Minnetonka, MN

Hope Springs at Minnetonka

1-star overall rating with 1-star inspections with $9,496 in total fines with 16 recent health deficiencies with 5 fire-safety deficiencies in the latest cycle

16913 Highway 7, Minnetonka, MN

(952) 474-4474

Compare this facility

Overall

1 / 5

CMS overall stars

Health inspections

1 / 5

Survey and complaint cycles

Staffing

3 / 5

RN + nurse staffing

Quality measures

2 / 5

Resident outcomes and process measures

Quick facts

Facility snapshot

Beds

Certified beds

Average residents

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

No chain reported

Operator or chain grouping

Approved since

1992-07-02

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Changed ownership

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

0.54

Registered nurse staffing · state 1.06 · national 0.68

LPN hours / resident day

1.18

Licensed practical nurse staffing · state 0.62 · national 0.87

Aide hours / resident day

1.39

Nurse aide staffing · state 2.56 · national 2.35

Total nurse hours

3.11

All reported nurse hours · state 4.23 · national 3.89

Licensed hours

1.73

RN + LPN hours · state 1.68 · national 1.54

Weekend hours

2.37

Weekend nurse staffing · state 3.68 · national 3.43

Weekend RN hours

0.50

Weekend registered nurse coverage · state 0.68 · national 0.47

Physical therapist

0.00

Reported PT staffing

Adjusted RN hours

0.79

CMS adjusted RN staffing hours

Adjusted total hours

4.52

CMS adjusted total nurse staffing hours

Case-mix index

0.94

Higher values indicate more complex resident acuity

RN turnover

Annual RN turnover

Total nurse turnover

Annual nurse turnover

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	Not Available	10.72%	Not Available · Eligible stays Not Available · Observed rate Not Available · Lower 95% interval Not Available · No data were submitted for this measure.
Discharge to community	Not Available	50.57%	Not Available · Eligible stays Not Available · Observed rate Not Available · Lower 95% interval Not Available · No data were submitted for this measure.
Medicare spending per beneficiary	Not Available	1.02	No data were submitted for this measure.
Drug regimen review with follow-up	Not Available	95.27%	Numerator Not Available · Denominator Not Available · No data were submitted for this measure.
Falls with major injury	Not Available	0.77%	Numerator Not Available · Denominator Not Available · No data were submitted for this measure.
Discharge self-care score	Not Available	53.69%	Numerator Not Available · Denominator Not Available · No data were submitted for this measure.
Discharge mobility score	Not Available	50.94%	Numerator Not Available · Denominator Not Available · No data were submitted for this measure.
Pressure ulcers or injuries, new or worsened	Not Available	2.29%	Numerator Not Available · Denominator Not Available · Adjusted rate Not Available · No data were submitted for this measure.
Healthcare-associated infections requiring hospitalization	Not Available	7.12%	Not Available · Eligible stays Not Available · Observed rate Not Available · Lower 95% interval Not Available · No data were submitted for this measure.
Staff COVID-19 vaccination coverage	Not Available	8.2%	Numerator Not Available · Denominator Not Available · No data were submitted for this measure.
Staff flu vaccination coverage	46.15%	42% 4.1 pts better	Numerator 18 · Denominator 39
Discharge function score	Not Available	56.45%	Numerator Not Available · Denominator Not Available · No data were submitted for this measure.
Transfer of health information to provider	Not Available	95.95%	Numerator Not Available · Denominator Not Available · No data were submitted for this measure.
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator Not Available · No data were submitted for this measure.
Resident COVID-19 vaccinations up to date	Not Available	25.2%	Numerator Not Available · Denominator Not Available · No data were submitted for this measure.

