CLICK ON BELOW LINKS FOR INFORMATION ABOUT MINNESOTA MDH FINDINGS OF SUBSTANTIATED NEGLECT AND ABUSE AGAINST ELDER CARE AND VULNERABLE ADULT PROVIDERS

Facilities and Providers with Substantiated Complaints According the MDH*

*The following list are providers who are determined to have substantiated complaint findings by the Minnesota Department of Health.  The information provided by this site is a summary of listed complaints.  There is no assurance made that the information is complete, accurate or that it has not changed.  See the MDH website for additional information. For information explaining investigative process see Complaint Investigations of Minnesota Health Care Facilities.

Minnesota Department of Health
Minnesota Department of Health Investigations of Complaints Against Nursing Homes and Assisted Living Facilities

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1-0 Granny’s Helpful Hands LLC, Neglect of Supervision

Able Inc La Crescent, Death from Sepsis

Able Inc Houston

Accesible Space Inc 4

Aftenro Home, Accidents Fall Hip Fracture, Accidents, Quality of Care/Treatment

Atkin Health Services, Fall from Lift, Safety Transfers Accidents, Resident Safety Falls Neglect, Pressure Ulcer Change in Condition, Resident Safety Falls

All Saints Senior Living, No Assessment Change in Condition

Allina Health Hospice & Palliative Care, Assessment

Amira Choice Plymouth, Financial Exploitation

Andrew Residence, Res to Res Sexual Contact, Resident to Resident Sexual Abuse

Annadale Care Center, Medication Error with Insulin Death, Resident Safety Falls Not Following Care Plan, Accident Burns

Anoka Metro Reg Treatment, Supervision and Safety, Patient Safety/Supervision

Anoka Rehab & Living Center, Resident Safety Falls, Fall While Being Transferred in Mechanical Lift, Sexual Abuse, Accidents

Appleton Area Health, Unsafe Smoking, Rehabilitation Services Resident Safety Fall, Elopement, Resident Safety Elopement

Arbor Lakes Senior Living, Infection Control

Assumption Home, Sexual Abuse, Falls with Bruises, Physical Abuse

Atwater ICFIID, Client Abuse Restraints

Augustana Chapel View Care Ctr, Choking Event Leading to Death

Augustana HCC of Minneapolis, Quality of Care

Augustana Health CC of Apple, Physical Abuse Staff to Resident, Neglect of Supervision

Aurora on France, Pressure Ulcer, Financial Exploitation

Avera Morningside Heights CC, Employee to Resident Physical Abuse, Accidents

Avera Sunrise Manor, Accident Burn

Avera Tyler

Axis on Seneca, Fracture of Hand Unknow Origin

Bay View Nursing & Rehab Ctr, Medication Error Death, Accidents, Resident to Resident Physical Abuse, Physical Abuse

Bayside Manor, LLC, Not Following Care Plan Rough with Cares 

Belgrade Nursing Home, Resident Safety Falls Not Following POC, Staff to Resident Abuse

Benedictine Care Community, Safety Elopement, Significant Med Error

Benedictine Health Ctr of Minneapolis, Pressure Ulcers Physical Abuse, Death

Benedictine Health Ctr Duluth, Not Treated With Dignity, Not Providing Medications as Ordered, Pharmacy Services, Pharmaceuticals Meds Not Per MD Order

Benedictine Health Ctr Innsbruck, Wound Care Wounds Not Healing, Resident to Resident Physical Abuse

Benedictine Lvg Comm St Peter, Bed Placed in High Position, Care Planned for Low, Fall from Bed

Benedictine Lvg Comm Winstead, Death Quality of Care and Treatment, Resident Abuse

Berkeley Heights Home LLC, Emotional Abuse

Bigfork Valley Communities, Resident Safety Falls, Resident to Resident Sexual Cognitively Impaired Residents, Accident Hazards Falls, Elopement

Birchwood Care Home, Physical Abuse by Visitor, Resident to Resident Physical Abuse, Exploitation by Staff, Resident to Resident 

Birchwood Cottages, Sexual Behavior Resident to Resident, Infection Control

Birchwood Health Care Center, Resident to Resident Physical Abuse

Bridgewater at Owatonna, Pressure Sore

Brighton Hospice, Lack of Assessment, 24 On Call Not Provided, Medication Orders Not Communicated

Boundary Waters Care Center, Staff to Resident Abuse, Sexual Abuse

Brookview A Villa Center, Neglect Quality of Care, Physical Abuse by Staff, Left in Soiled Linen

Buffalo Lake Healthcare Center, Pharmacy Services

Bywood East HealthCare, Resident to Resident Physical Abuse, Resident to Resident, Resident to Resident, Physical Abuse Resident to Resident, Physical Abuse to Resident, Staff to Res Verbal Abuse, Res to Res Physical, Environment Infection Control, Misappropriation Meds Division

Caledonia Rehab and Retirement, Resident Safety Falls

Camilla Rose Care Center, Resident to Resident Physical, Pressure Ulcer, Resident to Resident Sexual Touch

Camilla Rose Group Home, Daily Seizure Medication Not Given as Needed, Pressure Ulcer

Capitol View Transitional Care, Resident Safety Falls, Not Following POC

Careco Apartment Inc 

Caremate Home Health Care Inc, Sexual Abuse, Sexual Abuse

Caring Meadows, Pressure Sores

Carondelet Village Care Center, Quality of Care and Treatment, Care Plan Not Followed Resident Sustained Injury from Improper Use of Lift for Toileting

