Mayo Clinic Health System - Lake City
Lake City, Minnesota · CCN 245218
28 surveys since 2011. The first finding at harm level was recorded in 2023.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
- Citations on record
- 100
- Surveys
- 28
- Harm or worse
- 4
- Immediate jeopardy
- 2
Findings at the most serious level CMS records.
Older surveys no longer in CMS’s monthly file or on Care Compare. They are shown here.
The facility
- Certified beds
- 90
- Ownership
- Non profit - Corporation
- Chain
- Independent
- County
- Goodhue · rural
- Medicare-certified since
- 1978
CMS ratings
- Overall
- 2
- Health inspection
- 1
- Staffing
- 5
- Quality measures
- 4
CMS’s own Five-Star ratings.
Compared with similar facilities
Since 2021, this facility recorded somewhat more weighted findings than its peer group.
Weighted by harm level, against 52 not-for-profit facilities of 66–99 beds in Minnesota.
Last survey on record
Jul 31, 2026
101 days ago.
Counts surveys with at least one finding. A clean survey leaves no record here, so the real gap may be shorter.
Staffing
| Measure | This facility | Peer median |
|---|---|---|
| Nurse hours per resident day | 4.70 | 4.39 |
| Registered-nurse hours per resident day | 1.38 | — |
| Annual nurse turnover | 44.4% | 37.0% |
As reported by the facility to CMS, beside the peer-group median.
Enforcement
- Fines
- $145,117 across 2 penalties
- Abuse icon
- Flagged by CMS on Care Compare
Federal civil money penalties and remedies as CMS currently publishes them. Amounts may still be under appeal.
Severity of recent findings
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J14.0% | K— | L— |
| Actual harm | G28.0% | H— | I— |
| No harm, potential for more than minimal | D2184.0% | E— | F— |
| No harm, potential for minimal | A— | B14.0% | C— |
Most frequently cited here
In CMS’s current monthly file.
- F6092×
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
- F6842×
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- F6892×
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- F8422×
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
- F8802×
Provide and implement an infection prevention and control program.
In the surveyor’s words
From the most serious findings on record at Mayo Clinic Health System - Lake City, in the surveyor’s own words.
- Immediate jeopardy, isolatedF600Apr 20, 2026
Based on observation, interview and document review, the facility failed to protect 1 of 1 resident (R1) who had severe cognitive impairment and was unable to give consent for sexual activity from inappropriate sexual touching from R2, who had known history of sexually inappropriate behavior resulting in R2 placing his hand underneath R1's shirt and touching her breast on 4/4/26. This deficient practice resulted in immediate jeopardy (IJ) for R1, as a reasonable person would have experienced severe psychosocial harm, including dehumanization and humiliation as a result of sexual abuse. […]
- Immediate jeopardy, isolatedF760Jan 3, 2023
Based on interview and document review the facility failed to accurately transcribe order for baclofen (medication used to treat muscles spasms) upon admission, identify withdrawal symptoms, and tapered baclofen according to manufacturer's recommendations for 1 of 3 residents (R1) who received baclofen. R1 had significant withdrawal symptoms resulting in hospitalization . The facility failure resulted in an immediate jeopardy (IJ) for R1. The IJ began on 12/14/22, when nurse practitioner (NP)-A abruptly discontinued R1's baclofen resulting in R1 having significant withdrawal symptoms was sent to the emergency department (ED) on 12/18/22 and admitted to the ICU where R1 remained hospitalized . […]
- Actual harm, isolatedF689Apr 3, 2025
Based on interviews and document reviews, the facility did not assess or analyze trends in falls to determine causal factors or root causes and implemented individualized interventions aimed at preventing or reducing the risk of falls with major injuries for one of three residents (R1) who experienced falls. This resulted in actual harm when R1 suffered two thoracic spinal fractures and hospitalization after he was left unsupervised on the commode and fell . Findings include: R1's After Visit Summary (AVS) dated 2/1/25 to 2/20/25, identified R1 had a newly diagnosed stroke with left sided hemianopsia (loss of vision in half of visual field) hemiparesis (weakness on one side of body), left sided neglect, and right gaze deviation (condition where the right eye deviates to one side and… […]
- Actual harm, isolatedF760Dec 18, 2024
Based on observation, interview and document review, the facility failed to ensure medications were administered to the correct resident for 1 of 3 residents (R1) reviewed for medication errors. This failure resulted in actual harm when R1 became hypotensive that required treatment in the emergency department (ED) and ongoing symptom monitoring and treatment. The facility had implemented appropriate corrective action prior to the onsite investigation so the deficiency is being cited at past non-compliance. […]
- No harm, potential for more than minimal, isolatedF656Aug 20, 2026
Based on observation, interview, and record review, the facility failed to ensure a comprehensive care plan was developed, revised and implemented to address unsafe smoking practices for 1 of 1 residents (R16) reviewed for smoking. R16 was found in the facility parking lot smoking a cigarette within close proximity of an active oxygen source.Findings include.See also F689R16's quarterly Minimum Data Set (MDS) dated [DATE], indicated R16 was cognitively intact, uses oxygen and was dependent on staff for mobility. R16's smoking assessment dated [DATE] indicated R16 the interdisciplinary team recommended that the resident cannot smoke independently.R16's smoking assessment dated [DATE] indicated R16 failed due unsafe oxygen use. […]
Read 21 findings in full →The most serious and the most recent: 21 of 100 on record.
Every survey on record
FindingsAt actual harm or above
- Aug 20, 2026Standard2 findings
- Jul 31, 2026Complaint3 findings
- Apr 20, 2026Complaint4 findings · 1 harm
- Dec 4, 2025Complaint1 finding
- Jul 31, 2025Standard1 finding
- Apr 3, 2025Complaint1 finding · 1 harm
- Dec 18, 2024Complaint1 finding · 1 harm
- Jun 13, 2024Standard9 findings
Show the 20 earlier surveys
- Nov 6, 2023Complaint5 findings
- Feb 28, 2023Complaint1 finding
- Jan 3, 2023Complaint1 finding · 1 harm
- Nov 22, 2022Complaint1 finding
- Nov 4, 2022Complaint2 findings
- Dec 9, 2021Complaint2 findings
- Nov 2, 2020Infection control1 finding
- Sep 24, 2020Complaint2 findings
- Apr 30, 2020Infection control1 finding
- Sep 19, 2019Standard and complaint7 findings
- May 31, 2019Complaint1 finding
- Jul 12, 2018Standard6 findings
- May 11, 2017Standard2 findings
- Apr 1, 2016Standard10 findings
- Apr 10, 2015Standard4 findings
- Jan 31, 2014Standard7 findings
- Dec 14, 2012—4 findings
- Mar 29, 2012—13 findings
- May 31, 2011—2 findings
- May 19, 2011—6 findings
Surveys that found no deficiencies are not in CMS’s files and do not appear here.
Comparable facilities
The nearest facilities to this one in the same peer group, by weighted findings.
Deficiency Index is independent and is not affiliated with, endorsed by, or approved by CMS, Medicare, or any government agency. About this data · Report a correction