Assisted Living and Memory Care
Farmstead Care of Moorhead
3200 28th Street South, Moorhead, MN 56560 · Map
Licensed for 137 residents · FARMSTEAD CARE OF MOORHEAD LP
Farmstead Care of Moorhead is a state-licensed assisted living, memory care community in Moorhead, Minnesota. It is licensed for 137 residents. Lilisity publishes no score or ranking for this community; the details below come from the state licensing record.
Prices
This community does not publish its prices.
Area costs
Care and services
From the community’s website
What Farmstead Care of Moorhead says about itself, quoted from its own site. We have not checked these claims against licensing records. Ask about each one on a tour.
- 3 meals a day.
Three nutritious meals per day, with set up
(page, checked Oct 15, 2026)
Lilisity’s independent report
What the public record shows
Gathered by Lilisity from state and federal sources. Communities can’t edit this part of the page.
License
Active, 137 residents
Assisted Living Facility Dementia Care 422417, current license dated Sep 1, 2025. Licensee FARMSTEAD CARE OF MOORHEAD LP.
Nearest emergency room
3.0 miles
Sanford Medical Center Fargo, rated 4 of 5 stars by CMS.
Side by side with nearby communities
The 4 nearest communities that offer assisted living, by straight-line distance. Prices are starting prices each community publishes; we never show estimates.
| Community | Distance | Licensed capacity | Published starting price | License | Inspection citations |
|---|---|---|---|---|---|
| Farmstead Care of Moorhead this community | 137 | Not published | Active | 4 substantiated | |
| Moorhead Manor | 1.6 mi | 30 | Not published | Active | 0 substantiated |
| Beehive Homes of Moorhead | 1.8 mi | 16 | Not published | Active | 0 substantiated |
| Arbor Park Living Center | 1.9 mi | 57 | Not published | Active | 0 substantiated |
| Serenity Assisted Living, 1125 Oakview Drive | 2.1 mi | 27 | Not published | Active | 0 substantiated |
State inspection record4 substantiated
- Last evaluation
- January 29, 2026
- Evaluations on record
- 2
- Investigations substantiated
- 4 kept 7 years
- Inconclusive
- 1 kept 4 years
- Unsubstantiated
- 1 kept 3 years
Most recent evaluation (January 29, 2026, state report P15M11)
MDH: “On January 26, 2026, through January 29, 2026, the Minnesota Department of Health conducted a full survey at the above provider and the following correction orders are issued.”
Survey completed January 29, 2026: 17 correction orders
- Tag 470: 144G.41 Subdivision 1 Minimum requirements Level 2, widespread scope, scope/level letter F
Details
Summary: MDH found the licensee failed to ensure the clinical nurse supervisor (CNS) developed and implemented a staffing plan to determine staffing levels to meet the needs of all residents, which included reviewing the staffing plan at least twice per year.
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure the clinical nurse supervisor (CNS) developed and implemented a staffing plan to determine staffing levels to meet the needs of all residents, which included reviewing the staffing plan at least twice per year. In addition, the licensee failed to ensure the daily staffing schedule was posted in a central location as required. This had the potential to affect all residents, staff, and visitors. [...]”
Rule cited: “(11) develop and implement a staffing plan for determining its staffing level that: (i) includes an evaluation, to be conducted at least twice a year, of the appropriateness of staffing levels in the facility; (ii) ensures sufficient staffing at all times to [...]”
- Tag 480: 144G.41 Subdivision 1 Subd. 1a (a-b) Minimum requirements; required food services Level 2, widespread scope, scope/level letter F · correction period: Please refer to the FBEIR for any compliance dates
Details
Summary: MDH found the licensee failed to ensure food was prepared and served 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 and served according to the Minnesota Food Code. This practice resulted in a level two violation (a violation that did not harm a resident's health or safety but had the potential to have harmed a resident's health or safety, but was not likely to cause serious injury, impairment, or death), and is issued at a widespread scope (when problems are pervasive or represent a systemic failure that has [...]”
Rule cited: “(a) Except as provided in paragraph (b), food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626. [...]”
- Tag 485: 144G.41 Subdivision 1.a (a) Minimum requirements; required food services Level 1, widespread scope, scope/level letter C · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to ensure the assisted living contract did not require any resident to include and pay for meals as a part of their assisted living contract.
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure the assisted living contract did not require any resident to include and pay for meals as a part of their assisted living contract. This had the potential to affect all residents. [...]”
Rule cited: “(a) All assisted living facilities must offer to provide or make available 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 Agriculture (USDA) [...]”
- Tag 640: 144G.42 Subd. 7 Posting information for reporting suspected c Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to post required content in common areas to include posting the 911 emergency number and the reporting number
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to post required content in common areas to include posting the 911 emergency number and the reporting number for the Minnesota Adult Abuse Reporting Center (MAARC) to report suspected maltreatment of a vulnerable adult under section 626.557 at the assisted living. This had the potential to affect all residents, staff, and visitors. [...]”
Rule cited: “The facility shall support protection and safety through access to the state's systems for reporting suspected criminal activity and suspected vulnerable adult maltreatment by: (1) posting the 911 emergency number in common areas and near telephones provided [...]”
- Tag 650: 144G.42 Subd. 8 (a) Staff records Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to ensure employee records contained the required content for two of
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure employee records contained the required content for two of two employees (unlicensed personnel (ULP)-I, ULP-J). [...]”
Rule cited: “(a) The facility must maintain current records of each paid staff member, each regularly scheduled volunteer providing services, and each individual contractor providing services. [...]”
Show all 17
- Tag 775: 144G.45 Subd. 2. (a) Fire protection and physical environment Level 2, widespread scope, scope/level letter F · correction period: Seven (7) days · fine: $500.00 assessed
Details
Summary: MDH found the licensee failed to ensure the physical environment of the facility was maintained in compliance with the requirements of Minnesota Statute 144G.
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure the physical environment of the facility was maintained in compliance with the requirements of Minnesota Statute 144G. [...]”
Rule cited: “Each assisted living facility must comply with the State Fire Code in Minnesota Rules, chapter 7511, and:”
- Tag 1290: 144G.60 Subdivision 1 Background studies required Level 3, widespread scope, scope/level letter I · correction period: Immediate · fine: $1,000.00 assessed
Details
Summary: MDH found the licensee failed to ensure current employee records contained all the required content to include a current background study clearance letter for two of seven employees (dining staff (DS) -F, DS-G).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure current employee records contained all the required content to include a current background study clearance letter for two of seven employees (dining staff (DS) -F, DS-G). This had the potential to affect all residents living within the facility. [...]”
