Augustana HCC Of Apple Valley, Apple Valley Galtier Health Center, St Paul Augustana HCC of Minneapolis, Minneapolis Gil Mor Manor, Morgan
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1 Minnesota Department of Health Compliance Monitoring Division, Licensing & Certification Program Nursing Home QIS Survey Data Report-Surveys-- February, 2008 through May, 2009 Aitkin Health Services, Aitkin Faribault Commons Nursing and Rehab, Faribault Angels Care Center, Cannon Falls First Care Medical Services, Fosston Augustana HCC Of Apple Valley, Apple Valley Galtier Health Center, St Paul Augustana HCC of Minneapolis, Minneapolis Gil Mor Manor, Morgan Avera Marshall Reg Med Center, Marshall Glen Oaks Care Center, New London Belgrade Nursing Home, Belgrade Glencoe Regional Health Srv, Glencoe Benedictine Health Center, Duluth Golden Living Center Franklin, Franklin Benedictine Health Center Innsbruck, New Brighton Golden Living Center Greeley, Stillwater Benedictine Living Community, St Peter Golden Living Center Lake Ridge, Roseville Berkshire Residence, Osseo Golden Living Center Linden, Stillwater Bethel Care Center, St Paul Golden Living Center Lynnhurst, St. Paul Bethesda NH - Pleasantview, Willmar Golden Living Center St Louis Park, St Louis Park Bigfork Valley Communities, Bigfork Golden Living Center Wabasso, Wabasso Birchwood Care Home, Minneapolis Golden Living Center Walker, Walker Birchwood Health Care Center, Forest Lake Golden Valley Rehab and CC, Golden Valley Bridges Medical Center, Ada Good Samaritan Society-Bethany, Brainerd Camilia Rose Care Center LLC, Coon Rapids Good Samaritan Society-International Falls, Int. Falls Catholic Eldercare on Main, Minneapolis Good Sam Society Inver Gr Hgts, Inver Grove Hts (2) Central Health Care, Le Center Good Sam Society Maplewood, Maplewood Cerenity Care Center, White Bear Lake (2) Good Sam Society Pine River, Pine River Cerenity Care Ctr - Bethesda, South St. Paul Good Sam Society Pipestone, Pipestone Cerenity Care Center-Marian, St Paul Good Sam Society-Roseville, Roseville Cerenity Care Ctr on Dellwood Place, St. Paul Good Sam Society-St. James, St. James Clara City Care Center, Clara City Good Sam Society-Warren, Warren Cokato Manor, Cokato Good Sam Society-Winthrop, Winthrop Colonial Acres Health Care Center, Golden Valley Good Sam Society-Woodland, Brainerd Colonial Manor Nursing Home, Lakefield Gracepointe Crossing Gables East, Cambridge Colonial Manor of Balaton, Balaton Grand Avenue Rest Home, Minneapolis Cornerstone NH & Rehab Center, Bagley Grand Village, Grand Rapids Country Manor Hlth & Rehab Ctr, Sartell Green Pine Acres Nursing Home, Menahga Courage Residence, Golden Valley Guardian Angels Care Center, Elk River Crest View Lutheran Home, Columbia Heights Halstad Living Center, Halstad Cuyuna Regional Medical Center, Crosby Havenwood Care Center, Bemidji (2) Divine Providence Community Home, Sleepy Eye Health and Rehab New Brighton, New Brighton (2) Divine Providence Health Center, Ivanhoe Heritage Manor, Chisholm Ebenezer Care Center, Minneapolis Highland Chateau HCC, St. Paul (2) Ebenezer Ridges Geriatric Care Center, Burnsville Hillcrest Health Care Center, Mankato (2) Edgebrook Care Center, Edgerton Hillcrest Senior Living, Red Lake Falls Elim Home, Milaca Hilltop Care Center, Watkins Elliot Care Home Inc, Minneapolis Homestead Rehab & Living Center, Deer River Episcopal Church Home of Minnesota, St. Paul Janesville Nursing Home, Janesville Fair Meadow Nursing Home, Fertile Johnson Memorial Hosp. & Home, Dawson Fair Oaks Lodge Inc, Wadena Jones Harrison Residence, Minneapolis Fairfax Community Home, Fairfax Jourdain/Perpich Ext Care Fac, Red Lake Fairmont Med Ctr Mayo Health, Fairmont Kittson Memorial Hospital, Hallock -1-