Carris Hlth CC Therapy Suites, Therapeutic Diet Not Provided Choking, Diet Not Followed, Significant Error, Quality of Care – Call Light Not within Reach

Castle Ridge Care Center, Falls During Cares

Catholic Elder Care on Main, Resident to Resident Sexual Assault, Resident Safety Falls, Fracture of Unknown Origin

Cedars of Austin, Falls

Centennial Gardens, Resident Neglect Resident Safety Falls

CentraCare Health Monticello, Resident Safety Falls, Fall with Fracture, Therapeutic Diet Not Followed

Centracare Health Paynesville, Sexually Inappropriate Advances, Not Turned and Repositioned Timely, Quality of Care

Centracare Health System, Resident Safety Falls

Centracare Health System Sauk Centre, Resident Patient Client Abuse

Centracare Health System Melrose, Resident to Resident, Elopement, Resident to Resident Sexual Abuse, Neglect of Care Lack of Supervision

Central Health Care, Sexual Abuse, Resident Safety Falls, Accidents, Quality of Care Pharmaceutical Services

Central Minnesota Senior Care, Exploitation by Facility/Staff

Centric Heatlhcare LLC, Discharge Rights

Cerenity Care Center White Bear Lake, Bed Sores, Pressure Ulcers

Cerenity Care Ctr of Humboldt, Wound Care Pain, Physical Abuse, Accident Choking, Physical Abuse, Significant Medication Error

Cerenity Marian St Paul LLC, Quality of Care and Treatment

Charter House, Aspiration Precautions

Chris Jensen Health & Rehab Ctr, Resident to Resident Sexual, Missed Doses of Critical Medication, Staffing Resident Safety Falls, Call Light Not Functioning

Clara City Care Center, Resident Safety Falls

Clarkfield Care Center, Staff to Resident Abuse Safety, Fall

Comfort Keepers, Exploitation by Facility/Staff

Compassioncare, Sexual Abuse

Cornerstone Nursing & Rehab Center, Resident to Resident

Cornerstone Residence, Pressure Sores

Country Manor Health and Rehab Ctr, Quality of Care, Resident Neglect

Covenant Living Care and Rehab Center, Resident Abuse

Crest View Lutheran Home, Resident to Resident Physical Abuse, Resident to Resident Sexual Abuse, Resident Safety Falls, Fracture Unknown Origin Fall

Crossroads Care Center, Elopement

Cuyuna Regional Medical Center, Resident to Resident Sexual Abuse, Resident to Resident Physical Abuse, Resident Safety Elopement, Fall with Injury, Physical Abuse

Divine Providence Community Home, Resident Left on Bed Pan, Resident to Resident

Divine Providence Health Center, Quality of Care Treatment Resident Safety

DRCC Aurora, Sexual Abuse

Ebenezer Home Care Edina, Physical Abuse, Physical Abuse, Plan of Care Not Followed, Neglect of Supervision Pressure Sore

Ebenezer Management Services Edina, No Assessment After Change in Condition, Physical Abuse, Sexual Abuse

Ebenezer Ridges Geriatric Care Center, Quality of Care Treatment, Unexplained Injury

Ecumen Lakeshore Duluth, Fall with Fracture, Falls

Ecumen North Branch, Quality of Care Treatment, Resident Safety Falls, Financial Exploitation 

Ecumen of Litchfield, Falls

Edenbrook of Edina, No Feeding Assistance with Weight Loss, Fall with Fracture

Edenbrook of Rochester, Development of Pressure Ulcers, Accidents, Resident Safety Falls

Edgebrook Brainerd Senior Living, Failure to Provide CPR, Exploitation by Facility/Staff

Edgebrook Care Center Edgerton, Resident Abuse, Plan of Care Not Followed

Elim Home Princeton, Fall from Mechanical Transfer Device, Abuse Physical, Resident Abuse

Elim Home Milaca, Resident to Resident Physical Abuse

Elim Wellspring, Resident to Resident Physical Abuse, Resident Abuse, Resident to Resident Physical and Verbal Altercation

Elk Ridge Alzheimer’s Special, Restraints

Elmore Assisted Living, Physical Abuse, No Assessment After Change in Condition

Emmanuel Nursing Home, Staff to Resident Abuse, Quality of Care/Treatment

Episcopal Church Home Gardens, Abuse Neglect

Episcopal Church Home of St. Paul, Physical Abuse

Essentia Health Homestead, Resident to Resident Physical

Essentia Health Grace Home, Significant Medication Error

Essentia Health Virginia Care, Employee to Resident Abuse, Injury of Unknown Origin

Eventide Lutheran Home, Fall with Fracture, Resident to Resident Abuse, Unwitnessed Fall, Resident to Resident Abuse, Resident Safety Falls, Resident Abuse, Quality of Care Treatment, Resident Abuse

Fair Meadow Nursing Home, Accident Falls, Not Following POC Resulting in a Fall

Fair Oaks Nursing and Rehab, Resident to Resident Abuse, Resident Abuse, Physical Abuse

Family Choice Homecare, Physical Abuse

Faribault Senior Living

Field Crest Care Center, Resident Safety Accidents Elopement, Resident to Resident

First Care Living Center, Safety Unqualified Staff, Safety Falls with Abrasion

Firstat Nursing Services, Wound Care Sponge Left in Wound

Flagstone, Medication Error

Folkestone, Resident Safety Falls

Franciscan Health Center, Staff to Resident Physical Abuse, Resident to Resident Abuse, Inappropriate Touch Resident to Resident

