Flagstone.
Flagstone is Grade C, ranked in the top 44% of Minnesota memory care with 1 MDH citation on record; last inspected Aug 2025.
A large home, reviewed on public record.
Ranked against 142 Minnesota facilities.
ALF memory care · 36-month window. Higher percentile = better. Source: Minnesota Dept. of Health · Health Regulation Division.
FACILITY WATCH · BETA
Flagstone 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 Flagstone's record and state requirements.
The most recent MDH inspection on August 5, 2025 found zero deficiencies across all areas — can you walk us through the written policies and staff training protocols that support your dementia care program under Minnesota Statute chapter 144G?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
One complaint was filed with the Minnesota Department of Health during the inspection period on file — was that complaint substantiated, and what documentation can you provide showing how the facility responded?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
With 87 licensed beds and an Assisted Living Facility with Dementia Care designation, how does the facility describe its dementia supports in writing, and can families review the specific programming and environmental adaptations referenced in your license application?
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.
2026-04-15Complaint Investigation1 · Substantiated Finding
Plain-language summary
A complaint investigation found the facility was responsible for neglecting a resident by missing required daily "I'm okay" wellness checks for two consecutive days; the resident was subsequently found in bed severely dehydrated and soiled with urine and stool, was hospitalized with influenza and sepsis, and died approximately three weeks later from complications of influenza. The investigation determined that on the first day a staff member had marked the check complete before the resident ate breakfast, so the resident was not checked again that day, and on the second day the daily check sheet was never provided to staff responsible for monitoring residents who did not come to meals. The facility's policy required daily "I'm okay" checks for all residents, and facility leadership acknowledged the checks were missed for this resident over the two-day period.
“MDH substantiated maltreatment or licensing violation finding”
Full inspector notes
Finding: Substantiated, facility 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 facility neglected the resident when the resident was found in bed incontinent with urine and stool resulting in hospitalization. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was substantiated. The facility was responsible for the maltreatment. The resident was to receive “I’m okay” checks daily. The checks were missed for two consecutive days. The resident was found by family in bed, incontinent with urine, and confused. The resident was transported to the hospital, diagnosed with influenza and sepsis (a life-threatening medical emergency caused by the body’s extreme, overwhelming response to an infection, which triggers widespread inflammation and damages its own tissues and organs), and passed away approximately three weeks later while receiving hospice services. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigation included review of the resident records, death record, hospital records, facility incident reports, staff schedules, and related facility policy and procedures. Also, the investigator observed interactions between staff and residents. The resident resided in an assisted living facility. The resident’s diagnoses included giant cell arteritis (GCA) with polymyalgia rheumatica (PMR) (GCA is a severe vasculitis affecting large vessels, causing headaches and vision loss, while PMR causes proximal joint pain/stiffness) and dementia. The resident’s service plan included assistance with weekly medication management. The resident’s assessment indicated the resident was independent with activities of daily living, walked independently with a walker and had intact cognition. The resident’s medical record indicated the resident’s family attempted to call the resident and the resident did not answer. When the resident’s family arrived, the resident was severely dehydrated and ill. The medical record indicated the daily “I’m okay” check for the resident was missed or was not completed for two consecutive days. The resident’s family called emergency medical services, and the resident was transported to the hospital. Hospital record indicated emergency medical services found the resident confused in bed and soaked with urine. When the resident arrived at the hospital, the resident had a fever, altered mental status, weakness, and difficulty speaking. The resident was hospitalized for 16 days. The resident was positive with influenza A and sepsis. The hospital record indicated the resident was in a very “tenuous condition” (a state that is extremely weak, fragile, uncertain, or shaky). The hospital record indicated the resident was treated with medication and antibiotics, but the resident remained bed bound with poor appetite and failed to thrive. The resident was started on comfort care and transferred to a higher level of care. The resident’s death certificate indicated the resident passed away six