Rule cited: “(a) Employees, contractors, and regularly scheduled volunteers of the facility are subject to the background study required by section 144.057 and may be disqualified under chapter 245C. [...]”
- Tag 1470: 144G.63 Subd. 2 Content of required orientation Level 2, isolated scope, scope/level letter D · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to ensure orientation to assisted living statutes included all the required content for one of three employees (registered nurse (RN)-B).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure orientation to assisted living statutes included all the required content for one of three employees (registered nurse (RN)-B). [...]”
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 [...]”
- Tag 1530: 144G.64 (a) (1-2) Training in Dementia, Mental Illness, and De- Level 2, isolated scope, scope/level letter D · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to ensure orientation to assisted living statutes included all the required content for one of two employees (registered nurse (RN)-E).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure orientation to assisted living statutes included all the required content for one of two employees (registered nurse (RN)-E). [...]”
Rule cited: “(a) All assisted living facilities must meet the following dementia care, mental illness, and de-escalation training requirements: (1) supervisors of direct-care staff must have at least eight hours of initial training on dementia topics specified under [...]”
- Tag 1730: 144G.71 Subd. 5 Individualized medication management plan Level 2, isolated scope, scope/level letter D · correction period: Seven (7) days
Details
MDH’s finding, as written: “Based on observation, interview, and record review, the registered nurse (RN) failed to develop and maintain a current individualized medication management plan for each resident to include all required content for one of four residents (R6). [...]”
Rule cited: “(a) For each resident receiving medication management services, a registered nurse, advanced practice registered nurse, or qualified staff delegated the task by a registered nurse must prepare and include in the service plan a written statement of the [...]”
- Tag 1760: 144G.71 Subd. 8 Documentation of administration of medication Level 2, isolated scope, scope/level letter D · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to ensure medication was administered per prescriber orders for one of three employees (unlicensed personnel (ULP)-I).
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure medication was administered per prescriber orders for one of three employees (unlicensed personnel (ULP)-I). [...]”
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. [...]”
- Tag 1890: 144G.71 Subd. 20 Prescription drugs Level 2, isolated scope, scope/level letter D · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to ensure medications were maintained bearing the original prescription label with legible information including the expiration date for time sensitive medications for one of four residents (R4).
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure medications were maintained bearing the original prescription label with legible information including the expiration date for time sensitive medications for one of four residents (R4). [...]”
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 1910: 144G.71 Subd. 22 Disposition of medications Level 2, isolated scope, scope/level letter D · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to document in the resident's record all required content for disposition of the medications for one of one resident (R1) upon discharge.
MDH’s finding, as written: “Based on interview and record review, the licensee failed to document in the resident's record all required content for disposition of the medications for one of one resident (R1) upon discharge. [...]”
Rule cited: “(a) Any current medications being managed by the assisted living facility must be provided to the resident when the resident's service plan ends or medication management services are no longer part of the service plan. [...]”
- Tag 1950: 144G.72 Subd. 4 Administration of treatments and therapy Level 2, isolated scope, scope/level letter D
Details
Summary: MDH found the licensee failed to ensure the registered nurse (RN) specified, in writing, specific instructions for one of four residents (R4) receiving treatment management services.
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure the registered nurse (RN) specified, in writing, specific instructions for one of four residents (R4) receiving treatment management services. [...]”
Rule cited: “Ordered or prescribed treatments or therapies must be administered by a nurse, physician, or other licensed health professional authorized to perform the treatment or therapy, or may be delegated or assigned to unlicensed personnel by the licensed health [...]”
- Tag 2110: 144G.82 Subd. 3 Policies Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to develop and implement all required policies and procedures related to dementia care.
MDH’s finding, as written: “Based on interview and record review, the licensee failed to develop and implement all required policies and procedures related to dementia care. In addition, the licensee failed to ensure the required dementia care policies and procedures were provided to each resident and/or the resident's legal and designated representatives. [...]”
Rule cited: “(a) In addition to the policies and procedures required in the licensing of all facilities, the assisted living facility with dementia care licensee must develop and implement policies and procedures that address the: (1) philosophy of how services are [...]”
- Tag 2350: 144G.91 Subd. 7 Courteous treatment Level 2, isolated scope, scope/level letter D · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to ensure residents were treated with dignity and respect in relation to privacy of health provisions of care for one of two residents (R7).
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure residents were treated with dignity and respect in relation to privacy of health provisions of care for one of two residents (R7). [...]”
Rule cited: “Residents have the right to be treated with courtesy and respect, and to have the resident's property treated with respect”
- Tag 3090: 144.6502, Subd. 8 Notice to Visitors Level 1, widespread scope, scope/level letter C · correction period: Twenty-one (21) days
Details
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
MDH’s finding, as written: “Based on observation, interview, and record review, 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 residents, staff, and visitors of the licensee. [...]”
Rule cited: “(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. [...]”
From MDH’s letter: the letter says the facility is in substantial compliance.
Food and beverage inspection (included in this report): Food and beverage inspection report included
Fines assessed by MDH
- Tag 775 (144g.45 Subd. 2. (a) - Fire Protection And Physical Environment): $500.00
- Tag 1290 (144g.60 Subdivision 1 - Background Studies Required): $1,000.00
Total fines assessed, as printed in the letter: $1,500.00.
Earlier evaluations (1)
- January 13, 2023: report SUUQ11 · 28 correction orders
Details
Survey completed January 13, 2023: 28 correction orders
- 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 show they met the requirements of licensure by attesting the managerial officials who were in charge of the day-to-day operations developed and implemented current policies and procedures as required with records reviewed.
MDH’s finding, as written: “Based on interview and record review, the licensee failed to show they met the requirements of licensure by attesting the managerial officials who were in charge of the day-to-day operations developed and implemented current policies and procedures as required with records reviewed. This had the potential to affect all residents. [...]”
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 450: 144G.41 Subdivision 1 Minimum requirements Level 1, widespread scope, scope/level letter C · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to provide the current Minnesota Assisted Living Bill of Rights (BOR) to three of three residents (R1, R2, R3).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to provide the current Minnesota Assisted Living Bill of Rights (BOR) to three of three residents (R1, R2, R3). [...]”