Franklin Restorative Care Center, Resident to Resident Altercation, Neglect of Care Accidents, Resident to Resident Physical, Death

Franzee Care Center, Rough Treatment, 20 Pound Weight Loss, Employee to Resident

Gables of Boutwells Landing, Inappropriate Touching by Staff, Physical Abuse Resident to Resident, Abuse by Staff

Galtier A Villa Center, St. Paul, Elopement

Gil Mor Manor, Physical Abuse

Glencoe Regional Health Services, Client Abuse, Accidents

Glenoaks Senior Living Campus, Burns from Heat Register, Resident Abuse, Resident to Resident Abuse, Resident to Resident Physical Abuse

Good Sam Albert Lea, Elopement Suicide, Significant Medical Error, Resident Safety Falls Quality of Care, Significant Med Error, Missing Narcotics, Fall without Injury; Failure to Follow Transfer Care Plan, Call Light Not in Reach and VA Slide Out of W/C onto the Floor No Injuries, Medical Error

Good Sam Bethany, Elopement Accidents Resident Safety, Accident Fall Fracture

Good Sam Woodland, Resident Safety Falls, Resident Safety, Accidents Elopement

Good Sam Ambassador, Pressure Ulcer Concerns, Neglect of Care

Good Sam Arlington, Nursing Staffing

Good Sam Battle Lake, Resident Safety Falls, Falls, Resident Safety Elopement, Fall

Good Sam Black Duck, Client Neglect, Resident to Resident Abuse

Good Sam Comforcare, Significant Med Error

Good Sam International Falls

Good Sam Jackson, Resident to Resident Sexual

Good Sam Mountain Lake, Fall with Fx Not Assessed Timely

Good Sam Pine River, Quality of Care and Treatment

Good Sam Pipestone, Quality of Care Treatment, Fall with Fracture

Good Sam Howard Lake, Resident to Resident

Good Sam St James, Fall with Injury

Good Sam Society Stillwater, Quality of Care

Good Sam Specialty Care Comm, Quality of Care

Good Sam Waconia and Westview Acre, Medication Not Given, INR Draw, Neglect of Care, Staff Abuse, Neglect of Supervision

Good Sam Westbrook, Quality of Care Treatment

Good Sam Windom, Fall Failure to Assess Change in Condition, Elopement

Good Sam Winthrop, Fx Right Femur, Neglect of Care, Failure to Assess

Good Samaritan Mary Jane Brown, Physician Orders Plan of Care Pressure Ulcer

Good Shepard Lutheran Home, Nursing Services Resident Neglect, Call Light Not Working

Grand Ave Rest Home, Resident to Resident Abuse

Grand Village, Lying in Feces, No Call Light, No Food, Resident to Resident Physical Abuse, Quality of Care, Resident to Resident Abuse

Green Lea Senior Living, Resident to Resident Physical Sex, Quality of Care, Exit Elopement With Fall

Green Pine Acres Nursing Home, Plan of Care Not Followed, Quality of Care

Guardian Angels Care Center, Medication Error Significant ErrorQOC Falls Resident Safety, Quality of Care, Client Abuse, Medication Errors Causing CVA, Quality of Care, Employee to Resident, Physical Abuse

Guardian Angels Care Center, Employee to Resident, Physical Abuse

Guardian Angels Health and Rehab, Resident Abuse, Employee to Resident Abuse, Resident to Resident Abuse, Bed Bugs, Sexual Abuse

Gundersen Harmony Care Center, Pharmacy Services Not Provided

Halstad Living Center, Resident Abuse, Dropped During Transfer

Hammer McGlinch, Medication Error Dilantin Incorrect Dosage Causing 2 Grandmal Seizures

Harmony River Living Center, Resident to Resident Altercation

Harry Meyering Center, Accidents Fall with Serious Injury, Quality of Care Treatment

Havenwood Care Center, Resident to Resident Physical, Resident to Resident Physical Abuse, Malnutrition Dehydration

Hayes Residence, Resident to Resident, Resident to Resident Physical

Hazel Senior Living, Neglect of Supervision

Healing Homes Living Services, Neglect of Supervision

Healtheast Pillars, Significant Med Error

Heritage Have Inc, Falls, Fall with Fractured Hip, Exploitation by Staff Facility

Heritage Manor, Elopement

Highland Chateau St Paul, Death CPR Not Performed Correctly, Quality of Care, Unqualified Staff, Death, Change in Conditions Falls, Resident to Resident Sexual Abuse, Accidents

Highland GW, Pressure Sores

Hillcrest Health Care, Resident to Resident Altercation, Accidents Elopement Resident Safety, Significant Medication Error, Fall with Fracture, Substantiated Neglect, Fractured Hip Fall from Bed

Hillcrest Terrace of Chisholm, Sexual Abuse

Hillcrest Wayzata Rehab and HCC, Accidents

Hilltop Health Care Center, Resident to Resident

Home Care Solutions, Neglect of Supervision

Home Health at North Ridge, Pressure Sores

Home Health Care Inc, Wound Care Not Provided

Homeward Bound Brooklyn Park, Found Pressure Injuries to Bilateral Heels

Homeward Bound Plymouth, Accidents Falls No Injury

Hopkins Health Services, Resident to Resident Abuse, No Assessment After Change in Condition

Hyatt House LLC, No Assessment After Change in Condition, Safety Hazards

Indigo Healthcare Services LLC, Resident to Resident

Ingleside, Falls, Resident to Resident

Interfaith Care Center, Safety Falls, Resident to Resident Abuse, Neglect Injury of Unknown Origin Failure to Notify MD of Change in Condition, Fall, Fall with Injury

