Ingleside.

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 abused the resident when staff restrained the resident with a gait belt in her wheelchair over a two-hour period. Investigative Findings and Conclusion: The Minnesota Department of Health determined abuse was substantiated. The facility was responsible for the maltreatment. Facility staff unreasonably confined the resident when a transfer belt was used to secure the resident to a wheelchair for over two hours. The incident was not thoroughly investigated by management staff and no action was taken to prevent further occurrence. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigation included review of the resident record, facility documentation, personnel files, staff schedules, video footage, and related facility policies and procedures. Also, the investigator observed resident cares at the time of the onsite visit. The resident resided in an assisted living memory care unit. The resident’s diagnoses included dementia, anxiety, and history of a stroke. The resident’s service plan indicated the resident was independent with transfers, required assistance with walking and wheelchair mobility. The resident’s assessment indicated the resident was cognitively impaired and was at risk for abuse. A facility report indicated the resident fell and was restrained to her wheelchair in the dining room. Facility management documented they were not initially aware of the fall or the use of a restraint, but initiated an internal investigation when they became aware of the incident during a review of video surveillance footage. A facility investigation of the incident identified that the resident fell at 3:47 p.m. and staff assisted the resident off the floor and into her wheelchair. Video footage indicated that at 3:50 p.m., a staff member wrapped a transfer belt around the resident’s waist and wheelchair and fastened the belt on the back of the wheelchair. The internal investigation indicated the resident remained restrained in the wheelchair until after 6:30 p.m., when staff assisted her with evening cares. The investigation included no documentation of interviews with staff who worked at the time of the incident. The resident’s medical record included no documentation of the fall or the use of the restraint and no documentation of assessment or monitoring of the resident following the incident. Video surveillance footage showed the resident sitting in the dining room attempting to remove the transfer belt and unlock the wheelchair brakes; staff present in the area made no attempt to assist the resident or remove the resident from the restraint. The resident was restrained to the wheelchair for over two hours, until staff assisted with evening cares. During an interview, management staff stated the transfer belt should not have been used to restrain the resident and they were in the process of re-training all staff. During an interview, the resident’s family stated they were not notified of the incident. The AP did not respond to requests for interview. Additional staff working at the time of the incident declined to be interviewed. In conclusion, the Minnesota Department of Health determined abuse 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. Abuse: Minnesota Statutes section 626.5572, subdivision 2. "Abuse" means: (a) An act against a vulnerable adult that constitutes a violation of, an attempt to violate, or aiding and abetting a violation of: (1) assault in the first through fifth degrees as defined in sections 609.221 to 609.224; (2) the use of drugs to injure or facilitate crime as defined in section 609.235; (3) the solicitation, inducement, and promotion of prostitution as defined in section 609.322; and (4) criminal sexual conduct in the first through fifth degrees as defined in sections 609.342 to 609.3451. A violation includes any action that meets the elements of the crime, regardless of whether there is a criminal proceeding or conviction. (b) Conduct which is not an accident or therapeutic conduct as defined in this section, which produces or could reasonably be expected to produce physical pain or injury or emotional distress including, but not limited to, the following: (1) hitting, slapping, kicking, pinching, biting, or corporal punishment of a vulnerable adult; (2) use of repeated or malicious oral, written, or gestured language toward a vulnerable adult or the treatment of a vulnerable adult which would be considered by a reasonable person to be disparaging, derogatory, humiliating, harassing, or threatening; (3) use of any aversive or deprivation procedure, unreasonable confinement, or involuntary seclusion, including the forced separation of the vulnerable adult from other persons against the will of the vulnerable adult or the legal representative of the vulnerable adult; and (4) use of any aversive or deprivation procedures for persons with developmental disabilities or related conditions not authorized under section 245.825. (c) Any sexual contact or penetration as defined in section 609.341, between a facility staff person or a person providing services in the facility and a resident, patient, or client of that facility. (d) The act of forcing, compelling, coercing, or enticing a vulnerable adult against the vulnerable adult's will to perform services for the advantage of another. Vulnerable Adult interviewed: No, due to cognitive impairment. Family/Responsible Party interviewed: Yes Alleged Perpetrator interviewed: No, did not respond to subpoena request. the Action taken by facility: The AP was no longer employed by the facility. Action taken by the Minnesota Department of Health: If substantiated and facility responsibility, or facility and individual:  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 The responsible party will be notified of their right to appeal the maltreatment finding. If the maltreatment is substantiated against an identified employee, this report will be submitted to the nurse aide registry for possible inclusion of the finding on the abuse registry and/or to the Minnesota Department of Human Services for possible disqualification in accordance with the provisions of the background study requirements under Minnesota 245C. cc: The Office of Ombudsman for Long Term Care The Office of Ombudsman for Mental Health and Developmental Disabilities Martin County Attorney Fairmont City Attorney Fairmont Police Department Minnesota Board of Executives for Long Term Services and Supports PRINTED: 10/22/2024 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 _____________________________ 30245 07/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 2811 ROLAND AVENUE INGLESIDE FAIRMONT, MN 56031 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****** ASSISTED LIVING PROVIDER CORRECTION ORDER In accordance with Minnesota Statutes, section 144G.08 to 144G.95, these correction orders are issued pursuant to a complaint investigation. Determination of whether a violation is corrected requires compliance with all requirements provided at the statute number indicated below. When a Minnesota Statute contains several items, failure to comply with any of the items will be considered lack of compliance. INITIAL COMMENTS: #HL302453020C/#HL302453100M/#HL30245290 5C/#HL302453002M On July 31, 2024, the Minnesota Department of Health conducted a complaint investigation at the above provider, and the following correction orders are issued. At the time of the complaint investigation, there were 51 residents receiving services under the Assisted Living with Dementia Care license. The following correction orders are issued for #HL302453020C/#HL302453100M, #HL302452905C/#HL302453002M, tag identification 0250, 0430, 0490, 0510, 0620, 2170 and 2360. The following correction orders are issued for HL302453020C/#HL302453100M, tag identification 620, 2320, and 2360. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 07OF11 If continuation sheet 1 of 42 PRINTED: 10/22/2024 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.