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.
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1-0 Granny’s Helpful Hands LLC, Neglect of Supervision
Able Inc La Crescent, Death from Sepsis
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
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
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
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
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
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
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
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
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
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 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 Error, QOC 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
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
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
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
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
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 Abuse, Resident 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
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
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
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
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.
Click the link for more information about Medicare & Medicaid and State of Minnesota Nursing Home Surveys.
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