Brookdale North Oaks.

Finding: Not Substantiated Nature of Visit: 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. Allegation(s): The facility neglected the resident when staff failed to assess and monitor the resident with a change in condition after the resident fell. The resident was later sent to the hospital, but only after being seen by family members who reported a change in condition. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. Although facility staff initially assessed and treated the resident after an unwitnessed fall, she later developed symptoms that required hospitalization. It is unable to be determined if the action or inaction of facility staff was the direct cause of the resident’s condition or progression of her injury. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigator also interviewed the resident’s family. The investigation included review of the resident’s medical record, nursing assessments, service An equal opportunity employer. plans, care plans, and progress notes. The investigator also conducted an onsite visit and observed staff’s interactions with residents. The resident resided in an assisted living facility memory care unit. The resident’s diagnoses included Parkinson’s disease, dementia, and Balint's syndrome (a rare neurologic disease that affects visual perception). The resident’s service plan directed staff to assist with medication administration, activities of daily living, laundry, housekeeping services, and meals. Complaint documents indicated the resident fell one month prior and sustained injuries of a bilateral odontoid fracture of C1, (a bone in the neck) as well as T12 (a bone in the low back) compression fracture, and frontal scalp lacerations which required stiches. The resident was admitted to the hospital for further treatment and later returned to the facility. Two weeks after returning to the facility, the resident fell in her room. Facility staff assessed the resident for injuries, documented there was no apparent harm to the resident, and assisted her back to bed. Hours later, a family member and an outside agency therapist came to visit the resident and alerted staff of a change in the resident’s condition. New symptoms were observed including the resident not holding her head in a midline position. The nurse contacted emergency medical services (EMS) and the resident was sent to the emergency room for an evaluation. The resident was again admitted to the hospital for observation. Following the hospital stay, the resident admitted to a skilled nursing facility and did not return to the facility. During an interview with an unlicensed staff member at the facility, they recalled the unwitnessed fall where the resident sustained the laceration but could not recall any details of the subsequent fall. Current administrative members were not employed at the time the alleged incident occurred and had no knowledge of the incident. The resident’s family was interviewed and expressed concerns with care provided at the facility and the delay in staff’s response to the resident’s fall. 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, deceased. Family/Responsible Party interviewed: Yes. Alleged Perpetrator interviewed: N/A Action taken by facility: None Action taken by the Minnesota Department of Health: 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 PRINTED: 08/30/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ C B. WING _____________________________ 30692 08/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 300 VILLAGE CENTER DRIVE BROOKDALE NORTH OAKS NORTH OAKS, MN 55127 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****** STATE HOME CARE PROVIDER/ASSISTED LIVING ASSISTED LIVING PROVIDER CORRECTION PROVIDER POC TEXT ORDER Assisted Living Provider 144G. In accordance with Minnesota Statutes, section 144G.08 to 144G.95, these correction orders are Minnesota Department of Health is issued pursuant to a complaint investigation. documenting the State Correction Orders using federal software. Tag numbers have Determination of whether a violation is corrected been assigned to Minnesota State requires compliance with all requirements Statutes for Assisted Living Facilities. The provided at the statute number indicated below. assigned tag number appears in the far When a Minnesota Statute contains several left column entitled "ID Prefix Tag." The items, failure to comply with any of the items will state Statute number and the be considered lack of compliance. corresponding text of the state Statute out of compliance is listed in the "Summary INITIAL COMMENTS: Statement of Deficiencies" column. This column also includes the findings which #HL306927716C/#HL306924503M are in violation of the state requirement after the statement, "This Minnesota On August 14, 2023, the Minnesota Department requirement is not met as evidenced by." of Health conducted a complaint investigation at Following the evaluators' findings is the the above provider, and the following correction Time Period for Correction. orders are issued. At the time of the complaint investigation, there were 34 residents receiving PLEASE DISREGARD THE HEADING OF services under the provider's Assisted Living with THE FOURTH COLUMN WHICH Dementia Care license. STATES,"PROVIDER'S PLAN OF CORRECTION." THIS APPLIES TO The following correction order is issued/orders FEDERAL DEFICIENCIES ONLY. THIS are issued for WILL APPEAR ON EACH PAGE. #HL306927716C/#HL306924503M, tag identification 0650 and 2240. 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 LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 100P11 If continuation sheet 1 of 6 PRINTED: 08/30/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ C B. WING _____________________________ 30692 08/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 300 VILLAGE CENTER DRIVE BROOKDALE NORTH OAKS NORTH OAKS, MN 55127 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 Continued From page 1 0 000 ISSUED PURSUANT TO 144G.31 SUBDIVISION 1-3. 0 650 144G.42 Subd. 8 Employee records 0 650 SS=G (a) The facility must maintain current records of each paid employee, each regularly scheduled volunteer providing services, and each individual contractor providing services.