Presbyterian Homes of Blooming.
Presbyterian Homes of Blooming is Grade C, ranked in the top 48% of Minnesota memory care with 1 MDH citation on record; last inspected Sep 2025.
A large home, reviewed on public record.
Ranked against 138 Minnesota facilities.
ALF memory care · 36-month window. Higher percentile = better. Source: Minnesota Dept. of Health · Health Regulation Division.
FACILITY WATCH · BETA
Presbyterian Homes of Blooming has 1 citation on record. Know the moment anything changes.
New findings, complaint investigations, or status changes — emailed to you free.
Citation history, plotted month by month.
1 deficiencie on record. Each bar is a month with a citation.
Finding distribution
1 total · 36 monthsScope × Severity (CMS A–L)
Questions to ask before you visit.
A short pre-tour checklist tailored to Presbyterian Homes of Blooming's record and state requirements.
The facility holds an Assisted Living Facility with Dementia Care license under Minnesota Statute chapter 144G with 111 licensed beds — can you walk us through the written dementia care program and explain how care plans are individualized for residents with memory loss?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
Minnesota Department of Health records show one complaint on file — can you share what that complaint involved, whether it was substantiated, and what corrective actions the facility implemented in response?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
The most recent MDH inspection on September 18, 2025 found zero deficiencies across all regulatory standards — can you explain the facility's internal quality assurance process and how staff prepare for state inspections to maintain compliance?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
Every MDH visit, verbatim.
3 inspections in the public record, most recent first. Click any row to expand — cited rows open automatically.
2026-02-11Complaint Investigation1 · Substantiated Finding
Plain-language summary
A complaint investigation found that a staff member financially exploited six residents by taking their debit cards, credit cards, and cash to make unauthorized purchases and fraudulent charges totaling thousands of dollars; the staff member admitted to the theft during interviews with law enforcement. For one resident, missing cash and a check were later found in her room, and for another resident, suspicious account activity was determined to be unrelated identity theft from outside the facility. The staff member was placed on administrative leave during the investigation.
“MDH substantiated maltreatment or licensing violation finding”
Full inspector notes
Finding: Substantiated, individual responsibility Nature of Investigation: The Minnesota Department of Health investigated an allegation of maltreatment, in accordance with the Minnesota Reporting of Maltreatment of Vulnerable Adults Act, Minn. Stat. 626.557, and to evaluate compliance with applicable licensing standards for the provider type. Initial Investigation Allegation(s): The alleged perpetrator (AP) financially exploited residents (resident 1, resident 2, resident 3, resident 4, resident 5, resident 6, resident 7, resident 8) when she took resident debit cards, credit cards, and cash to make personal purchases with them. Investigative Findings and Conclusion: The Minnesota Department of Health determined financial exploitation was substantiated. The AP was responsible for the maltreatment of resident 1, resident 2, resident 4, resident 5, resident 6, and resident 7. The AP admitted she stole resident credit and debit cards, and made fraudulent charges to the accounts of resident 1, resident 2, resident 4, resident 5, resident 6, and resident 7, to law enforcement. Resident 3’s missing cash and check were found in her room approximately two weeks after they were reported missing. Law enforcement determined the fraudulent activity to the saving’s account of resident 8 were a result of identity theft of another person in another state and was not related to the fraudulent activity that occurred at the facility. The investigator conducted interviews with facility staff members, including administrative staff and unlicensed staff. The investigator contacted law enforcement. The investigation included review of resident records, resident financial records, facility internal investigations, facility incident reports, personnel files, staff schedules, law enforcement reports, and related facility policy and procedures. Resident 1 Resident 1 resided in an assisted living facility. The resident’s diagnoses included type two diabetes, chronic heart failure, and difficulty walking. The resident’s service plan included assistance with toileting, laundry, and