The Lodge

Last evaluation

December 19, 2024

Evaluations on record

2

Investigations substantiated

3 kept 7 years

Inconclusive

0 kept 4 years

Unsubstantiated

1 kept 3 years

Most recent evaluation (December 19, 2024, state report IYYB11)

MDH: “On December 16, 2024, through December 19, 2024, the Minnesota Department of Health conducted a full survey at the above provider.”

Survey completed December 19, 2024: 10 correction orders

• Tag 480: 144G.41 Subdivision 1 Subd. 1a (a-b) Minimum requirements; required food services Level 2, widespread scope, scope/level letter F · correction period: Please refer
  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, but was not likely to cause serious injury, impairment, or death), and is issued at a widespread scope (when problems are pervasive or represent a systemic failure that has [...]”

  Rule cited: “(a) Except as provided in paragraph (b), food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626. [...]”

• Tag 510: 144G.41 Subd. 3 Infection control program Level 2, widespread scope, scope/level letter F · correction period: Seven (7) days · fine: $500.00 assessed
  Details

  Summary: MDH found the licensee failed to establish and maintain an effective infection control program that complied with accepted health care, medical, and nursing standards related to gloving, hand hygiene, and catheter care for two of three employees (unlicensed personnel (ULP)-D, and ULP-E).

  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 complied with accepted health care, medical, and nursing standards related to gloving, hand hygiene, and catheter care for two of three employees (unlicensed personnel (ULP)-D, and ULP-E). [...]”

  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 660: 144G.42 Subd. 9 Tuberculosis prevention and control Level 2, widespread scope, scope/level letter F · correction period: Twenty-one (21) days
  Details

  Summary: MDH found the licensee failed to establish and maintain a tuberculosis (TB) prevention and control program based on the most current guidelines issued by the Centers for Disease Control and Prevention (CDC) to include completion of a two-step tuberculin skin test (TST) or other evidence of TB screening such as a blood test for two of three unlicensed personnel ((ULP)-D, ULP-E).

  MDH’s finding, as written: “Based on interview and record review, the licensee failed to establish and maintain a tuberculosis (TB) prevention and control program based on the most current guidelines issued by the Centers for Disease Control and Prevention (CDC) to include completion of a two-step tuberculin skin test (TST) or other evidence of TB screening such as a blood test for two of three unlicensed personnel ((ULP)-D, ULP-E). [...]”

  Rule cited: “(a) The facility must establish and maintain a comprehensive tuberculosis infection control program according to the most current tuberculosis infection control guidelines issued by the United States Centers for Disease Control and Prevention (CDC), Division [...]”

• Tag 780: 144G.45 Subd. 2 (a) (1) Fire protection and physical environment Level 2, isolated scope, scope/level letter D · correction period: Two (2) days
  Details

  Summary: MDH found the licensee failed to comply with the current Minnesota Fire Code provisions.

  MDH’s finding, as written: “Based on observation and interview, the licensee failed to comply with the current Minnesota Fire Code provisions. This had the potential to directly affect all residents, staff, and visitors. [...]”

  Rule cited: “for dwellings or sleeping units, as defined in the State Fire Code: (i) provide smoke alarms in each room used for sleeping purposes; (ii) provide smoke alarms outside each separate sleeping area in the immediate vicinity of bedrooms; (iii) provide smoke [...]”

• 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 the fire safety and evacuation plan with the required content and failed to conduct required drills.

  MDH’s finding, as written: “Based on observation, interview, and record review, the licensee failed to develop the fire safety and evacuation plan with the required content and failed to conduct required drills. This had the potential to directly affect all residents, staff, and visitors. [...]”

  Rule cited: “(b) Each assisted living facility shall develop and maintain fire safety and evacuation plans. [...]”

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

Fines assessed by MDH

• Tag 510 (144g.41 Subd. 3 - Infection Control Program): $500.00

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

Substantiated investigations (state reports)

• July 18, 2024 · report HL350512741M · MDH finding: Substantiated, individual responsibility
  Details

  Allegation, as written: “The alleged perpetrator (AP) financially exploited a resident when they took the resident's Percocet (narcotic) medication.”

  “The Minnesota Department of Health determined financial exploitation was substantiated.”