days after being discharged from the hospital. The resident’s cause of death was complication from influenza A including sepsis. The facility’s documents and website indicated daily “I’m okay” checks would be completed for all residents. The facility’s investigation indicated the daily “I’m okay” checks were missed for the resident for two consecutive days. The facility had daily check sheets of all the residents and hung them up in the kitchen area. Culinary staff were to highlight the resident’s name on the sheets to indicate the “I’m okay” checks were completed for the residents when they enter the dining room for breakfast and lunch. On the first day, the resident’s name was highlighted green before breakfast started, which indicated the resident’s “I’m okay” check was already completed by someone. Because the resident’s name was highlighted, the resident was not included in the daily checks for residents that did not dine for breakfast or lunch that day. On the second day, the daily check sheet was not provided from the culinary team to the receptionist. Because the receptionist never received the daily check sheet, the resident’s “I’m okay” check was never completed. During an interview, an unlicensed staff member stated the evening the resident’s family called for help, she entered the resident’s apartment and there was a “stinky foul smell.” The resident was observed laying in a wet bed and the room smelled like urine. The resident was disorientated with a mouth dry. The unlicensed staff member stated the resident was trying to talk, but the resident could not be understood. During an interview, facility leadership stated a facility investigation was completed and revealed the resident did not receive daily “I’m okay” checks for two consecutive days. The resident was transferred to the hospital and did not return to the facility. Facility leadership stated the daily “I’m okay” checks were to ensure the residents were safe. During an interview, a family member stated after trying to call the resident multiple times without an answer, she drove to the facility. When they arrived, there was a package outside the resident’s door that had been delivered the previous day. Upon entering the resident’s apartment, there was a “terrible” smell, and the resident was moaning loudly. The resident was lying in a soiled bed, not able to talk, and her lips looked “terrible.” The family member stated they called emergency medical services and facility staff. The resident was transported to the hospital and enrolled into hospice services. The resident moved to a higher level of care and passed away approximately a week later. In conclusion, the Minnesota Department of Health determined neglect was substantiated. Substantiated: Minnesota Statutes, section 626.5572, Subdivision 19. “Substantiated” means a preponderance of evidence shows that an act that meets the definition of maltreatment occurred. Neglect: Minnesota Statutes, section 626.5572, subdivision 17 “Neglect” means neglect by a caregiver or self-neglect. (a) "Caregiver neglect" means the failure or omission by a caregiver to supply a vulnerable adult with care or services, including but not limited to, food, clothing, shelter, health care, or supervision which is: (1) reasonable and necessary to obtain or maintain the vulnerable adult's physical or mental health or safety, considering the physical and mental capacity or dysfunction of the vulnerable adult; and (2) which is not the result of an accident or therapeutic conduct. Vulnerable Adult interviewed: No. The resident was deceased. Family/Responsible Party interviewed: Yes. Alleged Perpetrator interviewed: Not Applicable. the Action taken by facility: The facility educated staff on the process of completing the “I’m okay” checks. Action taken by the Minnesota Department of Health: The responsible party will be notified of their right to appeal the maltreatment finding. The facility was found to be in noncompliance. To view a copy of the Statement of Deficiencies and/or correction orders, please visit: https://www.health.state.mn.us/facilities/regulation/directory/provcompselect.html If you are viewing this report on the MDH website, please see the attached Statement of Deficiencies. You may also call 651-201-4200 to receive a copy via mail or email cc: The Office of Ombudsman for Long Term Care The Office of Ombudsman for Mental Health and Developmental Disabilities Hennepin County Attorney Eden Prairie City Attorney Eden Prairie Police Department PRINTED: 04/ 17/ 2026 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/ SUPPLIER/ CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ C B. WING _____________________________ 21183 03/ 24/ 2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 615 PRAIRIE CENTER DRIVE FLAGSTONE EDEN PRAIRIE, MN 55344 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 ******ATTENTION****** Minnesota Department of Health is documenting the State Correction Orders ASSISTED LIVING PROVIDER CORRECTION using federal software. Tag numbers have ORDER 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. " The issued pursuant to a complaint investigation. state Statute number and the corresponding text of the state Statute out Determination of whether a violation is 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.
