Based on interview and document review, the facility failed to ensure 1 of 1 resident (R41) was accurately and comprehensively assessed as certified when it was R41 exhibited behaviors and refusal of all cares, medication, treatment and evaluation. Findings include: Review of the Resident Assessment Instrument (RAI) 3.0 manual identified The RAI process has multiple regulatory requirements. Federal regulations require the assessment accurately reflects the resident's status, a registered nurse conducts or coordinates each assessment with the appropriate participation of health professionals, and the assessment process includes direct observation, as well as communication with the resident and direct care staff on all shifts. …
F642 citations in Minnesota
Resident Assessment and Care Planning Deficiencies
Ensure a qualified health professional conducts resident assessments.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Minnesota cites F642 more often than its own record predicts
7.01 times the share F642 takes of citations nationally.
Of every deficiency written in Minnesota in 2025, this is the portion that was F642.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Minnesota surveyors wrote
F642 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 interview and document review, the facility failed to complete a discharge Minimum Data Set (MDS) assessment for 1 of 1 resident (R1) reviewed for MDS discrepancy. Findings include: R1's Face Sheet indicated an admission date of [DATE]. Review of resident's electronic health record indicated R1 was discharged from the facility on 11/19/18, and returned to her home. Review of R1's closed record indicated an MDS discharge assessment had not been completed for R1. On 4/30/19, at 4:09 p.m. registered nurse (RN)-A, the facility MDS, confirmed R1 did not have a MDS discharge assessment completed. RN-A stated the facility has a tracking system in place on the computer, and R1 was missed. RN-A stated she should have completed the discharge assessment and it should not have been missed.
The short window
Recent years
| Year | Share of Minnesota citations | vs expected |
|---|---|---|
| 2024 | 0.04% | 2.18× |
| 2025 | 0.04% | 7.01× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Minnesota surveyors cite →
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