Interlude, POC Not Followed Resident Obtained a Pelvic Fx

Interlude Restorative Suites, Resident Safety Elopement

International Quality Homecare

Inver Grove Heights WP II LLC, Plan of Care Not Followed, Resident to Resident, Plan of Care Not Followed

Johnson Memorial Hosp and Home, Physical Abuse Sexual Abuse, Employee to Resident, Resident to Resident Altercation, Failure to Provide CPR

Jones Harrison Residence, Falls, Accidents, Sexual Abuse, Falls, Resident Abuse

Joyful Home Health Care LLC, Neglect of Supervision

Kaplan Woods Care Home, Abuse Fracture Does Not Walk

Keller Lake Commons, Medication Errors

Kingsway Retirement Living, Plan of Care Not Followed, Call Light Not Answered

Kittson Memorial Hospital, Quality of Care Pressure Ulcer Prevention

Knute Nelson, Resident Safety Falls, Falls

Koda Living Community, Quality of Care Treatment, Quality of Care and Treatment, Change of Condition Weight Loss Death

La Crescent Health Services, Staff Neglect With Use of Hoyer Lift

Lake Minnetonka Care Center, Quality of Care Treatment, Resident to Resident

Lake Owasso Residence, Client to Client Abuse, Quality of Care

Lake Ridge Care Center of Buffalo, Significant Medication Error, Omitted Wound Care Resulting in Worsening Wounds, Emotional Abuse

Lake Winona Manor, Substantiated Neglect, Wound Care, Resident Safety Falls, Elopement Did Not Sign Out, Choking Accidents Not Following Care Plan Possible Chemical Restraint

Lakeshore Inn Nursing Home, Resident Safety Falls, Falls Accidents Fracture Below the Knee

Lakeside Health Care Center, Resident to Resident Abuse, Resident to Resident Physical Abuse, Resident to Resident Physical

Lakeside Medical Center, Facility Cold and Without Heat

Lakewood Care Center, Change in Condition Quality of Care, Neglect of Care Fall with Injury

Lakewood Health System, Quality of Care Treatment, Neglect Falls, Resident to Resident Abuse, Resident to Resident Physical, Medication Error, Nursing Services

Lakewood Health System Home Care, Medication Error, Nursing Services

Langton Shores, Quality of Care Treatment, Development of Pressure Ulcer

Laura Baker Services Assc, Elopement Not Properly Dressed for Weather, Quality of Care Treatment, Physical Abuse, Accidents Death, Staff to Client Physical Harm, Resident to Resident, Elopement, Resident to Resident, Substantiated Neglect, Nursing Services Quality of Care Treatment, Client to Client Physical Abuse Hit VA on Head

Laurels Peak Care and Rehab Ctr, Change in Condition Falls

LB Broen Home Fergus Falls, Resident Safety Falls, Care Plan Not Followed, Failure to Follow MD Orders

Lifecare Greenbush Manor, Fall from Stand Lift

Lifecare Roseau Manor, Resident to Resident, Resident Patient Client Abuse

Lino Lakes Assisted Living LLC, Improper Incontinent Care (Left Soiled)

Lino Lakes Gracewood, Plan of Care Not Followed

Little Falls Care Center, Little Falls Health Services, Call Light Not Answered Timely, Fluids Not Provided, Failure to Assess and Monitor, Resident to Resident Physical Abuse, Fall

Living Well Diane, PU Worsened From Lack of Consistent Wound Care and W/C Insert Assess for Proper Fit

Living Well East Emerson, Significant Injury of Unknown Origin, Resident Patient Client Abuse

Luther Haven, Elopement, Resident Safety Elopement

Lyngblomsten Care Center, Resident Abuse, Unexplained Injury, Quality of Care, Coumadin Not Given for 2 Days, Medication Error

Madison Healthcare Services, Fall with Fracture, Elopement, Fall with Injury, Quality of Care Treatment, Quality of Care

Madonna Meadows, Pressure Sores, Substantiated Neglect

Madonna Towers of Rochester, Quality of Care Treatment, Staffing Call Lights Abuse Several Quality of Care Issues, Lack of Notification of MD with Change in Condition

Mala Strana Care and Rehab, Mala Strana Health Care LLC, Resident Safety Falls, Quality of Care Fall Resulting in Death, Pressure Ulcers, Quality of Care, Accidents

Maple Hill Senior Living, No Assessment After Change in Condition, Plan of Care Not Followed

Maple Hill Senior Living LLC, Physical Abuse

Mapleton Community Home, Accidents Elopement, Staff to Resident Abuse, Resident to Resident, Plan of Care Not Followed Fall from Lift

Maplewood Care Center, Death, Development of PU Dressing Changes Not Done, High Risk Med Error, Resident to Resident Physical Altercation, Resident to Resident Physical, Resident to Resident Altercation, Not Notifying MD After Change in Condition, Staff Abuse, Quality of Care Staff to Resident Improper Transfer, Quality of Care and Treatment, Physician Not Notified of Change in Condition, Resident to Resident, Neglect of Care, Sexual Abuse, Resident to Resident Abuse, Physical Abuse

Mary T Home Health, Sexual Assault

Mayo Clinic Albert Lea, Resident Patient Client Abuse

Mayo Clinic Health System, Resident to Resident Altercation, Resident to Resident Physical, Resident to Resident Physical Abuse, Resident Patient Client Abuse, Injury of Unknown Origin, Medications Not Given Per Orders Pharmacy Services, Medication Administration by Unlicensed Staff, Staff to VA Physical Restraint