bathing. The resident’s assessment indicated the resident was alert, oriented, used a walker for walking, and was independent with her finances. A facility internal investigation document indicated resident 1 notified facility staff her debit card was missing. The following day, facility staff assisted resident 1 by calling her bank, reviewed surveillance video footage, contacted law enforcement, and placed the AP on administrative leave. The document indicated law enforcement notified the facility the AP admitted to taking resident 1’s debit card to the law enforcement officer during an interview with the AP. The document indicated $3,838.39 was fraudulently charged to resident 1’s debit card. Resident 1’s debit card statement indicated 17 fraudulent charges were placed on resident 1’s account, three of which were in person attempts at a local coffee shop and store. The remaining attempts were online purchases. The facility staff schedule indicated the AP was scheduled to work from 3:30 p.m. to 10:00 p.m. and was not assigned to resident 1’s care on the day resident 1’s debit card was noted to be missing by resident 1. Facility video surveillance footage showed the AP entering resident 1’s room, and exiting two minutes later on the day resident 1 noted her debit card missing. An email from the law enforcement detective to the facility, included photos of the AP at the store on the date and at the time a fraudulent charge was placed to resident 1’s debit card from the same store. Facility notes from an investigative interview with the AP indicated the AP stated she entered resident 1’s room to answer resident 1’s call light. The AP stated she assisted resident 1 to pull up her pants in the bathroom and left. The AP stated she did not see anything laying out in resident 1’s apartment and asked if any other staff were being questioned about resident 1’s missing debit card. The same document, dated six days later, indicated a second interview was completed by facility staff with the AP. The AP was questioned about the date she was noted on camera at the store while she was scheduled to be on shift at the facility. The document indicated the AP stated she went to her car to eat and take her break, but staff had noted her to be gone for 45 minutes. The document indicated the AP stated she had left the facility and went to the store to get medicine for herself. The document indicated facility staff had record the AP left the facility and returned to the building 45 minutes later. The document indicated it took seven minutes to drive back to the facility from the store. An email received from law enforcement indicated the AP admitted to taking and using resident 1’s card during two interviews completed by law enforcement. Resident 2 Resident 2 resided in an assisted living facility. The resident’s diagnoses included dementia and bone cancer. The resident’s service plan included assistance with medication administration, laundry, grooming and bathing. The resident’s assessment indicated the resident used a walker for walking, had severe cognitive impairment, and had a family member manage her finances. A facility internal investigation document indicated the facility was notified resident 2’s credit card was missing, and law enforcement was contacted. The document indicated 31 known fraudulent charges to resident 2’s account that totaled $571.19 at the time the incident was reported. The document indicated the fraudulent charges started one month earlier. The facility staff schedule indicated the AP was scheduled to work at the facility and assigned to care for resident 2 the day fraudulent charges started on resident 2’s credit card. An email received from law enforcement indicated the AP admitted to taking and using resident 2’s card during two interviews completed by law enforcement. Resident 3 Resident 3 resided in an assisted living facility. The resident’s diagnoses included hypertension, osteoporosis, and anemia. The resident’s service plan included assistance with medication administration. The resident’s assessment indicated the resident was independent with activities of daily living, alert, oriented, and made her own financial decisions. A facility internal investigation document indicated resident 3’s family notified the facility that resident 3 was missing $400 in cash and a check written out to resident 3 for $600. The document indicated the cash and check were found in resident 2’s room two weeks later. Resident 4 Resident 4 resided in an assisted living facility. The resident’s diagnoses included atrial fibrillation, physical debility and history of falls. The resident’s service plan included assistance with homemaking, medication administration, and