2025-08-05Annual Compliance VisitNo findings
Plain-language summary
A routine inspection of Flagstone on August 5, 2025 found a violation of the facility's infection control program requirements, resulting in a $500 fine assessed at Level 2. The facility must document in its records the actions taken to correct this violation and may appeal or request a hearing within 15 business days of receiving the correction order.
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. 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 . . ." IMPOSITION OF FINES In accordance with Minn. Stat. § 144G.31, Subd. 4, fines and enforcement actions 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: Level 1: no fines or enforcement; Level 2: a fine of $500 per violation, in addition to any enforcement mechanism authorized in § 144G.20; Level 3: a fine of $1,000 per incident, in addition to any enforcement mechanism authorized in § 144G.20; Level 4: a fine of $3,000 per incident, in addition to any enforcement mechanism authorized in An equal opportunity employer. Letter ID: IS7N REVISED 09/13/2021 Flagstone September 17, 2025 Page 2 § 144G.20; Level 5: a fine of $5,000 per violation, in addition to any enforcement mechanism authorized in § 144G.20. Therefore, in accordance with Minn. Stat. §§ 144G.01 to 144G.9999, the following fines are assessed pursuant to this survey: St - 0 - 0510 - 144g.41 Subd. 3 - Infection Control Program - $500.00 Therefore, in accordance with Minn. Stat. §§ 144G.01 to 144G.9999, t he total amount you are assessed is $500.00. You will be invoiced approximately 30 days after receipt of this notice, subject to appeal. 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). 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 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 REQUESTING A HEARING Alternatively, in accordance with Minn. Stat. § 144G.31, Subd. 5(d), an assisted living provider that has been assessed a fine under this subdivision has a right to a reconsideration or a hearing under this section and chapter 14. Pursuant to Minn. Stat. § 144G.20, Subd. 14 and Subd. 18, a request for a hearing must be in writing and received by the Department of Health within 15 business days 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. Flagstone September 17, 2025 Page 3 To submit a hearing request, please visit: https://forms.web.health.state.mn.us/form/HRDAppealsForm To appeal fines via reconsideration, please follow the procedure outlined above. P lease note that you may request a reconsideration o r 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 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, Renee L. Anderson, Supervisor State Evaluation Team Email: Renee.L.Anderson@state.mn.us Telephone: 651-201-5871 Fax: 1-866-890-9290 AH PRINTED: 09/17/2025 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 _____________________________ 21183 08/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 615 PRAIRIE CENTER DRIVE FLAGSTONE EDEN PRAIRIE, MN 55344 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 *****ATTENTION****** Minnesota Department of Health is documenting the State Correction Orders ASSISTED LIVING PROVIDER LICENSING using federal software. Tag numbers have CORRECTION ORDER been assigned to Minnesota State Statutes for Assisted Living Facilities with In accordance with Minnesota Statutes, section Dementia Care. The assigned tag 144G.08 to 144G.95 this correction order(s) has number appears in the far-left column been issued pursuant to a survey. entitled "ID Prefix Tag." The state Statute number and the corresponding text of the Determination of whether a violation has been state Statute out of compliance is listed in corrected requires compliance with all the "Summary Statement of Deficiencies" requirements provided at the Statute number column. This column also includes the indicated below. When Minnesota Statute findings which are in violation of the state contains several items, failure to comply with any requirement after the statement, "This of the items will be considered lack of Minnesota requirement is not met as compliance. evidenced by." Following the evaluators ' findings is the Time Period for Correction. INITIAL COMMENTS: SL21183016-0 PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On August 4, 2025 through August 5, 2025, the STATES,"PROVIDER'S PLAN OF survey at the above provider, and the following FEDERAL DEFICIENCIES ONLY. THIS correction orders are issued. At the time of the WILL APPEAR ON EACH PAGE. survey, there were 53 residents, all of whom were receiving services under the provider's Assisted THERE IS NO REQUIREMENT TO Living with Dementia Care license. 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. 0 510 144G.41 Subd. 3 Infection control program 0 510 SS=F (a) All assisted living facilities must establish and LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 DH7Z11 If continuation sheet 1 of 8 PRINTED: 09/17/2025 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 _____________________________ 21183 08/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 615 PRAIRIE CENTER DRIVE FLAGSTONE EDEN PRAIRIE, MN 55344 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) 0 510 Continued From page 1 0 510 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 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.
