The Emeralds at St. Paul LLC

Inspectors wroteBased on observation, interview, and document review the facility failed to ensure proper cleaning of snack/nourishment refrigerators maintained with food items are dated and labeled to prevent the potential for foodborne illness for 3 of 3-unit refrigerators.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure call light was accessable for 1 of 1 residents (R61) reviewed for call lights.

Inspectors wroteBased on interview and record review the facility failed to ensure a Provider Order for Life Sustaining Treatment (POLST) was updated to reflect the current wishes for 1 of 1 residents (R7) reviewed for advanced directives.

Inspectors wroteBased on interview and record review the facility failed to ensure target behaviors were monitored for 1 of 5 residents (R3) who received psychotropic medications (medications that affect mood, thoughts, or behaviors).

Inspectors wroteBased on observation, interview, and document review the facility failed to provide nail care for 1 of 1 (R79) resident reviewed for activities of daily living (ADL).

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure a hand splint/brace was used consistently for 1 of 1 resident (R37) reviewed for range of motion (ROM).

Inspectors wroteBased on document review and interview, the facility failed to identify triggers to avoid potential re-traumatization and failed to develop the care plan to include individualized trauma-informed approaches for 1 of 1 resident (R6) who had a history of trauma.

Inspectors wroteBased on document review and interview, the facility failed to identify triggers to avoid potential re-traumatization and failed to develop the care plan to include individualized trauma-informed approaches for 1 of 1 resident (R6) who had a history of trauma.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure staff followed transmission-based precautions (TBP) for 1 of 2 residents (R7) reviewed for TBP. Furthermore, the facility failed to ensure hand hygiene was completed during medication administration for 3 of 11 residents (R15, R21, R78) observed for medication administration.

Inspectors wroteBased on interview and document review the facility failed to ensure that 1 of 3 residents (R1) reviewed for pressure ulcers received care and services to prevent occurrence of newly developed pressure ulcers. The facility's failure resulted in actual harm to R1 when R1's skin was not comprehensively assessed and failed to develop a care plan for pressure ulcer prevention that resulted in six (6) pressure ulcers including Stage 4 pressure ulcer to R1's nose and deep tissue injuries to R1's ear.

Inspectors wroteBased on interview and document review the facility failed to ensure a comprehensive care plan was developed for 1 of 1 resident (R1) reviewed for pressure ulcersFindings include:R1's admission Minimum Data Set (MDS) dated [DATE], identified R1 had highly impaired hearing that required a hearing device. R1 had severe cognitive impairment, no speech, and was completely dependent on staff for all activities of daily living (ADL's). R1's diagnoses included acute and chronic respiratory failure (when the lungs can't adequately provide oxygen to the blood or remove carbon dioxide from it) with hypoxia (when the body doesn't receive enough oxygen), encounter for tracheostomy (a surgical procedure creating an opening in the trachea (windpipe) to facilitate breathing) and anxiety disorder. Further identified R1 was at risk for pressure ulcers. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure medical records were accurate and readily accessible for 1 of 1 resident (R1) reviewed for pressure ulcers.

Inspectors wroteBased on observation, interview, and document review, the facility failed to provide adequate supervision and identify a foreseeable hazard for 1 of 3 residents (R1) reviewed who required supervision. R1's was found unsupervised on two occasions; On 6/7/27 while outside in the staff smoking area and on 6/13/25 as a result of nonfunctional wanderguard and the facility not performing physician ordered 15-minute checks was found at a busy intersection. This resulted in an immediate jeopardy for R1 health and safety. The Immediate Jeopardy (IJ) began on 6/7/25, was corrected on 6/14/25 when the facility implemented interventions to prevent reocurrance. The Administrator, Director of Nursing (DON), Regional Director of Operations, and Regional Nurse Consultant were notified of the IJ on 6/24/25 at 5:50 p.m. [...]

Inspectors wroteBased on interview, and document review, the facility failed to report lack of supervision incident (6/7/25) and elopement (6/13/25) was reported timely to the State Agency (SA) for 1 of 1 resident (R1) reviewed for elopement.

Inspectors wroteBased on interview and document review the facility failed to ensure a thorough investigation for an incident that involved the lack of required supervision for 1 of 3 residents (R1) reviewed who required supervision. R1 was found outside the facility on 6/7/25 in an unsafe unauthorized area.

