Not rated by CMS — ratings are suppressed for new or low-volume facilities.
A standard survey is most likely before around October 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Shakopee Friendship Manor during CMS and state inspections, most recent first.
A resident with a history of colon cancer and recent bowel surgery was admitted after a fall. Staff failed to report and evaluate a distinctive foul odor in the resident's room, which was later associated with a large, bloody, black stool observed during hospital transfer. The odor, recognized by an EMT as indicative of a GI bleed, was not reported to nursing staff, resulting in a lack of timely assessment and physician notification. The facility's policy did not specifically address GI bleed symptoms, contributing to the delay in care.
A resident with multiple medical conditions and care needs did not have a comprehensive care plan in place. The care plan lacked essential information on ADLs, cognitive concerns, and specific preferences, leading to inadequate guidance for staff. Interviews with staff confirmed the care plan's incompleteness, despite facility policies requiring individualized care plans.
A resident with a foley catheter was not provided with proper enhanced barrier precautions (EBP) as required. Despite EBP signage, the care plan and records lacked mention of the catheter and EBP. A nursing assistant was observed not wearing a PPE gown while providing catheter care, although gloves were worn. Interviews with staff confirmed the expectation to wear gowns and gloves, but the nursing assistant admitted to forgetting. The infection control preventionist noted the absence of EBP documentation in the resident's records.
The facility failed to ensure RN coverage for a minimum of eight consecutive hours daily, as required. This deficiency was identified through staffing data and schedules, revealing gaps in RN coverage on specific dates, including weekends and holidays. Interviews with staff confirmed the expectation of RN presence, but acknowledged challenges in maintaining coverage, particularly during call-ins. Despite efforts to improve staffing, the facility did not meet the requirement on several occasions.
Failure to Timely Evaluate and Act on Signs of GI Bleed
Penalty
Summary
A deficiency occurred when the facility failed to timely act upon or evaluate signs of a potential gastrointestinal (GI) bleed in a resident who was later hospitalized with GI complications. The resident, who had a history of colon cancer, chronic kidney disease, and a recent right hemicolectomy, was admitted to the facility following a fall and cervical fracture. Initial assessments and documentation did not indicate any active or monitored GI bleed, and bowel movements were recorded as formed and normal in consistency. However, on the day of the incident, a nursing assistant noticed a foul, unusual odor in the resident's room in the early morning, which was later identified as similar to the odor present when the resident had a large, bloody, black stool during transfer to the hospital. The nursing assistant did not report the abnormal odor to the nurse, assuming it had already been addressed based on information from a previous shift. Later that day, while preparing the resident for hospital transfer due to complaints of head and neck pain, staff observed a large amount of bloody, loose stool with a distinctive odor, which an EMT identified as indicative of a GI bleed. The nurse confirmed that if such an odor had been reported earlier, they would have initiated monitoring and notified the physician immediately. The medical record lacked evidence that the odor noticed by direct care staff was evaluated in a timely manner or that the resident was assessed for other symptoms of a GI bleed prior to the EMT's arrival. Interviews with the assistant director of nursing and director of nursing confirmed that no concerns about a potential GI bleed were reported by staff prior to the incident. The facility's change of condition policy required evaluation and physician notification for significant changes in status but did not specifically mention GI bleed symptoms such as abnormal stool odor or black stools. The failure to recognize and act upon early signs of a GI bleed resulted in a delay in care for the resident.
