Keystone Place at Lavalle Fiel

Summary: MDH found the licensee failed to provide smoke alarms that are interconnected in the resident apartment unit 201 so that the actuation of one alarm causes all alarms in the unit to actuate.

MDH’s finding, as written: “Based on observation and interview, the licensee failed to provide smoke alarms that are interconnected in the resident apartment unit 201 so that the actuation of one alarm causes all alarms in the unit to actuate. This deficient condition had the ability to affect apartment unit 201. [...]”

Rule cited: “(a) Each assisted living facility must comply with the State Fire Code in Minnesota Rules, chapter 7511, and: (1) for dwellings or sleeping units, as defined in the State Fire Code: (i) provide smoke alarms in each room used for sleeping purposes; (ii) [...]”

Summary: MDH found the licensee failed to provide portable fire extinguishers that were properly serviced.

MDH’s finding, as written: “Based on observation and interview, the licensee failed to provide portable fire extinguishers that were properly serviced. This deficient condition had the ability to affect all staff and residents. [...]”

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 maintain the physical environment in a continuous state of good repair and operation regarding the health, safety, comfort, and well-being of the residents.

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

Summary: MDH found the licensee failed to maintain a current and an accurate facility floor plan layout and the required resident and employee training on fire safety and evacuation plan.

MDH’s finding, as written: “Based on documentation, interview, and observation, the licensee failed to maintain a current and an accurate facility floor plan layout and the required resident and employee training on fire safety and evacuation plan. This deficient condition had the ability 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 develop and execute an assisted living written contract with the required content for one of one resident (R3).

MDH’s finding, as written: “Based on interview and record review, the licensee failed to develop and execute an assisted living written contract with the required content for one of one resident (R3). [...]”

Rule cited: “(a) An assisted living facility may not offer or provide housing or assisted living services to any individual unless it has executed a written contract with the resident. [...]”

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 facility's liability for health, safety, or personal property of a resident. This had the potential to affect all ninety (90) residents residing in the facility. [...]”

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 provide a written notice with the required content for an emergency relocation to the Office of Ombudsman for Long-Term Care (OOLTC) if the resident has been relocated and has not returned to the facility within four days for one of one resident (R8) who had an emergency relocation.

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 Office of Ombudsman for Long-Term Care (OOLTC) if the resident has been relocated and has not returned to the facility within four days for one of one resident (R8) who had an emergency relocation. [...]”

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. [...]”

Summary: MDH found the licensee failed to ensure a background study was submitted and a clearance received in affiliation with the assisted living with dementia care license for one of one employee (unlicensed personnel (ULP)-B).

MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure a background study was submitted and a clearance received in affiliation with the assisted living with dementia care license for one of one employee (unlicensed personnel (ULP)-B). [...]”

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. [...]”

Summary: MDH found the licensee failed to ensure direct supervision of staff performing delegated tasks was provided within 30 calendar days after the date on which the individual begins working for the licensee for two of three unlicensed personnel ((ULP)-B and ULP-G).

MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure direct supervision of staff performing delegated tasks was provided within 30 calendar days after the date on which the individual begins working for the licensee for two of three unlicensed personnel ((ULP)-B and ULP-G). [...]”

Rule cited: “(a) Staff who perform delegated nursing or therapy tasks must be supervised by an appropriate licensed health professional or a registered nurse according to the assisted living facility's policy where the services are being provided to verify that the work [...]”

Summary: MDH found the licensee failed to ensure the registered nurse (RN) completed an ongoing resident reassessment that did not exceed 90 days as required for four of five residents (R3, R4, R5, R6).

MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure the registered nurse (RN) completed an ongoing resident reassessment that did not exceed 90 days as required for four of five residents (R3, R4, R5, R6). Additionally, the licensee failed to ensure the RN completed a comprehensive reassessment after a change of condition for one of one resident (R9) after 13 documented falls. [...]”

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 the registered nurse (RN) conducted an individualized assessment with the required content for four of four residents (R3, R4, R5, R6).

MDH’s finding, as written: “Based on observation, interview and record review, the licensee failed to ensure the registered nurse (RN) conducted an individualized assessment with the required content for four of four residents (R3, R4, R5, R6). [...]”

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 [...]”

Summary: MDH found the licensee failed to develop an individualized medication management record with the required content for three of four residents (R3, R5, R6).

MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to develop an individualized medication management record with the required content for three of four residents (R3, R5, R6). [...]”

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.”

Summary: MDH found the licensee failed to develop an

MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to develop an individualized medication management record with the required content for four of four residents (R3, R4, R5, R6). [...]”

Rule cited: “(a) For each resident receiving medication management services, the assisted living facility must prepare and include in the service plan a written statement of the medication management services that will be provided to the resident. [...]”

Summary: MDH found the licensee failed to ensure the registered nurse (RN) developed training and competencies for unlicensed personnel (ULP) who provided medications to residents for unplanned time away from home when the licensed nurse was not available for one of one unlicensed personnel (ULP-B).

MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure the registered nurse (RN) developed training and competencies for unlicensed personnel (ULP) who provided medications to residents for unplanned time away from home when the licensed nurse was not available for one of one unlicensed personnel (ULP-B). [...]”

Rule cited: “(2) for unplanned time away, when the pharmacy is not able to provide the medications, a licensed nurse or unlicensed personnel shall provide medications in amounts and dosages needed for the length of the anticipated absence, not to exceed seven calendar [...]”

Summary: MDH found the licensee failed to ensure prescriptions were renewed at least every 12 months for three of five residents (R3, R5, R6).

MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure prescriptions were renewed at least every 12 months for three of five residents (R3, 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, but was not likely to cause serious injury, impairment, or death), and was issued at a widespread scope (when problems are pervasive or represent a systemic [...]”

Rule cited: “Prescriptions must be renewed at least every 12 months or more frequently as indicated by the assessment in subdivision 2. Prescriptions for controlled substances must comply with chapter 152.”

Summary: MDH found the licensee failed to ensure an opened insulin pen was correctly dated when the insulin would expire for one of one resident (R3).

MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure an opened insulin pen was correctly dated when the insulin would expire for one of one resident (R3). Additionally, the licensee failed to monitor for expired medication for one of two unidentified residents. [...]”

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 [...]”

Summary: MDH found the licensee failed to follow procedure for loss and spillage of a controlled substance that was managed by the licensee for two of two residents (R7, R10).

MDH’s finding, as written: “Based on observation and record review, the licensee failed to follow procedure for loss and spillage of a controlled substance that was managed by the licensee for two of two residents (R7, R10). [...]”

Rule cited: “(a) Assisted living facilities providing medication management must develop and implement procedures for loss or spillage of all controlled substances defined in Minnesota Rules, part 6800.4220. [...]”

Summary: MDH found the licensee failed to obtain prescribed orders for a treatment and therapy for one of four residents (R3).

MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to obtain prescribed orders for a treatment and therapy for one of four residents (R3). 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 [...]”

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 [...]”

Summary: MDH found the licensee failed to obtain prescribed orders for a treatment and therapy for one of four residents (R3).

MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to obtain prescribed orders for a treatment and therapy for one of four residents (R3). 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 [...]”

Rule cited: “There must be an up-to-date written or electronically recorded order from an authorized prescriber for all treatments and therapies. [...]”

Summary: MDH found the licensee failed to provide hazard vulnerability assessment (or safety risk assessment) plan to identify hazard vulnerabilities and mitigations of the physical environment on and around the property for the facility to protect the memory care residents from harm.

MDH’s finding, as written: “Based on document review and interview, the licensee failed to provide hazard vulnerability assessment (or safety risk assessment) plan to identify hazard vulnerabilities and mitigations of the physical environment on and around the property for the facility to protect the memory care residents from harm. 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 [...]”

Summary: MDH found the licensee failed to ensure the assisted living facility with dementia care provided the required policies and procedures for four of four residents (R3, R4, R5, R6).

MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure the assisted living facility with dementia care provided the required policies and procedures for four of four residents (R3, R4, R5, R6). [...]”

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 [...]”

Summary: MDH found the licensee failed to ensure an individualized activity plan contained all required content for four of four residents (R3, R4, R5, R6).

MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure an individualized activity plan contained all required content for four of four residents (R3, R4, R5, R6). [...]”

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

Summary: MDH found the licensee failed to provide care and services according to acceptable health care standards, medical or nursing standards for two of two residents (R3, R7) who utilized side 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 standards, medical or nursing standards for two of two residents (R3, R7) who utilized side 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.”