Rule cited: “All assisted living facilities shall: (1) distribute to residents the assisted living bill of rights; (2) provide services in a manner that complies with the Nurse Practice Act in sections 148.171 to 148.285; (3) utilize a person-centered planning and service [...]”
- Tag 470: 144G.41 Subdivision 1 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 a staffing plan was developed and a daily staff schedule was posted as required, potentially affecting all licensee's current residents, staff, and visitors.
MDH’s finding, as written: “Based on observation and interview, the licensee failed to ensure a staffing plan was developed and a daily staff schedule was posted as required, potentially affecting all licensee's current residents, staff, and visitors. [...]”
Rule cited: “(11) develop and implement a staffing plan for determining its staffing level that: (i) includes an evaluation, to be conducted at least twice a year, of the appropriateness of staffing levels in the facility; (ii) ensures sufficient staffing at all times to [...]”
- 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 and served 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 and served according to the Minnesota Food Code. This had the potential to affect all residents in the Assisted Living Dementia Care facility. [...]”
Rule cited: “(13) offer to provide or make available at least the following services to residents: (B) food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626; and”
- Tag 510: 144G.41 Subd. 3 Infection control program Level 2, widespread scope, scope/level letter F · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to establish and maintain an infection control program that complies with accepted health care, medical and
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to establish and maintain an infection control program that complies with accepted health care, medical and nursing standards for infection control. The deficient practice had the potential to affect all residents, employees, and visitors. [...]”
Rule cited: “(a) All assisted living facilities must establish and maintain an infection control program that complies with accepted health care, medical, and nursing standards for infection control. [...]”
Show all 28
- Tag 550: 144G.41 Subd. 7 Resident grievances; reporting maltreatment Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to post the required information related to the grievance procedure.
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to post the required information related to the grievance procedure. This had the potential to affect all the licensee's current residents, staff, and visitors. [...]”
Rule cited: “All facilities must post in a conspicuous place information about the facilities' grievance procedure, and the name, telephone number, and email contact information for the individuals who are responsible for handling resident grievances. [...]”
- Tag 650: 144G.42 Subd. 8 Employee records Level 1, widespread scope, scope/level letter F · correction period: Twenty-One (21) days
Details
Summary: MDH found the licensee failed to ensure the employee record contained the required content for two of two employees (registered nurse (RN)-A, unlicensed personnel (ULP)-B).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure the employee record contained the required content for two of two employees (registered nurse (RN)-A, unlicensed personnel (ULP)-B). Based on interview and record review, the licensee failed to ensure employee records included an annual performance review for two of two employees (registered nurse (RN)-A, unlicensed personnel (ULP)-B). [...]”
Rule cited: “(a) The facility must maintain current records of each paid employee, each regularly scheduled volunteer providing services, and each individual contractor providing services. [...]”
- Tag 660: 144G.42 Subd. 9 Tuberculosis prevention and control Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to establish and maintain a tuberculosis (TB) prevention program, based on the most current guidelines issued by the Centers for Disease Control and Prevention (CDC) which included completion of a two-step tuberculin skin test (TST) or other evidence of TB screening such as a blood test for one of two employees (unlicensed personnel (ULP)-B).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to establish and maintain a tuberculosis (TB) prevention program, based on the most current guidelines issued by the Centers for Disease Control and Prevention (CDC) which included completion of a two-step tuberculin skin test (TST) or other evidence of TB screening such as a blood test for one of two employees (unlicensed personnel (ULP)-B). [...]”
Rule cited: “(a) The facility must establish and maintain a comprehensive tuberculosis infection control program according to the most current tuberculosis infection control guidelines issued by the United States Centers for Disease Control and Prevention (CDC), Division [...]”
- Tag 680: 144G.42 Subd. 10 Disaster planning and emergency preparedness Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
Details
MDH’s finding, as written: “Based on observation, interview, and record review the licensee failed to have a written emergency preparedness plan with all the required content as defined in Appendix Z. This had the potential to affect all residents, 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 [...]”
- Tag 730: 144G.43 Subd. 3 Contents of resident record Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to ensure the resident record included documentation of discharge summary for two of two residents (R5, R6).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure the resident record included documentation of discharge summary for two of two residents (R5, R6). This practice resulted in a level two violation (a violation that did not harm a resident's health or safety but had the potential to have harmed a resident's health or safety) and was issued at a widespread scope (when problems are pervasive or represent a systemic failure that has affected or has the potential to affect a large [...]”
Rule cited: “Contents of a resident record include the following for each resident: (1) identifying information, including the resident's name, date of birth, address, and telephone number; (2) the name, address, and telephone number of the resident's emergency contact, [...]”
- Tag 800: 144G.45 Subd. 2 (a) (4) Fire protection and physical environment Level 2, widespread scope, scope/level letter F · correction period: Two (2) days
Details
MDH’s finding, as written: “Based on observation and interview, the licensee failed to maintain the path of egress in a manner that allowed the facility to be accessible to fire department services and emergency medical services. This had the potential to directly affect all residents, staff, and visitors. [...]”
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 Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to provide the required documentation of employee and resident training on fire safety and evacuation drills.
MDH’s finding, as written: “Based on a record review and interview, the licensee failed to provide the required documentation of employee and resident training on fire safety and 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. [...]”
- Tag 1060: 144G.52 Subd. 9 Emergency relocation Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to provide a written notice with the required content for an emergency relocation to the resident, legal representative, or designated representative for one of one resident (R5), and additionally failed to notify the Office of Ombudsman for Long Term Care (OOLTC) of the emergency relocation within the required timeframe.
MDH’s finding, as written: “Based on interview and record review, the licensee failed to provide a written notice with the required content for an emergency relocation to the resident, legal representative, or designated representative for one of one resident (R5), and additionally failed to notify the Office of Ombudsman for Long Term Care (OOLTC) of the emergency relocation within the required timeframe. [...]”
Rule cited: “(a) A facility may remove a resident from the facility in an emergency if necessary due to a resident's urgent medical needs or an imminent risk the resident poses to the health or safety of another facility resident or facility staff member. [...]”
