Aurora On France

During the interview, the clobetasol cream was on top of her nightstand.

The clobetasol's box was labeled by a local pharmacy with R1's information. R1 stated she had been applying the cream every day to the affected area, and as needed.

During interview on 5/27/26 at 12:41 p.m., registered nurse (RN)-E stated residents can self- administer medications if they are alert and oriented, and after a self-administration of medication (SAM) assessment was completed. RN-E added, the facility also needed a doctor's order.During interview on 5/27/26 at 12:51 p.m., RN-H stated she was not aware R1 had a medicated cream in her room. RN-H looked in the medication cart for the cream and was not there. RN-H retrieved the cream from R1's room and stated she will need a SAM assessment and provider's order to self-administer the medicated cream, and they would need to re-order the medicated cream from our pharmacy.

During interview on 5/27/26 at 1:00 p.m., nurse manager RN-F stated before a resident was allowed to self-administer a medication a procedure needed to be followed. RN-F stated a SAM assessment needed to be completed, and the staff needed to obtain a doctor's order for SAM and to be okay to leave medication at bedside.

During interview on 5/28/26 at 10:32 a.m., the director of nursing (DON) stated staff needed to screen the resident's cognition, complete a SAM, and contact the provider to obtain an order. DON stated the expectation was no medications will be left at bedside without proper assessment and orders.

Facility's policy titled Self Administration of Medications dated 9/2024, indicated the policy of this facility was to establish uniform guidelines concerning the self-administration of drugs in compliance with federal regulations.

The policy's procedure indicated a SAM will be completed for any resident requesting to administer any medication without the direct supervision of a nurse.

The attending physician's order will be signed and dated prior to self-administration and left at bedside.

The medication kept at bedside must be stored in a locked box, attached to something that can't be easily moved.

Nurses will educate the resident on the proper use of medications.

245634 05/28/2026

Aurora on France 6500 France Avenue Edina, MN 55435

During an interview on 5/27/26 at 12:15 p.m., registered nurse (RN)-E stated she sent documents

notice, which included information like ombudsman information and appeal rights, or a written bed hold notice. RN-E stated she believed that social services would follow up with the resident later to see if they would like to hold their bed.

During an interview on 5/27/26 at 1:15 p.m., RN-F, the nurse manager for the unit, stated she did not believe they had a process in place to give residents a written notice of transfer, which included information like ombudsman information and appeal rights, or bed hold on transfer to the hospital, although social services did follow up with residents after transfer to see if they would like to hold their bed.

During an interview on 5/28/26 at 9:44 a.m., the director of nursing (DON) deferred questions regarding written transfer and bed-hold notices to the assistant administrator (AA).

During an interview on 5/28/26 at 9:53 a.m., the AA stated that staff might go through a written bed hold notice with the resident before transfer to the hospital, depending on their responsiveness status.

The AA stated otherwise, the social services department would contact the resident or representative at a later time to determine if they would like their bed hold.

The AA stated the expected process would be for these conversations to be documented in a progress note, but he wasn't sure how often this was happening.

The AA stated he believed the facility had a form that could be given on transfer that included things such as the ombudsman and appeal information but was not sure if staff were giving out this form on transfer to the hospital.

The AA stated that if this form was given, he would expect it to be scanned into the electronic medical record, but he did not see it for R69.

The facility's Transfer and Discharge from the Facility policy dated 1/22/25, indicated that the Notice of Transfer or Therapeutic Leave would be given to the resident or representative at the time of transfer.

The policy indicated this would be documented in the resident's record.

The policy indicated that if the resident representative was not present at the time of transfer, nursing staff would contact them and notify them of the transfer and clarify the status of the bed hold.

The policy indicated that on the first business day following the resident's transfer, social services staff should continue to attempt to reach the representative to clarify the bed-hold status.

The policy indicated that social services staff should document the resident's bed hold status in the electronic medical record and should send the notice of transfer, along with the bed hold notice, to the representative for signature.

The policy indicated social services would then scan these notices into the electronic health record.

245634 05/28/2026

Aurora on France 6500 France Avenue Edina, MN 55435

During an interview on 5/27/26 at 12:36 p.m., registered nurse (RN)-D, an MDS coordinator, confirmed she had reviewed R42's record and stated that it looked like a DRA assessment had been completed but never sent to CMS. RN-D confirmed she had reviewed R8's record and stated that a DRNA assessment had been completed but also had never been sent to CMS.

The facilities MDS/Care Plan Process/Resident Assessment policy dated 10/21/25, indicated that when MDS forms are completed directly on the facility's computer, each assessor signs and dates it, after it is reviewed for accuracy.

The policy did not include the expected time frame for submitting DRA/DRNA MDS's to CMS.

245634 05/28/2026

Aurora on France 6500 France Avenue Edina, MN 55435

During an interview on 5/27/26 at 2:13 p.m., the admissions coordinator (AC) stated that when a resident was admitted from the hospital, the hospital would complete a PAS, and the screening would then be sent to them.

The AC stated that generally she would reach out to the lead agency, and they would sometimes send the final PAS.

The AC confirmed that they did see the final PAS from the lead agency, which was Medica, after reviewing R45's medical record.

The AC stated she did not keep documentation on any attempts to reach out to the lead agency for the final PAS.