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine	97.6%	97.3% 0.3 pts better	93.4% 4.2 pts better	Long Stay · 2024Q4-2025Q3 · Q2 95.2% · Q3 95.2% · Q4 100.0% · 4Q avg 97.6%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	100.0%	96.1% 3.9 pts better	95.5% 4.5 pts better	Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0%
Percentage of long-stay residents experiencing one or more falls with major injury	8.5%	3.9% 4.6 pts worse	3.3% 5.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q2 9.5% · Q3 9.5% · Q4 4.8% · 4Q avg 8.5% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	18.9%	4.3% 14.6 pts worse	11.4% 7.5 pts worse	Long Stay · 2024Q4-2025Q3 · Q3 10.0% · 4Q avg 18.9%
Percentage of long-stay residents who lose too much weight	4.9%	4.1% 0.8 pts worse	5.4% 0.5 pts better	Long Stay · 2024Q4-2025Q3 · Q2 9.5% · Q3 0.0% · Q4 0.0% · 4Q avg 4.9%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	59.8%	12.4% 47.4 pts worse	19.6% 40.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q2 57.1% · Q3 52.4% · Q4 47.6% · 4Q avg 59.8%
Percentage of long-stay residents who received an antipsychotic medication	52.0%	17.5% 34.5 pts worse	16.7% 35.3 pts worse	Long Stay · 2024Q4-2025Q3 · 4Q avg 52.0% · 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 · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0%
Percentage of long-stay residents whose ability to walk independently worsened	5.5%	22.5% 17 pts better	16.3% 10.8 pts better	Long Stay · 2024Q4-2025Q3 · 4Q avg 5.5% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	12.7%	18.6% 5.9 pts better	14.9% 2.2 pts better	Long Stay · 2024Q4-2025Q3 · Q2 19.0% · Q3 10.0% · 4Q avg 12.7% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	9.7%	2.3% 7.4 pts worse	1.0% 8.7 pts worse	Long Stay · 2024Q4-2025Q3 · Q3 11.3% · Q4 8.1% · 4Q avg 9.7% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	4.9%	2.6% 2.3 pts worse	1.7% 3.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q2 9.5% · Q3 4.8% · Q4 4.8% · 4Q avg 4.9% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	15.1%	24.8% 9.7 pts better	19.8% 4.7 pts better	Long Stay · 2024Q4-2025Q3 · 4Q avg 15.1%
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 · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 2.4% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2025-02-14 · Fire 2025-02-14

16 health deficiencies

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

5 fire-safety deficiencies

Top issue: Smoke (3 deficiencies)

Cycle 2 Health 2024-05-16 · Fire 2024-05-16

16 health deficiencies

Top issue: Resident Rights (4 deficiencies)

7 fire-safety deficiencies

Top issue: Emergency Preparedness (3 deficiencies)

Cycle 3 Health 2023-04-27 · Fire 2023-04-27

7 health deficiencies

Top issue: Infection Control (2 deficiencies)

5 fire-safety deficiencies

Top issue: Emergency Preparedness (4 deficiencies)

Fire safety

Fire-safety citations

F · Potential for more than minimal harm 2025-02-14

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2025-03-15

F · Potential for more than minimal harm 2025-02-14

K712 · Miscellaneous Deficiencies

Fire Safety

Have simulated fire drills held at unexpected times.

Corrected 2025-03-31

F · Potential for more than minimal harm 2025-02-14

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

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

Corrected 2025-03-31

E · Potential for more than minimal harm 2025-02-14

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2025-03-15

D · Potential for more than minimal harm 2025-02-14

K363 · Smoke Deficiencies

Fire Safety

Install corridor and hallway doors that block smoke.

Corrected 2025-03-15

F · Potential for more than minimal harm 2024-05-16

E37 · Emergency Preparedness Deficiencies

Fire Safety

Establish staff and initial training requirements.

Corrected 2024-06-30

F · Potential for more than minimal harm 2024-05-16

E39 · Emergency Preparedness Deficiencies

Fire Safety

Conduct testing and exercise requirements.

Corrected 2024-07-30

F · Potential for more than minimal harm 2024-05-16

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2024-06-10

D · Potential for more than minimal harm 2024-05-16

K225 · Egress Deficiencies

Fire Safety

Have stairways and smokeproof enclosures used as exits that meet safety requirements.

