Elk River, MN

Guardian Angels Care Center

2-star overall rating with 2-star inspections with $98,353 in total fines with 2 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle

400 Evans Avenue, Elk River, MN

(763) 635-5475

Compare this facility

Overall

2 / 5

CMS overall stars

Health inspections

2 / 5

Survey and complaint cycles

Staffing

4 / 5

RN + nurse staffing

Quality measures

3 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

120

Certified beds

Average residents

104

Average occupied residents

Ownership

Non-Profit

Publicly displayed owner type

Chain

No chain reported

Operator or chain grouping

Approved since

1967-01-01

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Changed ownership

No

Within the last 12 months

Family council

Yes

Resident and family council reported

Sprinklers

Yes

Automatic sprinklers in all required areas

Staffing

Hours and turnover

RN hours / resident day

1.50

Registered nurse staffing · state 1.06 · national 0.68

LPN hours / resident day

0.65

Licensed practical nurse staffing · state 0.62 · national 0.87

Aide hours / resident day

2.74

Nurse aide staffing · state 2.56 · national 2.35

Total nurse hours

4.89

All reported nurse hours · state 4.23 · national 3.89

Licensed hours

2.15

RN + LPN hours · state 1.68 · national 1.54

Weekend hours

4.18

Weekend nurse staffing · state 3.68 · national 3.43

Weekend RN hours

0.89

Weekend registered nurse coverage · state 0.68 · national 0.47

Physical therapist

0.10

Reported PT staffing · state 0.08 · national 0.07

Adjusted RN hours

1.42

CMS adjusted RN staffing hours

Adjusted total hours

4.63

CMS adjusted total nurse staffing hours

Case-mix index

1.44

Higher values indicate more complex resident acuity

RN turnover

61%

Annual RN turnover · state 39% · national 45%

Total nurse turnover

47%

Annual nurse turnover · state 42% · national 46%

SNF VBP

Value-based purchasing

Program rank

3,025

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

46.37

Composite VBP score used to determine payment impact.

Payment multiplier

0.9997

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

1.24

Baseline 18.39% · Performance 20.86% · Measure score 1.24 · Achievement 1.24 · Improvement 0

Healthcare-associated infections

5.37

Baseline 4.47% · Performance 6.23% · Measure score 5.37 · Achievement 5.37 · Improvement 0

Total nurse turnover

5.99

Baseline 55.06% · Performance 39.19% · Measure score 5.99 · Achievement 5.99 · Improvement 4.75

Adjusted total nurse staffing

5.95

Baseline 4.42 hours · Performance 4.77 hours · Measure score 5.95 · Achievement 5.95 · Improvement 2.09

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	9.78%	10.72% 0.9 pts better	No Different than the National Rate · Eligible stays 330 · Observed rate 7.58% · Lower 95% interval 7.31%
Discharge to community	64.08%	50.57% 13.5 pts better	Better than the National Rate · Eligible stays 342 · Observed rate 64.04% · Lower 95% interval 57.42%
Medicare spending per beneficiary	0.8	1.02 0.2 pts better
Drug regimen review with follow-up	98.96%	95.27% 3.7 pts better	Numerator 190 · Denominator 192
Falls with major injury	0.52%	0.77% 0.2 pts better	Numerator 1 · Denominator 192
Discharge self-care score	44.44%	53.69% 9.2 pts worse	Numerator 68 · Denominator 153
Discharge mobility score	34.64%	50.94% 16.3 pts worse	Numerator 53 · Denominator 153
Pressure ulcers or injuries, new or worsened	1.57%	2.29% 0.7 pts better	Numerator 3 · Denominator 191 · Adjusted rate 1.74%
Healthcare-associated infections requiring hospitalization	6.23%	7.12% 0.9 pts better	No Different than the National Rate · Eligible stays 186 · Observed rate 4.3% · Lower 95% interval 3.27%
Staff COVID-19 vaccination coverage	6.45%	8.2% 1.7 pts worse	Numerator 26 · Denominator 403
Staff flu vaccination coverage	4.76%	42% 37.2 pts worse	Numerator 13 · Denominator 273
Discharge function score	29.41%	56.45% 27 pts worse	Numerator 45 · Denominator 153
Transfer of health information to provider	96.67%	95.95% 0.7 pts better	Numerator 145 · Denominator 150
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator 14 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date	48.86%	25.2% 23.7 pts better	Numerator 43 · Denominator 88

