01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-12-11 | 0 | 2025-12-11 | 2 |
| Cycle 2 | 2024-10-16 | 5 | 2024-10-16 | 6 |
| Cycle 3 | 2024-01-25 | 6 | 2024-01-25 | 8 |
CMS CCN 2451382026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Boundary Waters Care Center
200 West Conan Street · Ely, MN 55731 · St. Louis County
Certified beds38CMS provider file
Recent citation rows27current CMS citation release
Penalty rows0current 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
27 rows in the current release
0 rows carry G–L scope/severity codes; 0 carry J–L. 2 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-12-11 · FIREK0353Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2025-12-292025-12-11 · 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 · 2026-01-132024-10-16 · HEALTHF0580Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Correction field: Deficient, Provider has date of correction · 2024-11-182024-10-16 · HEALTHF0688Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Correction field: Deficient, Provider has date of correction · 2024-11-182024-10-16 · HEALTHF0695Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2024-11-182024-10-16 · HEALTHF0809Severity F · widespread; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
Correction field: Deficient, Provider has date of correction · 2024-11-182024-10-16 · HEALTHF0825Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide or get specialized rehabilitative services as required for a resident.
Correction field: Deficient, Provider has date of correction · 2024-11-182024-10-16 · FIREK0163Severity D · isolated; potential for more than minimal harm
Construction Deficiencies
Install noncombustible or limited-combustible interior walls.
Correction field: Deficient, Provider has date of correction · 2024-11-182024-10-16 · FIREK0226Severity F · widespread; potential for more than minimal harm
Egress Deficiencies
Have horizontal exits used in accordance with safety requirements.
Correction field: Deficient, Provider has date of correction · 2024-11-182024-10-16 · FIREK0353Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2024-11-182024-10-16 · FIREK0741Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Correction field: Deficient, Provider has date of correction · 2024-11-182024-10-16 · 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 · 2024-11-182024-10-16 · FIREK0921Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure that testing and maintenance of electrical equipment is performed.
Correction field: Deficient, Provider has date of correction · 2024-11-182024-01-25 · HEALTHF0582Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Correction field: Deficient, Provider has date of correction · 2024-02-242024-01-25 · HEALTHF0583Severity F · widespread; potential for more than minimal harm
Resident Rights Deficiencies
Keep residents' personal and medical records private and confidential.
Correction field: Deficient, Provider has date of correction · 2024-02-242024-01-25 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2024-02-242024-01-25 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2024-02-242024-01-25 · 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 · 2024-02-242024-01-25 · HEALTHF0880Severity E · pattern; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2024-02-242024-01-25 · FIREK0226Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Have horizontal exits used in accordance with safety requirements.
Correction field: Deficient, Provider has date of correction · 2024-02-242024-01-25 · FIREK0281Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Install proper backup exit lighting.
Correction field: Deficient, Provider has date of correction · 2024-02-242024-01-25 · FIREK0346Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
Correction field: Deficient, Provider has date of correction · 2024-02-242024-01-25 · 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 · 2024-02-242024-01-25 · FIREK0363Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Install corridor and hallway doors that block smoke.
Correction field: Deficient, Provider has date of correction · 2024-02-2403 / 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 |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- CHAMPA, KATHLEENIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 06/01/2022
- FORSMAN, MICHAELIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 04/01/2015
- JOHNSON, WARRENIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 07/01/2024
- LOBE, JONEENEIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 02/01/2023
- PEKURI, ROGERIndividual · MANAGING CONTROL - GOVERNING BODYNOT APPLICABLE · since 01/01/2015
- CHAMPA, KATHLEENIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 06/01/2022
- FORSMAN, MICHAELIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 04/01/2015
- JOHNSON, WARRENIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2024
- LOBE, JONEENEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 10/01/2011
- PEKURI, ROGERIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2015
- LOBE, JONEENEIndividual · CORPORATE OFFICERNOT APPLICABLE · since 10/01/2011
- PEKURI, ROGERIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/01/2015
- ELY-BLOOMENSON COMMUNITY HOSPITALOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 09/30/2011
- HEALTH DIMENSIONS CONSULTING INCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/17/2011
- BRISCOE, DAVIDIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/07/2011
- BRISCOE, PATRICIAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 03/07/2011
- HENNESSEY, ERINIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 01/01/2020
- MASLOSKI, ADAMIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 06/01/2016
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 hours4.29per resident day
RN hours1.30per resident day
Weekend nurse hours3.61per resident day
Staff turnover41.7%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.