The Birches At Trillium Woods

Inspection findings

1. May 27, 2026 Health · 5 findings
   • Not serious Scope/severity F

     F0572 Resident Rights Deficiencies

     Give residents a notice of rights, rules, services and charges.

     Corrected Jun 26, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0628 Resident Rights Deficiencies

     Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

     Corrected Jun 26, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0697 Quality of Life and Care Deficiencies

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

     Corrected Jun 26, 2026 · CMS health inspection

   • Not serious Scope/severity D

     F0759 Pharmacy Service Deficiencies

     Ensure medication error rates are not 5 percent or greater.

     Corrected Jun 26, 2026 · CMS health inspection

   • Not serious Scope/severity F

     K0921 Gas, Vacuum, and Electrical Systems Deficiencies

     Ensure that testing and maintenance of electrical equipment is performed.

     Corrected Jul 10, 2026 · CMS fire safety

2. Sep 12, 2024 Health · 6 findings
   • Not serious Scope/severity D

     F0758 Pharmacy Service Deficiencies

     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 Oct 3, 2024 · CMS health inspection

   • Not serious Scope/severity D

     F0760 Pharmacy Service Deficiencies

     Ensure that residents are free from significant medication errors.

     Corrected Oct 3, 2024 · CMS health inspection

   • Not serious Scope/severity E

     K0225 Egress Deficiencies

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

     Corrected Sep 24, 2024 · CMS fire safety

   • Not serious Scope/severity D

     K0372 Smoke Deficiencies

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

     Corrected Sep 24, 2024 · CMS fire safety

   • Not serious Scope/severity F

     K0521 Services Deficiencies

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

     Corrected Sep 26, 2024 · CMS fire safety

   • Not serious Scope/severity F

     K0761 Miscellaneous Deficiencies

     To conduct inspection, testing and maintenance of fire doors by qualified individuals.

     Corrected Sep 27, 2024 · CMS fire safety

3. Aug 17, 2023 Fire Safety · 5 findings
   • Not serious Scope/severity C

     E0041 Emergency Preparedness Deficiencies

     Implement emergency and standby power systems.

     Corrected Sep 13, 2023 · CMS fire safety

   • Not serious Scope/severity E

     K0211 Egress Deficiencies

     Keep aisles, corridors, and exits free of obstruction in case of emergency.

     Corrected Aug 18, 2023 · CMS fire safety

   • Not serious Scope/severity F

     K0372 Smoke Deficiencies

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

     Corrected Aug 21, 2023 · CMS fire safety

   • Not serious Scope/severity C

     K0901 Electrical Deficiencies

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

     Corrected Sep 6, 2023 · CMS fire safety

   • Not serious Scope/severity F

     K0918 Gas, Vacuum, and Electrical Systems Deficiencies

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

     Corrected Sep 13, 2023 · CMS fire safety

4. Nov 24, 2020 MDH complaint investigation · 1 finding
   • Severity not stated

     H5627007C Substantiated complaint (MDH Office of Health Facility Complaints)

     MDH substantiated this complaint. The finding and its severity are in MDH's investigation report (linked).

     Statement of deficiencies (PDF)

Owners and managers (as published by CMS)

• AMEND-MARSHALL, JOSEPH — operational/managerial control, NOT APPLICABLE, since 01/01/2025
• BIRD, JOHN — managing control - governing body, NOT APPLICABLE, since 01/01/2025
• LAHEY, DANIEL — managing control - governing body, NOT APPLICABLE, since 01/01/2025
• PAIDER, SAMANTHA — operational/managerial control, NOT APPLICABLE, since 01/01/2025
• PAIDER, SAMANTHA — adp of the snf, NOT APPLICABLE, since 02/26/2025
• REIMEN, HANNAH — operational/managerial control, NOT APPLICABLE, since 12/22/2025
• REIMEN, HANNAH — adp of the snf, NOT APPLICABLE, since 12/15/2025
• SHAW, GELYNNA — managing control - governing body, NOT APPLICABLE, since 01/01/2025
• UHLEMANN, BRIDGETTE — managing control - governing body, NOT APPLICABLE, since 01/01/2025
• VICTOR, JASON — managing control - governing body, NOT APPLICABLE, since 01/01/2025
• VICTOR, JASON — corporate officer, NOT APPLICABLE, since 01/01/2025
• BANK OF AMERICA CORP — 5% or greater mortgage interest, NOT APPLICABLE, since 01/01/2025
• BANK OF AMERICA CORP — 5% or greater security interest, NOT APPLICABLE, since 01/01/2025
• LCS MINNEAPOLIS LLC — 5% or greater indirect ownership interest, 100%, since 12/10/2021
• LCS TRILLIUM WOODS JV LLC — 5% or greater direct ownership interest, 100%, since 12/10/2021
• LIFE CARE SERVICES LLC — operational/managerial control, NOT APPLICABLE, since 07/01/2015
• LIFE CARE SERVICES LLC — adp of the snf, NOT APPLICABLE, since 03/24/2025