2 Lake City Med Ctr Mayo Hlth System, Lake City Lake Minnetonka Care Center, Deephaven Lake Ridge Care Center of Buffalo, Buffalo Lake Shore Inn Nursing Home, Waseca Lakeside Health Care Center, Dassel Lakeview Methodist HCC, Fairmont -2- Sleepy Eye Care Center, Sleepy Eye South Shore Care Center, Worthington Southview Acres Health Care Center Inc, West St. Paul St. Anthony Health Center, St. Anthony St. Anthony Park Home, St. Paul St. John Lutheran Home, Springfield Lakewood Care Center, Baudette St. Lucas Care Center, Faribault Lakewood Health System, Staples St. Lukes Lutheran Care Center, Blue Earth Little Sisters of the Poor, St. Paul St. Mary s Home, St. Paul Littlefork Medical Center, Littlefork St. Mary s Regional Health Ctr, Detroit Lakes Luther Haven, Montevideo St. Michael s Hosp & NH, Sauk Center(2) Lyngblomsten Care Center, St. Paul St. Olaf Residence, Minneapolis (2) Madison Lutheran Home, Madison St. Otto s Care Center, Little Falls Mala Strana Health Care Center, New Prague Sterling Park Health Care Center, Waite Park McIntosh Manor, McIntosh (2) Talahi Care Center, St. Cloud Melrose Area Hosp Centracare (Pine Villa), Melrose The Margaret S Parmly Residence, Chisago City Midway Care Center Thief River Care Center, Thief River Falls Minnesota Masonic Home Care Ctr, Bloomington Trimont Health Care Center, Trimont Mission Nursing Home, Plymouth Trinity Care Center, Farmington Mount Olivet Careview Home, Minneapolis Twin Valley Living Center, Twin Valley Mount Olivet Home, Minneapolis Tyler Healthcare Center, Tyler Neilson Place, Bemidji Valley View Manor, Lamberton New Harmony Care Center, St. Paul Viking Manor Nursing Home, Ulen North Ridge Care Center, New Hope (2) Villa St. Vincent, Crookston Oakland Park Communities, Inc, Thief River Falls Walker Methodist Health Center, Minneapolis Oaklawn Health Care Center, Mankato Warroad Care Center, Warroad Park View Care Center, Buffalo Willmar Commons Nursing & Rehab Ctr, Willmar Parkview Home, Belview Wood Dale Home Inc., Redwood Falls Pathstone Living, Mankato Woodbury Health Care Center, Woodbury (2) Pierz Villa, Inc., Pierz Woodlyn Heights HCC, Inver Grove Heights (2) Pine Haven Care Center, Pine Island Pioneer Memorial Care Center, Erskine Pleasant Manor, Inc. Faribault Presbyterian Homes of Arden Hills, Arden Hills Presbyterian Homes Lake Minnetonka, Spring Park Presbyterian Homes North Oaks, North Oaks Providence Place, Minneapolis (2) Ramsey County Care Center, Maplewood Redeemer Residence Inc, Minneapolis Regina Medical Center, Hastings Renvilla Health Center, Renville Rice Care Center, Willmar Richfield Health Center, Richfield Riverview Hosp & Nursing Home, Crookston Rose Of Sharon Manor, Roseville Samaritan Bethany Heights, Rochester Shakopee Friendship Manor, Shakopee Sholom Home West, St. Louis Park
