Waterview Shores: Dignity Violations in Dining Room - MN
Six of them had no say in any of it.
Federal inspectors visited Waterview Shores LLC on August 21, 2025, and found the practice running exactly as staff described it, without embarrassment. A nursing assistant identified only as NA-B told inspectors that dinner was served at 5:00 p.m. in the large dining room, but that the kitchen brought food earlier for residents who needed help eating, so they could finish before the main service began. NA-B was in a separate dinette at the far end of the building, assisting one of those residents, when inspectors observed the conversation.
The explanation from a licensed practical nurse was blunter. LPN-A told inspectors that sometimes there were many feeders, so staff got them out of the way so they could pass trays to everyone else.
The administrator confirmed the practice had been going on, on and off, for a few years. The nursing department had asked for the early trays, the administrator said, and staff wanted to make it easier for them. When inspectors reviewed the list of residents receiving early trays, six of the seven had no documented opportunity to choose whether they wanted to eat in the main dining room alongside the other residents in the facility.
The facility's own meal assistance policy, dated July 2017, said residents who cannot feed themselves will be fed with attention to safety, comfort, and dignity. The policy specifically listed avoiding the use of labels when referring to residents, with "feeders" as the example of what not to say.
Staff were using the word anyway. And the practice the policy was designed to prevent had been built into the daily schedule.
There is a particular quality to a violation that staff describe openly, in real time, to federal inspectors. NA-A, another nursing assistant, explained the logic of the system without being asked: the residents who needed feeding assistance got their trays first so there were enough staff in the dining room to pass out trays to everyone else. The sequencing was designed around staffing convenience. The residents who required the most help ate earliest, alone or nearly so, in a side room, so the dining room operation could run more smoothly for the people who didn't need anything.
What inspectors documented was not a single lapse or an employee acting outside the rules. It was a system. The kitchen was delivering trays on a separate schedule. Staff across the facility knew the routine and could explain it. The administrator knew it and had known it for years. The word "feeders" had not been corrected out of daily use despite appearing in the facility's own policy as an example of language to avoid.
Six residents who needed help eating had, for some period of years, been separated from the rest of the resident population at mealtimes as a matter of operational convenience, without being asked whether that was what they wanted.
The inspection cited the violation at a level of minimal harm or potential for actual harm, and noted that some residents were affected. The citation fell under the federal standard requiring facilities to treat residents with dignity, which includes honoring each resident's right to make choices about daily life.
The dining room at Waterview Shores seated residents at 5:00 p.m. Six of them had already been fed.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for The Waterview Shores LLC from 2025-08-22 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: October 8, 2026 · Our methodology
THE WATERVIEW SHORES LLC in TWO HARBORS, MN was cited for violations during a health inspection on August 22, 2025.
Six of them had no say in any of it.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.