Based on observation, interview and document review the facility failed to ensure 1 of 3 residents (R1) reviewed for use of electric wheelchairs in the community was free from involuntary seclusion. This resulted in actual psychosocial harm for R1 when the facility took away her personal mobile equipment (power wheelchair), which restricted R1's access to her community (including family), causing increased depressive symptoms, isolation and withdrawal from usual activities. Findings include: R1's admission Record indicated she admitted to the facility on [DATE]. Diagnosis included diabetes, arthritis, right above the knee amputation, post-traumatic stress disorder, depression and anxiety. …
F603 citations in Minnesota
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from separation (from other residents, his/her room, or confinement to his/her room).
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Minnesota cites F603 less often than its own record predicts
0.86 times the national share — cited less often here than elsewhere.
Of every deficiency written in Minnesota in 2025, this is the portion that was F603.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Minnesota surveyors wrote
F603 findings written in Minnesota, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on observation, interview, and document review, the facility failed to ensure residents were free from involuntary seclusion when the facility maintained locked exit doors that prevented residents from freely exiting the building, without conducting individualized assessments, clinical justification, or care planning to support the restriction. This deficient practice had the potential to affect 8 of 34 residents (R4, R6, R11, R16, R20, R7, R29, R39) residing at the facility.Findings include: R4's annual Minimum Data Set (MDS) assessment dated [DATE], indicated moderately impaired cognition, very important to go outside to get fresh air when the weather is good, no exhibited behaviors of wandering, utilized a motorized wheelchair independently. …
The short window
Recent years
| Year | Share of Minnesota citations | vs expected |
|---|---|---|
| 2023 | 0.06% | 3.27× |
| 2025 | 0.04% | 0.86× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Minnesota surveyors cite →
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