Havenwood of Burnsville

Survey completed April 12, 2023: 7 correction orders

• 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 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 all the [...]”

  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 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 develop a fire safety and evacuation plan with the required elements, failed to provide required employee training on fire safety and evacuation, and failed to conduct required evacuation drills as required.

  MDH’s finding, as written: “Based on the interview and record review, the licensee failed to develop a fire safety and evacuation plan with the required elements, failed to provide required employee training on fire safety and evacuation, and failed to conduct required evacuation drills as required. 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
  Details

  Summary: MDH found the licensee failed to provide a written notice with the required content for an emergency relocation and failed to notify the Office of Ombudsman for Long-Term Care of the emergency relocation for two of two residents (R4, R5).

  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 and failed to notify the Office of Ombudsman for Long-Term Care of the emergency relocation for two of two residents (R4, R5). [...]”

  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 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

  MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure medication procedures were followed during medication administration for 1 of 1 resident (R4) who received insulin. [...]”

  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 time sensitive medications were dated when opened for one of one resident (R4) with insulin.

  MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure time sensitive medications were dated when opened for one of one resident (R4) with insulin. [...]”

  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 1940: 144G.72 Subd. 3 Individualized treatment or therapy managemen Level 2, isolated scope, scope/level letter D · correction period: Twenty-one (21) days
  Details

  Summary: MDH found the licensee failed to develop and maintain a current individualized treatment plan with the required content for one of one resident (R2) receiving oxygen.

  MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to develop and maintain a current individualized treatment plan with the required content for one of one resident (R2) receiving oxygen. [...]”

  Rule cited: “For each resident receiving management of ordered or prescribed treatments or therapy services, the assisted living facility must prepare and include in the service plan a written statement of the treatment or therapy services that will be provided to the [...]”

• Tag 2170: 144G.84 SERVICES FOR RESIDENTS WITH DEMENTIA Level 2, widespread scope, scope/level letter F · correction period: Twenty-One (21) days
  Details

  Summary: MDH found the licensee failed to conduct an individualized written activity evaluation that addressed all six provisions and failed to develop an individualized activity plan based on the evaluation, for one of one resident (R4) who received services in the memory care unit.

  MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to conduct an individualized written activity evaluation that addressed all six provisions and failed to develop an individualized activity plan based on the evaluation, for one of one resident (R4) who received services in the memory care unit. [...]”

  Rule cited: “(b) Each resident must be evaluated for activities according to the licensing rules of the facility. [...]”

From MDH’s letter: the letter says the facility is in substantial compliance; no immediate fines.

Allegation, as written: “The facility neglected the resident when the facility failed to provide staff assistance for transfers and the resident fell acquiring injuries to the face.”

“The Minnesota Department of Health determined neglect was not substantiated.”

Summary: MDH looked into an allegation and found: neglect not substantiated.

MDH’s conclusion, as written: “The Minnesota Department of Health determined neglect was not substantiated. The facility assessed the resident as an increased risk for falls and implemented several interventions to prevent the resident from falling before the incident. The resident was able to transfer independently using a walker. During the incident, a staff member assisted the resident to transfer between wheelchairs with a walker. The resident's legs gave out and she fell during the transfer. After the incident, nursing and physical therapy assessed the resident and met with the family to discuss additional interventions including two staff assistance with a mechanical lift.”

Action taken by facility: “The facility implemented fall interventions and the resident had physical therapy services prior to the fall. The facility called for emergency services after the incident. The facility completed an internal investigation, assessed the resident, and increased her level of transfer assistance to two staff with a mechanical lift. The resident continued with physical therapy services after the fall. [...]”

Action taken by MDH: “No further action taken at this time.”

Survey completed November 21, 2024: no correction orders issued.

Allegation, as written: “The facility neglected the resident when the resident fell multiple times. The resident's health deteriorated, and the resident could no longer walk.”

“The Minnesota Department of Health determined neglect was not substantiated.”

Summary: MDH looked into an allegation and found: neglect not substantiated.

MDH’s conclusion, as written: “The Minnesota Department of Health determined neglect was not substantiated. Evidence did not indicate the facility neglected the resident. Although the resident died as a result of a recent fall, the resident had been on hospice due to his health declining. The facility implemented interventions after falls, contacted the provider, and communicated with family.”

Action taken by facility: “The facility contacted the provider, implemented interventions to attempt to help prevent future falls, and communicated with family and hospice.”

Action taken by MDH: “No further action taken at this time.”

Survey completed May 1, 2024: no correction orders issued.