- Tag 1290: 144G.60 Subdivision 1 Background studies required Level 3, widespread scope, scope/level letter I · correction period: Immediate
Details
Summary: MDH found the licensee failed to ensure current employee records contained all the required content to include a background study (BGS) clearance letter for three of three employees, (unlicensed personnel (ULP)-B, ULP-C, ULP-D).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure current employee records contained all the required content to include a background study (BGS) clearance letter for three of three employees, (unlicensed personnel (ULP)-B, ULP-C, ULP-D). [...]”
Rule cited: “(a) Employees, contractors, and regularly scheduled volunteers of the facility are subject to the background study required by section 144.057 and may be disqualified under chapter 245C. [...]”
- Tag 1360: 144G.61 Subdivision 1 Instructor and competency evaluation requirem Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to ensure training and competency evaluations of unlicensed personnel (ULP) providing assisted living services were conducted by a registered nurse (RN) for two of two unlicensed professional (ULP-B, ULP-E).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure training and competency evaluations of unlicensed personnel (ULP) providing assisted living services were conducted by a registered nurse (RN) for two of two unlicensed professional (ULP-B, ULP-E). [...]”
Rule cited: “Instructors and competency evaluators must meet the following requirements: (1) training and competency evaluations of unlicensed personnel who only provide assisted living services specified in section 144G.08, subdivision 9, clauses (1) to (5), must be [...]”
- Tag 1460: 144G.63 Subdivision 1 Orientation of staff and supervisors Level 2, isolated scope, scope/level letter D · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to ensure staff providing services completed an orientation to assisted living facility licensing requirements and regulations before providing services for one of one employee (registered nurse (RN)-A).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure staff providing services completed an orientation to assisted living facility licensing requirements and regulations before providing services for one of one employee (registered nurse (RN)-A). [...]”
Rule cited: “All staff providing and supervising direct services must complete an orientation to assisted living facility licensing requirements and regulations before providing assisted living services to residents. [...]”
- Tag 1500: 144G.63 Subd. 5 Required annual training Level 2, isolated scope, scope/level letter D · correction period: Twenty-One (21) days
Details
Summary: MDH found the licensee failed to ensure employees received at least eight hours of annual training for each twelve months of employment for one of one employee (registered nurse (RN)-A).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure employees received at least eight hours of annual training for each twelve months of employment for one of one employee (registered nurse (RN)-A). [...]”
Rule cited: “(a) All staff that perform direct services must complete at least eight hours of annual training for each 12 months of employment. [...]”
- Tag 1610: 144G.70 Subd. 2 (a-b) Initial reviews, assessments, and monitoring Level 2, widespread scope, scope/level letter F
Details
Summary: MDH found the licensee failed to ensure a registered nurse (RN) conducted a pre-admission assessment prior to move in for three of three residents (R4, R5, R6).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure a registered nurse (RN) conducted a pre-admission assessment prior to move in for three of three residents (R4, R5, R6). [...]”
Rule cited: “(a) Residents who are not receiving any assisted living services shall not be required to undergo an initial nursing assessment. [...]”
- Tag 1620: 144G.70 Subd. 2 (c-e) Initial reviews, assessments, and monitoring Level 2, widespread scope, scope/level letter F
Details
Summary: MDH found the licensee failed to ensure the registered nurse (RN) completed a 14-day reassessment using the uniform assessment tool for three of three residents (R4, R5, R6).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure the registered nurse (RN) completed a 14-day reassessment using the uniform assessment tool for three of three residents (R4, R5, R6). [...]”
Rule cited: “(c) Resident reassessment and monitoring must be conducted no more than 14 calendar days after initiation of services. [...]”
- Tag 1650: 144G.70 Subd. 4 (f) Service plan, implementation and revisions to Level 2, isolated scope, scope/level letter D · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to ensure service plans included all the required content for one of one resident (R2).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure service plans included all the required content for one of one resident (R2). This practice resulted in a level two violation (a violation that did not harm a resident's health or safety but had the potential to have harmed a resident's health or safety, but was not likely to cause serious injury, impairment, or death), and was issued at an isolated scope (when one or a limited number of residents are affected or one or a [...]”
Rule cited: “(f) The service plan must include: (1) a description of the services to be provided, the fees for services, and the frequency of each service, according to the resident's current assessment and resident preferences; (2) the identification of staff or [...]”
- Tag 1710: 144G.71 Subd. 3 Individualized medication monitoring and reas Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to ensure the
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure the registered nurse (RN) completed medication assessments for two of two residents (R3, R4). [...]”
Rule cited: “The assisted living facility must monitor and reassess the resident's medication management services as needed under subdivision 2 when the resident presents with symptoms or other issues that may be medication-related and, at a minimum, annually.”
- Tag 1750: 144G.71 Subd. 7 Delegation of medication administration Level 3, widespread scope, scope/level letter I · correction period: Immediate
Details
Summary: MDH found the licensee failed to ensure prior to delegating the nursing tasks of medication administration, the unlicensed personnel (ULP) were trained in the proper methods to perform the task or procedure for each resident and were able to demonstrate the ability to competently follow the procedure to a registered nurse (RN) for one of two employees (ULP-B).
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure prior to delegating the nursing tasks of medication administration, the unlicensed personnel (ULP) were trained in the proper methods to perform the task or procedure for each resident and were able to demonstrate the ability to competently follow the procedure to a registered nurse (RN) for one of two employees (ULP-B). [...]”
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 [...]”
- Tag 1820: 144G.71 Subd. 13 Prescriptions Level 2, isolated scope, scope/level letter D · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to ensure written or electronically recorded prescriptions contained all the required content for one of one resident (R2) with record reviewed.
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure written or electronically recorded prescriptions contained all the required content for one of one resident (R2) with record 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.”
- Tag 1880: 144G.71 Subd. 19 Storage of medications Level 2, widespread scope, scope/level letter F · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to ensure all medications were securely locked in substantially constructed compartments and permit only authorized personnel to have access.
MDH’s finding, as written: “Based on observation and interview, the licensee failed to ensure all medications were securely locked in substantially constructed compartments and permit only authorized personnel to have access. [...]”
Rule cited: “An assisted living facility must store all prescription medications in securely locked and substantially constructed compartments according to the manufacturer's directions and permit only authorized personnel to have access.”
