St Therese of Woodbury: Call System Failures - MN
At St. Therese of Woodbury, inspectors found that system wasn't reliably there.
Federal health inspectors cited the Woodbury facility on May 29 for a pattern of failures involving emergency call systems in resident bathrooms and bathing areas. The deficiency, classified under the environmental category, was not a one-time equipment glitch. Inspectors characterized it as a pattern, meaning the problem showed up in more than one place, more than once, across the facility.
No resident was documented as harmed. That is the narrow good news. The rest of the picture is less reassuring.
The inspection finding carries a scope and severity rating that signals potential for more than minimal harm. That language is regulatory shorthand for a specific conclusion: if something had gone wrong in one of those bathrooms, a resident would have had no reliable way to call for help. Bathrooms and bathing areas are among the highest-risk spaces in any nursing home. Residents who are frail, unsteady, or cognitively impaired are at their most vulnerable when they are bathing, toileting, or transferring on wet or slippery surfaces. A working call system in those spaces is not a convenience. It is the last line of communication between a resident in distress and anyone who can respond.
St. Therese of Woodbury is a long-term care facility operating in the eastern Twin Cities suburb of Woodbury. The May 29 inspection was a complaint inspection, meaning it was triggered by a concern brought to regulators rather than a routine scheduled visit. The call system deficiency was one of four total violations cited during that inspection.
The facility submitted a plan of correction and reported the problem resolved as of June 29, a month after inspectors documented it.
A month is a long time to have a pattern of non-working call systems in resident bathrooms. The inspection report does not specify how many bathrooms or bathing areas were affected, how long the systems had been out of service before inspectors arrived, or whether staff had identified the failures internally before the complaint brought inspectors through the door. Those details matter, because a pattern deficiency suggests the problem was not invisible. It was visible enough to recur, in enough locations, that inspectors could characterize it as something beyond an isolated incident.
Facilities are required to conduct their own routine checks of safety equipment. Whether St. Therese of Woodbury had a process for verifying that call systems were functional, and whether that process was working, is not addressed in the inspection record.
What the record does show is that when inspectors came, the systems were not all working, and the failure was widespread enough to constitute a pattern.
The practical consequence for residents is straightforward. A person who falls while bathing and cannot reach the pull cord or button has to wait until staff check on them, or until someone notices they have been in the bathroom too long. In a facility with any degree of staffing pressure, that wait can stretch. Residents who are disoriented may not be able to call out. Residents who are injured may not be able to move. The call system exists precisely for those moments.
St. Therese of Woodbury told regulators it corrected the problem by late June. Inspectors have not returned to verify that correction on the public record available at the time of this report.
The other three deficiencies cited during the same inspection have not been detailed in the available inspection narrative. What is known is that all four violations emerged from a single complaint-driven visit, suggesting the concerns that prompted the inspection touched on more than one area of the facility's operations.
For residents and families at St. Therese of Woodbury, the call system finding raises a question that a plan of correction does not fully answer: how long were those bathrooms without working emergency systems before anyone with authority to fix them knew, or acted?
The inspection report does not say. The facility has not said publicly. And the residents who used those bathrooms during that period had no way of knowing the system they reached for might not have worked.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for St Therese of Woodbury LLC from 2026-05-29 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: August 4, 2026 · Our methodology
St Therese Of Woodbury Llc in WOODBURY, MN was cited for violations during a health inspection on May 29, 2026.
Therese of Woodbury, inspectors found that system wasn't reliably there.
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.