01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-05-22 | 0 | 2025-05-22 | 3 |
| Cycle 2 | 2024-04-11 | 3 | 2024-04-11 | 0 |
| Cycle 3 | 2023-08-31 | 1 | 2023-08-31 | 4 |
CMS CCN 2453222026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Covenant Living Of Golden Valley Care & Rehab Ctr
5825 St Croix Avenue · Golden Valley, MN 55422 · Hennepin County
Certified beds88CMS provider file
Recent citation rows11current 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
11 rows in the current release
0 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.
2025-05-22 · FIREK0211Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Correction field: Deficient, Provider has date of correction · 2025-06-092025-05-22 · 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 · 2025-06-092025-05-22 · 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 · 2025-06-092025-05-09 · HEALTHF0627Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
Correction field: Deficient, Provider has date of correction · 2025-06-06 · complaint2025-05-09 · HEALTHF0842Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Correction field: Deficient, Provider has date of correction · 2025-06-06 · complaint2025-02-27 · HEALTHF0755Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Correction field: Deficient, Provider has date of correction · 2025-03-28 · complaint2023-08-31 · HEALTHF0554Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Allow residents to self-administer drugs if determined clinically appropriate.
Correction field: Deficient, Provider has date of correction · 2023-09-222023-08-31 · FIREK0293Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Have properly located and lighted "Exit" signs.
Correction field: Deficient, Provider has date of correction · 2023-08-292023-08-31 · FIREK0324Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2023-08-292023-08-31 · 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 · 2023-08-292023-08-31 · FIREK0901Severity F · widespread; potential for more than minimal harm
Electrical Deficiencies
Ensure that building systems meet requirements determined by risk assessment procedures performed by qualified personnel.
Correction field: Deficient, Provider has date of correction · 2023-09-0103 / 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
- COVENANT LIVING COMMUNITIES & SERVICESOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 01/01/1966
- CUNLIFFE, TERRIIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 03/19/2009
- BENTLEY, SARAHIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2019
- CHRISTENSEN, PAMELAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2013
- DAVIS, KARAIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2019
- EASTBURG, MARKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2019
- KINCANNON, KURTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2019
- MANLOVE, MATTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2019
- MARTIN, ROBERTIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2019
- NELSON, RICHARDIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2019
- OXENDALE, ROGERIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2017
- RINARD, DALEIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2019
- VANOVER, ANDREWIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2019
- WENRICH, JOHNIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 07/01/2019
- CUNLIFFE, TERRIIndividual · CORPORATE OFFICERNOT APPLICABLE · since 03/19/2009
- ERICKSON, DAVIDIndividual · CORPORATE OFFICERNOT APPLICABLE · since 01/31/2008
- ERICKSON, REBEKAHIndividual · CORPORATE OFFICERNOT APPLICABLE · since 07/01/2019
- HOLT, JODYIndividual · CORPORATE OFFICERNOT APPLICABLE · since 06/02/2017
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 hours4.70per resident day
RN hours1.02per resident day
Weekend nurse hours4.36per resident day
Staff turnover22.5%CMS reported field
06 / LOCAL RECORDS
Open the Golden Valley ledger →