Thorne Crest Retirement Center

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

stated it does not look like anyone notified Resident R1's family of his change in condition with his right eye and they should have. ADON stated anytime a resident has a change in condition the resident representative should be notified immediately and should be documented in the resident's medical record. During an interview on 9/17/25 at 2:29 p.m., licensed practical nurse (LPN)-A indicated on 9/4/25, Resident R1 had a change in condition when Resident R1 was complaining of soreness in his right eye. LPN-A stated Resident R1 had redness in his right eye and his eye lid that extended above his eyebrow. LPN-A further stated his eye worsened on 9/5/25 due to swelling and warmth. LPN-A stated she did not notify FM-B of Resident R1's change in condition and should have.During a phone interview on 9/18/25 at 8:31 a.m., FM-B stated Resident R1 was seen by a virtual doctor for his infected right eye on 9/5/25. FM-B stated she was Resident R1's resident representative and was upset the facility never contacted her about Resident R1's eye infection. FM-B stated they should have called me when Resident R1's eye first started getting red. FM-B stated she wanted to be notified of any changes Resident R1 had. FM-B stated she didn't find out until she went to the facility to visit Resident R1.During an observation and interview on 9/18/25 at 9:25 a.m., Resident R1 was lying in bed eating breakfast. Resident R1 indicated when he has changes in his health, he would like the facility to notify FM-B.During an interview on 9/17/25 at 3:38 p.m., director of nursing (DON) reviewed Resident R1's electronic medical record and stated there was no documentation that FM-B was notified of Resident R1's change in condition of his right eye. DON indicated FM-B should have been notified immediately and should have been documented in Resident R1's medical record. Facility policy regarding notification with a change in condition was requested and not received.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Thorne Crest Retirement Center

1201 Garfield Avenue Albert Lea, MN 56007

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

clinic would take Resident R1 to his appointment, so he left. TD-A stated when he got back to the facility, he found out he was supposed to have taken Resident R1 to the ED, he stated he felt terrible about the mix up.During an

interview on 9/17/25 at 3:38 p.m., DON indicated she was not aware that Resident R1 was left unattended at the ED

on 9/10/25, while he was in a manual wheelchair and stated it was not safe for Resident R1 because he was immobile in the manual wheelchair. DON was unsure if Resident R1 was ever assessed for safety in a manual wheelchair and normally used his specialized electric wheelchair that he was independent with mobility in.Facility policy for transporting residents to outside appointments was requested and not received.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Thorne Crest Retirement Center

1201 Garfield Avenue Albert Lea, MN 56007

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

the nurse reports the incident to the appropriate supervisor and completes the incident or occurrence report.Review of facility paper Medication Error Report form, revised 5/2000, identified Part 1 description of error, outcome to resident, corrective action taken and measures to prevent the reoccurrence of similar errors. Part 2-Assessment and Summary of error that included type of error, and reason for error. Further identified a disnature and date was needed for person making the error, person finding the error, DON, attending physician, medical director, pharmacist and administrator.Facility policy does not identify resident or resident representative notification or documentation of resident assessment.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Thorne Crest Retirement Center

1201 Garfield Avenue Albert Lea, MN 56007

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

on the front of the chart so that personnel and visitors are aware of the need for and the type of precaution. a. The signage informs the staff of the type of CDC precaution(s), instructions for use of PPE, and/or instructions to see a nurse before entering the room. b. Signs and notifications comply with the resident's right to confidentiality or privacy. 6. When transmission-based precautions are in effect, non-critical resident-care equipment items such as a stethoscope, sphygmomanometer, or digital thermometer will be dedicated to a single resident (or cohort of residents) when possible. Contact Precautions I. Contact precautions are implemented for residents known or suspected to be infected with microorganisms that can be transmitted by direct contact with the resident or indirect contact with environmental surfaces or resident-care items in the resident's environment. 2. Contact precautions are also used in situations when a resident is experiencing wound drainage, fecal incontinence or diarrhea, or other discharges from the body that cannot be contained and suggest an increased potential for extensive environmental contamination and risk of transmission of a pathogen, even before a specific organism has been identified. 6. The individual on contact precautions is placed in a private room if possible. If a private room is not available,

the infection preventionist will assess various risks associated with other resident placement options (e.g., cohorting, placing with a low-risk roommate). 7. Staff and visitors wear gloves (clean, non-sterile) when entering the room. a. While caring for a resident, staff will change gloves after having contact with infective material (for example, fecal material and wound drainage). b. Gloves are removed and hand hygiene performed before leaving the room. c. Staff avoid touching potentially contaminated environmental surfaces or items in the resident's room after gloves are removed. 8. Staff and visitors wear a disposable gown upon entering the room and remove before leaving the room and avoid touching potentially contaminated surfaces with clothing after gown is removed.Facility policy, Equipment and Supplies Used During Isolation, revised October 2018, identified appropriate infection prevention and control equipment and supplies are obtained, stored and used in accordance with current guidelines and manufacturer instructions. 1. All equipment and supplies needed to implement transmission-based (isolation) precautions are obtained from

an approved vendor. 2. Infection prevention and control supplies are stored and maintained in accordance with current guidelines and manufacturer's recommendations. 3. The infection preventionist (or designee) oversees the availability and inventory of infection prevention and control supplies.The facility policy did not identify where PPE carts should be placed for a resident on contact precautions.Facility policy, Standard Precautions revised September 2022, identified Standard precautions are used in the care of all residents regardless of their diagnoses, or suspected or confirmed infection status. Standard precautions presume that all blood, body fluids, secretions, and excretions (except sweat), non-intact skin and mucous membranes may contain transmissible infectious agents. Policy Interpretation and Implementation 1.

Standard precautions apply to the care of all residents in all situations regardless of suspected or confirmed presence of infectious diseases. 2. Personnel are trained in the various aspects of standard precautions to ensure appropriate decision-making in various clinical situations. 3. Residents and family members are provided with information pertaining to standard precautions and the prevention of infection upon the resident's admission to the facility. 4. Visitors are reminded and encouraged to maintain hand hygiene and follow instructions regarding infection prevention and control while in the facility. Standard precautions include the following practices: 1. Hand hygiene a. Hand hygiene refers to handwashing with soap (anti-microbial or non-antimicrobial) or the use of alcohol-based hand rub (ABHR), which does not require access to water. b. Hand hygiene is performed with ABHR or soap and water: (1) before and after contact with the resident.(4) after contact with items in the residents room.

Event ID:

Facility ID:

If continuation sheet