Corrected 2024-06-10

D · Potential for more than minimal harm 2024-05-16

K324 · Smoke Deficiencies

Fire Safety

Provide properly protected cooking facilities.

Corrected 2024-06-10

C · Minimal harm 2024-05-16

E26 · Emergency Preparedness Deficiencies

Fire Safety

Establish roles under a Waiver declared by secretary.

Corrected 2024-06-30

C · Minimal harm 2024-05-16

K901 · Electrical Deficiencies

Fire Safety

Ensure that building systems meet requirements determined by risk assessment procedures performed by qualified personnel.

Corrected 2024-06-17

F · Potential for more than minimal harm 2023-04-27

K918 · Gas, Vacuum, and Electrical Systems Deficiencies

Fire Safety

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

Corrected 2023-06-12

C · Minimal harm 2023-04-27

E26 · Emergency Preparedness Deficiencies

Fire Safety

Establish roles under a Waiver declared by secretary.

Corrected 2023-06-12

C · Minimal harm 2023-04-27

E37 · Emergency Preparedness Deficiencies

Fire Safety

Establish staff and initial training requirements.

Corrected 2023-06-12

C · Minimal harm 2023-04-27

E39 · Emergency Preparedness Deficiencies

Fire Safety

Conduct testing and exercise requirements.

Corrected 2023-06-12

C · Minimal harm 2023-04-27

E41 · Emergency Preparedness Deficiencies

Fire Safety

Implement emergency and standby power systems.

Corrected 2023-06-12

Inspection history

Recent health citations

F · Potential for more than minimal harm 2025-02-14

F727 · Nursing and Physician Services Deficiencies

Health

Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.

Corrected 2025-04-04

F · Potential for more than minimal harm 2025-02-14

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 2025-04-28

F · Potential for more than minimal harm 2025-02-14

F865 · Administration Deficiencies

Health

Have a plan that describes the process for conducting QAPI and QAA activities.

Corrected 2025-04-04

F · Potential for more than minimal harm 2025-02-14

F867 · Administration Deficiencies

Health

Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

Corrected 2025-04-04

F · Potential for more than minimal harm 2025-02-14

F868 · Administration Deficiencies

Health

Have the Quality Assessment and Assurance group have the required members and meet at least quarterly

Corrected 2025-04-04

E · Potential for more than minimal harm 2025-02-14

F641 · Resident Assessment and Care Planning Deficiencies

Health

Ensure each resident receives an accurate assessment.

Corrected 2025-04-04

D · Potential for more than minimal harm 2025-02-14

F554 · Resident Rights Deficiencies

Health

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

Corrected 2025-05-01

D · Potential for more than minimal harm 2025-02-14

F561 · Resident Rights Deficiencies

Health

Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

Corrected 2025-04-25

D · Potential for more than minimal harm 2025-02-14

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 2025-05-01

D · Potential for more than minimal harm 2025-02-14

F584 · Resident Rights Deficiencies

Health

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.

Corrected 2025-05-06

D · Potential for more than minimal harm 2025-02-14

F684 · Quality of Life and Care Deficiencies

Health

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

Corrected 2025-04-25

D · Potential for more than minimal harm 2025-02-14

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 2025-05-01

D · Potential for more than minimal harm 2025-02-14

F697 · Quality of Life and Care Deficiencies

Health

Provide safe, appropriate pain management for a resident who requires such services.

Corrected 2025-05-01

D · Potential for more than minimal harm 2025-02-14

F700 · Quality of Life and Care Deficiencies

Health

Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.

Corrected 2025-04-25

D · Potential for more than minimal harm 2025-02-14

F758 · Pharmacy Service Deficiencies

Health

Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

Corrected 2025-04-04

D · Potential for more than minimal harm 2025-02-14

F805 · Nutrition and Dietary Deficiencies

Health

Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.

Corrected 2025-05-05

F · Potential for more than minimal harm 2024-05-16

F576 · Resident Rights Deficiencies

Health

Ensure residents have reasonable access to and privacy in their use of communication methods.