3 Frequency of tags issued Scope and severity ranged from an A to a K and the total number of deficiencies issued at a QIS survey ranged from 0 to 27 deficiencies, average number of deficiencies: F154-1 F155-7 F F F159-5 F163-1 F F166-4 F167-9 F170-3 F174-2 F F205-2 F F223-1 F224-3 F F F F F243-1 F244-8 F F247-2 F F F F F258-2 F271-1 F F F F F F F F F F F F313-2 F F F F319-6 F322-5 F F F F328-1 F F332-3 F333-3 F F353-9 F354-4 F F361-1 F363-6 F F365-1 F366-3 F367-1 F368-4 F F372-2 F386-2 F387-4 F388-2 F406-5 F F412-5 F F F F F F445-6 F456-7 F458-6 F463-8 F464-1 F F467-7 F468-2 F469-1 F492-4 F494-1 F495-1 F496-1 F497-7 F498-1 F500-1 F501-1 F502-1 F505-1 F514-6 F516-1 F517-1 F518-3 F519-1 F520-9 Total tags = 1827 Total # surveys=181-3-
4 Name of Provider with I J Findings=10, Tags=11 Level Tag# Benedictine Health Center Innsbruck, New Brighton K F225, F226 Bethesda NH Pleasantview, Willmar J F323 Good Samaritan Society-Bethany, Brainerd J F323 Good Samarian Society-Maplewood, Maplewood J F323 Good Samaritan Society-Warren, Warren J F323 Lakeview Methodist Health Care Center, Fairmont J F323 Midway Care Center, Fosston J F323 North Ridge Care Center, New Hope K F323 Oaklawn Health Care Center, Mankato J F323 St. Anthony Park Home, St. Paul J F323 Name of Provider with Actual Harm Deficiencies=18,Tags=24 Level Tag# Bridges Medical Center, Ada G F323 Central Health Care, Le Center G F318 Cerenity Care Center on Dellwood Place, St. Paul G F309 Colonial Manor of Balaton, Balaton G F318 Divine Providence Community Home, Sleepy Eye G F323 Fairmont Med Ctr Mayo Health, Fairmont G F315 Faribault Commons Nursing and Rehab, Faribault G F323 Gil Mor Manor, Morgan G F224 Golden Living Center Greeley, Stillwater G F309, F323 Good Samarian Society-Maplewood, Maplewood G F314 Luther Haven, Montevideo G and H F309 F314 Madison Lutheran Home, Madison G F309 McIntosh Manor, McIntosh G (5/08) F323 McIntosh Manor, McIntosh G (11/08) F314, F318 Midway Care Center, Fosston G F314 Pine Haven Care Center, Inc., Pine Island G F309 Pioneer Memorial Care Center, Erskine G F157, F309, F323 Presbyterian Homes of Arden Hills, Arden Hills G F314 Rose of Sharon Manor, Roseville G 319 South Shore Care Center, Worthington G F315 St. Anthony Health Center, St. Anthony G F323 St. Lucas Care Center, Faribault G F314 Willmar Commons Nursing & Rehab, Willmar G F314 Woodlyn Heights, Inver Grove Heights G F241-4-
5 IIDR/IDRs requested: Ten to date Two completed with one tag with wording change only; one with tag removed and three valid; two with the one tag issued removed; one with one removed and three valid; and four still in progress. Top 10 Deficiencies as of 05/28/09-Source OSCAR Top 10 QIS Deficiencies as of 5/31/09 F329 Unnecessary Medications F329 Unnecessary Medications F282 Prov. Care According to Care Plan F272 Comprehensive Assessment F323 Accidents/Supervision F323 Accidents/Supervision F272 Comprehensive Assessment F279 Comprehensive Care Plan F315 Urinary Incontinence F428 Drug Regimen Review F314 Pressure Ulcer Tx/Prevention F282 Prov. Care According to Care Plan F279 Comprehensive Care Plan F280 Care Plan Revision F371 Food Handling & Sanitation F371 Food Handling & Sanitation F465 Environment F315 Urinary Incontinence F274 Assessment after Significant Change F314 Pressure Ulcer Tx/Prevention-TIE F309 Quality of Care-TIE -5-
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