01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-08-13 | 1 | 2025-08-13 | 0 |
| Cycle 2 | 2024-05-15 | 2 | 2024-05-15 | 7 |
| Cycle 3 | 2023-07-26 | 2 | 2023-07-26 | 4 |
CMS CCN 2453642026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Annandale Care Center Inc
500 Park Street East · Annandale, MN 55302 · Wright County
Certified beds42CMS provider file
Recent citation rows16current CMS citation release
Penalty rows1current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
16 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 1 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-08-13 · HEALTHF0761Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Correction field: Deficient, Provider has date of correction · 2025-09-15 · complaint2025-06-17 · HEALTHF0689Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2025-07-23 · complaint2024-10-23 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2024-11-15 · complaint2024-05-15 · FIREK0353Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2024-06-202024-05-15 · FIREK0355Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Properly select, install, inspect, or maintain portable fire extinguishes.
Correction field: Deficient, Provider has date of correction · 2024-06-202024-05-15 · FIREK0363Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2024-06-202024-05-15 · FIREK0712Severity C · widespread; potential for minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2024-06-202024-05-15 · FIREK0761Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Correction field: Deficient, Provider has date of correction · 2024-06-202024-05-15 · FIREK0914Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Correction field: Deficient, Provider has date of correction · 2024-06-202024-05-15 · FIREK0920Severity E · pattern; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Correction field: Deficient, Provider has date of correction · 2024-06-202023-07-26 · HEALTHF0790Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide routine and 24-hour emergency dental care for each resident.
Correction field: Deficient, Provider has date of correction · 2023-09-292023-07-26 · HEALTHF0883Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Correction field: Deficient, Provider has date of correction · 2023-09-292023-07-26 · FIREK0321Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2023-09-292023-07-26 · FIREK0324Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2023-09-292023-07-26 · FIREK0372Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Correction field: Deficient, Provider has date of correction · 2023-09-292023-07-26 · FIREK0511Severity E · pattern; potential for more than minimal harm
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Correction field: Deficient, Provider has date of correction · 2023-09-2903 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2025-06-17 | Payment Denial | $0 | 6 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- BROWN, SHELDONIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 04/01/2024
- GRUYS, KATHERINEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 03/01/2023
- MILLNER, ROGERIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 04/01/2013
- DIRCKS, LINDAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/01/2020
- MANUEL, ANGELAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/01/2022
- MILLER, MARKIndividual · CORPORATE OFFICERNOT APPLICABLE · since 04/01/2015
- NISKA, ELSAIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/11/2023
- NISKA, ELSAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/11/2023
- WATKINS, DOUGLASIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 05/01/2023
- NISKA, ELSAIndividual · ADP OF THE SNFNOT APPLICABLE · since 01/11/2023
- WATKINS, DOUGLASIndividual · ADP OF THE SNFNOT APPLICABLE · since 05/01/2023
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours4.41per resident day
RN hours1.01per resident day
Weekend nurse hours3.70per resident day
Staff turnover47.5%CMS reported field
06 / LOCAL RECORDS
Open the Minnesota ledger →Other published facilities nearby
No second facility in the same city met the directory rule.