Inspectors wroteBased on observation, interview, and document review, the facility failed to complete a comprehensive skin assessment identifying pressure ulcers, treatments, and monitoring, resulting in serious harm, for 1 of 3 residents (R1) reviewed for pressure ulcers. R1 returned from a hospital admission and the hospital discharge summary indicated upon admission to the hospital, R1 had pressure ulcers to his coccyx, left heel, right heel, lateral right foot. The treatment for all the wounds was to cleanse and change the dressing. This resulted in an Immediate Jeopardy for R1 when the facility failed to provide the necessary treatment to R1 upon his return from the hospital for approximately six weeks. The immediate jeopardy began on 3/19/25, when R1 returned from a hospital admission with pressure ulcers. These pressure ulcers were not treated for approximately six weeks. [...]

Inspectors wroteBased on observation, interview, and record review the facility did not ensure a residents pain was managed in accordance with professional standards of practice and hospice plan care, for 1 of 3 residents (R1) reviewed for pain. R1's medication regimen was ineffective; he would scream and moan in pain contacting EMS and his daughter for help. This resulted in immediate jeopardy (IJ) when the facility did not have a system in place to manage R1's pain causing R1 unnecessary physical and psychological harm. The immediate jeopardy began on 4/1/25 when R1's pain medication became ineffective and subsequently lacked follow-up of effectiveness, the patient called emergency services for pain medication, and called his daughter crying in pain, and was identified on 4/28/25. The Administration, director of nursing, and regional nurse manager were notified of the immediate jeopardy at 5:10 p.m. [...]

Inspectors wroteBased on observation, interview and document review, the facility failed to establish a communication process between the facility and the hospice provider to ensure that the needs of a resident were addressed and met for 1 of 3 residents (R1) reviewed for hospice services. This resulted in an immediate jeopardy (IJ) when R1 did not receive the necessary care and services for the treatment of pressure ulcers and pain management. R1's pressure ulcer went untreated for approximately six weeks and R1's pain was not controlled, limiting staff's ability to perform activities of daily living for R1. In addition, the facility failed to have a designated member of the interdisciplinary team who was responsible to work with hospice to ensure residents receiving hospice services needs were met. [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident assessment accurately reflected a resident health status for 1 of 3 residents (R1) reviewed when R1's significant change of status did not reflect R1's pressure ulcers.

Inspectors wroteBased on observation, interview, and record review the facility failed to attempt alternative devices before the use of bedrails on residents beds, assess the residents for risk of entrapment, ensure bed dimensions were appropriate for 2 of 2 residents (R1, R2) reviewed for bed rails. In addition, the facility failed to use caution as R1 had bed rails used in conjunction with an air mattress.

Inspectors wroteBased on observation, interview, and record review the facility failed to conduct regular inspections of bed frames, mattress, and bed rails as part of the regular maintenance program to identify areas for entrapment for 2 of 2 residents (R1, R2) reviewed for bed rails.

Inspectors wroteBased on observation, interview and document review, the facility failed to report an allegation of abuse and chemical ingestion for 1 of 3 residents (R1) reviewed for incidents and abuse allegations.

Inspectors wroteBased on observation, interview and document review, the facility failed to investigate an allegation of abuse and chemical ingestion for 1 of 3 residents (R1) reviewed for incidents and abuse allegations.

Inspectors wroteBased on observation, interview, and document review, the facility failed to assess and monitor a resident for bruises, pulse oximeter alarms and after ingesting wound spray for 1 of 3 residents (R1) reviewed for assessment and monitoring.

Inspectors wroteBased on interview and record review, the facility failed to ensure a sufficient number of licensed nurses had the necessary training on vest therapy treatments and cough assist therapy treatments for 6 of 6 residents (R1, R3, R4, R5, R6, and R7) reviewed who had orders for vest therapy treatments and 8 of 8 residents(R1, R5, R8, R9, R10, R11, R12, and R13) reviewed who had orders for cough assist therapy.

Inspectors wroteBased on interview and document review the facility failed to ensure a resident right to be free from abuse for 2 of 3 residents (R1 and R2) reviewed when the facility did not comprehensively assess R1 and R2 for vulnerabilities for sexual abuse. R1 had an extensive mental health disease leading to impaired judgement, altered decision making, impaired insight, and hypersexual arousal. R2 had history of alcohol abuse and inappropriate and unwanted sexual behaviors with female staff and residents.

Inspectors wroteBased on interview and document review the facility failed to follow the care plan interventions for inappropriate sexual behavior, intoxication, and develop a care plan for behavioral health for 2 of 3 residents (R1 and R2), when R2 was found abusing R1. R1's care plan indicated placing him on every 15-minute checks or 1:1 observation when found having sexual activity. In addition, vital signs every 15 minutes when staff suspected alcohol use. [...]