McIntosh, Resident Abuse

Meadow Lake Restorative CC, Quality of Care Treatment, Fall Unkept, Resident to Resident, Resident Patient Client Abuse, Wound Care

Meadows on Fairview, No Call Lite Left in Recliner 6.5 Hours Restraint, Resident Safety Falls

Meeker Manor Rehab Ctr LLC, Elopement, Death After No CPR, Accidents

Meeker Memorial Hospital, Staff to Resident Physical

Mercy Home Health, Suicide Attempt Self Injurious Behavior

Metro Care Human Services, Physical Abuse

Milestone Senior Living, Falls

Mille Lacs Health System, Fall, Neglect of Care

Minneota Manor HCC, Resident Safety Falls, Neglect Fall Out of Lift, Accidents

Minnesota Greenleaf, No Assessment After Change in Condition

Minnesota Masonic Home Care, Resident to Resident, Resident Safety, Fall with Hip Fracture

Minnesota Valley Health Ctr Long, Quality of Care Treatment, Resident Safety Falls, Client Services Not Performed

Mission Nursing Home, Resident to Resident Physical Altercation, Resident Abuse, Resident to Resident Physical Abuse, Resident Physical Abuse, Physical Abuse to Resident

MN Veterans Home Fergus Falls, Quality of Care, Not Repositioned Timely by Staff, Resident to Resident Altercation, Sexual Abuse Resident to Resident, Quality of Care Treatment, Elopement, Sexual Abuse Staff to Resident, Resident Patient Client Abuse

MN Veterans Home Luverne, Plan of Care Not Followed

MN Veterans Hone Minneapolis, Resident to Resident Physical Abuse, Resident to Resident Physical, Resident to Resident Physical Abuse

MN Veterans Home Silver Bay, Resident to Resident, Resident Abuse, Resident to Resident Physical

Moorhead Rehab and HCC, Abuse, Resident to Resident Physical Abuse, Injury of Unknown Origin, Pressure Sores, Pressure Sores, Resident to Resident

Mother of Mercy, Mother of Mercy Senior Living, Restraint, Abuse, Physical Abuse, Failure to Provide CPR

Mount Olivet Rolling Acres, Staff to Client Physical Abuse

MSOP Pexton Shantz, Patient Rights

MTAI Trillium, Resident Patient Client Abuse

Neilson Place, QOC Fall with Fracture

New Brighton A Villa Center, Sexual Abuse, Resident to Resident, Quality of Care, Resident Safety, Quality of Care, Verbal Abuse

New Brighton Care Center, Served Wrong Diet Choked and Hospitalized

New Perspective Cloquet, Physical Abuse, Falls, No Assessment After Change in Condition, No Assessment After Change in Condition

New Richland Care Ctr, Resident to Resident, Employee to Resident Abuse, Sores on Feet Rehabilitation, Left Wet for Extended Time Lack of Pressure Ulcer Interventions Not Repositioned, Safety Falls

Norris Square, Falls with Injury, Fall with Fracture Pressure Ulcer Malnutrition, Quality of Care Treatment, Accidents Communication Change of Condition, Quality of Care Resident Safety

North Ridge Health and Rehab, Resident to Resident Physical, Sexual Abuse, Resident Safety, QOC Pressure Ulcer Worsening, Resident to Resident, Quality of Care, Resident to Resident, Verbal Abuse by Staff, Resident Rights/Quality of Care, Resident Not Treated With Dignity and Respect, Pain With Transfers

North Shore Health, Development of Heel Wound, Dr. Orders Not Followed

North Star Manor, Dignity, Plan of Care Not Followed

Northwood Childrens SVS INC

Nurturing Care Residence, Physical Abuse

Oak Park Senior Living, Physical Abuse

Oaklawn Health Center LLC, Rough Care, Employee to Staff Abuse, Failed to Follow Providers Orders, Substantiated, Meds Not Given Resulting in Presyncopal Orthostatic Hypotension

Oakland Park Communities Inc, Resident to Resident, Resident Abuse, Resident to Resident Physical

Olivia Rehab and HCC, Fall with Head Injury and Death, Resident to Resident

Ostrander Care and Rehab, Pressure Ulcer

Paradise Care Home LLC, Resident Safety (Entrapment Burns)

Park Health A Villa Center, Resident Abuse, Misappropriation of Property

Park View Care Center, Diet Not Per MD Order

Parkview Care Center Wells, Quality of Care Treatment, Resident Left on Toilet

Parkview Manor Nursing Home, Resident Safety Falls

Parmly on the Lake LLC, Resident to Resident, Elopement, Accidents, Quality of Care

Partners in Care Inc, Resident to Resident 

Pathstone Crossing, Medication Errors

Pathstone Living, Infection Control Change of Condition Surgical Prep, Self Transfer with Fall and Fracture, Resident Safety Falls

Perham Living, Resident Abuse, Resident Safety Falls

Phoenix at English, VA Swallowed Razor Blade

Pierz Villa Inc, Quality of Care Treatment, Resident Safety, Quality of Care Treatment Not Received

Pine Have Care Center Inc, Resident to Resident Physical, Fall Death

Pioneer Care Center, Resident Safety Quality of Care

Pioneer Estates, Pressure Sores

Pioneer Home Inc, Physical Abuse

Pleasant Manor, Neglect of Care Plan Fall from Lift, Injury of Unknown Origin, Fractured Finger, Call Lights Not Answered, Quality of Care Treatment, Pressure Ulcers

