Oak Terrace Senior Housing of.
Oak Terrace Senior Housing of is Grade C, ranked in the top 48% of Minnesota memory care with 1 MDH citation on record; last inspected Feb 2026.
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
Oak Terrace Senior Housing of 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 Oak Terrace Senior Housing of's record and state requirements.
The most recent Minnesota Department of Health inspection on June 22, 2023 found zero deficiencies — can you walk us through how you prepare for state surveys and share your written policies for maintaining compliance with Minnesota Statutes Chapter 144G dementia care requirements?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
Two complaints were filed with MDH during the inspection period on record — were either of those complaints substantiated, and what documentation can you provide about how the facility responded and any corrective actions taken?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
This facility holds an Assisted Living Facility with Dementia Care license under Minnesota law — can you show us the written dementia care program that MDH reviews during inspections, and explain how staff demonstrate competency in dementia-specific care practices?
Ask the operator on tour. Take notes and compare answers across facilities you visit.
Every MDH visit, verbatim.
4 inspections in the public record, most recent first. Click any row to expand — cited rows open automatically.
2026-02-12Annual Compliance VisitNo findings
Plain-language summary
A routine inspection of Oak Terrace Housing of Jordan on February 12, 2026 found violations of Minnesota assisted living facility rules related to fire protection and physical environment, and background studies requirements. The facility was assessed a total fine of $1,500.00 and issued correction orders requiring documented corrective actions to bring the facility into compliance with state statutes.
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 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 § 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 - 0775 - 144g.45 Subd. 2. (a) - Fire Protection And Physical Environment - $500.00 St - 0 - 1290 - 144g.60 Subdivision 1 - Background Studies Required - $1,000.00 An equal opportunity employer. Letter ID: IS7N REVISE D09/13/2021 Oak Terrace Housing of Jordan February 27, 2026 Page 2 Therefore, in ac cordanc e wi th Minn. Stat . §§ 144G .01 to 144 G.99 99, the total amount you are assessed is $1,500.00. You will be invoiced approximately 30 days after receipt of this notice, subject to appeal . DOCUMENTATIO ONF ACTION TO COMPLY In acc ordanc e with Minn. Stat. § 14 4G. 30, Subd. 5(c), the lic ense e mus t doc ume nt actions tak en to com ply 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). 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 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 GA 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. To submit a hearing request, please visit: https: / / forms. web. health. state. mn. us/ form/ HRDAppealsForm To appe al fi nes via rec onsi deratio n, pleas e follo w the procedure outlined above. Pl eas e note that you may re quest a re considerat ion or a he ari ng, but no t both . If you wish to contest tags witho ut fines in a reconsideration and tags with the fines at a hearing, please submit two separate appeals forms at the website listed above. Oak Terrace Housing of Jordan February 27, 2026 Page 3 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 convenienc e at this link: https: / / forms. office.com/ g/ Bm5uQEpHVa. Your input is impo rtant 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 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, Jodi Johnson, Supervisor State Evaluation Team Email: Jodi.Johnson@state. mn.us Telephone: 507-344-2730 Fax: 1-866-890-9290 KKM PRINTED: 02/ 27/ 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: ______________________ B. WING _____________________________ 28513 02/ 12/ 2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 622 ABERDEEN AVENUE OAK TERRACE HOUSING OF JORDAN JORDAN, MN 55352 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 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 survey. 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. SL28513016- 0 PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On February 9, 2026, through February 12, 2026, STATES, "PROVIDER' S PLAN OF the Minnesota Department of Health conducted a CORRECTION. " THIS APPLIES TO full 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 68 residents; 66 receiving services under the Assisted Living Facility with THERE IS NO REQUIREMENT TO Dementia Care license. SUBMIT A PLAN OF CORRECTION FOR VIOLATIONS OF MINNESOTA STATE STATUTES. 1290: An immediate correction order was issued on February 10, 2026, at a level 3/Widespread. THE LETTER IN THE LEFT COLUMN IS The licensee took immediate action; however, the USED FOR TRACKING PURPOSES AND scope and level remains at I. REFLECTS THE SCOPE AND LEVEL ISSUED PURSUANT TO 144G. 31 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 E3CN11 If continuation sheet 1 of 23 PRINTED: 02/ 27/ 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: ______________________ B.