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure medications were administered in accordance with physician orders and failed to identify and report medication errors according to facility policy for 3 of 3 (R1, R2, R3) residents reviewed for medication administration.

Inspectors wroteBased on interview and document review the facility failed inform a resident of the outcome of a grievance 1 of 1 resident (R3) who filed a grievance regarding concerns for another resident, R4.

Inspectors wroteBased on observation, interview and document review, the facility failed to assess, monitor for side effects and drug interactions, implement interventions and follow facility policy to ensure the safety of 2 of 3 residents (R1, R6) who were reported to use crack cocaine all weekend on the facility smoking patio. This resulted in an immediate jeopardy (IJ) for R1 and R6 and had the potential to affect 20 other residents who were identified at risk for illicit drug use. The IJ began on 7/6/24 when R1 and R6 were seen smoking crack cocaine on the facility patio and were not assessed or monitored for potential life-threatening side effects and drug interactions. The director of nursing and administrator were notified of the IJ on 7/25/24 at 5:10 p.m. [...]

Inspectors wroteBased on observation, interview, and document review, the facility failed to report allegations of verbal and emotional abuse immediately (within two hours) to the State Agency (SA) for 1 of 4 residents (R10) reviewed for abuse.

Inspectors wroteBased on interview and document review the facility failed to timely respond to ventilator alarms for 1 of 3 residents (R1) reviewed for response to ventilator alarms. This resulted in an immediate jeopardy (IJ) for R1 when R1's ventilator alarmed intermittently on [DATE] from 3:19 a.m. to 5:47 a.m., 237 times, for an alarm that indicated high pressure in the ventilator or an obstruction in the ventilation system. The IJ began on [DATE] at 3:19 a.m., when R1's ventilator alarmed intermittently on [DATE], 237 times between 3:19 a.m., and 5:47 a.m., without staff response. The director of nursing (DON), facility owner, and senior nurse consultant were notified of the IJ on [DATE] at 1:31 p.m. [...]

Inspectors wroteBased on interview and document review, the facility failed to identify in the facility assessment (FA) protocol related to the acuity for day-to-day operations and for emergencies for fifteen ventilator-dependent residents. Additionally, the facility failed to review the FA annually.

Inspectors wroteBased on observation, interview and document review the facility failed to perform a self-administration of medication assessment and obtain provider order to have medication left in room and self-administered for 1 of 1 (R46) resident reviewed for self-administration of medication.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure a physician was notified of elevated blood glucose results for 1 of 1 resident (R20) reviewed who had specific physician's orders with parameters for physician notification of high blood glucose results. Findings Include: R20's admission Minimum Data Set (MDS) dated [DATE], indicated R20 was cognitively intact, did not exhibit rejection of care during the assessment period, and diagnosis included diabetes mellitus and peripheral vascular disease. R20 also received insulin seven days during the assessment period. R20's care plan printed 5/22/24, indicated a focus for potential for alteration in blood sugar related to diagnosis of diabetes with history of refusing blood sugar checks, and medications. Goals included R20's blood sugar would be maintained between 60 and 120. [...]

Inspectors wroteBased on observation, interview, and document review, the facility failed to provide a homelike environment for 1 of 1 residents (R65) reviewed who had enteral feeding liquid spilled on the bottom of the tube feeding pump pole and on the floor.

Inspectors wroteBased on observation, interview and document review, the facility failed to develop a comprehensive resident-centered care plan with resident-specific target symptom monitoring and resident-specific interventions for 1 of 5 residents (R72) reviewed for unnecessary medications.

Inspectors wroteBased on interview, observation and document review the facility failed to ensure diagnostic standards of practice were followed for 1 of 1 resident (R24) who was newly diagnosed with schizophrenia.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure a resident's preferred activities for individual entertainment were available for 1 of 2 residents (R64) reviewed for activities.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure blood thinner medications were held per provider order for 1 of 1 resident (R65), and failed to implement a physician order for 1 of 1 resident (R57) related to a rash.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure a resident was positioned appropriately with the head of the bed (HOB) at 30-45° (degrees) or higher during and after medication administration via gastric tube, failed to label tube feeding nutrition when started, and failed to replace a tube feeding administration set daily for 1 of 1 residents (R65) reviewed for tube feeding.

Inspectors wroteBased on observation, interview, and document review, the facility failed to provide assistance and coordination of services to ensure timely referral and treatment for prosthetic fit for 1 of 1 resident (R37) reviewed who needed a prosthesis.

