The Centennial House of Apple

Survey completed March 23, 2023: 11 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 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 effective infection control program that complies with accepted health care, medical and nursing standards related to glove use and handwashing during treatment and medication administration by five of five unlicensed personnel (ULP-G, ULP-E, ULP-J, ULP-I, ULP-K).

  MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to establish and maintain an effective infection control program that complies with accepted health care, medical and nursing standards related to glove use and handwashing during treatment and medication administration by five of five unlicensed personnel (ULP-G, ULP-E, ULP-J, ULP-I, ULP-K). This had the potential to affect all residents. [...]”

  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, isolated scope, scope/level letter D · correction period: Seven (7) days
  Details

  Summary: MDH found the licensee failed to ensure an individual abuse prevention plan was developed to include the required content for one of four residents (R3).

  MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure an individual abuse prevention plan was developed to include the required content for one of four residents (R3). [...]”

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

• 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 required content for an emergency relocation and failed to notify the Office of Ombudsman for Long-Term Care of the emergency relocation for one of three residents (R5).

  MDH’s finding, as written: “Based on interview and record review, the licensee failed to provide a written notice with required content for an emergency relocation and failed to notify the Office of Ombudsman for Long-Term Care of the emergency relocation for one of three residents (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 1440: 144G.62 Subd. 4 Supervision of staff providing delegated nurs Level 2, isolated scope, scope/level letter D · correction period: Twenty-one (21) days
  Details

  Summary: MDH found the licensee failed to ensure the registered nurse (RN) conducted direct supervision of staff performing delegated nursing or therapy tasks within 30 days of first providing those services for one of two unlicensed personnel (ULP-I).

  MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to ensure the registered nurse (RN) conducted direct supervision of staff performing delegated nursing or therapy tasks within 30 days of first providing those services for one of two unlicensed personnel (ULP-I). [...]”

  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 [...]”

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

Allegation, as written: “The facility neglected the resident when the facility failed to ensure the resident was checked hourly, given meals, and given water per her plan of care. The resident experienced falls and had an instance when she was not given food and water for twenty hours.”

“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 there were instances when the resident did not have meals, it could not be determined if the resident was declining meals or if meals were not offered. The resident was found on the floor, however, there was conflicting accounts of how often the resident was checked and it could not be determined if neglect contributed to the residents fall(s).”

Action taken by facility: “The facility conducted internal reviews of food related incidents.”

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

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

Allegation, as written: “The facility neglected the resident when had a change in condition with neurological changes.”

“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. An unlicensed caregiver noticed changes in the resident and notified the nurse appropriately. The nurse assessed the resident and arranged transport to the hospital.”

Action taken by facility: “The facility staff transferred the resident when a change in condition was identified.”

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

Survey completed July 14, 2026: no correction orders issued.

Allegation, as written: “The alleged perpetrator (AP) neglected the resident when the resident did not receive prescribed medications as ordered.”

“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. Upon review of the resident record, transcription errors were present, and medications were not given to the resident as prescribed, however, the alleged perpetrator was unaware of errors in the order transcription process.”

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

Survey completed October 1, 2024: 1 correction order

• Tag 650: 144G.42 Subd. 8 Employee records Level 2, isolated scope, scope/level letter D · correction period: Twenty-one (21) days
  Details

  Summary: MDH found the licensee failed to ensure the employee record contained the required content for one of one employee records (RN-D).

  MDH’s finding, as written: “Based on interview, and record review, the licensee failed to ensure the employee record contained the required content for one of one employee records (RN-D). 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: “(a) The facility must maintain current records of each paid employee, each regularly scheduled volunteer providing services, and each individual contractor providing services. [...]”