- Tag 1910: 144G.71 Subd. 22 Disposition of medications Level 2, widespread scope, scope/level letter F · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to ensure the resident record included disposition of medications for one of one resident (R5).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure the resident record included disposition of medications for one of one resident (R5). This practice resulted in a level two violation (a violation that did not harm a resident's health or safety but had the potential to have harmed a resident's health or safety) and was issued at a widespread scope (when problems are pervasive or represent a systemic failure that has affected or has the potential to affect a large portion or [...]”
Rule cited: “(a) Any current medications being managed by the assisted living facility must be provided to the resident when the resident's service plan ends or medication management services are no longer part of the service plan. [...]”
- Tag 1950: 144G.72 Subd. 4 Administration of treatments and therapy Level 3, widespread scope, scope/level letter I · correction period: Immediate
Details
Summary: MDH found the licensee failed to ensure prior to delegating the nursing tasks or treatments, the unlicensed personnel (ULP) were trained in the proper methods to perform the task or procedure for each resident and were able to demonstrate the ability to competently follow the procedure to a registered nurse (RN) for one of two employees (ULP-B).
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure prior to delegating the nursing tasks or treatments, the unlicensed personnel (ULP) were trained in the proper methods to perform the task or procedure for each resident and were able to demonstrate the ability to competently follow the procedure to a registered nurse (RN) for one of two employees (ULP-B). [...]”
Rule cited: “Ordered or prescribed treatments or therapies must be administered by a nurse, physician, or other licensed health professional authorized to perform the treatment or therapy, or may be delegated or assigned to unlicensed personnel by the licensed health [...]”
- Tag 2040: 144G.81 Subdivision 1 Fire protection and physical environment Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to provide hazard vulnerability assessment or safety risk assessment of the physical environment on and around the property for the facility.
MDH’s finding, as written: “Based on record review and interview, the licensee failed to provide hazard vulnerability assessment or safety risk assessment of the physical environment on and around the property for the facility. This deficient practice had the ability to affect all staff, residents, and visitors. [...]”
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 [...]”
- Tag 2140: 144G.83 Subd. 3 Supervising staff training Level 2, widespread scope, scope/level letter F
Details
Summary: MDH found the licensee failed to designate a qualified person to oversee staff training in the care of individuals with dementia.
MDH’s finding, as written: “Based on interview and record review, the licensee failed to designate a qualified person to oversee staff training in the care of individuals with dementia. This had the potential to affect all residents, staff, and visitors. [...]”
Rule cited: “Persons providing or overseeing staff training must have experience and knowledge in the care of individuals with dementia, including: (1) two years of work experience related to Alzheimer's disease or other dementias, or in health care, gerontology, or [...]”
From MDH’s letter: the letter says the facility is in substantial compliance.
Total fines assessed, as printed in the letter: $9,500.00.
- Tag 250: 144G.20 Subdivision 1 Conditions Level 2, widespread scope, scope/level letter F · correction period: Twenty-One (21) days
Substantiated investigations (state reports)
- June 4, 2025 · report HL315579801C
Details
Survey completed June 4, 2025: 1 correction order
- Tag 730: 144G.43 Subd. 3 Contents of resident record Level 2, isolated scope, scope/level letter D · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to ensure the resident's advanced directives were accurately reflected in the resident's record 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 the resident's advanced directives were accurately reflected in the resident's record for one of one residents (R1) with records reviewed. [...]”
Rule cited: “Contents of a resident record include the following for each resident: (1) identifying information, including the resident's name, date of birth, address, and telephone number; (2) the name, address, and telephone number of the resident's emergency contact, [...]”
- Tag 730: 144G.43 Subd. 3 Contents of resident record Level 2, isolated scope, scope/level letter D · correction period: Twenty-one (21) days
- February 20, 2025 · report HL315578362M · MDH finding: Substantiated, facility responsibility
Details
Allegation, as written: “The facility neglected the resident when facility staff failed to implement cares and interventions to meet the resident's needs when the resident had multiple falls, experienced a significant weight loss, and developed a sacrum (tail bone) wound.”
“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's assessments did not accurately depict the resident's health care status and failed to provide unlicensed staff with interventions or directions to meet the resident's changing needs.”
Action taken by facility: “Facility caregivers assisted the resident with assigned tasks and notified on-call triage nurses of falls after hours.”
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 February 11, 2025: 2 correction orders
- Tag 1620: 144G.70 Subd. 2 (c-e) Initial reviews, assessments, and monitoring Level 3, isolated scope, scope/level letter G · correction period: Twenty-One (21) days
Details
Summary: MDH found the licensee failed to complete an accurate comprehensive reassessment by a registered nurse (RN) for one of one resident (R1) with a change of condition, including addition of interventions as needed for falls, significant weight loss and a wound.
MDH’s finding, as written: “Based on interview and record review, the licensee failed to complete an accurate comprehensive reassessment by a registered nurse (RN) for one of one resident (R1) with a change of condition, including addition of interventions as needed for falls, significant weight loss and a wound. [...]”
Rule cited: “(c) Resident reassessment and monitoring must be conducted no more than 14 calendar days after initiation of services. [...]”
- Tag 2360: 144G.91 Subd. 8 Freedom from maltreatment
Details
Summary: MDH found the facility failed to ensure one of one resident reviewed (R1) was free from maltreatment.
MDH’s finding, as written: “The facility failed to ensure one of one resident reviewed (R1) was free from maltreatment. 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.”
- Tag 1620: 144G.70 Subd. 2 (c-e) Initial reviews, assessments, and monitoring Level 3, isolated scope, scope/level letter G · correction period: Twenty-One (21) days
- February 26, 2024 · report HL315579706M · MDH finding: Substantiated, facility responsibility
Details
Allegation, as written: “The facility neglected the resident when staff failed to implement interventions after the resident had a series of falls. The resident sustained a fall which resulted in a brain bleed requiring hospitalization in the intensive care unit.”
“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 assess the resident's risk for falls and implement individualized interventions to prevent falls or reduce the risk of serious injury after falling. The resident had approximately 14 falls in the month prior to the fall that resulted in a brain bleed requiring hospitalization in the intensive care unit. Emergency room physicians considered the possibility that the resident had been assaulted or abused at the facility since the injuries from the fall were so significant and the bruises observed were in various stages of healing. An equal opportunity employer.”
Action taken by facility: “No action taken.”
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 February 2, 2024: 12 correction orders
- Tag 130: 144G.12, Subd. 1 Application for Licensure Level 1, widespread scope, scope/level letter C · correction period: Two (2) days
Details
Summary: MDH found the licensee failed to hold an assisted living with dementia care license for their current capacity of residents.