2024-08-25Complaint InvestigationNo findings
Plain-language summary
A complaint investigation found that staff mixed two medications into the same bottle, causing a resident to be hospitalized for fluid overload, but the Minnesota Department of Health determined the neglect allegation was not substantiated because there was insufficient evidence the medication error caused the resident's death given his complex health conditions including end-stage kidney disease and heart failure. The facility held a staff meeting about proper medication handling and required all medication staff to sign acknowledgment forms confirming they understand medications must never be combined.
Full inspector notes
Finding: Not Substantiated 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 a staff member combined Metolazone and Mirtazapine in the same bottle. As a result, the resident was hospitalized due to fluid overload. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. Due to the resident’s complex health history, there was insufficient evidence to prove that the incident caused the resident's death. Although a staff member combined Metolazone and Mirtazapine in the same bottle, the error was an isolated incident. The resident’s weight was elevated, and he was sent to the hospital due to fluid overload. He received treatment and returned to the facility two days later. The investigator conducted interviews with administrative staff and a family member. The investigation included review of the resident’s records, internal investigation documentation, incident reports, policies, and procedures. The resident resided in an assisted living building. The resident’s diagnoses include end stage renal disease and heart failure. The resident’s service plan included assistance with all activities of daily living which included hygiene, dressing, toileting, medications, meals, and housekeeping. According to the resident's medication administration record, the resident was prescribed Metolazone 5 milligrams (mg) by mouth daily for excess fluid, and Mirtazapine 7.5 mg at bedtime for sleep and mood. According to the progress notes, the resident’s health had been declining, and his weight had fluctuated between 166-175 lbs. over the past three months. An incident report indicated that a staff member notified a nurse about Mirtazapine pills being mixed into the Metolazone bottle. The facility did not know when this happened or who mixed the medications together. According to hospital records, the resident was admitted to the hospital due to fluid overload. His baseline weight was 167-168 pounds (lbs.), and his weight at admission was 180 lbs. The record also indicated that the resident elected to forgo dialysis. The documentation of death indicated that the cause of death was end-stage kidney disease and type 2 diabetes. During an interview, a nurse stated that a staff member told her there were two different pills, metolazone and mirtazapine, in a metolazone bottle. She started the investigation but could not determine when and who combined the medications. She immediately notified the kidney specialist and the family. The resident had an appointment with the kidney specialist the next day, and the specialist agreed that it was fine for him to wait until the appointment. He was sent to the hospital right after his appointment due to shortness of breath and was discharged back to the facility after two days. As soon as a nurse found out about the incident, a staff meeting was scheduled, and she said she provided re-education to all the staff about not combining medications. During an interview, a family member stated that a nurse called her and informed her about the medication incident. She said he was sent to the hospital but did not remember how long his stay was. In conclusion, the Minnesota Department of Health determined neglect was not substantiated. “Not Substantiated” means: An investigatory conclusion indicating the preponderance of evidence shows that an act meeting the definition of maltreatment did not occur. 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 . Action taken by facility: A Medication Pass meeting was held where it was discussed that medications should never be mixed, or pill bottles combined. In addition, all staff members who pass medications were given an acknowledgment form to sign and return, confirming that they understand they cannot combine pill bottles and must use each bottle until it is gone. Action taken by the Minnesota Department of Health: No further action taken at this time. cc: The Office of Ombudsman for Long Term Care The Office of Ombudsman for Mental Health and Developmental Disabilities PRINTED: 08/26/2024 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 _____________________________ 28513 06/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 622 ABERDEEN AVENUE OAK TERRACE HOUSING OF JORDAN JORDAN, MN 55352 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 On June 18, 2024, the Minnesota Department of Health initiated an investigation of complaints #HL285133365M/HL285133548C and #HL285132242M/HL285131208C. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 SYV511 If continuation sheet 1 of 1
2024-01-02Complaint Investigation1 · Substantiated Finding
Plain-language summary
A complaint investigation found that a staff member abused a resident by forcibly administering medications: the staff member directed unlicensed workers to restrain the resident's arms while the staff member forced medication into the resident's mouth and held it shut to prevent spitting it out, an action that occurred at least twice and was substantiated as abuse under Minnesota law. The investigation included interviews with facility staff and review of medical records, training documents, and medication administration practices. The resident, who had dementia with behavioral disturbance and a history of refusing care, was given medication specifically to make him easier for staff to manage rather than to address a medical need.