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	99.7%	97.3% 2.4 pts better	93.4% 6.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 98.7% · Q4 100.0% · 4Q avg 99.7%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	98.8%	96.1% 2.7 pts better	95.5% 3.3 pts better	Long Stay · 2024Q3-2025Q2 · 4Q avg 98.8%
Percentage of long-stay residents experiencing one or more falls with major injury	2.3%	3.9% 1.6 pts better	3.3% 1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 2.5% · Q2 0.0% · Q3 2.7% · Q4 4.1% · 4Q avg 2.3% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	2.7%	4.3% 1.6 pts better	11.4% 8.7 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 4.5% · Q4 7.1% · 4Q avg 2.7%
Percentage of long-stay residents who lose too much weight	3.7%	4.1% 0.4 pts better	5.4% 1.7 pts better	Long Stay · 2024Q4-2025Q3 · Q1 6.7% · Q2 8.2% · Q3 0.0% · Q4 0.0% · 4Q avg 3.7%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	5.7%	12.4% 6.7 pts better	19.6% 13.9 pts better	Long Stay · 2024Q4-2025Q3 · Q1 7.9% · Q2 4.9% · Q3 4.8% · Q4 5.1% · 4Q avg 5.7%
Percentage of long-stay residents who received an antipsychotic medication	11.9%	17.5% 5.6 pts better	16.7% 4.8 pts better	Long Stay · 2024Q4-2025Q3 · Q1 10.2% · Q2 14.3% · Q3 11.3% · Q4 12.0% · 4Q avg 11.9% · Used in QM five-star
Percentage of long-stay residents who were physically restrained	0.0%	0.1% 0.1 pts better	0.1% 0.1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0%
Percentage of long-stay residents whose ability to walk independently worsened	59.6%	22.5% 37.1 pts worse	16.3% 43.3 pts worse	Long Stay · 2024Q4-2025Q3 · 4Q avg 59.6% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	18.1%	18.6% 0.5 pts better	14.9% 3.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 21.1% · Q2 21.2% · Q3 20.0% · Q4 9.8% · 4Q avg 18.1% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	0.0%	2.3% 2.3 pts better	1.0% 1 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	3.0%	2.6% 0.4 pts worse	1.7% 1.3 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 2.6% · Q2 2.7% · Q3 5.3% · Q4 1.4% · 4Q avg 3.0% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	31.9%	24.8% 7.1 pts worse	19.8% 12.1 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 25.1% · Q2 27.6% · Q3 40.9% · Q4 33.9% · 4Q avg 31.9%
Percentage of long-stay residents with pressure ulcers	2.4%	5.4% 3 pts better	5.1% 2.7 pts better	Long Stay · 2024Q4-2025Q3 · Q1 2.1% · Q2 0.8% · Q3 2.2% · Q4 4.5% · 4Q avg 2.4% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	96.2%	88.6% 7.6 pts better	81.7% 14.5 pts better	Short Stay · 2024Q4-2025Q3 · Q1 97.6% · Q2 99.0% · Q3 94.9% · Q4 93.6% · 4Q avg 96.2%
Percentage of short-stay residents who had an outpatient emergency department visit	10.8%	14.0% 3.2 pts better	12.0% 1.2 pts better	Short Stay · 20240701-20250630 · Adjusted 10.8% · Observed 9.9% · Expected 10.2% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	2.2%	1.9% 0.3 pts worse	1.6% 0.6 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 1.8% · Q2 1.9% · Q3 3.1% · Q4 2.0% · 4Q avg 2.2% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	97.1%	82.7% 14.4 pts better	79.7% 17.4 pts better	Short Stay · 2024Q3-2025Q2 · 4Q avg 97.1%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	27.9%	23.1% 4.8 pts worse	23.9% 4 pts worse	Short Stay · 20240701-20250630 · Adjusted 27.9% · Observed 21.9% · Expected 18.7% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-12-10 · Fire 2025-12-10

2 health deficiencies

Top issue: Quality of Life and Care (1 deficiency)

3 fire-safety deficiencies

Top issue: Gas and Vacuum and Electrical Systems (2 deficiencies)

Cycle 2 Health 2025-01-24 · Fire 2025-01-24

11 health deficiencies

Top issue: Nutrition and Dietary (3 deficiencies)

7 fire-safety deficiencies

Top issue: Smoke (4 deficiencies)

Cycle 3 Health 2024-04-11 · Fire 2024-04-11

7 health deficiencies

Top issue: Quality of Life and Care (4 deficiencies)

2 fire-safety deficiencies

Top issue: Miscellaneous (1 deficiency)

Fire safety

Fire-safety citations

D · Potential for more than minimal harm 2025-12-10

K321 · Smoke Deficiencies

Fire Safety

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

Corrected 2025-12-26

D · Potential for more than minimal harm 2025-12-10

K930 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Ensure proper storage of liquid oxygen.

Corrected 2025-12-26

C · Minimal harm 2025-12-10

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have generator or other power source capable of supplying service within 10 seconds.

Corrected 2025-12-26

E · Potential for more than minimal harm 2025-01-24

K321 · Smoke Deficiencies

Fire Safety

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

Corrected 2025-03-24

E · Potential for more than minimal harm 2025-01-24

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2025-03-24

E · Potential for more than minimal harm 2025-01-24

K372 · Smoke Deficiencies

Fire Safety

Ensure smoke barriers are constructed to a 1 hour fire resistance rating.

Corrected 2025-03-24

D · Potential for more than minimal harm 2025-01-24

K226 · Egress Deficiencies

Fire Safety

Have horizontal exits used in accordance with safety requirements.

