Birches at Trillium Woods: Pain Order Failures - MN
The resident, identified in inspection records only as R58, had Alzheimer's disease and severe cognitive impairment. She was entirely dependent on staff for her daily care. After her hip surgery, her doctor ordered lidocaine gel applied to the injection site thirty minutes before her daily blood thinner shot, a simple step meant to numb the skin so she wouldn't feel the needle.
Her family had noticed it wasn't happening.
On the afternoon of May 26, a family member was in R58's room when a licensed practical nurse arrived to give the injection. The family member asked whether the lidocaine would be applied first, so R58 would have less pain. The nurse said no, they put it on after to take away the pain. The family member explained that wasn't right, that it needed to go on at least fifteen minutes before the injection so R58 wouldn't feel it. The nurse repeated that it went on after, and gave the injection anyway.
R58 screamed. She called the nurse a jerk and struck out at her.
The family member had already told inspectors, at 3:37 that afternoon, that nurses had been inconsistent for some time. Some applied the gel after the injection. Some didn't apply it at all. Some put it on one part of the body and then gave the injection somewhere else entirely.
The next morning, May 27, a registered nurse removed R58's prefilled injection syringe from the medication cabinet and administered it directly into R58's abdomen. No lidocaine. R58 screamed again. "Ouch, damn it you jerk, that hurt." She kept yelling, grabbed the nurse's arm, and scratched the back of her hand. Staff offered her breakfast. She said she didn't want breakfast, damn it.
When inspectors spoke with the registered nurse at 10:22 that morning, the nurse said she would reapproach R58 to apply the lidocaine gel after R58 had calmed down. The nurse said it wouldn't be a good idea to try now because R58 was too upset to allow it. Then the nurse looked at R58's electronic medical record. "Oh," she said, "I should have applied that before the injection was done. I did not do it."
The order was clear. Lidocaine external gel, four percent, applied in a thin layer to the injection site thirty minutes before the shot, once daily. It was in the record. It was in the care plan, revised as recently as May 6. The director of nursing, interviewed that same afternoon, confirmed that applying the lidocaine after the injection would not help R58 with the pain. The expectation, the director said, was for nurses to review residents' orders before administering medications to make sure they were following them correctly.
That review wasn't happening. Not consistently, and apparently not for some time before inspectors arrived.
R58's care plan listed pain as an active problem. Her diagnoses included anxiety, a femur fracture, the presence of an artificial hip joint, and Alzheimer's disease. She could not manage her own medications, advocate for herself in a medical setting, or fully communicate what she was experiencing. What she could do, and did, was scream.
The facility's own pain management policy instructed staff to watch for behavioral signs of pain, including screaming, crying, resisting care, and negative vocalizations. R58 screamed twice in two days during her injection. Both times, a nurse had skipped the order meant to prevent exactly that.
Her family had been asking about it before inspectors ever walked through the door.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for The Birches At Trillium Woods from 2026-05-27 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: August 12, 2026 · Our methodology
The Birches at Trillium Woods in PLYMOUTH, MN was cited for violations during a health inspection on May 27, 2026.
The resident, identified in inspection records only as R58, had Alzheimer's disease and severe cognitive impairment.
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.