During an interview on 5/28/26 at 9:50 a.m., the administrator stated that admissions was in charge of receiving the PAS and then following up as needed to obtain the final PAS.

The facility's PASARR Level I & II policy dated 10/2017, indicated that prior to a resident's admission, the admissions coordinator or designee would ensure the PASARR Level I screening was completed and received.

The admissions coordinator or designee would then work with the appropriate community provider to ensure completion of the PASARR level I screening form and verification was received.

The policy indicated that the PASARR Level I would be scanned into the resident's medical record.

245634 05/28/2026

Aurora on France 6500 France Avenue Edina, MN 55435

During an interview and observation on 5/26/26 at 11:59 a.m., R13 was observed in bed with his fingernails over 1/4 of an inch beyond the end of his fingertip with a brown substance underneath the tips of his fingernails. R28 stated he did not have a fingernail clipper and was unsure if he would be able to cut them by himself anyway. R28 stated he had wanted his nails trimmed for a while, but the staff had not offered to assist him with trimming them.

During an observation and interview on 5/27/26 at 10:09 a.m., R13 was observed with fingernails over 1/4 of an inch beyond the end of his fingertip with a brown substance underneath the tips of his fingernails. R13 stated that no one had offered to help him cut or clean his fingernails.

During an interview and observation on 5/27/26 at 1:42 p.m., nursing assistant (NA)-A confirmed he was the aide assisting R13 during the day shift. NA-A stated that R13 required assistance with his activities of daily living, and he did not think R13 would be able to cut his nails by himself.

When asked about the appearance of R13's nails, NA-A was unsure. NA-A was observed to enter R13's room and stated R13's nails looked pretty long, and he thought it was not likely they were short on 5/23/26. NA-A confirmed he had not offered to help R13 complete nail care.

During an interview on 5/28/26 at 7:41 a.m., registered nurse (RN)-G stated that the aides should assist the residents with trimming and cleaning their nails on shower days and as needed. RN-G stated that generally, nails would be something the aides would look at, but if the nurse notices that they were long or dirty, they could then delegate nail care to the aide. RN-G stated that if the nurse happened to notice the nail status, they would document this on the weekly bath sheet, but usually the aides would look at a resident's nail status and relay that to the nurse to document.

During an interview on 5/28/26 at 9:42 a.m., the director of nursing (DON) stated that nursing staff should be checking resident nail status and trimming and cleaning as needed and on bath days, if indicated.

The DON stated that the nurses should be assessing the resident's nail status themselves on bath days to ensure it is accurate.

The facility's Care of Nails policy dated 6/20/25, indicated nail care should be completed on bath days and as needed.

245634 05/28/2026

Aurora on France 6500 France Avenue Edina, MN 55435

and stated nurse managers were responsible for determining which discharge recommendations were

policy on Heart Failure monitoring was requested; however, the facility did not have this specific

245634 05/28/2026

Aurora on France 6500 France Avenue Edina, MN 55435

During observation and interview on 05/27/2026 at 8:01 a.m., RN-E conducted a medication pass for R29 and identified four medications that were unavailable for administration, including ginkgo biloba, a multivitamin with minerals, vitamin B12, and vitamin E. RN-E checked the medication cart and available house stock but was unable to locate the medications. RN-E stated she would need to fax and call the pharmacy to ensure the medications were delivered that day and reported medications generally should be reordered when the supply reached the last row of a medication card or when there was still a few days of the medication left giving time for the medication to be delivered before it ran out. RN-E stated the assistant administrator, who was also filling the supplier role, reordered house stock medications. RN-E further stated she would need to notify the provider regarding the unavailable medications because they were vitamins and not considered urgent. RN-E stated, So I am missing 4 different med, that's a lot.

During observation and interview on 05/28/2026 at 7:51 a.m., LPN-C conducted a medication pass for R57 and was unable to locate cyclosporine ophthalmic drops ordered for administration. LPN-C stated the medication should have been reordered when the supply reached the last package of eye drops and reported she would administer the resident's other medications and continue searching because mornings were busy.

During the same medication pass, LPN-C identified that the resident's ordered losartan 75 mg was unavailable and only losartan 50 mg was present. LPN-C stated the resident should have had one 50 mg tablet and one 25 mg tablet available for administration and reported she had called the pharmacy twice during her previous shift on Tuesday regarding the missing medication.

During a follow-up interview on 05/28/2026 at 9:50 a.m., LPN-C stated she obtained a one-time order from the nurse practitioner to administer losartan 50 mg in place of the prescribed losartan 75 mg because the ordered dose was unavailable. LPN-C stated staff were not permitted to split tablets to achieve the ordered dose.During interview on 05/28/2026 at 8:18 a.m., the nurse manager and RN-F stated the expectation was for the nurse administering the medication to reorder it when approximately seven days of supply remained.

RN-F stated staff were expected to fax refill requests to the pharmacy and follow up by telephone to confirm receipt of the fax. RN-F stated pharmacy staff sometimes responded that refill requests were submitted too early and at other times reported they had not received the faxed request. RN-F stated nurses did not always have time to call the pharmacy to verify receipt of refill requests and acknowledged, it should not be that way, but life happens.A pharmacy policy titled Ordering and Receiving Medication from the Dispensing Pharmacy, dated 9/10/24, indicated refill request of current medications should be placed 5-7 days before the current supply runs out to ensure to gaps in medication administration.