bathing. The resident’s assessment indicated the resident was independent walking with a walker, was alert and oriented, and had a family member manage his finances. A facility internal investigation document indicated resident 4’s family member notified the facility of fraudulent charges to resident 4’s debit card and credit card accounts, that occurred approximately two months prior. Resident 4’s bank statement indicated 10 fraudulent transactions on resident 4’s bank account that totaled $551.61. The facility staff schedule indicated the AP worked at the facility the day the fraudulent charges started on resident 4’s bank account. Resident 4’s service delivery record indicated the AP assisted resident 4 with his shower the day before fraudulent charges started on his bank account. An email received from law enforcement indicated the AP admitted to taking and using resident 4’s cards during two interviews completed by law enforcement. Resident 5 Resident 5 resided in an assisted living facility. The resident’s diagnoses included cirrhosis of the liver and edema. The resident’s service plan included daily assistance with his leg wraps. The resident’s assessment indicated the resident was independent with activities of daily living, was alert and oriented, and managed his own finances with help from a family member. A facility internal investigation document indicated resident 5 notified facility staff his credit card and wedding ring were missing for four to five days. The document indicated there was $1000.00 of known fraudulent charges to resident 5’s credit card. The facility staff schedule indicated the AP was assigned to care for resident 5 for two shifts during the time frame resident 5 stated his credit card and wedding ring went missing. An email received from law enforcement indicated the AP admitted to taking and using resident 5’s card during two interviews completed by law enforcement. Resident 6 Resident 6 resided in an assisted living facility. The resident’s diagnoses included atrial fibrillation, anemia, and anxiety. The resident’s service plan included assistance with incontinence care, homemaking, bathing, and transfers. The resident’s assessment indicated the resident was alert and oriented, used a wheelchair independently, and managed her own finances.
2025-09-18Annual Compliance VisitNo findings
Plain-language summary
A routine inspection of Pres Homes of Bloomington on September 18, 2025, found violations in infection control program, fire protection and physical environment, and appropriate care and services. The facility was assessed a total fine of $2,000.00 and issued correction orders requiring documentation of how the violations were corrected. The facility has 15 calendar days to request reconsideration or a hearing if it wishes to challenge these findings.
Full inspector notes
correction orders. MDH documents state licensing correction orders using federal software. Tag numbers are assigned to Minnesota state statutes for Assisted Living Facilities .The assigned tag number appears in the far left column entitled "ID Prefix Tag". The state statute number and the corresponding text of the state statute out of compliance are listed in the "Summary Statemen tof Deficiencies "column. This column also includes the findings that are in violation of the state statute after the statement ,"This MN Requiremen its not met as evidenced by . . ." IMPOSITION OF FINES In accordanc ewith Minn. Stat. § 144G3. 1, Subd .4, fines and enforcemen tactions may be imposed based on the level and scope of the violations and may be imposed immediately with no opportunity to correct the violation first as follows: Leve l1: no fines or enforcement; Leve l2: a fine of $500 per violation, in addition to any enforcemen tmechanism authorized in § 144G2. 0; Leve l3: a fine of $1,000 per incident, in addition to any enforcemen tmechanism authorized in § 144G2. 0; Leve l4: a fine of $3,000 per incident, in addition to any enforcemen tmechanism authorized in § 144G2. 0; Leve l5: a fine of $5,000 per violation, in addition to any enforcemen tmechanism authorized in § 144G2. 0. Therefore ,in accordanc ewith Minn. Stat. §§ 144G0. 1 to 144G9. 999, the following fines are assessed pursuan tto this survey: An equal opportunity employer . Letter ID: IS7N REVISED 09/13/2021 Pres Homes Of Bloomington October 28, 2025 Page 2 0510 - 144g.41 Subd. 3 - Infection Control Program - $500.00 0775 - 144g.45 Subd. 2. (a) - Fire Protection And Physica lEnvironment - $500.00 2310 - 144g.91 Subd. 4 (a) - Appropriate Care And Services - $1,000.00 Therefore ,in accordanc ewith Minn. Stat. §§ 144G0. 1 to 144G9. 