Incomplete Care Plan for Resident
Penalty
Summary
The facility failed to develop and maintain a comprehensive care plan for a resident, identified as R29, which resulted in a deficiency in providing appropriate care. R29 was admitted with several medical conditions, including atrial fibrillation, mild cognitive impairment, muscle weakness, repeated falls, cardiomyopathy, chronic kidney disease, hypertension, and congestive heart failure. The Minimum Data Set (MDS) assessment indicated that R29 required maximum assistance for various activities of daily living (ADLs) and had specific care needs, such as assistance with toileting, dressing, and transfers. However, the care plan lacked evidence of addressing these needs, as well as cognitive concerns, behavioral symptoms, falls, pressure ulcers, communication, bowel and bladder management, dental care, skin integrity, medication needs, and pain management. Interviews with staff members, including nursing assistants and a registered nurse, revealed that the care plan did not provide sufficient guidance for R29's care. Nursing assistants relied on the Kardex, a shorter version of the care plan, which also lacked critical information about R29's care needs, such as transfer assistance, preference for female caregivers, and the requirement for two staff members to be present due to past accusations. The registered nurse confirmed that R29 had specific preferences and behaviors that were not adequately addressed in the care plan, and the MDS coordinator acknowledged that the care plan was incomplete, missing essential sections that should have been included. The facility's policy on care planning emphasized the importance of developing an individualized plan of care to address each resident's specific problems and needs. Despite this policy, the care plan for R29 was not comprehensive, as confirmed by the assistant director of nursing and the administrator. The deficiency in the care plan was identified during a survey, highlighting the facility's failure to ensure that R29 received appropriate and consistent care based on her needs and preferences.
Failure to Implement Enhanced Barrier Precautions
Penalty
Summary
The facility failed to implement and maintain enhanced barrier precautions (EBP) for a resident who was reviewed for transmission-based precautions. The resident, who had intact cognition and diagnoses of hemiplegia and rhabdomyolysis, was admitted with a foley catheter following a visit to the emergency room for urinary retention. Despite the presence of EBP signage outside the resident's room, the care plan, physician orders, and nursing assistant care sheet did not mention the foley catheter or EBP precautions. During an observation, a nursing assistant was seen rinsing a graduated cylinder used for catheter drainage without wearing the required personal protective equipment (PPE) gown, although gloves were worn. Interviews with various nursing staff, including nursing assistants and a licensed practical nurse, revealed that there was an understanding that PPE, including gowns and gloves, should be worn when providing hands-on care to residents with catheters. However, the nursing assistant admitted to forgetting to wear a gown while providing care. The infection control preventionist confirmed that the resident was placed under EBP upon returning from the emergency room and that the expectation was for staff to sanitize hands and wear gowns and gloves during care. It was also noted that the electronic medical record lacked documentation of EBP in the orders, care plan, and Kardex, which was acknowledged by the infection control preventionist and the assistant director of nursing.
Failure to Maintain RN Coverage for Required Hours
Penalty
Summary
The facility failed to ensure that a registered nurse (RN) was scheduled for a minimum of eight consecutive hours a day, as required. This deficiency was identified through a review of the Payroll Based Journal (PBJ) Staffing Data Report for the first quarter of 2024, which showed no RN hours on specific dates. Additionally, the facility's staffing schedules confirmed the absence of RN coverage on several occasions, including weekends and holidays. Interviews with the staffing coordinator, nursing assistants, and the assistant director of nursing (ADON) verified the expectation of having an RN on duty for eight consecutive hours each day, and acknowledged the failure to meet this requirement on the identified dates. The staffing coordinator mentioned that the facility had been working to improve RN coverage by hiring another RN in March and utilizing medical staffing agencies to fill open shifts. Despite these efforts, there were still instances where RN coverage was not maintained, particularly when there were call-ins. The administrator confirmed the absence of RN coverage on the specified dates and stated that the facility aimed to have an RN on duty for the required hours each day. A facility policy on staffing was requested during the investigation but was not provided.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Shakopee
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| St Gertrudes Health & Rehabilitation Center | 2.7 mi | — | 16 | 0 |
| Auburn Manor | 2.7 mi | — | 8 | 0 |
| Flagstone | 6.8 mi | — | 15 | 0 |
| The Estates At Excelsior Llc | 7.3 mi | — | 18 | 1 |
| Friendship Village Of Bloomington | 8.6 mi | — | 13 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.