Suite Living Senior Care of Br

Survey completed December 1, 2022: 18 correction orders

• 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 the staffing plan was posted for residents, staff, and visitors to review as required.

  MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure the staffing plan was posted for residents, staff, and visitors to review 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 Subd 1 (13) (i) (B) Minimum requirements Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
  Details

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

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

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

• Tag 510: 144G.41 Subd. 3 Infection control program Level 2, widespread scope, scope/level letter F · correction period: Seven (7) days
  Details

  MDH’s finding, as written: “Based on observation, interview, and record 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. This practice had the potential to affect the licensee's 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 630: 144G.42 Subd. 6 (b) Compliance with requirements for reporting ma Level 2, widespread scope, scope/level letter F · correction period: Seven (7)
  Details

  Summary: MDH found the licensee failed to ensure an individual abuse prevention plan (IAPP) was developed to include the required content for one of three residents (R4).

  MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure an individual abuse prevention plan (IAPP) was developed to include the required content for one of three residents (R4). [...]”

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

• 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 interview and record review the licensee failed to have a written emergency preparedness plan (EPP) with all the required content. This had the potential to affect all residents receiving services under the assisted living license. [...]”

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

From MDH’s letter: the letter says the facility is in substantial compliance.

Total fines assessed, as printed in the letter: $3,500.00.

Allegation, as written: “The alleged perpetrator (AP), who was an unknown facility staff member, abused the resident when they restricted his movement by taking away his wheelchair and locking his room. As a result, the resident could not access his bathroom, bedroom, or personal property.”

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

Summary: MDH looked into an allegation and found: abuse inconclusive.

MDH’s conclusion, as written: “The Minnesota Department of Health determined abuse was inconclusive. It could not be determined if staff encouraged the resident to stay out of his room for his safety or if staff consistently locked the resident's door to prevent him from entering due to conflicting information. The resident fell fifteen times within three months while unattended in his room self-transferring. Additionally, the resident was observed sitting in a chair with his wheelchair out of reach, however nursing staff indicated that was not a directive given to the unlicensed personnel (ULP).”

Action taken by facility: “The facility leadership staff told ULPs to keep the resident's wheelchair next to him.”

Action taken by MDH: “The facility was found to be in noncompliance.”

Survey completed August 27, 2025: 1 correction order

• Tag 450: 144G.41 Subdivision 1 Minimum requirements Level 2, isolated scope, scope/level letter D
  Details

  Summary: MDH found the facility failed to provide services in a person-centered manner by utilizing confinement as a fall intervention for one of one resident (R1) with record reviewed.

  MDH’s finding, as written: “Based on interview, observation, and record review, the facility failed to provide services in a person-centered manner by utilizing confinement as a fall intervention for one of one resident (R1) with record reviewed. [...]”

  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 [...]”

Allegation, as written: “The facility neglected a resident when staff did not administer her prescribed medication for several days. The resident was hospitalized with abdominal pain and distention.”

“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 may not have received all her scheduled doses of a prescribed medication during approximately two weeks, there was conflicting staff member documentation on the medication's availability and administration. The facility had a process in place for unlicensed staff members to notify nurses when a medication was low and needed to be refilled. Nursing and unlicensed staff members gave conflicting information during interviews on when the nurse was notified about the medication needing to be refilled. The resident was hospitalized for one week for treatment of abdominal pain. In addition, the hospital physician and primary physician had conflicting causes of the resident's hospitalization. An equal opportunity employer.”

Action taken by facility: “The nurse re-educated staff members on the resident's lactulose, documentation expectations and the refill process. The nurse increased her medication cart audits and ensured competency testing of unlicensed staff.”

Action taken by MDH: “The facility was found to be in noncompliance.”

Survey completed July 24, 2023: 5 correction orders

• Tag 620: 144G.42 Subd. 6 (a) Compliance with requirements for reporting ma Level 2, isolated scope, scope/level letter D
  Details

  Summary: MDH found the licensee failed to comply with the requirements for reporting maltreatment of vulnerable adults for one of one residents (R1) reviewed.

  MDH’s finding, as written: “Based on record review and interview, the licensee failed to comply with the requirements for reporting maltreatment of vulnerable adults for one of one residents (R1) reviewed. Staff failed to report a medication error after R1's medical doctor (MD)-I informed them that R1 had missed multiple prescribed doses of lactulose. R1 was hospitalized for abdominal pain. [...]”

  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 730: 144G.43 Subd. 3 Contents of resident record Level 2, isolated scope, scope/level letter D
  Details

  Summary: MDH found the licensee lacked documentation that the nurse refilled a prescription medication for one of one (R1) resident.

  MDH’s finding, as written: “Based on record review, observation and interview, the licensee lacked documentation that the nurse refilled a prescription medication for one of one (R1) resident. R1 was hospitalized for abdominal pain and neurogenic bowel. [...]”

  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 750: 144G.43 Subd. 5 Record retention Level 2, isolated scope, scope/level letter D
  Details

  Summary: MDH found the licensee lacked prescription medication refill records for one of one (R1)

  MDH’s finding, as written: “Based on record review, observation and interview, the licensee lacked prescription medication refill records for one of one (R1) resident. 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 limited [...]”

  Rule cited: “Following the resident's discharge or termination of services, an assisted living facility must retain a resident's record for at least five years or as otherwise required by state or federal regulations. [...]”

• Tag 1760: 144G.71 Subd. 8 Documentation of administration of medication Level 3, isolated scope, scope/level letter G
  Details

  Summary: MDH found the licensee failed to administer medications as ordered for one of one residents, (R1) reviewed.

  MDH’s finding, as written: “Based on record review, observation and interview, the licensee failed to administer medications as ordered for one of one residents, (R1) reviewed. Staff members documented conflicting information on R1's prescribed lactulose as given or unavailable. R1 was hospitalized for one week with abdominal distention after not receiving several doses of her lactulose. [...]”

  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 3000: 626.557 Subd. 3 Timing of report Level 2, isolated scope, scope/level letter D
  Details

  Summary: MDH found the licensee failed to comply with the requirements for reporting maltreatment of vulnerable adults for one of one residents (R1) reviewed.

  MDH’s finding, as written: “Based on record review and interview, the licensee failed to comply with the requirements for reporting maltreatment of vulnerable adults for one of one residents (R1) reviewed. Staff failed to report a medication error after R1's medical doctor (MD)-I informed them that R1 had missed multiple prescribed doses of lactulose. R1 was hospitalized for abdominal pain. [...]”

  Rule cited: “(a) A mandated reporter who has reason to believe that a vulnerable adult is being or has been maltreated, or who has knowledge that a vulnerable adult has sustained a physical injury which is not reasonably explained shall immediately report the information [...]”