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to hold an assisted living with dementia care license for their current capacity of residents. The assisted living with dementia care license effective September 1, 2023, indicated a capacity of 93 residents, however 100 residents resided at the facility. [...]”
Rule cited: “Each application for an assisted living facility license, including provisional and renewal applications, must include information sufficient to show that the applicant meets the requirements of licensure, including: (1) the business name and legal entity [...]”
- 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 demonstrate they met the requirements of licensure, by attesting the managerial officials who oversaw the day-to-day operations understood applicable statutes and rules; nor developed and/or implemented current policies and procedures as required with records reviewed.
MDH’s finding, as written: “Based on interview and record review, the licensee failed to demonstrate they met the requirements of licensure, by attesting the managerial officials who oversaw the day-to-day operations understood applicable statutes and rules; nor developed and/or implemented current policies and procedures as required with records reviewed. This had 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 495: 144G.41 Subd. 1 (14) Minimum Requirements Level 2, widespread scope, scope/level letter F · correction period: Two (2) days
Details
Summary: MDH found the licensee failed to provide staff access to an on-call registered nurse (RN) 24 hours per day, seven days per week.
MDH’s finding, as written: “Based on interview and record review, the licensee failed to provide staff access to an on-call registered nurse (RN) 24 hours per day, seven days per week. This had the potential to affect all residents receiving assisted living services. [...]”
Rule cited: “(14) provide staff access to an on-call registered nurse 24 hours per day, seven days per week”
- Tag 620: 144G.42 Subd. 6 (a) / 626.557, Subd. 3 Compliance with requirements for reporting ma Level 2, isolated scope, scope/level letter D · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to immediately report to the Minnesota Adult Abuse Reporting Center (MAARC) suspected maltreatment for one of one residents (R1) reviewed for maltreatment.
MDH’s finding, as written: “Based on interview and record review, the licensee failed to immediately report to the Minnesota Adult Abuse Reporting Center (MAARC) suspected maltreatment for one of one residents (R1) reviewed for maltreatment. [...]”
Rule cited: “(a) The assisted living facility must comply with the requirements for the reporting of maltreatment of vulnerable adults in section 626.557. [...]”
- Tag 1620: 144G.70 Subd. 2 (c-e) Initial reviews, assessments, and monitoring Level 3, isolated scope, scope/level letter G · correction period: Twenty-One (21) days
Details
Summary: MDH found the licensee failed to ensure the RN assessed one of one resident (R1) who utilized a fall alarm and a diagnosis of anxiety and documented behaviors.
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure the RN assessed one of one resident (R1) who utilized a fall alarm and a diagnosis of anxiety and documented behaviors. [...]”
Rule cited: “(c) Resident reassessment and monitoring must be conducted no more than 14 calendar days after initiation of services. [...]”
Show all 12
- Tag 1650: 144G.70 Subd. 4 (f) Service plan, implementation and revisions to Level 2, isolated scope, scope/level letter D · correction period: Twenty-one (21) days
Details
Summary: MDH found the licensee failed to ensure a service plan was updated to reflect current services being provided by the licensee for one of one resident (R1).
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure a service plan was updated to reflect current services being provided by the licensee for one of one resident (R1). [...]”
Rule cited: “(f) The service plan must include: (1) a description of the services to be provided, the fees for services, and the frequency of each service, according to the resident's current assessment and resident preferences; (2) the identification of staff or [...]”
- Tag 1700: 144G.71 Subd. 2 Provision of medication management services Level 2, isolated scope, scope/level letter D · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to ensure a medication management assessment was completed by the registered nurse/RN to determine what medication management services would be provided and included identification and review in all required areas for one of one resident (R1).
MDH’s finding, as written: “Based on interview, and record review, the licensee failed to ensure a medication management assessment was completed by the registered nurse/RN to determine what medication management services would be provided and included identification and review in all required areas for one of one resident (R1). [...]”
Rule cited: “(a) For each resident who requests medication management services, the facility shall, prior to providing medication management services, have a registered nurse, licensed health professional, or authorized prescriber under section 151.37 conduct an [...]”
- Tag 1710: 144G.71 Subd. 3 Individualized medication monitoring and reas Level 2, isolated scope, scope/level letter D · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to ensure the registered nurse (RN) conducted a face-to-face medication management reassessment at least annually for one of one resident (R1) who received medication management services.
MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure the registered nurse (RN) conducted a face-to-face medication management reassessment at least annually for one of one resident (R1) who received medication management services. In addition, the licensee failed to ensure the RN completed a reassessment when medication related symptoms presented, and there was a change in the resident's medications for one of one resident (R1). [...]”
Rule cited: “The assisted living facility must monitor and reassess the resident's medication management services as needed under subdivision 2 when the resident presents with symptoms or other issues that may be medication-related and, at a minimum, annually.”
- Tag 2310: 144G.91 Subd. 4 (a) Appropriate care and services Level 3, isolated scope, scope/level letter G · correction period: Seven (7) Days
Details
Summary: MDH found the licensee failed to provide care and services according to acceptable health care, medical, or nursing standards, for one of one residents (R1) who utilized bed rails.
MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to provide care and services according to acceptable health care, medical, or nursing standards, for one of one residents (R1) who utilized bed rails. [...]”
Rule cited: “(a) Residents have the right to care and assisted living services that are appropriate based on the resident's needs and according to an up-to-date service plan subject to accepted health care standards.”
- Tag 2320: 144G.91 Subd. 4 (b) Appropriate care and services Level 4, isolated scope, scope/level letter J · correction period: Seven (7) days
Details
Summary: MDH found the licensee failed to provide care and services according to acceptable health care, medical, or nursing standards related to falls.
MDH’s finding, as written: “Based on interview and record review, the licensee failed to provide care and services according to acceptable health care, medical, or nursing standards related to falls. The licensee failed to have a fall management system that ensured staff provided the resident with supervision and implemented interventions after falls for one of one resident (R1) reviewed. [...]”
Rule cited: “(b) Residents have the right to receive health care and other assisted living services with continuity from people who are properly trained and competent to perform their duties and in sufficient numbers to adequately provide the services agreed to in the [...]”
- 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 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.”