Inspectors wroteBased on interview and document review, the facility failed to ensure gradual dose reductions (GDR) were attempted, or an adequate medical justification for the use of psychotropic medications for 1 of 5 residents (R42) reviewed for unnecessary medications.

Inspectors wroteBased on observation, interview and document review, the facility failed to adhere to infection control evidence based practices for a resident urinary catheter bag being placed on the floor for 1 of 1 resident (R72) reviewed for infection prevention and control practices.

Inspectors wroteBased on interview and document review, the facility failed to ensure 2 of 5 residents (R24, R52) reviewed for immunizations were offered or received the pneumococcal vaccine in accordance with the Center for Disease Control (CDC) recommendations.

Inspectors wroteBased on interview, observation, and document review, the facility failed to report allegations of verbal and emotional abuse immediately (within two hours) to the State Agency for 1 of 4 residents (R1) reviewed for abuse.

Inspectors wroteBased on interview, and document review the facility failed to perform skin assessments for 3 of 3 residents (R25, R37, R45) and failed to obtain physician ordered weights to monitor for weight loss for 2 of 4 residents (R29, R79) reviewed for quality of care.

Inspectors wroteBased on observation, interview, and document review, the facility failed to maintain a clean and sanitary condition of the walk-in cooler, kitchen equipment, and kitchen floor to promote sanitation in the kitchen. This had the potential to affect 75 residents receiving food from the kitchen.

Inspectors wroteBased on observation, interview, and document review, the facility failed to identify multidrug resistant organism (MDRO) in 4 of 4 residents (R6, R12, R53, R68) reviewed for infections. The facility also failed to ensure proper personal protective equipment (PPE) was utilized for 1 of 1 residents (R68) reviewed for PPE. Furthermore, the facility failed to ensure current standards of practice for glove use and handwashing were being followed for 1 of 1 resident (R24), when staff provided personal care.

Inspectors wroteBased on observation, interview, and document review, the facility failed to assess the resident and determine safety for self-administration of medications (SAM) for 1 of 1 (R25) resident who was observed to have prescribed nicotine replacement gum at the bedside.

Inspectors wroteBased on interview and document review, the facility failed to notify the physician timely of a change of condition (COC) for 1 of 1 (R92) resident reviewed for hospitalization.

Inspectors wroteBased on interview, observation, and document review, the facility failed to ensure resident room walls were in good repair to create a home-like environment for 3 of 4 residents (R9, R79, and R88) reviewed for room environment.

Inspectors wroteBased on interview and document review, the facility failed to ensure a discharge Minimum Data Set (MDS) was completed for`1 of 2(R30) residents who discharged from the facility.

Inspectors wroteBased on observation, interview and document review, the facility failed to ensure completed Minimum Data Set (MDS) assessments were accurate for 3 of 3 residents (R12, R25, R68) reviewed for resident assessment.

Inspectors wroteBased on interview and document review, the facility failed to ensure a Level II Pre-admission Screening and Resident Review (PASARR) was conducted, documented and retained to ensure mental health needs were appropriately addressed or provided for 1 of 3 resident (R28) reviewed for PASARR.

Inspectors wroteBased on observation, interview, and document review, the facility failed to ensure routine personal hygiene was completed and provided for 1 of 1 resident (R52) reviewed for nail care.

Inspectors wroteBased on observation, interview, and document review the facility failed to ensure a therapeutic diet that took into account a residents clinical condition for 1 of 1 resident (R79)

Inspectors wroteBased on observation, interview, and document review, the facility failed to comprehensively assess past trauma and implement care plan interventions utilizing a trauma-informed approach for 1 of 1 (R40) resident reviewed who had post-traumatic stress disorder (PTSD).

Inspectors wroteBased on interview and document review, the facility failed to ensure the consulting pharmacist (CP) identified or acted upon 1 of 1 resident (R53) reviewed for long term antibiotic use. Furthermore, the facility failed to ensure CP recommendations were addressed or acted upon for 1 of 5 residents (R25) reviewed for unnecessary medications.

Inspectors wroteBased on interview and document review, the facility failed to track and monitor the appropriate use of antibiotics use for 1 of 1 residents (R53) reviewed for antibiotic use.

Inspectors wroteBased on interview, observation, and document review, the facility failed to ensure residents' call lights were functioning for 1 of 1 resident (R52) reviewed for call lights.

Inspectors wroteBased on observation, interview, and document review, the facility failed to maintain sanitary equipment for 2 of 2 residents (R6, R14) reviewed for environmental cleanliness.