999, the total amount you are assesse dis $2,000.00. You will be invoiced approximately 30 days after receipt of this notice, subject to . appeal DOCUMENTATIO ONF ACTION TO COMPLY In accordance with Minn. Stat. § 144G3. 0, Subd .5(c), the licensee must documen tactions taken to comply with the correction orders within the time period outlined on the state form; however ,plans of correction are not required to be submitted for approval. The correction order documentation should include the following: x Identify how the area(s) of noncomplianc ewas corrected related to the resident(s)/ employees() identified in the correction order. x Identify how the area(s) of noncomplianc ewas corrected for all of the provider’s resident(s)/ employees that may be affected by the noncompliance. x Identify what changes to your systems and practices were made to ensure compliance with the specific statute(s). CORRECTIO ONRDER RECONSIDERATI PORNOCESS In accordanc ewith Minn. Stat. § 144G3. 2, Subd .2, you may challenge the correction order(s) issued, including the level and scope ,and any fine assesse dthrough the correction order reconsideration process T. he request for reconsideration must be in writing and received by MDH within 15 calendar days of the correction order receipt date. To submit a reconsideration request ,please visit: https:/ / forms.web.health.state.mn.us/form/ HRDAppealsForm REQUESTIN AG HEARING Alternatively ,in accordanc ewith Minn. Stat. § 144G3. 1, Subd .5(d), an assisted living provider that has been assesse da fine under this subdivision has a right to a reconsideration or a hearing under this section and chapter 14. Pursuan tto Minn. Stat. § 144G2. 0, Subd .14 and Subd .18, a request for a hearing must be in writing and received by the Departmen tof Health within 15 busines sdays of the correction order receipt date. The request must contain a brief and plain statement describing each matter or issue contested and any new information you believe constitutes a defense or mitigating factor. To submit a hearing request ,please visit: https:/ / forms.web.health.state.mn.us/form/ HRDAppealsForm Pres Homes Of Bloomington October 28, 2025 Page 3 To appea lfines via reconsideration p, lease follow the procedure outlined above .Please note that you may request a reconsideration or a hearing ,but not both. If you wish to contest tags without fines in a reconsideration and tags with the fines at a hearing ,please submit two separate appeals forms at the website listed above. The MDH Health Regulation Division (HRD )values your feedback about your experience during the survey and/or investigation process .Please fill out this anonymou sprovider feedback questionnaire at your convenienc eat this link: https:/ / forms.office.com/g/Bm5uQEpHV.a Your input is important to us and will enable MDH to improve its processe sand communication with providers .If you have any questions regarding the questionnaire p, lease contact Susan Winkelmann at susanw. inkelmann@state.mn.us or call 651-201-5952. You are encouraged to retain this documen tfor your records .It is your responsibility to share the information contained in the letter and state form with your organizations’ Governing Body. If you have any questions ,please contact me. Sincerely, Jess Schoenecke Sr,upervisor State Evaluation Team Email :jesss. choenecker@state.mn.us Telephone 6: 51-201-3789 Fax :1-866-890-9290 JMD PRINTED: 10/28/2025 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 _____________________________ 24062 09/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 9889 PENN AVENUE SOUTH PRES HOMES OF BLOOMINGTON BLOOMINGTON, MN 55431 SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X4) ID ID (X5) (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE PREFIX PREFIX REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE TAG TAG DEFICIENCY) 0 000 Initial Comments 0 000 *****ATTENTION***** Minnesota Department of Health is documenting the State Correction Orders ASSISTED LIVING PROVIDER LICENSING using federal software. Tag numbers have CORRECTION ORDER(S) been assigned to Minnesota State Statutes for Assisted Living Facilities. The In accordance with Minnesota Statutes, section assigned tag number appears in the 144G.08 to 144G.95, these correction orders are far-left column entitled "ID Prefix Tag." issued pursuant to a survey. The state Statute number and the corresponding text of the state Statute out Determination of whether violations are corrected of compliance is listed in the "Summary requires compliance with all requirements Statement of Deficiencies" column. This provided at the Statute number indicated below. column also includes the findings which When Minnesota Statute contains several items, are in violation of the state requirement failure to comply with any of the