The Cypress Manor

Survey completed November 23, 2022: 12 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: (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 650: 144G.42 Subd. 8 Employee records Level 2, widespread scope, scope/level letter F · correction period: Twenty-One
  Details

  Summary: MDH found the licensee failed to ensure employee records contained the required content for one of one

  MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure employee records contained the required content for one of one employee (unlicensed personnel (ULP)-C). [...]”

  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 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

  Summary: MDH found the licensee failed to have a written emergency preparedness plan with all the required content.

  MDH’s finding, as written: “Based on interview and record review, the licensee failed to have a written emergency preparedness plan with all the required content. 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 780: 144G.45 Subd. 2 (a) (1) Fire protection and physical environment Level 2, widespread scope, scope/level letter F · correction period: Seven (7) days
  Details

  Summary: MDH found the licensee failed to provide smoke alarms that complied with fire protection requirements.

  MDH’s finding, as written: “Based on observation and interview, the licensee failed to provide smoke alarms that complied with fire protection requirements. This had the potential to directly affect all residents and staff. [...]”

  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) [...]”

• 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

  Summary: MDH found the licensee failed to provide the physical environment in a continuous state of good repair and operation with regard to the health, safety, and well-being of the residents.

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

  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 [...]”

From MDH’s letter: no immediate fines.

Allegation, as written: “The alleged perpetrator (AP) abused the resident when the AP put a soiled wipe up to his face and then pushed him during a transfer.”

“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. The resident could not recall the incident; only the AP and one other staff member were able to provide firsthand knowledge of the incident.”

Action taken by facility: “The facility completed an investigation. The AP is no longer employed at the facility.”

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

Survey completed May 31, 2023: 3 correction orders

• Tag 590: 144G.42 Subd. 3 Facility restrictions Level 2, widespread scope, scope/level letter F · correction period: Seven (7) Days
  Details

  Summary: MDH found the licensee allowed a staff member, owner (OW)-F, to serve as power of attorney (POA) for two of two residents (R2, R3).

  MDH’s finding, as written: “Based on interview and record review, the licensee allowed a staff member, owner (OW)-F, to serve as power of attorney (POA) for two of two residents (R2, 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 a widespread scope (when problems are pervasive or represent a systemic [...]”

  Rule cited: “(a) This subdivision does not apply to licensees that are Minnesota counties or other units of government. [...]”

• Tag 620: 144G.42 Subd. 6 (a) 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 report suspected maltreatment of a vulnerable adult immediately, no longer than 24 hours, for an incident involving a resident (R1).

  MDH’s finding, as written: “Based on interview and record review, the licensee failed to report suspected maltreatment of a vulnerable adult immediately, no longer than 24 hours, for an incident involving a resident (R1). [...]”

  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 3000: 626.557 Subd. 3 Timing of report Level 2, isolated scope, scope/level letter D · correction period: Seven (7) Days
  Details

  Summary: MDH found the licensee failed to report suspected maltreatment of a vulnerable adult immediately, no longer than 24 hours, for an incident involving a resident (R1).

  MDH’s finding, as written: “Based on interview and record review, the licensee failed to report suspected maltreatment of a vulnerable adult immediately, no longer than 24 hours, for an incident involving a resident (R1). [...]”

  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 [...]”

Allegation, as written: “The facility neglected the resident when the facility staff failed to complete the resident's oral cares resulting in mucus plugs (mucus that is abnormally thick in consistency and plugs the airway) and a raw reddened throat.”

“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. Although mucus plugs were suctioned out of the resident's throat, the facility did not have a physician's order, or the means necessary, to complete suctioning on the resident. The facility provided oral care according to the resident's care plan and current medical provider orders.”

Action taken by facility: “The facility completed oral cares as ordered, assessed the resident, and sent him to the hospital when needed.”

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

Survey completed April 8, 2024: no correction orders issued.

Allegation, as written: “The facility neglected the resident when facility staff failed to complete turning and repositioning cares, resulting in a pressure ulcer and hospitalization.”

“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. When skin concerns were identified, the facility assessed, monitored, implemented interventions, and updated the resident's medical provider. The resident was hospitalized for issues unrelated to a pressure ulcer.”

Action taken by facility: “The facility assessed the resident's skin, notified the provider, and implemented treatments and interventions to prevent further skin breakdown.”

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

Survey completed April 8, 2024: no correction orders issued.