Corrected 2024-06-12

F · Potential for more than minimal harm 2024-05-16

F727 · Nursing and Physician Services Deficiencies

Health

Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.

Corrected 2024-06-10

F · Potential for more than minimal harm 2024-05-16

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 2024-06-10

F · Potential for more than minimal harm 2024-05-16

F851 · Administration Deficiencies

Health

Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.

Corrected 2024-06-30

F · Potential for more than minimal harm 2024-05-16

F865 · Administration Deficiencies

Health

Have a plan that describes the process for conducting QAPI and QAA activities.

Corrected 2024-07-31

F · Potential for more than minimal harm 2024-05-16

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2024-06-30

F · Potential for more than minimal harm 2024-05-16

F945 · Infection Control Deficiencies

Health

Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.

Corrected 2024-06-30

E · Potential for more than minimal harm 2024-05-16

F565 · Resident Rights Deficiencies

Health

Honor the resident's right to organize and participate in resident/family groups in the facility.

Corrected 2024-06-30

E · Potential for more than minimal harm 2024-05-16

F567 · Resident Rights Deficiencies

Health

Honor the resident's right to manage his or her financial affairs.

Corrected 2024-06-19

D · Potential for more than minimal harm 2024-05-16

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 2024-07-01

D · Potential for more than minimal harm 2024-05-16

F696 · Quality of Life and Care Deficiencies

Health

Provide appropriate care/assistance for a resident with a prosthesis.

Corrected 2024-06-10

D · Potential for more than minimal harm 2024-05-16

F756 · Pharmacy Service Deficiencies

Health

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

Corrected 2024-06-30

D · Potential for more than minimal harm 2024-05-16

F757 · Pharmacy Service Deficiencies

Health

Ensure each resident’s drug regimen must be free from unnecessary drugs.

Corrected 2024-06-30

D · Potential for more than minimal harm 2024-05-16

F790 · Quality of Life and Care Deficiencies

Health

Provide routine and 24-hour emergency dental care for each resident.

Corrected 2024-06-30

D · Potential for more than minimal harm 2024-05-16

F883 · Infection Control Deficiencies

Health

Develop and implement policies and procedures for flu and pneumonia vaccinations.

Corrected 2024-06-30

C · Minimal harm 2024-05-16

F577 · Resident Rights Deficiencies

Health

Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.

Corrected 2024-06-19

F · Potential for more than minimal harm 2023-04-27

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2023-06-12

E · Potential for more than minimal harm 2023-04-27

F756 · Pharmacy Service Deficiencies

Health

Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

Corrected 2023-06-12

D · Potential for more than minimal harm 2023-04-27

F553 · Resident Rights Deficiencies

Health

Allow resident to participate in the development and implementation of his or her person-centered plan of care.

Corrected 2023-06-12

D · Potential for more than minimal harm 2023-04-27

F655 · Resident Assessment and Care Planning Deficiencies

Health

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

Corrected 2023-06-12

D · Potential for more than minimal harm 2023-04-27

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 2023-06-12

D · Potential for more than minimal harm 2023-04-27

F700 · Quality of Life and Care Deficiencies

Health

Corrected 2023-06-12

C · Minimal harm 2023-04-27

F885 · Infection Control Deficiencies

Health

Report COVID19 data to residents and families.

Corrected 2023-06-12

Penalties and ownership

What sits behind the stars

$2,659 2024-02-20

Fine

Fine · fine $2,659

Fine

$2,279 2024-02-12

Fine

Fine · fine $2,279

Fine

$4,558 2024-01-22

Fine

Fine · fine $4,558

Fine

$0 2023-04-27

Payment Denial

Payment Denial · denial start 2023-07-27 · 35 days

35 day denial

Ownership

Nearby options

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The Estates at Excelsior LLC

Excelsior, MN

1-star overall rating with 1-star inspections with abuse icon flag with 22 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle

Overall: 1 / 5
Health: 1 / 5
Staffing: 4 / 5
Fines: $0