Zumbrota Care Center
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
from falls. D. Post Fall Assessment: If a fall occurs while the individual is residing in the care center (or off premises on a care center specific activity) staff will perform the incident fall tracking assessment. a.
Nursing staff will complete a fall scene investigation, assess the resident, and call for any additional assistance or 911 as necessary. b. An immediate intervention will be put into place, according to the immediate determination of the potential root cause of the fall, to prevent further falls until the root cause analysis (RCA) of the incident is completed. c. Nursing staff will document the fall by completing an Incident Report in the electronic medical record. From the immediate assessment of the incident, a determination will be made if the incident involved any maltreatment and/or serious bodily injury. If so, administrative staff will be notified, and a report of the incident will be sent to the State agency. e. The interdisciplinary team (IDT) will evaluate the fall by reviewing the fall incident report to determine a Root Cause Analysis (RCA) of
the fall and further interventions may be put into place according to the determined cause of the fall, to help prevent further falls. Any further interventions that are developed will be documented.
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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
11/26/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Zumbrota Care Center
433 Mill Street Zumbrota, MN 55992
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)
F-Tag F0690
F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
resident will be evaluated upon admission. The evaluation will include completion of a baseline review of the resident's elimination status. A comprehensive assessment, which will include a three (3) day bowel and bladder pattern assessment, will be completed within the initial assessment period. a. Based on the initial urinary incontinence or bowel incontinence history reported by the resident and/or family member(s), the new resident will be assisted in using incontinence products provided by the care center. Measurements of
the resident, pattern of reported incontinence, incontinence product protocols for product use, and resident choice will be considered in the choice of incontinence product(s). b. The 3-day bowel and bladder pattern assessment will be completed and documented in hourly increments. A component of the three (3) day bowel and bladder pattern assessment may include bladder ultrasound equipment use. c. The comprehensive bowel and bladder assessment will include a report of prior incontinence history, a physical examination, documentation of genitourinary tract anomalies, results of the three (3) day bowel and bladder pattern, a review of diagnoses and medications that may impact urinary or bowel status, food and fluid intake patterns, environmental concerns as well as the consideration of adaptive devices, review of potential or existing complications of incontinence, and the resident's level of need for assistance due to physical or cognitive impairments. This assessment will be used to determine an individualized bowel and bladder program for each resident. Bowel and Bladder Policy, revised 8/2023, indicated each resident receives the necessary care and service to attain or maintain the highest practicable level of bowel and bladder continence.2. The comprehensive assessment results are used to develop a care plan addressing
the individual needs of each resident. Care plan interventions are determined with consideration of: a. the ability of the resident to make decisions and call for assistance to use the toilet. B. The presence of permanent physical impairment or disease which could prevent incontinence. C. Resident's desire to participate in bowel and bladder programing. D. current standards of practice in accordance with state and federal law. 3. Review of the comprehensive assessment and care plan will occur on at least a quarterly basis and more frequently if there is a change in residents' condition.
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Zumbrota Care Center in ZUMBROTA, 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 ZUMBROTA, 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 Zumbrota Care Center or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.