The Estates At Excelsior Llc
Inspection Findings
F-Tag F0600
F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
when she entered Resident R1's room, she saw Resident R1 on the bed, and the DON was hitting Resident R1. NA-A separated the two and the DON walked towards the door. While NA-A was attempting to calm Resident R1 down, the DON came back and pushed Resident R1 down on the bed again and started fighting with her. It took two staff to pull the DON off Resident R1. In 20 years, NA-A had never witnessed a staff member fighting and cussing with a resident. She felt intimidated by the DON, so did not tell the truth on her first written statement. Interview on 11/25/25 at 3:41 p.m., Resident R3 stated the DON brought her to room [ROOM NUMBER] to discuss her complaint with Resident R1 regarding the shared space. She observed the DON move Resident R1's table, and Resident R1 was standing behind her shaking her fist. Resident R1 then ran up and started biting the DON. Resident R3 ran out of the room frightened by Resident R1 and what Resident R1 would do to her. Interview on 11/25/25 at 4:06 p.m., DON stated Resident R1's tray table was pushed into Resident R3's space. DON told Resident R1 the table could not push against the privacy curtain and moved it away. Resident R1 pushed the table back and when DON went to move the table again, Resident R1 lunged at her biting her elbow. The more DON told Resident R1 to stop biting, the harder she bit. DON pushed Resident R1 to a sitting position on the bed, but Resident R1 got up again. DON asked Resident R1, You want to fight me? when the other staff arrived. DON was angry and in a lot of pain. DON left the room to clean her wound. After the police spoke with Resident R1, Resident R1 apologized to her.
DON added, when Resident R1 stood up again she was frightened and in shock. She realized she should have left
the room but I got upset. Interview on 11/26/25 at 10:34 a.m., the administrator stated after the incident on 11/14/25, he reached out to his supervisor. He was instructed to have the DON fill out a workers' compensation form. He had Resident R3 transferred to another room for safety and spoke with the police. The police did not have any concerns and offered to transfer Resident R1 to the hospital but there would be a delay. He spoke with NA-A and LPN-A but what they told him was unclear to the actual events. He did not interpret what
they were saying was an indication of rough handling by the DON. He interviewed the DON but did not receive her written statement until 11/17/25. Once he spoke with NA-A on 11/16/25, he immediately told his supervisors to escalate the investigation. The DON was suspended pending the investigation. He called the facility to complete a skin assessment, and a small bruise was found on Resident R1's chest. He reported his findings to the state on the evening of 11/16/25 at 6:54 p.m. Interview on 11/26/25 at 1:39 p.m., registered nurse (RN)-A stated while talking with Resident R1 after the incident she thought she heard the DON and became anxious. RN-A told Resident R1 the DON was not at the facility. If she had been at the incident, she would have reported the DON's actions towards Resident R1 to the administrator right away. The facility policy Abuse Prohibition and Vulnerable Adult policy dated 4/20/25, indicated all staff are required to report a situation of abuse immediately. A prompt investigation would include determining probable cause. All staff who witness abuse are responsible to report the incident by notifying their supervisor immediately. If the alleged perpetrator was a staff member, they would be suspended immediately pending the investigation findings. If the alleged perpetrator was a department head, their supervisor would be notified or [NAME] President of Social Services and Behavioral Health. Definition of abuse was a willful infliction of injury. Suspected abuse would be reported to the state no later than 2 hours after the incident. Employees are encouraged to report any reasonable suspicion of a crime and they would be protected from retaliation. The PNC IJ began on 11/14/25, was removed on 11/17/25, when it was verified the facility implemented the following:- All staff were re-educated on what constitutes abuse, when to report and what allegations to report.- DON was suspended, then terminated.
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The Estates at Excelsior LLC in EXCELSIOR, MN inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in EXCELSIOR, MN, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from The Estates at Excelsior LLC or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.