Prairie Senior Cottages of Willmar, Neglect of Supervision

Prairie Edge, Physical Abuse

Presbyterian Homes, Safety Falls, Safety Fall from Lift

Presbyterian Homes Bloomington, Fall with Fracture, Resident Safety Falls

Presbyterian Homes North Oaks, Fall with Pelvic Fracture

Providence Place, Quality of Care Lack of Assessment and Monitoring

Rakhma, Inc, Resident to Resident

Ramsey County Care Center, Resident to Resident, Abuse Resident to Resident

Real Home Care Services, No Jurisdiction Admission Transfer Discharge Rights

Redeemer Residence Inc, Resident to Resident, Therapeutic Diet Not Served Resulting in Choking and Requiring Nursing Intervention, Resident to Resident Physical, Hot in Facility – No Airconditioning

Regina Assisted Living, Neglect of Supervision, Plan of Care Not Followed

REM Central Lakes Inc Fernwood, Safety Using Broken Lift Transferring Without Gait Belt, Untreated Sores

REM Heartland Inc Birch, Substantiated, Verbal Abuse from Staff to Client, Misappropriation of Property, Substantiated, Substantiated, Substantiated, Substantiated

REM Heartland Inc Budd, Quality of Care

REM Ramsey Inc Goodrich, Staff to Client Physical Abuse, Staff to Client Physical Abuse,

REM River Bluffs Rochester SE, Head Laceration with Suspected Fall

REM River Bluffs Stone Park, Physical Abuse

Rest Care Home Services, Substantiated

Richfield A Villa Center, Injury of Unknown Origin, Resident to Resident Physical, Resident Safety Falls Death, Accidents, Resident to Resident, Resident to Resident Sexual Abuse, Resident to Resident Physical Abuse, Resident Safety

Ridgeway Senior Living, Physical Abuse

River Valley Health and Rehab, Accidents

Riverview Hospital and NSG Home, Resident to Resident Physical, Physical, Resident Patient Client Abuse, Resident to Resident Physical Abuse No Injury, Resident to Resident Altercation, Resident Altercation, Staff Abuse, Resident to Resident Physical, Falls

Rochester East Health Svcs, Quality of Care Treatment, Pressure Area Developments, Resident Safety

Rochester Rehab and Living Ctr, Perforated Bowel, Quality of Care Nutrition, Call Light Not in Reach, Meds Not Per DO Pharmaceuticals Not Available Dignity, Resident to Resident Physical

Rochester West Health Services, Dropped from Lift Accidents Safety Falls

Rollingwood Home, Clients Not Supervised, Physical Abuse

Rose of Sharon A Villa Center, Resident to Resident, Quality of Care Treatment, Quality of Care Treatment, Failure to Notify Physician, Resident to Resident

Sacred Heart Care Center Inc, Neglect of Care with Toileting Dignity

Saint Anne Extended Healthcare, Elopement, Resident to Resident Physical Abuse, Resident to Resident Sexual Abuse, Resident Neglect

Samaritan Bethany HM on Eighth, Resident Safety Falls Assess Monitor, Quality of Care Treatment, Physical Abuse

Sandstone Health Care Center, Quality of Care, Accidents

Sauer Health Care, Quality of Care Weight Gain Not Receiving Diuretic, Fall with Fracture NA Did Not Hold Onto Gait Belt When VA Started to Walk to Bathroom, Undignified Use of Resident Pictures on Staff Social Media, Substantiated, Safety Accident, Undignified Use of Resident Pictures on Staff Social Media, Medication Error Pharmaceutical Services

Seasons Healthcare, Resident to Resident, Substantiated, Significant Medication Error Needing ER Visit to Stabilize Pulse Due to Narcotic Overdose

Shakopee Friendship Manor, Fall, Incorrect Medication Dose, Unwanted Sexual Contact, Unwanted Sexual Contact

Shingle Creek Option, Falls Safety with Head Trauma

Shirley Chapman Sholom Home E, Quality of Care Sexual Abuse, Resident Abuse, Narcotic Med Diversion, Med Diversion, Resident Abuse, Substantiated

Sholom Home West, Fall Death, Falsification of Records, Improper Transfer from Recliner to Bed, Resident to Resident Sexual Abuse

Sleepy Eye Care Center, Neglect of Medication Coumadin, Resident to Resident Client Abuse

Southside Care Center, Resident to Resident Physical, Elopement

Southview Acres Healthcare Ctr, Failure to Notify MD, Fall with Injury, QOC Falls with 6 Fractures, QOC Fall with Injury, Discharge Planning

Spectrum Community Health Inc, Plan of Care Not Followed

Spring Valley Care Center, Sexual Abuse, Medication Administration, Resident to Resident Abuse, Resident to Resident Abuse, Resident Abuse, Resident to Resident Physical and Verbal Abuse, Resident Abuse, Lack of Proper Nutrition, Inadequate Discharge, Resident to Resident Physical and Verbal Abuse

ST Anthony Health and Rehab, Neglect of Supervision, Resident to Resident Physical Altercation with Injury

ST Benedicts Senior Community, Fall from Lift, Resident to Resident Physical Abuse, Resident to Resident Physical, Elopement, Sexual Assault

ST Clare Lvg Comm of Mora, Quality of Care Treatment, Fall, Multiple Quality of Care Concerns

ST Crispin Living Community, Safety Burn, QOC Resident Safety with Lift, Substantiated, Fall with Fracture

