Bright Side Healthcare, Perry Avenue North

Summary: MDH found the licensee failed to ensure at least three nutritious meals daily, according to the recommended dietary allowances in the United Stated Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables.

MDH’s finding, as written: “Based on observation, interview and record review, the licensee failed to ensure at least three nutritious meals daily, according to the recommended dietary allowances in the United Stated Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables. This had the potential to affect all residents. [...]”

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 [...]”

Summary: MDH found the licensee failed to ensure staff had access to a registered nurse (RN) twenty-four (24) hours per day, seven (7) days per week.

MDH’s finding, as written: “Based on interview, the licensee failed to ensure staff had access to a registered nurse (RN) twenty-four (24) hours per day, seven (7) days per week. This affected all residents and staff. [...]”

Rule cited: “(14) provide staff access to an on-call registered nurse 24 hours per day, seven days per week.”

Summary: MDH found the licensee failed to ensure an individual abuse prevention plan (IAPP) was developed to include all required content and accurately reflected areas of vulnerabilities for two of two residents (R1, R3) with records reviewed.

MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure an individual abuse prevention plan (IAPP) was developed to include all required content and accurately reflected areas of vulnerabilities for two of two residents (R1, R3) with records reviewed. [...]”

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

Summary: MDH found the licensee failed to have a written emergency disaster plan with all required content as defined in Appendix Z. This had the potential to affect all residents receiving assisted living services, staff, and visitors.

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

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 [...]”

Summary: MDH found the licensee failed to ensure that the appropriate records for four of four residents (R1, R2, R3, R4), and unlicensed personnel (ULP)- D were readily available for timely access to employees, vendors, and the commissioner authorized to access the records.

MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure that the appropriate records for four of four residents (R1, R2, R3, R4), and unlicensed personnel (ULP)- D were readily available for timely access to employees, vendors, and the commissioner authorized to access the records. [...]”

Rule cited: “The facility must ensure that the appropriate records are readily available to employees and contractors authorized to access the records. Resident records must be maintained in a manner that allows for timely access, printing, or transmission of the records. [...]”

Summary: MDH found the licensee failed to maintain facility fire extinguishers.

MDH’s finding, as written: “Based on observation and interview, the licensee failed to maintain facility fire extinguishers. This had the potential to affect all current residents, staff and visitors. [...]”

Rule cited: “(2) install and maintain portable fire extinguishers in accordance with the State Fire Code; (3) install portable fire extinguishers having a minimum 2-A:10-B:C rating within Group R-3 occupancies, as defined by the State Fire Code, located so that the travel [...]”

Summary: MDH found the licensee failed to provide the physical environment in a continuous state of good repair and operation with regard to the health, safety, and well-being of the residents.

MDH’s finding, as written: “Based on observation and interview, the licensee failed to provide the physical environment in a continuous state of good repair and operation with regard to the health, safety, and well-being of the residents. This had the potential to directly affect all residents and staff. [...]”

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 [...]”

Summary: MDH found the licensee failed to develop a fire safety and evacuation plan with required elements, failed to provide required employee and resident training on fire safety and evacuation, and failed to conduct required evacuation drills.

MDH’s finding, as written: “Based on interview and record review, the licensee failed to develop a fire safety and evacuation plan with required elements, failed to provide required employee and resident training on fire safety and evacuation, and failed to conduct required evacuation drills. This had the potential to affect all staff, residents, and visitors. [...]”

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

Summary: MDH found the licensee failed to ensure the assisted living

MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure the assisted living contract did not include language waiving the licensee's liability for the health, safety, or personal property of a resident. This had the potential to affect all residents. [...]”

Rule cited: “The contract must not include a waiver of facility liability for the health and safety or personal property of a resident. [...]”

Summary: MDH found the licensee failed to ensure one of two employees (unlicensed personnel (ULP)-D) received orientation to assisted living facility licensing to include all the required topics with records reviewed.

MDH’s finding, as written: “Based on observation, interview and record review, the licensee failed to ensure one of two employees (unlicensed personnel (ULP)-D) received orientation to assisted living facility licensing to include all the required topics with records reviewed. [...]”

Rule cited: “(a) The orientation must contain the following topics: (1) an overview of this chapter; (2) an introduction and review of the facility's policies and procedures related to the provision of assisted living services by the individual staff person; (3) handling [...]”

Summary: MDH found the licensee failed to ensure a registered nurse (RN) completed a physical and cognitive assessment of a prospective resident on or before move-in for one of one residents (R1) with records reviewed.

MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure a registered nurse (RN) completed a physical and cognitive assessment of a prospective resident on or before move-in for one of one residents (R1) with records reviewed. [...]”

Rule cited: “(a) Residents who are not receiving any services shall not be required to undergo an initial nursing assessment. [...]”