  “The AP was responsible for the maltreatment.”

  Summary: MDH looked into an allegation and found: financial exploitation substantiated (individual responsibility).

  MDH’s conclusion, as written: “The Minnesota Department of Health determined financial exploitation was substantiated. The AP was responsible for the maltreatment. The AP counted narcotic medications at the beginning of her shift and the narcotic medication count was correct. The AP counted narcotic medications at the end of her shift and three narcotic pills (Percocet) were unaccounted for. A staff member saw the AP tape pills into a medication card during the shift. The AP said she did not go into the narcotic box for the entirety of her shift, but camera images showed the AP entered the narcotic box multiple times during the shift.”

  Action taken by facility: “The facility provided education to staff members regarding narcotic diversion.”

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

  Survey completed May 29, 2024: 1 correction order

  • Tag 2360: 144G.91 Subd. 8 Freedom from maltreatment
    Details

    Summary: MDH found the facility failed to ensure one of one resident(s) reviewed (R1) was free from maltreatment.

    MDH’s finding, as written: “The facility failed to ensure one of one resident(s) reviewed (R1) was free from maltreatment. Findings include: The Minnesota Department of Health (MDH) issued a determination maltreatment occurred, and an individual person was responsible for the maltreatment, in connection with incidents which occurred at the facility. Please refer to the public maltreatment report for details. No plan of correction is required for this tag”

    Rule cited: “Residents have the right to be free from physical, sexual, and emotional abuse; neglect; financial exploitation; and all forms of maltreatment covered under the Vulnerable Adults Act.”

• August 16, 2023 · report HL350513563M · MDH finding: Substantiated, facility and individual responsibility
  Details

  Allegation, as written: “The alleged perpetrator (AP) emotionally abused the resident when the AP made a social media post showing a video of the resident sitting in her wheelchair, pulling her pajama dress up. The AP can be heard laughing in the video while saying, "This lady can't walk and she keeps trying to get up, she still wears a diaper."”

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

  “The facility and the AP were responsible for the maltreatment.”

  Summary: MDH looked into an allegation and found: abuse substantiated (facility and individual responsibility).

  MDH’s conclusion, as written: “The Minnesota Department of Health determined abuse was substantiated. The facility and the AP were responsible for the maltreatment. The AP posted a video of herself laughing at the resident on her Snapchat (social media application) account. Several staff members saw the video and reported it to management. The AP was terminated shortly after the incident. The facility failed to ensure the AP was trained on all required content upon hire, including topics related to dementia, vulnerable adult reporting, protecting resident rights, and resident privacy. An equal opportunity employer.”

  Action taken by facility: “The facility immediately investigated the allegation and subsequently terminated the AP. The facility made a timely report to MAARC and retrained staff on resident privacy.”

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

  Survey completed July 17, 2023: 3 correction orders

  • Tag 1300: 144G.60 Subd. 2 Qualifications, training, and competency Level 2, widespread scope, scope/level letter F
    Details

    Summary: MDH found the licensee failed to ensure one of one unlicensed personnel (ULP-A) was trained and competent in the provision of services with current practice standards appropriate to the residents' needs.

    MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure one of one unlicensed personnel (ULP-A) was trained and competent in the provision of services with current practice standards appropriate to the residents' needs. [...]”

    Rule cited: “All staff persons providing assisted living services must be trained and competent in the provision of services consistent with current practice standards appropriate to the resident's needs; and promote and be trained to support the assisted living bill of [...]”

  • Tag 1760: 144G.71 Subd. 8 Documentation of administration of medication Level 3, isolated scope, scope/level letter G · correction period: Seven (7) days
    Details

    Summary: MDH found the licensee failed to ensure medication was administered as prescribed for one of one residents (R2).

    MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure medication was administered as prescribed for one of one residents (R2). This practice resulted in a level three violation (a violation that harmed a resident's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to 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: “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 2360: 144G.91 Subd. 8 Freedom from maltreatment
    Details

    Summary: MDH found the facility failed to ensure 2 of 2 residents reviewed (R1, R2) were free from maltreatment.

