Minnesota Masonic Home Care Center

During an interview on

LPN-E stated something that had worked previously and today for R101 when she was having behaviors or resistant to care, was talking about puppies and her daughter. LPN-E stated she would also assist R101 to a quiet spot, such as her room, when she was having behaviors, because that seems to calm her down.

During an interview on 2/12/26 at 8:39 a.m., the director of nursing (DON) stated that the nurse managers oversaw updating the care plan with personalized interventions.

The DON stated that she would expect personalization of the care plan, including the basic things that the resident likes, such as food items, and interventions specific to the resident, but acknowledged this can be hard to determine for residents with dementia, as this can change day to day.

The facility's Care Plans policy dated 10/2025, indicated the facility would provide resident-centered care in accordance with the resident's preferences and stated goals as outlined in the care plan.

The policy indicated the care plan must include the interventions that were to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being.

The care plan indicated the nurse was to update the care plan to reflect the changing needs of the resident.

The policy indicated that the nursing assistants were to participate in weekly interdisciplinary team meetings regarding all residents to ensure the residents' care plan was accurately developed.

The policy indicated that every two weeks, the nursing assistants would review the Kardex and provide attestation that any changes were reported to the nurse.

245343 02/12/2026

Minnesota Masonic Home Care Center 11501 Masonic Home Drive Bloomington, MN 55437

During an interview on 2/11/26 at 7:41 a.m., nursing assistant (NA)-C stated the NAs would place R150's CPAP machine at bedtime and remove it in the morning, stating the nurses were responsible cleaning the machine.

During an interview on 2/11/26 at 8:41 a.m., registered nurse (RN)-A stated the CPAPs she had worked with at the care facility came with the resident's preprogrammed from home. RN-A stated staff would simply fill the chamber with water and turn it on and did not monitor to ensure the machine was set at the correct settings. RN-A confirmed CPAP settings, including R150's, directed to use home settings and were not resident specific.

During an interview on 2/11/26 at 9:15 a.m., nurse manager and licensed practical nurse (LPN)-F confirmed that resident CPAPs came to the facility preprogrammed and most resident families managed the resident CPAPs. LPN-F stated if something looked not right with a resident's CPAP, staff would be expected to notify her, and she would try to get in touch with family or possibly the resident's pulmonologist if one was involved in the resident's care, to inquire about proper settings.

Facility policy on CPAP management and orders was requested and not received.

245343 02/12/2026

Minnesota Masonic Home Care Center 11501 Masonic Home Drive Bloomington, MN 55437

1 of 1 residents (R31) who were observed to be served and expressed concerns about inappropriate

identified R31 with intact cognition.During interview with R31 on 2/10/26 at 2:06 p.m., R31 stated, I have a problem with 90% of the time [when food] gets here it is lukewarm.During breakfast meal service to R31 room on 2/11/26 at 8:10 a.m., dietary aide (DA)-B was asked to obtain temperature of R31 food prior to bringing meal tray into her room.

Both DA-B and licensed practical nurse (LPN)-A verified the glass of milk was 51 degrees Fahrenheit (F), and oatmeal was 136 degrees F. DA-B stated, milk should be at 40 [degrees F] or below and oatmeal should be over 140 [degrees F]. DA-B stated importance of serving food at proper temp ,to make sure [residents] don't get sick. LPN-A unable to state acceptable temperature parameters.During interview with dietary supervisor (DS) on 2/10/26 at 8:25 a.m., DS stated expectation of serving food to residents as, Milk should be in the 40's [degree Fahrenheit] and Oatmeal should be at least 140 [degrees Fahrenheit]. DS stated the milk should have ben colder to be served and not [safe or] appetizing to have food that is not a desired temp.Facility policy on serving food to residents at desirable temperatures was requested and not received.

245343 02/12/2026

Minnesota Masonic Home Care Center 11501 Masonic Home Drive Bloomington, MN 55437

During observation on 2/9/26 at 3:08 p.m., an EBP sign was posted on the wall next to R8's door.