2023-07-26Annual Compliance VisitNo findings
Plain-language summary
A routine licensing survey was conducted at this facility on July 24-26, 2023, and correction orders were issued for violations of Minnesota statutes related to infection control procedures. No immediate fines were assessed, and the facility has a specified time period to correct the identified deficiencies and document the actions taken. The facility may request reconsideration of the correction orders within 15 calendar days if it disputes the findings.
Full inspector notes
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 ba sed on the level and scope of the vi ol ati ons ; however, no immediate fines are assessed for this survey of your facility. DOCUMENTATIO ONF ACTION TO COMPLY In accorda nc e wi th Mi nn. Sta t. § 144G.30, Subd. 5(c), the licens ee mus t doc ument acti ons ta ken 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 Castle Ridge August 22, 2023 Page 2 CORRECTIO NORDER RECONSIDERATIO PNROCESS 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. Pl ea se ema il rec ons idera ti on reques ts to: Health. HRDA. ppeals@state. mn. us. Pl ea se atta c h thi s 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, Jonathan Hill, Supervisor State Evaluation Team Email: jonathan. hill@state. mn.us Telephone: 651-201-3993 Fax: 651-281-9796 PMB PRINTED: 08/ 22/ 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: ______________________ B. WING _____________________________ 21183 07/ 26/ 2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 615 PRAIRIE CENTER DRIVE CASTLE RIDGE EDEN PRAIRIE, MN 55344 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 ******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 with Dementia In accordance with Minnesota Statutes, section Care license providers. The assigned tag 144G. 08 to 144G. 95, these correction orders are number appears in the far left column issued pursuant to a survey. entitled "ID Prefix Tag. " The state Statute number and the corresponding text of the Determination of whether violations are corrected state Statute out of compliance is listed in requires compliance with all requirements the "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. SL21183015- 0 PLEASE DISREGARD THE HEADING OF On July 24 through July 26, 2023, the Minnesota THE FOURTH COLUMN WHICH Department of Health conducted a survey at the STATES, "PROVIDER' S PLAN OF above provider, and the following correction CORRECTION. " THIS APPLIES TO orders are issued. At the time of the survey, there FEDERAL DEFICIENCIES ONLY. THIS were 43 active residents all of whom received WILL APPEAR ON EACH PAGE. 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. 0 510 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 LABORATORY DIRECTOR' S OR PROVIDER/ SUPPLIER REPRESENTATIVE' S SIGNATURE TITLE (X6) DATE STATE FORM 6899 XUXR11 If continuation sheet 1 of 27 PRINTED: 08/ 22/ 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: ______________________ B. WING _____________________________ 21183 07/ 26/ 2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 615 PRAIRIE CENTER DRIVE CASTLE RIDGE EDEN PRAIRIE, MN 55344 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) 0 510 Continued From page 1 0 510 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 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. This MN Requirement is not met as evidenced by: Based on observation and interview, the licensee failed to establish and maintain an effective infection control program to comply with accepted health care, medical, and nursing standards for infection control. The licensee failed to ensure direct care staff performed adequate hand hygiene (HH) during cares for 2 of 2 staff (registered nurse (RN)-H, unlicensed personnel (ULP)-D). In addition, the licensee failed to ensure skin was disinfected prior to blood glucose (BG) testing for 1 of 2 staff (ULP-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) and was issued at an isolated scope (when one or a limited number of residents are affected or one or a limited number of staff are involved, or the situation has occurred only occasionally) . The findings include: RN-H RN-H was hired September 20, 2022, and provided supervisory and direct care services for STATE FORM 6899 XUXR11 If continuation sheet 2 of 27 PRINTED: 08/ 22/ 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: ______________________ B.
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