The Gardens at Foley LLC
Foley, Minnesota · CCN 245325
29 surveys since 2010, 4 of them producing a finding at harm level or worse.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
- Citations on record
- 100
- Surveys
- 29
- Harm or worse
- 4
- Immediate jeopardy
- 1
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
- 78
- Ownership
- For profit - Corporation
- Chain
- MONARCH HEALTHCARE MANAGEMENT
- County
- Benton
- Medicare-certified since
- 1986
CMS ratings
- Overall
- 2
- Health inspection
- 2
- Staffing
- 3
- Quality measures
- 4
CMS’s own Five-Star ratings.
Compared with similar facilities
Since 2021, this facility recorded fewer weighted findings than most of its peer group.
Weighted by harm level, against 27 for-profit facilities of 66–99 beds in Minnesota.
Last survey on record
Jun 25, 2026
137 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 | 3.62 | 3.64 |
| Registered-nurse hours per resident day | 0.84 | — |
| Annual nurse turnover | 56.4% | 41.7% |
As reported by the facility to CMS, beside the peer-group median.
Enforcement
- Fines
- $8,824 across 1 penalty
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 | J— | K— | L— |
| Actual harm | G13.2% | H— | I— |
| No harm, potential for more than minimal | D2683.9% | E39.7% | F— |
| No harm, potential for minimal | A— | B— | C13.2% |
Most frequently cited here
In CMS’s current monthly file.
- F6844×
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- F7553×
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
- F8803×
Provide and implement an infection prevention and control program.
- F5502×
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
- F6412×
Ensure each resident receives an accurate assessment.
In the surveyor’s words
From the most serious findings on record at The Gardens at Foley LLC, in the surveyor’s own words.
- Immediate jeopardy, isolatedF689Sep 23, 2021
Based on observation, interview and document review, the facility failed to ensure staff were competently trained to perform transfers using a mechanical (Hoyer) lift. This resulted in an immediate jeopardy (IJ) for R1 who fell from a Hoyer lift and sustained injuries during a transfer. This practice had the potential to affect all nine facility residents who used a mechanical lift for transfers. The IJ began on 9/19/21, when R1 fell out of a mechanical lift during transfer and the facility failed to provide education that included staff return demonstration of lift use competency and failed to train staff on manufacturer's recommendations for connecting the lift slings to the lift. The administrator and director of nursing (DON) were informed of the IJ on 9/22/21, at 6:16 p.m. […]
- Actual harm, isolatedF689Apr 16, 2024
Based on interview and document review, the facility failed to follow a care planned intervention to reduce the risk of falls for 1 of 4 residents (R4) reviewed for falls. This resulted in actual harm for R4 when he fell and sustained a thoracic fracture. R4 required subsequent hospitalization , where he expired. The facility implemented corrective action so the deficient practice was issued at past non-compliance. The past non-compliance began on [DATE], when R4 fell and sustained a fracture after staff failed to follow a care planned intervention. […]
- No harm, potential for more than minimal, widespreadF851Aug 8, 2024
Based on observations, interview and document review the facility failed to submit complete and accurate direct care staffing information, including information for agency and contract staff, during 1 of 1 quarters (Quarter 2: January 1 - March 31, 2024), reviewed for payroll based journal (PBJ) for excessively low weekend staffing. Findings include: Review of the staffing schedules and timecard verifications with the facility for Quarter 2 identified the facility had licensed nursing staff, 24 hours per day 7 days per week, and 8 consecutive hours per 24 hours of registered nurse (RN) coverage documented. Observations during the facility's recertification survey (8/5/24 through 8/8/24) quality of care was observed. […]
- No harm, potential for more than minimal, patternF725Jun 25, 2026
Based on observation, interview and document review the facility failed to ensure they maintained sufficient numbers of staff to assist 5 of 5 residents (R5, R6, R7, R8 and R9) in a timely manner. This had the potential to affect all residents residing on the 300, 400 and 500 units of the facility.Findings include: R5R5's admission Record indicated she admitted to the facility 3/22/21. R5's diagnoses included chronic kidney disease, obesity and dysphagia.R5's quarterly Minimum Data Set (MDS) dated [DATE], identified intact cognition and indicated she was dependent on staff to complete toileting. The MDS indicated R5 was frequently incontinent of bowel and bladder and required assistance to transfer.During continuous observation on 6/23/26 at 1:05 p.m. […]
- No harm, potential for more than minimal, patternF867Jun 25, 2026
Based on observation, interview and document review the facilities Quality Assurance and Performance Improvement (QAPI) committee failed to address resident concerns related to call light wait times which resulted in cares not being performed and toileting tasks not being completed in a timely manner. This had the potential to affect all residents in the facility who required assistance from staff to completed activities of daily living. Findings include: Refer to F725:Based on observation, interview and document review the facility failed to ensure they maintained sufficient numbers of staff to assist residents in a timely manner on the 300, 400 and 500 units of the facility.During document review and interview on 6/25/26 at 1:38 p.m., with the administrator, the 2026, QAPI notes related… […]
Read 24 findings in full →The most serious and the most recent: 24 of 100 on record.
Every survey on record
FindingsAt actual harm or above
- Aug 21, 2026Complaint1 finding
- Jun 25, 2026Complaint5 findings
- Mar 18, 2026Complaint1 finding
- Oct 29, 2025Complaint1 finding
- Sep 17, 2025Standard7 findings
- Nov 14, 2024Complaint1 finding
- Aug 29, 2024Complaint2 findings
- Aug 8, 2024Standard5 findings
Show the 21 earlier surveys
- Apr 16, 2024Complaint2 findings · 1 harm
- Dec 28, 2023Complaint1 finding
- Sep 12, 2023Standard7 findings
- Feb 7, 2023Complaint2 findings
- Aug 18, 2022Standard4 findings
- Sep 23, 2021Complaint2 findings · 1 harm
- May 13, 2021Standard4 findings
- Jan 3, 2020Complaint1 finding
- Aug 28, 2019Standard and complaint5 findings
- Jun 21, 2018Standard2 findings
- Sep 7, 2017Complaint1 finding
- Apr 27, 2017Standard10 findings
- Jul 14, 2016Standard4 findings
- Jun 4, 2015Standard4 findings
- Feb 19, 2015Complaint2 findings
- May 15, 2014Standard2 findings
- Dec 9, 2013—1 finding · 1 harm
- Apr 12, 2013—7 findings
- Feb 2, 2012—6 findings
- May 10, 2011—3 findings · 1 harm
- Dec 2, 2010—7 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