ST Elizabeth Medical Center, Resident to Resident Spousal Abuse, Abuse Verbal

ST Francis Home, Injury of Unknown Origin, Plan of Care Not Followed

ST Gertrudes Health and Rehab Center, Verbal Abuse Dignity, Medication Error, Neglect Medications

ST John’s on Fountain Lake, Leaking Catheter Not Changed

ST John’s Lutheran Home, Accidents with Injury, Injury of Unknown Origin, Resident Safety Accidents Elopement, Resident Safety Falls, Resident Safety Falls Accidents

ST John’s Lutheran Home, Resident to Resident Physical Abuse, Resident to Resident Physical

ST Luke’s Lutheran Care Center, Dignity

ST Mark’s Living, Fall with Fx, Resident Abuse, Quality of Care Treatment Nursing Services, Pressure Ulcers Care, Quality of Care, Fall from Lift with Injury, Fall with Fracture, Quality of Care Treatment

ST Otto’s Care Center, Physical Abuse, Quality of Care

ST Therese Home, Significant Med Error, Development of Wounds, Staff to Resident Physical Abuse, Physical Abuse, Dignity, Staff to Resident Physical Abuse, Physical Abuse

ST Therese of Woodbury LLC, Neglect of Health Care, Resident Rights

ST Williams Living Center, Resident Safety, Incorrect Use of Sit and Stand

Sterling Park HCC, Resident to Resident Physical Abuse, Quality of Care, Resident to Resident Altercation Verbal Sexual Touch, Resident to Resident Sexual in Nature, Resident to Resident Sexual

Stewartville Care Center, Fall with Significant Injury, Resident Safety Falls, QOC Falls, Substantiated, Medication Error, Substantiated, Medication Error, Call Light Not Answered Timely Resulting in a Fall and Incontinence

Suite Living Senior Care, Physical Abuse

Suite Living of Little Canada, Physical Abuse

Summit Hill Senior Living, Physical Abuse, Sexual Abuse

Sunnyside Health Care Center, Accident Hazards

Sunrise Village of Milaca, Plan of Care Not Followed

Talahi Nursing and Rehab Center, Resident to Resident Physical, Assessment Monitoring, Resident Abuse, Resident to Resident Physical, Meds Not Given Timely Not Bathed, Verbal Abuse Refusal to Provide Care

Terrace at Crystal LLC, Resident Safety, No Assessment for Injuries, Quality of Care Call Light Not Functioning, Resident Neglect, Resident Safety Falls, Quality of Care, Sexual Abuse

Texas Terrace A Villa Center, Change of Condition Assessed, Resident to Resident Physical Abuse, Lack of Skin Care, Resident Neglect Accidents, Quality of Care, Resident to Resident, Accidents

TFF Care LLC, Unexplained Injury

The Birches at Trillium Woods, Resident Safety

The Cedars, Admissions Transfer Discharge Rights

The Emeralds at Faribault LLC, Sepsis, Injury of Unknown Origin, Resident to Resident, Failure to Notify MD of Change in Condition, Resident to Resident

The Emeralds at Grand Rapids, Adequate or No Wound Assessment, Resident Abuse, Quality of Care, Contamination During Trach Care

The Emeralds at St Paul LLC, Elopement, Resident to Resident, Staff to Resident Abuse, Resident Neglect Accidents, Resident Neglect Nursing Services, Resident to Resident, Substantiated

The Encore at the Twin Cities, Falls, Plan of Care Not Followed

The Estates at Bloomington, Physical Abuse Dignity

The Estates at Delano LLC, Quality of Care, Resident to Resident, Pressure Ulcer, Substantiated

The Estates at Greeley LLC, Resident to Resident Physical

The Estates at Fridley LLC, Resident to Resident Sexual Abuse

The Estates at Lynnhurst LLC, Resident to Resident Physical, Resident to Resident Abuse Safety, Abuse Resident to Resident, Substantiated

The Estates at Rush City LLC, Resident to Resident, Resident to Resident Physical, Resident to Resident Sexual Abuse, Resident Patient Client Abuse, Resident to Resident Physical and Verbal Abuse

The Estates at St. Louis Park, Abuse Physical, Restraints, Resident to Resident Physical, Resident to Resident Physical Abuse, Quality of Care Treatment, Plan of Care Not Followed, Accidents, Resident to Resident

The Estates at Twin Rivers LLC, Resident Safety, Worsening Wounds Dr Orders Not Followed, Substantiated

The Gardens at Foley LLC, Fall from Sling, Resident to Resident, Resident to Resident Altercation, Resident to Resident Physical

The Gardens at Winsted LLC, Resident to Resident Physical Abuse, Death General Quality of Care Treatment, Resident to Resident Physical, Resident Abuse, Resident to Resident Physical, Resident to Resident Physical, Resident Abuse

The Green Prairie Rehab Ctr, Staff to Resident Sexual Abuse, Med Error Coumadin Omitted, CP Not Followed and Fell,  Substantiated, Resident Safety Elopement, Accidents Fall

The Legacy of St Anthony, Physical Abuse

The North Shore Estates LLC, Fall with Fx, Resident Patient Client Abuse, Resident to Resident Sexual AbuseResident Safety Falls

The Prairie Lodge at Earle Bro, Pressure Sores, Falls

The Villa at Bryn Mawr, Resident to Resident Altercation, Elopement, Resident to Resident Physical Abuse, Resident Neglect, Medications Pressure Ulcers Staff to Resident Mental Abuse Environment, QOC Hygiene Pressure Sores

The Villa at Osseo, Resident Patient Client Abuse

The Villa at St. Louis Park, Resident to Resident, Quality of Care Wound Care, Quality of Care Treatment Resident Abuse