Corrected 2025-03-24

D · Potential for more than minimal harm 2025-01-24

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2025-03-24

D · Potential for more than minimal harm 2025-01-24

K923 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

Have proper medical gas storage and administration areas.

Corrected 2025-03-24

C · Minimal harm 2025-01-24

K521 · Services Deficiencies

Fire Safety

Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.

Corrected 2025-03-24

F · Potential for more than minimal harm 2024-04-11

K712 · Miscellaneous Deficiencies

Fire Safety

Have simulated fire drills held at unexpected times.

Corrected 2024-05-06

D · Potential for more than minimal harm 2024-04-11

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2024-05-06

Inspection history

Recent health citations

D · Potential for more than minimal harm 2025-09-09

F550 · Resident Rights Deficiencies

Health

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Corrected 2025-10-24

D · Potential for more than minimal harm 2025-04-24

F695 · Quality of Life and Care Deficiencies

Health

Provide safe and appropriate respiratory care for a resident when needed.

Corrected 2025-05-20

L · Immediate jeopardy 2025-01-24

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2025-03-24

F · Potential for more than minimal harm 2025-01-24

F812 · Nutrition and Dietary Deficiencies

Health

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Corrected 2025-03-24

E · Potential for more than minimal harm 2025-01-24

F677 · Quality of Life and Care Deficiencies

Health

Provide care and assistance to perform activities of daily living for any resident who is unable.

Corrected 2025-03-24

E · Potential for more than minimal harm 2025-01-24

F804 · Nutrition and Dietary Deficiencies

Health

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Corrected 2025-03-24

D · Potential for more than minimal harm 2025-01-24

F550 · Resident Rights Deficiencies

Health

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Corrected 2025-03-24

D · Potential for more than minimal harm 2025-01-24

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2025-03-24

D · Potential for more than minimal harm 2025-01-24

F684 · Quality of Life and Care Deficiencies

Health

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Corrected 2025-03-24

D · Potential for more than minimal harm 2024-09-12

F558 · Resident Rights Deficiencies

Health

Reasonably accommodate the needs and preferences of each resident.

Corrected 2024-10-09

J · Immediate jeopardy 2024-07-17

F806 · Nutrition and Dietary Deficiencies

Health

Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.

Corrected 2024-07-11

J · Immediate jeopardy 2024-05-16

F689 · Quality of Life and Care Deficiencies

Health

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Corrected 2024-06-07

J · Immediate jeopardy 2024-04-11

F578 · Resident Rights Deficiencies

Health

Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

Corrected 2024-04-29

D · Potential for more than minimal harm 2024-04-11

F554 · Resident Rights Deficiencies

Health

Allow residents to self-administer drugs if determined clinically appropriate.

Corrected 2024-05-06

D · Potential for more than minimal harm 2024-04-11

F688 · Quality of Life and Care Deficiencies

Health

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.

Corrected 2024-05-06

D · Potential for more than minimal harm 2024-04-11

F698 · Quality of Life and Care Deficiencies

Health

Provide safe, appropriate dialysis care/services for a resident who requires such services.

Corrected 2024-05-06

D · Potential for more than minimal harm 2024-03-14

F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies

Health

Respond appropriately to all alleged violations.

Corrected 2024-04-12

D · Potential for more than minimal harm 2023-05-10

F656 · Resident Assessment and Care Planning Deficiencies

Health

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Corrected 2023-06-14

D · Potential for more than minimal harm 2023-05-10

F689 · Quality of Life and Care Deficiencies

Health

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Corrected 2023-06-14

D · Potential for more than minimal harm 2023-05-10

F745 · Quality of Life and Care Deficiencies

Health

Provide medically-related social services to help each resident achieve the highest possible quality of life.

Corrected 2023-06-14

Penalties and ownership

What sits behind the stars

$59,010 2025-01-24

Fine

Fine · fine $59,010

Fine

$0 2025-01-24

Payment Denial

Payment Denial · denial start 2025-02-26 · 26 days

26 day denial

$13,627 2024-07-17

Fine

Fine · fine $13,627

Fine

$16,801 2024-05-16

Fine

Fine · fine $16,801

Fine

$8,915 2024-03-14

Fine

Fine · fine $8,915

Fine

Ownership

Guardian Angels Health Services, Inc.

Operational/Managerial Control · Organization

0% 1 facilities 1967-01-01

Heinecke, Carlie

W-2 Managing Employee · Individual

0% 1 facilities 2024-05-06

Herrmann, Daryl

Corporate Officer · Individual

0% 1 facilities 2018-01-01

Krieger, Linda

Corporate Officer · Individual

0% 1 facilities 2010-04-15

Larson, Traci

Operational/Managerial Control · Individual

0% 1 facilities 2022-05-02

Larson, Traci

Corporate Officer · Individual

0% 1 facilities 2022-05-02

Larson, Traci

W-2 Managing Employee · Individual

0% 1 facilities 2022-05-02

Leclaire, Joyce