is MDH’s own, shortened where marked [...]. Read the full reports at the links above or search every report on MDH’s site.

MDH keeps investigation results for seven years when allegations are substantiated, four years when inconclusive, and three years when unsubstantiated, so the counts cover different periods. This community is licensed for 42 residents; larger communities are evaluated and reported on more often, so read counts with size in mind. Source: Minnesota Department of Health, Health Regulation Division, data as of September 28, 2026. Always visit in person and ask the community about anything listed here.