The Villas At Robbinsdale
THE VILLAS AT ROBBINSDALE in ROBBINSDALE, MN — inspection on November 20, 2025.
Found 2 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and document review the facility failed to timely report an allegation of physical abuse to the state agency (SA) for 1 of 3 residents (R1) reviewed for abusefindings includeR1's quarterly Minimum Data Set (MDS) dated [DATE], indicated she was independent with all activities of daily living. R1's undated admission Record identified R1 admitted to the facility on [DATE].
Diagnosis included fracture of vertebrae, diabetes, depression and hypertension.R1's care plan dated 11/14/25, identified an alteration in mobility and staff were to assist with transfers and bed mobility. R1's Associated Clinic of Psychology (ACP) visit note dated 11/13/25, indicated a visit was requested due to an increase in confusion and falls. R1 expressed concern for how a staff person moved her around the previous day and spoke of people being in her bed with her.
Staff was consulted after session to report psychotic symptoms and clients care concern.
The visit note indicated R1's appearance was unkempt, lying in bed in a facility gown.
Head was craned to the left and R1 lied still during the visit. R1 endorsed pain in the left leg that she said was new. On 11/20/25 at 11:50 a.m., licensed social worker (SW)-A and the administrator were interviewed. SW-A stated R1 told her a staff member had picked her up and threw her on the floor, then picked her up and threw her back on the bed. SW-A stated R1 reported the allegation Friday morning on 11/14/25, when family member (FM)-A was present. SW-A said she reported the incident to the SA later that evening. SW-A said abuse allegations should have been reported to the SA within two hours but said R1's FM-A said R1 was confused.
The administrator said she felt the problem was that FM-A was insistent R1 was confused but said abuse allegations should have been reported within two hours.During interview on 11/20/25 at 1:53 p.m., the ACP- social worker (SW) stated she had been onsite at the facility and was asked to see R1.
The ACP-SW said R1 had presented as delusional.
She said R1 was in bed during the visit and had been pretty still and reported pain in her leg which she had attributed to the way staff had moved her around the previous day.
The ACP-SW said she reported the care concern and to LSW-A.During interview on 11/20/25 at 2:40 p.m., LSW-A stated she had spoken to the ACP-SW after her session with R1. LSW-A said she did not report the concern about pain to anyone because the ACP-SW said she had talked to someone.The facility Abuse Prohibition/Vulnerable Adult Policy dated 4/2025, indicated the policy was intended to protect residents against abuse by anyone, including, but not limited to, facility staff, other residents, consultants or volunteers, staff of other agencies serving the individual, family members or legal guardians, friends or other individuals, or self-abuse and to promptly report, document and investigate all incidents of alleged or suspected abuse/neglect.
Incidents to be reported included abuse and indicated suspected abuse shall be reported to the SA no later than two hours after forming the suspicion of abuse.
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 REPRESENTATIVE'S SIGNATURE
TITLE
Facility ID:
IDENTIFICATION NUMBER:
A.
Building
COMPLETED
11/20/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
The Villas at Robbinsdale
3130 Grimes Avenue North Robbinsdale, MN 55422
SUMMARY STATEMENT OF DEFICIENCIES
During interview on 11/20/25 at 12:04 p.m., nursing assistant (NA)-B stated she met R1 when she transitioned to the third floor. NA-B said R1 had been very independent and staff typically just checked on her. NA-B said before the two falls, R1 walked but afterward had been staying in her wheelchair.During interview on 11/20/25 at 12:09 p.m., NA-A stated on Friday morning (11/14/25), she asked R1 if she needed anything. NA-A said she attempted to change R1 due to incontinence and R1 did not want to put clothes on. NA-A said when she changed R1's incontinent brief she rolled a little to one side but could not roll onto the opposite side. NA-A said she did not recall if she saw any bruising.During interview on 11/20/25 at 12:47 p.m., the director of nursing (DON) stated R1 had a past medical history of falls and fractures and said any little thing would probably fracture her.
The DON said after a fall, staff should perform and assessment, completed neurological checks for 72 hours and if an obvious injury was noted, send the resident to the hospital.
The DON said he had been told a neurological flow sheet had been completed but he had not seen it and did not know where it was.
The DON said he had been told after R1 went to the hospital she had a fracture.During interview on 11/20/25 at 1:53 p.m., the ACP-SW stated she had been onsite at the facility and was asked to see R1.
The ACP-SW said R1 had presented as delusional.
She said R1 was in bed during the visit and had been pretty still and reported pain in her leg which she had attributed to staff care.
The ACP-SW said she reported the care concern and the report of pain to LSW-A.During interview on 11/13/25 at 2:01 p.m., the therapy director (TD) stated R1 had been doing better and was using a walker prior to her falls.
The TD said after the falls R1 had not made much progress.
The TD said she reviewed R1's therapy notes and she had not been wanting to walk.
During interview on 11/20/25 at 2:40 p.m., LSW-A stated she had spoken to the ACP-SW after her session with R1. LSW-A said she did not report the concern about pain to anyone because the ACP-SW said she had talked to someone.During interview on 11/20/25 at 2:44 p.m., the DON stated he expected staff to perform ongoing monitoring of vital signs, any pain and/or injury.
The DON stated if bruising was present staff were to put an order in the medication administration record to monitor. A policy related to ongoing assessment after a fall was requested but not received.
Facility ID: