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Complaint Investigation

Allina Health Restorative Suites

Inspection Date: August 28, 2025
Total Violations 2
Facility ID 245624
Location PLYMOUTH, MN
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Inspection Findings

F-Tag F0657

Resident Assessment and Care Planning Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0657 Level of Harm - Minimal harm or potential for actual harm

condition. Care plans were updated with MDS/care conference schedule and as needed to assure that they were an accurate reflection of the resident and their care needs. The comprehensive care plan included the care plan and physician orders.

Residents Affected - Few

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

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

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Allina Health Restorative Suites

2775 Campus Drive North Plymouth, MN 55441

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)

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F-Tag F0880

Infection Control Deficiencies
Harm Level: Potential for More Than Minimal Harm

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

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

precautions for diseases with multiple routes of transmission, including contact precautions. Contact or touch was the most common and significant mode of transmission of infectious agents and residents in contact precautions included those infected with C. diff.Facility policy titled Clostridium Difficile Infection dated 4/3/24, identified C. diff was a spore-forming bacteria found in feces and health care workers could spread the bacteria to other residents or contaminate surfaces through hand contact. Residents would be placed on contact or enhanced barrier precautions. Enhanced barrier precautions were only to be used if

the resident was continent of bowel or the diarrhea could be contained in an incontinence product.

Residents with acute diarrhea would be in contact precautions. A contact or enhanced barrier precautions sign was to be placed on the resident's door. Gloves would be worn prior to entering the room and removed

before exiting with hand hygiene performed before putting on gloves, after removing gloves, and any time hands were visibly soiled.

Event ID:

Facility ID:

If continuation sheet

📋 Inspection Summary

Allina Health Restorative Suites in PLYMOUTH, MN inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

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 PLYMOUTH, 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 Allina Health Restorative Suites or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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