items will be after the statement, "This Minnesota considered lack of compliance. requirement is not met as evidenced by." Following the evaluators' findings is the INITIAL COMMENTS: Time Period for Correction. SL24062016-0 PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On September 15, 2025, through September 18, STATES,"PROVIDER'S PLAN OF 2025, the Minnesota Department of Health CORRECTION." THIS APPLIES TO conducted a full survey at the above provider and FEDERAL DEFICIENCIES ONLY. THIS the following correction orders are issued. At the WILL APPEAR ON EACH PAGE. time of the survey, there were 90 residents receiving services under the Assisted Living THERE IS NO REQUIREMENT TO Facility with Dementia Care license. SUBMIT A PLAN OF CORRECTION FOR VIOLATIONS OF MINNESOTA STATE On September 18, 2025, an immediate correction STATUTES. order was issued for tag identification 2310. THE LETTER IN THE LEFT COLUMN IS During the course of the survey, the licensee USED FOR TRACKING PURPOSES AND took action to mitigate the imminent risk. REFLECTS THE SCOPE AND LEVEL Noncompliance remained and the scope and ISSUED PURSUANT TO 144G.31 level remain unchanged. SUBDIVISION 1-3. 0 480 144G.41 Subdivision 1 Subd. 1a (a-b) Minimum 0 480 SS=F requirements; required food services LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 TODM11 If continuation sheet 1 of 27 PRINTED: 10/28/2025 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 _____________________________ 24062 09/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 9889 PENN AVENUE SOUTH PRES HOMES OF BLOOMINGTON BLOOMINGTON, MN 55431 SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X4) ID ID (X5) (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE PREFIX PREFIX REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE TAG TAG DEFICIENCY) 0 480 Continued From page 1 0 480 (a) Except as provided in paragraph (b), food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626.
2023-06-08Annual Compliance VisitNo findings
Plain-language summary
A routine state licensing survey of this memory care facility was conducted June 5–8, 2023, and state correction orders were issued for violations of Minnesota statutes; no immediate fines were assessed. The facility must document in its records how it corrected each violation and what changes were made to prevent future noncompliance, with deadlines specified on the state form. The facility may request reconsideration of the correction orders in writing within 15 calendar days of receiving this letter.
Full inspector notes
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. STATE CORRECTION ORDERS The enclosed State Form documents the state correction orders. The MDH documents state licensing correction orders using federal software. Tag numbers are assigned to Minnesota state statutes for Assisted Living Facilities. The assigned tag number appears in the far left column entitled "ID Prefix Tag." The state statute number and the corresponding text of the state statute out of compliance are listed in the "Summary Statement of Deficiencies" column. This column also includes the findings that are in violation of the state statute after the statement, "This MN Requirement is not met as evidenced by . . ." In accordance with Minn. Stat. § 144G.31 Subd. 4, MDH may assess fines and enforcement actions based on the level and scope of the violations; however, no immediate fines are assessed for this survey of your facility. DOCUMENTATION OF ACTION TO COMPLY In accordance with Minn. Stat. § 144G.30, Subd. 5(c), the licensee must document actions taken to comply with the correction orders within the time period outlined on the state form; however, plans of correction are not required to be submitted for approval. The correction order documentation should include the following: Identify how the area(s) of noncompliance was corrected related to the resident(s)/employee(s) identified in the correction order. Identify how the area(s) of noncompliance was corrected for all of the provider’s resident(s)/employees that may be affected by the noncompliance. Identify what changes to your systems and practices were made to ensure compliance with the specific statute(s). An equal opportunity employer. Letter ID: IS7N REVISED 09/13/2021 Presbyterian Homes of Bloomington July 3, 2023 Page 2 CORRECTION ORDER RECONSIDERATION PROCESS In accordance with Minn. Stat. § 144G.32, Subd. 2, you may challenge the correction order(s) issued, including the level and scope, and any fine assessed through the correction order reconsideration process. The request for reconsideration must be in writing and received by the MDH within 15 calendar days of the correction order receipt date. A state correction