“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), facility staff, abused a resident when the AP restrained the residents’ arms and forced the resident to take medication. Investigative Findings and Conclusion: The Minnesota Department of Health determined abuse was substantiated. The AP was responsible for the maltreatment. The AP, a facility licensed staff, directed unlicensed staff to hold the resident’s arms while the AP forced medications into the resident’s mouth. The AP held the resident’s head to force the medications into the resident’s mouth and held the residents mouth closed to force the resident to swallow the medication. The investigator conducted interviews with facility staff members, including nursing staff and unlicensed staff. The investigation included review of staff training, staff schedules, facility policies and procedures, and resident medical records. Also, the investigator observed staff medication administration. An equal opportunity employer. The resident resided in an assisted living memory care unit. The resident’s diagnoses included dementia with behavioral disturbance. The resident’s service plan included assistance with dressing, bathing, grooming, toileting, and medication administration. The resident’s assessment indicated the resident had a history of refusing cares. Nursing progress notes indicated the AP, and two unlicensed personnel, entered the resident’s room to administer his medications. The resident attempted to hit the staff. The two unlicensed staff held the resident’s arms while the AP held the resident’s head in place and “snuck” the tip of a syringe (where the resident’s medication was) into the resident’s mouth. The AP held the resident’s mouth shut for a few seconds to prevent the resident from spitting the [unnamed] medication out. Nursing progress notes from the next day indicated the AP asked the unlicensed staff to hold [restrain] the resident’s hands so the AP could administer the resident’s medication. The AP mixed the residents medication with a small amount of water and put it into a syringe. The AP held the resident’s head and “pried” his mouth open enough to get the syringe in. The AP held the resident’s lips closed so the resident would not spit the medication out. The AP documented, “during the entire process the resident’s face was very, very angry.” The residents nursing progress notes from a week prior indicated the AP administered olanzapine (an antipsychotic medication) because the resident was, “starting to get anxious and rude”. The nursing notes indicate the resident was refusing to have his oxygen levels checked and when the AP asked the resident to sit still, the resident told the AP to “go to hell”. The nursing notes indicated, “Due to resident’s bad/difficult behavior, olanzapine was given so staff would be able to care for resident without too much hassle. Resident was then calmer and more willing to work with staff, not against them”. During an interview, a facility nurse stated she contacted the AP immediately after reading the progress notes the AP wrote regarding forcing the resident to take the medication. The nurse stated the resident was able to take medications and staff were not directed to dissolve the resident’s medication in water and administer them in a syringe. The nurse stated the AP was re-educated on use of restraints and the residents right to refuse. When interviewed, an unlicensed staff stated they [the AP and 2 unlicensed staff] tried to convince the resident to take the medications, but the resident continued to refuse. The unlicensed staff stated she held the resident’s hands while the AP administered the medications. The unlicensed staff stated she understands this was considered a restraint and has been retrained. During an interview, the AP stated she asked two unlicensed staff to assist with administering morphine (a narcotic medication) to the resident due to the resident possibly having pain at the time. The AP stated when attempting to administer the residents’ medications the resident was moving his head back and forth. Both of the unlicensed staff took one of the resident’s arms and held them at the resident’s waist. The resident was saying, “no, no, no,” and began squeezing his mouth shut. The AP stated she put the syringe with the morphine in the resident’s mouth and the resident appeared as if he would spit out the medication. The AP held the resident’s lips closed until the resident swallowed the medication. The AP stated on another day the resident was refusing cares so the AP administered olanzapine so the staff could more easily care for the resident. 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, deceased. Family/Responsible Party interviewed: Yes Alleged Perpetrator interviewed: Yes Action taken by facility: The facility provided education to staff regarding resident’s rights. Action taken by the Minnesota Department of Health: The facility was issued a correction order regarding the vulnerable adult’s right to be free from maltreatment. 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 Scott County Attorney Jordan City Attorney Jordan Police Department Minnesota Board of Nursing PRINTED: 01/03/2024 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.