The Waters of Edina, Plan of Care Not Followed

The Waterview Pines LLC, Lack of Assessment for Change in Condition Sepsis, Quality of Care Treatment, Fall, Turning Off Call Lights, Quality of Care, Quality of Care Pain Control

The Waterview Shores LLC, Fall with Injury, Resident to Resident Abuse, Abuse Resident to Resident

The Waterview Woods LLC, Quality of Care Treatment, Resident to Resident Physical, Resident to Resident Physical Altercation, Abuse Resident to Resident, Resident to Resident Physical Abuse, Resident to Resident Physical, Quality of Care and Treatment, Neglect of Healthcare, Neglect of Care Pressure Ulcers

The Wealshire of Bloomington, Falls

Thief River Care Center, Resident to Resident Physical Altercation, Falls, Resident to Resident Altercation, Substantiated

Thorne Crest Retirement Center, Staff to Resident Physical Abuse

Three Links Care Center, Resident Safety Accidents, Physical Abuse by Staff

Traditions of Montgomery LLC, No Assessment After Change in Condition

Traverse Care Center, Quality of Care Treatment, Fall with Fracture

Trillium at Woodsedge, Falls

Triple Angels Healthcare Comp, Plan of Care Not Followed

Truman Senior Living, Injury of Unknown Origin

Tweeten Lutheran Health Care Center, Resident to Resident Abuse, Death Quality of Care

Twin City Gardens, Sexual Abuse

Twin Diamond Operator LLC, Falls, Physical Abuse

Unison Group Home LLC, Neglect of Supervision

Uplifted Care Services LLC, Neglect of Supervision

Valley View Healthcare & Rehab, Dignity QOC, Misappropriation Drug Diversion

Valley View Manor HCC, Quality of Care Treatment, Staff to Resident Abuse

Victory Health and Rehab Ctr, Resident to Resident, Resident to Resident Abuse, Dehydration, Elopement, Feeding Tube Solution, Resident Abuse, Pressure Sores, Resident to Resident Physical, Resident to Resident Physical, Exploitation by Drug Diversion, Resident to Resident

Viewcrest Health Center, Quality of Care Treatment, Quality of Care, Resident Abuse, Falsification of Records Weight Loss, QOC Issues, PU Worsening, New PU Developed, Received Wrong Diet Resulting in Choking Aspiration, Facility Acquired Stage IV Decubitus Ulcer Lack of Bathing and Feet Care, Quality of Care Treatment, Resident to Resident Physical, Resident Safety Falls, Falls, Broken Wheelchair, Resident Safety Falls

Villa St. Vincent, Elopement, Resident to Resident, Resident to Resident Altercation

Wabasso Restorative Care Ctr, Resident to Resident Physical Altercation, Resident Safety, Abuse Staff to Resident Verbal, Sexual, Neglect of Care, Death, Long Call Light, Falls Bathing Call Lites Monitoring Per MD Orders

Walker Methodist Health Ctr, Resident to Resident Physical Abuse, Quality of Care Treatment, Staff to Resident Physical, Physical Abuse

Walker Methodist Highview Hill, Physical Abuse

Walker Methodist Westwood II, Staff to Resident Sexual Abuse

Warroad Care Center, Resident to Resident Altercation

Wesley Residence of Duluth, Sexual Abuse

West View Assisted Living Apartment, Fall with Fractured Ribs, Falls

West Wind Village, Physical Abuse, Physical Abuse, Injury of Unknown Origin

Westwood of Duluth

Whispering Oak Place, No Assessment After Change in Condition

Whispering Pines Assisted Living, Suicide Attempts Self Injurious Behavior

Whitewater Health Services, Physical Abuse, Sexual Assault, Elopement, Staff to Resident Abuse, Left Wet and Soiled Pressure Ulcers, QOC Resident Safety Elopement, Quality of Care Treatment, Resident Safety Falls, ADLS Not Provided Neglect Food Not Provided QOC

Woodbury Health Care Center, Falls, Call Light, Physical Abuse by Staff, Physical Abuse by Staff

Woodlyn Heights Healthcare Center, Physical Abuse by Staff, Physical Abuse Pressure Ulcer, Physical Abuse by Staff

Zumbro House Inc, Plan of Care Not Followed Medication Errors, Sexual Abuse, Sexual Abuse, QOC Falls, Medication Errors, Staff Verbal Abuse

 

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Facilities on the CMS Special Focus Facility Initiative List

Medicare & Medicaid CMS Special Focus Facility "SFF" List
Medicare & Medicaid CMS Special Focus Facility “SFF” List

The Centers for Medicare & Medicaid Services (CMS) and States visit nursing homes on a regular basis to determine if the nursing homes are providing the quality of care that Medicare and Medicaid requires. These “survey” or “inspection” teams will identify deficiencies in the quality of care that is provided. They also identify any deficiencies in meeting CMS safety requirements (such as protection from fire hazards).  The following facilities are either on the Special Focus Facility list or recently graduated after showing significant improvement:

moorhead-rehabilitation-and-health-center

bayview-nursing-and-rehabilitation

rochester-east-health-service

Click the link  for more information about the Special Focus Facility Initiative.

Click the link for The Medicare & Medicaid CMS Special Focus Facility Initiative list.

Minnesota Department of Health Survey Findings
Click here for Minnesota Department of Health Nursing Home Survey Findings

Click the link for more information about Medicare & Medicaid and State of Minnesota Nursing Home Surveys.

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