Engel Haus.

correction orders using federal software. Please disregard the heading of the fourth column that states, "Provider's Plan of Correction." A plan of correction is not required. MDH concludes the licensee is in substantial compliance. State law requires the facility must take action to correct the state correction orders and document the actions taken to comply in the facility's records. The Department reserves the right to return to the facility at any time should the Department receive a complaint or deem it necessary to ensure the health, safety, and welfare of residents in your care. The MDH Health Regulation Division (HRD) values your feedback about your experience during the survey and/or investigation process. Please fill out this anonymous provider feedback questionnaire at your convenience at this link: h ttps://forms.office.com/g/Bm5uQEpHVa. Your input is important to us and will enable MDH to improve its processes and communication with providers. If you have any questions regarding the questionnaire, please contact Susan Winkelmann at susan.winkelmann@state.mn.us or call 651-201-5952. You are encouraged to retain this document for your records. It is your responsibility to share the information contained in the letter and state form with your organization’s Governing Body. If you have any questions, please contact me. Sincerely, Kelly Thorson, Supervisor State Evaluation Team Email: kelly.thorson@state.mn.us Telephone: 320-223-7336 Fax: 1-866-890-9290 JMD An equal opportunity employer. Letter ID: IS7N REVISED 09/13/2021 PRINTED: 06/02/2025 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B. WING _____________________________ 30893 04/2 /2025 4 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 5101 KASSEL AVENUE NE ENGEL HAUS ALBERTVILLE, MN 55301 SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X4) ID ID (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE TAG TAG DEFICIENCY) 0 000 Initial Comments 0 000 ASSISTED LIVING PROVIDER LICENSING Minnesota Department of Health is CORRECTION ORDER(S) documenting the State Correction Orders using federal software. Tag numbers have In accordance with Minnesota Statutes, section been assigned to Minnesota State 144G.08 to 144G.95, these correction orders are Statutes for Assisted Living Facilities. The issued pursuant to a survey. assigned tag number appears in the far-left column entitled "ID Prefix Tag." The Determination of whether violations are corrected state Statute number and the requires compliance with all requirements corresponding text of the state Statute out provided at the Statute number indicated below. of compliance is listed in the "Summary When Minnesota Statute contains several items, Statement of Deficiencies" column. This failure to comply with any of the items will be column also includes the findings which considered lack of compliance. are in violation of the state requirement after the statement, "This Minnesota INITIAL COMMENTS: requirement is not met as evidenced by." Following the evaluators ' findings is the SL30893016-0 Time Period for Correction. On April 21, 2025, through April 24, 2025, the PLEASE DISREGARD THE HEADING OF survey at the above provider. At the time of the STATES,"PROVIDER'S PLAN OF survey, there were 68 resident(s); 51 receiving CORRECTION." THIS APPLIES TO services under the Assisted Living Facility with FEDERAL DEFICIENCIES ONLY. THIS Dementia Care license. As a result of the survey WILL APPEAR ON EACH PAGE. the licensee is in substantial compliance. THERE IS NO REQUIREMENT TO SUBMIT A PLAN OF CORRECTION FOR VIOLATIONS OF MINNESOTA STATE STATUTES. THE LETTER IN THE LEFT COLUMN IS USED FOR TRACKING PURPOSES AND REFLECTS THE SCOPE AND LEVEL ISSUED PURSUANT TO 144G.31 SUBDIVISION 1-3. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 9I4M11 If continuation sheet 1 of 1 3333 Division St #212 St. Cloud Type: Full Page 1 Food and Beverage Establishment Date: 04/21/25 Inspection Report Time: 11:00:00 Report: 1051251109 Location: Establishment Info: Engel Haus ID #: 0039347 Risk: 5101 Kassel Avenue Ne Announced Inspection: No Albertville, MN55301 Wright County, 86 License Categories: Operator: Phone #: 7634984594 Expires on: / / ID #: The violations listed in this report include any previously issued orders and deficiencies identified during this inspection. Compliance dates are shown for each item. No NEW orders were issued during this inspection. Surface and Equipment Sanitizers Hot Water: = at 169 Degrees Fahrenheit Location: DISHMACHINE Violation