- Tag 2400: 144G.91 Subd. 12 Visitors and social participation Level 2, isolated scope, scope/level letter D · correction period: Seven (7) days
Details
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 and record review, the licensee failed to respect the resident's right to receive visits at any time. This had the potential to affect the one resident (R1) 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. [...]”
- Tag 130: 144G.12, Subd. 1 Application for Licensure Level 1, widespread scope, scope/level letter C · correction period: Two (2) days
- September 15, 2022 · report HL315572508C
Details
Survey completed September 2, 2022: 1 correction order
- Tag 510: 144G.41 Subd. 3 Infection control program Level 3, widespread scope, scope/level letter I · correction period: Immediate
Details
Summary: MDH found the licensee failed to establish and maintain an effective infection control program to comply with accepted health care, medical, and nursing standards for infection control and current recommendations for COVID-19 regarding wearing appropriate personal protective equipment (PPE).
MDH’s finding, as written: “Based on observation, interview, and document review, the licensee failed to establish and maintain an effective infection control program to comply with accepted health care, medical, and nursing standards for infection control and current recommendations for COVID-19 regarding wearing appropriate personal protective equipment (PPE). This had the potential to affect all residents, staff, and visitors. [...]”
Rule cited: “(a) All assisted living facilities must establish and maintain an infection control program that complies with accepted health care, medical, and nursing standards for infection control. [...]”
- Tag 510: 144G.41 Subd. 3 Infection control program Level 3, widespread scope, scope/level letter I · correction period: Immediate
Inconclusive investigations (1)
- September 12, 2024 · report HL315574942M · MDH finding: Inconclusive
Details
Allegation, as written: “The facility neglected the resident when the resident became lethargic and unresponsive and was hospitalized in the ICU with high Co2 (carbon dioxide) levels.”
“The Minnesota Department of Health determined neglect was inconclusive.”
Summary: MDH looked into an allegation and found: neglect inconclusive.
MDH’s conclusion, as written: “The Minnesota Department of Health determined neglect was inconclusive. It was unable to be determined if the actions or inactions of facility staff contributed to the resident's change in respiratory condition.”
Action taken by facility: “The facility completed assessments, obtained vitals, and sent the resident to the emergency room when a change in condition occurred.”
Action taken by MDH: “No further action taken at this time.”
Survey completed August 7, 2024: no correction orders issued.
Unsubstantiated investigations (1)
- December 30, 2024 · report HL315576485M · MDH finding: Inconclusive
Details
Allegation, as written: “The resident was neglected when the facility staff failed to provide appropriate care and services when the resident's feeding and gastric tubes were switched around causing the resident to not receive medications, nutrition, or fluids as ordered. As a result, the resident was observed staring blankly and not responding normally.”
“The Minnesota Department of Health determined neglect was inconclusive.”
Summary: MDH looked into an allegation and found: neglect inconclusive.
MDH’s conclusion, as written: “The Minnesota Department of Health determined neglect was inconclusive. Although the resident's gastric and feeding tubes were observed connected incorrectly, the resident was connected to drainage for only 1 hour, and the resident's change in cognition occurred 2 days prior to when the error was observed. It could not be determined if the resident's change in cognition was the result of the error or related to other possible contributing factors.”
Action taken by facility: “After the error the facility re-educated, and competency tested all ULP staff to ensure they knew how to properly connect the resident's gastric and feeding tubes. The facility labeled the tubes and implemented a process for 2 staff verify the resident's gastric connection. Nursing implemented monitoring/documenting of the resident's daily intake and output (gastric drainage, and urinary output).”
Action taken by MDH: “No further action taken at this time.”
Survey completed November 13, 2024: no correction orders issued.
What the levels and scopes mean (MDH’s words)
Level 1: “a violation that has no potential to cause more than a minimal impact on the resident and does not affect health or safety”
Level 2: “a violation that did not harm a resident's health or safety but had the potential to have harmed a resident's health or safety, but was not likely to cause serious injury, impairment, or death”
Level 3: “a violation that harmed a resident's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to serious injury, impairment, or death”
Level 4: “a violation harmed a resident's health or safety, not including serious injury or death, or a violation that was likely to lead to serious injury or death”
Isolated scope: “when one or a limited number of residents are affected or one or a limited number of staff are involved, or the situation has occurred only occasionally”
Pattern scope: “when more than a limited number of residents are affected, more than a limited number of staff are involved, or the situation has occurred repeatedly; but is not found to be pervasive”
Widespread scope: “when problems are pervasive or represent a systemic failure that has affected or has the potential to affect a large portion or all of the residents”
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.
What these terms mean
MDH: “An evaluation is a process regulated by the division to ensure licensees comply with the laws, rules, and certifications for the type of care and services authorized under their license/certification.”
“An investigation may occur when the division is notified that care and services are not being provided by licensees as required by law. This may include allegations of abuse, neglect, or financial misuse.”
For maltreatment, Minnesota law defines substantiated as “a preponderance of the evidence shows that an act that meets the definition of maltreatment occurred” and inconclusive as “less than a preponderance of evidence to show that maltreatment did or did not occur” (Minn. Stat. 626.5572).
Correction orders, as MDH explains on each state form: “Tag numbers have been assigned to Minnesota State Statutes for Assisted Living Facilities.” “The letter in the left column is used for tracking purposes and reflects the scope and level issued pursuant to 144G.31 subd. 1, 2, and 3.” MDH adds that there is no requirement to submit a plan of correction for violations of Minnesota state statutes.
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 137 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.
License and ownershipActive license, licensee FARMSTEAD CARE OF MOORHEAD LP
- License type
- Assisted Living Facility Dementia Care
- License number
- 422417
- License status
- Active
- Current license dated
- 2025-09-01
- Licensed capacity
- 137
- Licensee
- FARMSTEAD CARE OF MOORHEAD LP
- County
- Clay County
- Executive Director
- Lisa Martin
Source: Minnesota state licensing records (agency listing), retrieved 2026-09-09. Licensing status is a matter of public record; it is not a quality rating.
Executive Director name from public records we reviewed, as of Oct 12, 2026.
Paying with Medicaid and other programsHow Medicaid pays for care in Minnesota, and other programs
How Medicaid pays for care in Minnesota
- Elderly Waiver (EW), customized living services. Minnesota's Elderly Waiver, part of Medical Assistance (Minnesota Medicaid), can pay for "customized living" services, and a provider of those services must hold an assisted living license (or meet certain exceptions). You must qualify for Medical Assistance and need a nursing-home level of care. (state page)
Ask the community whether it accepts Medicaid.