2023-06-22Annual Compliance VisitNo findings
Plain-language summary
A routine inspection was conducted at Oak Terrace Housing of Jordan on June 20 and 22, 2023, and the facility received correction orders for violations of Minnesota assisted living facility regulations. No immediate fines were assessed, but the facility must document how it corrected the areas of noncompliance and made system changes to prevent future violations. The facility may request reconsideration of the correction orders in writing within 15 calendar days of receiving this notice.
Full inspector notes
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; h owever, 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 Oak Terrace Housing Of Jordan July 17, 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 JMD PRINTED: 07/17/2023 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 _____________________________ 28513 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 622 ABERDEEN AVENUE OAK TERRACE HOUSING OF JORDAN JORDAN, MN 55352 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 Licensing ASSISTED LIVING PROVIDER LICENSING Correction Orders using federal software. CORRECTION ORDER(S) Tag numbers have been assigned to Minnesota State Statutes for Assisted In accordance with Minnesota Statutes, section Living Facilities. 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 evaluators' INITIAL COMMENTS: findings is the Time Period for Correction. SL28513015-0 PLEASE DISREGARD THE HEADING OF On June 20, 2023, June 22, 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 sixty four active residents receiving services WILL APPEAR ON EACH PAGE. 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 SUBDIVISION 1-3. 0 480 144G.41 Subd 1 (13) (i) (B) Minimum 0 480 SS=C requirements LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 VOWE11 If continuation sheet 1 of 23 PRINTED: 07/17/2023 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 _____________________________ 28513 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 622 ABERDEEN AVENUE OAK TERRACE HOUSING OF JORDAN JORDAN, MN 55352 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) 0 480 Continued From page 1 0 480 (13) offer to provide or make available at least the 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 one violation (a violation that has no potential to cause more than a minimal impact on the resident and does not affect 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 21, 2023, for the specific Minnesota Food Code deficiencies. TIME PERIOD FOR CORRECTION: Twenty-one (21) days 0 550 144G.41 Subd. 7 Resident grievances; reporting 0 550 SS=F maltreatment All facilities must post in a conspicuous place information about the facilities' grievance procedure, and the name, telephone number, and email contact information for the individuals who STATE FORM 6899 VOWE11 If continuation sheet 2 of 23 PRINTED: 07/17/2023 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 _____________________________ 28513 06/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 622 ABERDEEN AVENUE OAK TERRACE HOUSING OF JORDAN JORDAN, MN 55352 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) 0 550 Continued From page 2 0 550 are responsible for handling resident grievances. The notice must also have the contact information for the Office of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health and Developmental Disabilities and must have information for reporting suspected maltreatment to the Minnesota Adult Abuse Reporting Center. The notice must also state that if an individual has a complaint about the facility or person providing services, the individual may contact the Office of Health Facility Complaints at the Minnesota Department of Health.
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