Issued: No Acid: = 704 PPM at Degrees Fahrenheit Location: WIPING CLOTH BUCKET-MAIN KITCHEN Violation Issued: No Acid: = 1875 PPM at Degrees Fahrenheit Location: WIPING CLOTH BUCKET-PREP SINK Violation Issued: No Food and Equipment Temperatures Process/Item: Hot Holding Temperature: 157 Degrees Fahrenheit - Location: BEEF Violation Issued: No Process/Item: Cold Line Temperature: 38 Degrees Fahrenheit - Location: HAM Violation Issued: No Process/Item: Upright Cooler Temperature: 41 Degrees Fahrenheit - Location: POOL EGGS Violation Issued: No Process/Item: Walk-In Cooler Temperature: 37 Degrees Fahrenheit - Location: PIZZA SAUCE Violation Issued: No Type: Full Page 2 Food and Beverage Establishment Date: 04/21/25 Inspection Report Time: 11:00:00 Report: 1051251109 Engel Haus Process/Item: Walk-In Cooler Temperature: 41 Degrees Fahrenheit - Location: PARMESAN CHEESE Violation Issued: No Process/Item: Upright Cooler Temperature: 41 Degrees Fahrenheit - Location: MILK-MEMORY CARE AREA Violation Issued: No Total Orders In This Report Priority 1 Priority 2 Priority 3 0 0 0 DISCUSSED THE FOLLOWING WITH THE CULINARY MANAGER, JACKIE: EMPLOYEE ILLNESS LOG VOMIT CLEAN-UP PROCEDURE HANDWASHING & GLOVE NOTE: Plans and specifications must be submitted for review and approval prior to new construction, remodeling or alterations. I acknowledge receipt of the Minnesota Department of Health inspection report number 1051251109 of 04/21/25. Jaclyn M. Hemingson Certified Food Protection Manager: 114283 11/30/25 Certification Number: Expires: Inspection report reviewed with person in charge and emailed. Signed: Signed: Jackie Uribe Kai Yang Culinary Manager Public Health Sanitarian 1 St. Cloud Kai.Yang@state.mn.us Food Establishment Inspection Report Report #: 1051251109 No. of Repeat RF/PHI Categories Out 0 Time In 11:00:00 3333 Division St #212 St. Cloud Legal Authority MN Rules Chapter 4626 Time Out Engel Haus Address City/ State Zip Code Telephone 5101 Kassel Avenue Ne Albertville, MN 55301 7634984594 License/ Permit # Permit Holder Purpose of Inspection Est Type Risk Category 0039347 Full FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS Circle designated compliance status (IN, OUT, N/O, N/A) for each numbered item Mark "X" in appropriate box for COS and/or R IN= in compliance OUT= not in compliance N/O= not observed N/A= not applicable COS=corrected on-site during inspection R= repeat violation Compliance Status COS R Compliance Status COS R Surpervision Time/Temperature Control for Safety 1 IN OUT PIC knowledgeable; duties & oversight 18 IN OUT N/A N/O Proper cooking time & temperature 2 IN OUT N/A Certified food protection manager, duties 19 IN OUT N/A N/O Proper reheating procedures for hot holding Employee Health 20 IN OUT N/A N/O Proper cooling time & temperature 3 IN OUT Mgmt/Staff;knowledge,responsibilities&reporting 21 IN OUT N/A N/O Proper hot holding temperatures 4 IN OUT Proper use of reporting, restriction & exclusion 22 IN OUT N/A Proper cold holding temperatures Procedures for responding to vomiting & diarrheal 5 23 IN OUT N/A N/O Proper date marking & disposition IN OUT events 24 IN OUT N/A N/O Time as a public health control: procedures & records Good Hygenic Practices 6 IN OUT N/O Proper eating, tasting, drinking, or tobacco use Consumer Advisory 7 IN OUT N/O No discharge from eyes, nose, & mouth 25 IN OUT N/A Consumer advisory provided for raw/undercooked food Highly Susceptible Populations Preventing Contamination by Hands 8 IN OUT N/O Hands clean & properly washed 26 IN OUT N/A Pasteurized foods used; prohibited foods not offered Food and Color Additives and Toxic Substances No bare hand contact with RTE foods or pre-approved 9 IN OUT N/A N/O alternate pprocedure properly followed 27 IN OUT N/A Food additives: approved & properly used 10 IN OUT Adequate handwashing sinks supplied/accessible 28 IN OUT Toxic substances properly identified, stored, & used Approved Source Conformance with Approved Procedures 11 IN OUT Food obtained from approved source 29 IN OUT N/A Compliance with variance/specialized process/HACCP 12 IN OUT N/A N/O Food received at proper temperature 13 IN OUT Food in good condition, safe, & unadulterated Required records available; shellstock tags, 14 IN OUT N/A N/O parasite destruction Risk factors (RF) are improper practices or proceedures identified as the most prevalent contributing factors of foodborne illness or injury. Protection from Contamination Public Health Interventions (PHI) are control measures to prevent foodborne illness or injury.