    MDH’s finding, as written: “The facility failed to ensure 2 of 2 residents reviewed (R1, R2) were free from maltreatment. R1 was abused. R2 was neglected. Findings include: The Minnesota Department of Health (MDH) issued a determination maltreatment occurred, and the facility was responsible for the maltreatment of R2, in connection with incidents which occurred at the facility. [...]”

    Rule cited: “Residents have the right to be free from physical, sexual, and emotional abuse; neglect; financial exploitation; and all forms of maltreatment covered under the Vulnerable Adults Act.”

• August 16, 2023 · report HL350516023M · MDH finding: Substantiated, facility responsibility
  Details

  Allegation, as written: “The facility neglected the resident when they failed to administer medications as ordered, resulting in the resident getting incorrect doses of Bumex (a medication to reduce extra fluid/edema in the body) over the course of several weeks. The resident had a seizure and received treatment at the hospital.”

  “The Minnesota Department of Health determined neglect was substantiated.”

  “The facility was responsible for the maltreatment.”

  Summary: MDH looked into an allegation and found: neglect substantiated (facility responsibility).

  MDH’s conclusion, as written: “The Minnesota Department of Health determined neglect was substantiated. The facility was responsible for the maltreatment. The facility failed to ensure the resident received his scheduled Bumex (a medication to reduce extra fluid/edema in the body) and missed approximately 56 doses of the medication. The resident suffered an episode of seizure-like activity and was treated in the emergency room for fluid overload. Facility nursing staff failed to notice the medication was documented as "not given" on the medication record and staff failed to notify the nurse the medication was not available and not administered. An equal opportunity employer.”

  Action taken by facility: “The facility identified the medication error after conducting an audit. The facility immediately reported the incident to MAARC and completed a medication error report.”

  Action taken by MDH: “The responsible party will be notified of their right to appeal the maltreatment finding. The facility was found to be in noncompliance.”

  Survey completed July 17, 2023: 3 correction orders

  • Tag 1300: 144G.60 Subd. 2 Qualifications, training, and competency Level 2, widespread scope, scope/level letter F
    Details

    Summary: MDH found the licensee failed to ensure one of one unlicensed personnel (ULP-A) was trained and competent in the provision of services with current practice standards appropriate to the residents' needs.

    MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure one of one unlicensed personnel (ULP-A) was trained and competent in the provision of services with current practice standards appropriate to the residents' needs. [...]”

    Rule cited: “All staff persons providing assisted living services must be trained and competent in the provision of services consistent with current practice standards appropriate to the resident's needs; and promote and be trained to support the assisted living bill of [...]”

  • Tag 1760: 144G.71 Subd. 8 Documentation of administration of medication Level 3, isolated scope, scope/level letter G · correction period: Seven (7) days
    Details

    Summary: MDH found the licensee failed to ensure medication was administered as prescribed for one of one residents (R2).

    MDH’s finding, as written: “Based on interview and record review, the licensee failed to ensure medication was administered as prescribed for one of one residents (R2). This practice resulted in a level three violation (a violation that harmed a resident's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to 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: “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 2360: 144G.91 Subd. 8 Freedom from maltreatment
    Details

    Summary: MDH found the facility failed to ensure 2 of 2 residents reviewed (R1, R2) were free from maltreatment.

    MDH’s finding, as written: “The facility failed to ensure 2 of 2 residents reviewed (R1, R2) were free from maltreatment. R1 was abused. R2 was neglected. Findings include: The Minnesota Department of Health (MDH) issued a determination maltreatment occurred, and the facility was responsible for the maltreatment of R2, in connection with incidents which occurred at the facility. [...]”

    Rule cited: “Residents have the right to be free from physical, sexual, and emotional abuse; neglect; financial exploitation; and all forms of maltreatment covered under the Vulnerable Adults Act.”

Summaries are ours and are marked “Summary”; quoted text is MDH’s own, shortened where marked [...]. Read the full reports at the links above or search every report on MDH’s site.

MDH keeps investigation results for seven years when allegations are substantiated, four years when inconclusive, and three years when unsubstantiated, so the counts cover different periods. This community is licensed for 150 residents; larger communities are evaluated and reported on more often, so read counts with size in mind. Source: Minnesota Department of Health, Health Regulation Division, data as of September 28, 2026. Always visit in person and ask the community about anything listed here.