The sign indicated the staff needed to clean their hands before entering the room. It also indicated staff needed to wear a gown and gloves for high contact resident care activities including providing hygiene, changing briefs and catheter care.

During observation on 2/10/26 at 2:05 p.m., nursing assistant (NA)-E and NA-D provided bowel incontinent care to R8. NA-D and NA-E were wearing gloves but not gowns.

During interview on 2/10/26 at 2:14 p.m., NA-D stated she had worked at the facility for a month. NA-D stated she forgot to wear a gown and said she should wear one for potential infections.During interview on 2/10/26 at 2:19 p.m., NA-E stated the sign next to R8's room meant he had to wear a gown and gloves when he provided catheter care, but not when R8 had a bowel movement. NA-E smiled and said I knew I needed to use a gown. I didn't use it because I was rushing. NA-E stated it was important to use a gown because the catheter can transfer germs, and the employees can get in contact with germs.

During an interview on 2/11/26 at 12:56 p.m., the infection preventionist (IP), stated she would expect staff to utilize required PPE such as gowns and gloves to follow EBP.

When asked if she would expect staff to wear a gown and gloves when completing perineal care after a bowel movement for a resident with a catheter, she stated she would if the staff were in prolonged close contact.

Facility's policy titled Standard and Transmission Based Precautions dated 3/2025, indicated EBP was designed to reduce transmission of multidrug-resistant organisms (MDROs).

The policy indicated Nursing home residents with chronic wounds or indwelling medical devices are at especially high risk of both acquisition of and colonization with MDROs.

and the public.

room was maintained in a clean, sanitary manner when 25% of the shower walls were observed to be

resided on D1 and utilized the shower room on a routine basis.Findings include:During observation on 2/11/26 at 9 a.m., pink matter deposits were observed on the shower walls.

The shower walls were covered with white tiles, and the pink matter was observed over the caulking lines and the baseboard tiles.

The water knob/handle was covered with white calcium-like deposits, and there was a chrome fixture with rust-colored spots and a rust-colored stain on one of the walls right below the chrome fixture.

Two plastic brushes with long handles were on the shower floor.

Both brushes had pink matter on the base of the bristles. A clear plastic bag was knotted to the handheld shower head, the bag had pink matter on both ends.During observation and interview on 9/11/26 at 9:22 a.m., nursing assistant (NA)- G stated she gave a shower to a resident at 8:00 a.m. NA-G stated, after the shower, she picked up the garbage and linen and took it to the respective areas and went back to the shower room to clean the shower chair. NA-G stated, she used one of the white brushes that were on the shower floor. NA-G verified there was pink matter on the shower walls and white brushes. NA-G stated the housekeeper cleans the walls and floors.During observation and interview on 2/11/26 at 9:29 a.m., housekeeper (H)-A stated she cleaned the shower rooms every day. H-A verified the walls and brushes had pink matter as previously noted and said sometimes she uses bleach to clean those areas. H-A stated she didn't clean the shower the day before.

She said she used white brushes and washcloths when she washed the shower walls. H-A stated she would ask her supervisor to supply new brushes.During observation on 2/12/26 at 9:06 a.m., the shower walls had been cleaned but there was still some pink matter on the tiles closer to the floor.

The two brushes containing pink matter were leaning against the wall.During observation and interview on 2/12/26 at 9:30 a.m., infection preventionist nurse (IP) stated she was not sure what the pink matter was, but the shower needed to be cleaned, and she removed the brushes from the shower room and said they needed to be replaced.

During an interview on 9/12/26 at 9:50 a.m., the administrator stated the shower should be cleaned to provide a clean environment for the residents.

Administrator added, the brushes are being replaced right now.Facility's policy titled Cleaning of Resident's Spaces dated 10/2025, indicated the procedure was in place to ensure that all resident spaces were cleaned and maintained to the highest standards of hygiene and comfort.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

245343 02/12/2026

Minnesota Masonic Home Care Center 11501 Masonic Home Drive Bloomington, MN 55437