order under Minn. Stat. § 144G.91, Subd. 8, Free from Maltreatment is associated with a maltreatment determination by the Office of Health Facility Complaints. If maltreatment is substantiated, you will receive a separate letter with the reconsideration process under Minn. Stat. § 626.557. Please email reconsideration requests to: Health.HRD.Appeals@state.mn.us. Please attach this letter as part of your reconsideration request. Please clearly indicate which tag(s) you are contesting and submit information supporting your position(s). Please address your cover letter for reconsideration requests to: Reconsideration Unit 85 East Seventh Place St. Paul, MN 55164‐0970 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, Jess Schoenecker, Supervisor State Evaluation Team Email: jess.schoenecker@state.mn.us Telephone: 651‐201‐3789 Fax: 651‐281‐9796 HHH PRINTED: 07/03/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ 24062 B. WING _____________________________ 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 9889 PENN AVENUE SOUTH PRES HOMES OF BLOOMINGTON BLOOMINGTON, MN 55431 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) 0 000 Initial Comments 0 000 ******ATTENTION****** Minnesota Department of Health is documenting the State Correction Orders ASSISTED LIVING PROVIDER LICENSING using federal software. Tag numbers have CORRECTION ORDER(S) been assigned to Minnesota State Statutes for Assisted Living License In accordance with Minnesota Statutes, section Providers. The assigned tag number 144G.08 to 144G.95, these correction orders are appears in the far left column entitled "ID issued pursuant to a survey. Prefix Tag." The state Statute number and the corresponding text of the state Statute Determination of whether violations are corrected out of compliance is listed in the requires compliance with all requirements "Summary Statement of Deficiencies" provided at the Statute number indicated below. column. This column also includes the When Minnesota Statute contains several items, findings which are in violation of the state failure to comply with any of the items will be requirement after the statement, "This considered lack of compliance. Minnesota requirement is not met as evidenced by." Following the surveyors' INITIAL COMMENTS: findings is the Time Period for Correction. SL24062015 PLEASE DISREGARD THE HEADING OF On June 5, 2023, through June 8, 2023, the THE FOURTH COLUMN WHICH survey at the above provider, and the following CORRECTION." THIS APPLIES TO correction orders are issued. At the time of the FEDERAL DEFICIENCIES ONLY. THIS survey, there were 88 active residents; 80 WILL APPEAR ON EACH PAGE. receiving services under the Assisted Living with Dementia Care license. 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 subd. 1, 2, and 3. 0 480 144G.41 Subd 1 (13) (i) (B) Minimum 0 480 SS=F requirements (13) offer to provide or make available at least the LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 379N11 If continuation sheet 1 of 13 PRINTED: 07/03/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ 24062 B. WING _____________________________ 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 9889 PENN AVENUE SOUTH PRES HOMES OF BLOOMINGTON BLOOMINGTON, MN 55431 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) 0 480 Continued From page 1 0 480 following services to residents: (B) food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626; and This MN Requirement is not met as evidenced by: 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 residents). The findings include: Please refer to the included document titled, Food and Beverage Establishment Inspection Report dated June 5, 2023, for the specific Minnesota Food Code deficiencies. TIME PERIOD FOR CORRECTION: Twenty-one (21) days 0 510 144G.41 Subd. 3 Infection control program 0 510 SS=D (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. (b)The facility's infection control program must be consistent with current guidelines from the STATE FORM 6899 379N11 If continuation sheet 2 of 13 PRINTED: 07/03/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ 24062 B. WING _____________________________ 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 9889 PENN AVENUE SOUTH PRES HOMES OF BLOOMINGTON BLOOMINGTON, MN 55431 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) 0 510 Continued From page 2 0 510 national Centers for Disease Control and Prevention (CDC) for infection prevention and control in long-term care facilities and, as applicable, for infection prevention and control in assisted living facilities. (c) The facility must maintain written evidence of compliance with this subdivision.
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