01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-12-10 | 3 | 2025-12-10 | 2 |
| Cycle 2 | 2024-10-24 | 2 | 2024-10-24 | 3 |
| Cycle 3 | 2023-11-03 | 8 | 2023-11-03 | 9 |
CMS CCN 2456372026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Norris Square
6993 80Th Street South · Cottage Grove, MN 55016 · Washington County
Certified beds72CMS provider file
Recent citation rows27current 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
27 rows in the current release
1 rows carry G–L scope/severity codes; 0 carry J–L. 3 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-12-10 · HEALTHF0565Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to organize and participate in resident/family groups in the facility.
Correction field: Deficient, Provider has date of correction · 2026-01-302025-12-10 · HEALTHF0584Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Correction field: Deficient, Provider has date of correction · 2026-01-302025-12-10 · HEALTHF0699Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care or services that was trauma informed and/or culturally competent.
Correction field: Deficient, Provider has date of correction · 2026-01-302025-12-10 · FIREK0511Severity F · widespread; potential for more than minimal harm
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Correction field: Deficient, Provider has date of correction · 2026-02-022025-12-10 · FIREK0918Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2026-02-022024-10-24 · HEALTHF0584Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Correction field: Deficient, Provider has date of correction · 2024-11-202024-10-24 · 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 · 2024-11-202024-10-24 · FIREK0321Severity F · widespread; 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 · 2025-01-022024-10-24 · FIREK0324Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2024-12-032024-10-24 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2024-12-032023-11-03 · HEALTHF0585Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Correction field: Deficient, Provider has date of correction · 2023-11-282023-11-03 · HEALTHF0604Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Correction field: Deficient, Provider has date of correction · 2023-11-282023-11-03 · HEALTHF0677Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Correction field: Deficient, Provider has date of correction · 2023-11-282023-11-03 · HEALTHF0679Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide activities to meet all resident's needs.
Correction field: Deficient, Provider has date of correction · 2023-11-282023-11-03 · 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 · 2023-11-282023-11-03 · HEALTHF0686Severity G · isolated actual 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 · 2023-11-282023-11-03 · 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 · 2023-11-28 · complaint2023-11-03 · HEALTHF0756Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Correction field: Deficient, Provider has date of correction · 2023-11-282023-11-03 · FIREK0324Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Provide properly protected cooking facilities.
Correction field: Deficient, Provider has date of correction · 2023-12-152023-11-03 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2023-12-152023-11-03 · 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 · 2023-12-152023-11-03 · 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 · 2023-12-152023-11-03 · FIREK0372Severity F · widespread; 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 · 2023-12-152023-11-03 · FIREK0712Severity F · widespread; potential for more than minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2023-12-1503 / 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 |
|---|---|---|---|
| 2023-11-03 | Payment Denial | $0 | 16 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- PRESBYTERIAN HOMES AND SERVICESOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 07/25/2017
- TCF INVESTMENTS MANAGEMENT, INC.Organization · 5% OR GREATER MORTGAGE INTERESTNOT APPLICABLE · since 08/17/2017
- TCF INVESTMENTS MANAGEMENT, INC.Organization · 5% OR GREATER SECURITY INTERESTNOT APPLICABLE · since 08/17/2017
- FLETCHER, JONATHANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 02/01/2025
- MEYER, MARKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 02/09/2016
- PEDERSON, MARKIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2023
- FLETCHER, JONATHANIndividual · CORPORATE OFFICERNOT APPLICABLE · since 02/01/2025
- MEYER, MARKIndividual · CORPORATE OFFICERNOT APPLICABLE · since 02/09/2016
- PHS MANAGEMENT, LLCOrganization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 08/17/2017
- PRESBYTERIAN HOMES HOUSING AND ASSISTED LIVING, INC.Organization · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 11/18/2024
- KISPERT, CHRISTOPHERIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 08/28/2023
- MIELKE, JOHNIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 08/29/2019
- PHS MANAGEMENT, LLCOrganization · ADP OF THE SNFNOT APPLICABLE · since 04/14/2025
- KISPERT, CHRISTOPHERIndividual · ADP OF THE SNFNOT APPLICABLE · since 08/28/2023
- MIELKE, JOHNIndividual · ADP OF THE SNFNOT APPLICABLE · since 08/29/2019
- PEDERSON, MARKIndividual · ADP OF THE SNFNOT APPLICABLE · since 01/12/2025
- PETERSON, HEIDIIndividual · ADP OF THE SNFNOT APPLICABLE · since 01/01/2023
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 hours4.47per resident day
RN hours1.53per resident day
Weekend nurse hours3.90per resident day
Staff turnover40.0%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.