Location and nearby careNearest hospital 3.0 mi, nursing home 2.6 mi, pharmacy 2.4 mi
- Nearest hospital with an emergency room
- Sanford Medical Center Fargo, Fargo. 3.0 miles away, straight line. CMS overall hospital rating: 4 of 5 stars.
- Nearest Medicare nursing home
- SMP Health - St Catherine North, Fargo. 2.6 miles away, straight line.
- Nearest home health agency office
- Healthy At Home, Fargo. 3.9 miles away, straight line. Agencies travel to clients, so ask which ones serve this address.
- Nearest pharmacy
- CVS Pharmacy. 2.4 miles away, straight line. From OpenStreetMap, which does not list every pharmacy, so one may be closer.
- Area
- USDA classes ZIP code 56560 as metropolitan (metropolitan core).
- Dialysis within 15 miles
- Davita Moorhead Dialysis, Dilworth, 2.8 miles away, straight line (CMS rating 3 of 5 stars)
Sanford Dialysis Fargo, Fargo, 5.5 miles away, straight line (CMS rating 3 of 5 stars)
Davita Fargo Dialysis Center, Fargo, 7.4 miles away, straight line (CMS rating 3 of 5 stars) - Hospice
- 4 Medicare hospices tell CMS they serve ZIP code 56560.
Sanford Fargo Hospice, office in Fargo, 3.0 miles away, straight line (CMS family survey rating 4 of 5 stars)
Ethos Hospice, office in Fargo, 8.1 miles away, straight line (CMS family survey rating 3 of 5 stars)
Hia Hospice, office in Fargo, 9.5 miles away, straight line (CMS family survey rating 4 of 5 stars) - Nearest geriatric medicine practice
- Tapestry Telehealth PLLC, Fargo. 6.1 miles away, straight line. 1 geriatric medicine doctor listed there.
Distances are straight lines from the community, not driving distance. Hospitals, home health, dialysis, hospice and doctors come from CMS provider data (CMS, hospital list updated Jul 22, 2026). Star ratings are CMS’s own.
Emergency and natural hazard riskFEMA overall risk relatively high; outside FEMA's high-risk flood areas
Public hazard maps for this location. Ask the community about its emergency plan, its generator and where residents would go in an evacuation.
- Flood zone
- Outside the high and moderate risk flood areas on FEMA's flood map (Zone X, minimal flood hazard, or not studied). (FEMA flood map)
- FEMA National Risk Index
- Overall: relatively high. By hazard: inland flooding very high, wildfire relatively low, tornado relatively moderate, heat wave very low, earthquake very low. These are FEMA’s ratings for the census tract, compared with tracts nationwide. (FEMA, December 2025)
A flood zone describes the map at this point, not the building's elevation. In an emergency, follow the local emergency management agency.
Questions to ask on a tour10 questions picked for this community from its record
Picked for this community from its record. Ask them in person and write down the answers.
- The state recorded a finding in June 2025. What was it, and how was it fixed?
- The current license dates from 2025. Has the owner or operator changed recently?
- What does the base rate include, and when did rates last go up?
- How many caregivers work in memory care during the day, the evening and overnight, and for how many residents?
- What dementia training does each caregiver get before working alone, and every year after?
- How do staff respond when a resident is agitated, frightened or tries to leave?
- How many caregivers are on duty during the day and at night?
- What happens if care needs increase? When would someone need to move?
- What fees are charged at move-in?
- How do you tell families about falls, illness or changes?
What we checked12 public sources we searched, with dates
Every public source we searched for this community. “Nothing on record” means we found no record that matched it. A record can be missed when a name or address differs.
| Source | Data as of | What we found |
|---|---|---|
| Minnesota Department of Health, Health Regulation Division inspection records | Sep 28, 2026 | See above |
| U.S. Department of Labor wage and hour cases | Oct 15, 2026 | Nothing on record |
| OSHA workplace safety inspections since 2016 | Oct 15, 2026 | Nothing on record |
| FEMA flood map | See above | |
| USDA wildfire risk | Apr 15, 2026 | Not shown: FEMA rates wildfire risk here relatively low |
| FEMA National Risk Index | See above | |
| CMS hospitals, home health, dialysis, hospice and doctors; OpenStreetMap pharmacies | See above | |
| HUD Multifamily Properties - Assisted | Jul 6, 2026 | Nothing on record |
| State Veterans Homes (NASVH directory) | Sep 20, 2026 | Nothing on record |
| CMS Hospice - General Information | Aug 19, 2026 | Nothing on record |
| CMS Home Health Care Agencies | May 27, 2026 | Nothing on record |
| The community’s own website | See above |
Common questionsAnswers to 4 questions families ask
What type of care does Farmstead Care of Moorhead provide?
Farmstead Care of Moorhead is licensed by the state of Minnesota for assisted living, memory care in Moorhead, Minnesota. Its licensed capacity is 137 residents.
Does Lilisity rate Farmstead Care of Moorhead?
No. We publish state licensing details for Farmstead Care of Moorhead but no score, rating, or ranking. Only communities on the Top Communities list or with a Senior Living Alliance Excellence Award, both based on phone-verified resident and family interviews, are ranked.
How much does Farmstead Care of Moorhead cost?
Assisted Living in Minnesota typically starts at $2,200 to $4,800 a month. Based on 74 communities that publish prices. These are area figures, not this community's price. Farmstead Care of Moorhead does not publish its prices.
How do I contact Farmstead Care of Moorhead?
Use Farmstead Care of Moorhead's website, farmsteadliving.org, or visit at 3200 28th Street South, Moorhead, MN 56560.
How Lilisity works. The only scores or rankings Lilisity publishes are the Top Communities list and the Excellence Awards, both built from phone-verified resident and family interviews. Communities can pay Lilisity a flat monthly fee to manage their own listing: photos, prices, contact details, and receiving the inquiries families choose to send them. The fee is the same no matter how many families contact them or move in. Senior Living Alliance, which runs Lilisity, offers the same listing to its member communities as part of their membership; members pay SLA for its resident and family interview program. No community pays Lilisity per inquiry, per referral or per move-in. Payment never changes a testimonial, a rating, or the order of search results. The "Nearby Senior Living Alliance communities" box shows member communities only. How we verify testimonials · How we are paid