Summary: MDH found the licensee failed to ensure the registered nurse (RN) completed comprehensive re-assessments timely for two of two residents (R1, R3).

MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure the registered nurse (RN) completed comprehensive re-assessments timely for two of two residents (R1, R3). In addition, the licensee failed to ensure the uniform assessment tool included all required content for one of one residents re-assessed (R1). [...]”

Rule cited: “(c) Resident reassessment and monitoring must be conducted no more than 14 calendar days after initiation of services. [...]”

Summary: MDH found the licensee failed to ensure a service plan was completed within 14 days including a signature or other authentication by the resident/guardian to document agreement on the services provided for one of two residents (R1) with records reviewed.

MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure a service plan was completed within 14 days including a signature or other authentication by the resident/guardian to document agreement on the services provided for one of two residents (R1) with records reviewed. [...]”

Rule cited: “(a) No later than 14 calendar days after the date that services are first provided, an assisted living facility shall finalize a current written service plan. [...]”

Summary: MDH found the licensee failed to ensure the registered nurse (RN) prepared in writing specific instructions for each resident and documented those instructions for two of two residents (R1, R3) when the RN did not provide staff with a medication administration record (MAR).

MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure the registered nurse (RN) prepared in writing specific instructions for each resident and documented those instructions for two of two residents (R1, R3) when the RN did not provide staff with a medication administration record (MAR). [...]”

Rule cited: “When administration of medications is delegated to unlicensed personnel, the assisted living facility must ensure that the registered nurse has: (1) instructed the unlicensed personnel in the proper methods to administer the medications, and the unlicensed [...]”

Summary: MDH found the licensee failed to provide unlicensed personnel (ULP) the medication administration records (MAR) and maintain documentation of medication administered for two of two residents (R1, R3) reviewed.

MDH’s finding, as written: “Based on interview and record review, the licensee failed to provide unlicensed personnel (ULP) the medication administration records (MAR) and maintain documentation of medication administered for two of two residents (R1, R3) reviewed. [...]”

Rule cited: “Each medication administered by the assisted living facility staff must be documented in the resident's record. The documentation must include the signature and title of the person who administered the medication. [...]”

Summary: MDH found the licensee failed to ensure a current written or electronically recorded prescription was obtained for all medications the provider managed to two of two residents (R1, R3) with records reviewed.

MDH’s finding, as written: “Based on observation, interview and record review, the licensee failed to ensure a current written or electronically recorded prescription was obtained for all medications the provider managed to two of two residents (R1, R3) with records reviewed. [...]”

Rule cited: “There must be a current written or electronically recorded prescription as defined in section 151.01, subdivision 16a, for all prescribed medications that the assisted living facility is managing for the resident.”

Summary: MDH found the licensee limited the rights of two of two residents (R1, R3) reviewed when the licensee required the resident or their representative to sign a Behavior Contract as a condition of admission.

MDH’s finding, as written: “Based on observation, interview and record review, the licensee limited the rights of two of two residents (R1, R3) reviewed when the licensee required the resident or their representative to sign a Behavior Contract as a condition of admission. [...]”

Rule cited: “The rights established under this section for the benefit of residents do not limit any other rights available under law. [...]”

Summary: MDH found the licensee failed to respect the resident's right to receive visits at any time.

MDH’s finding, as written: “Based on interview, the licensee failed to respect the resident's right to receive visits at any time. This had the potential to affect all four residents at the facility. [...]”

Rule cited: “(a) Residents have the right to meet with or receive visits at any time by the resident's family, guardian, conservator, health care agent, attorney, advocate, or religious or social work counselor, or any person of the resident's choosing. [...]”

Summary: MDH found the licensee failed to ensure residents personal health and medical information was kept private.

MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure residents personal health and medical information was kept private. This has the potential to affect all four residents residing at the facility. [...]”

Rule cited: “(a) Residents have the right to have personal, financial, health, and medical information kept private, to approve or refuse release of information to any outside party, and to be advised of the assisted living facility's policies and procedures regarding [...]”

Summary: MDH found the licensee failed to ensure the required notice to visitors was posted at the main entry way of the establishment to display statutory language to disclose electronic monitoring activity, potentially affecting all four current residents, staff, and visitors.

MDH’s finding, as written: “Based on observation and interview, the licensee failed to ensure the required notice to visitors was posted at the main entry way of the establishment to display statutory language to disclose electronic monitoring activity, potentially affecting all four current residents, staff, and visitors. [...]”

Rule cited: “Subd. 8.Notice to visitors. (a) A facility must post a sign at each facility entrance accessible to visitors that states: "Electronic monitoring devices, including security cameras and audio devices, may be present to record persons and activities." (b) The [...]”