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(KNSI) – A St. Cloud assisted living facility was recently cited by the Minnesota Department of Health’s Office of Health Facilities Complaints after it gave a resident the wrong medicine on at least four different occasions.

The investigation report shows staff at St. Cloud Carefree Living on Division Street East gave a patient with dementia and sclerosis the prescription drug Tegretol even though there was a note in their file about being allergic to it. They were given repeated doses over the course of three days until the patient became delirious.

The patient was rushed to the hospital and failed basic tests like being able to follow a finger with both eyes or being able to demonstrate movement and full function of their lower legs. They remained at the hospital for 12 days before they were ready for rehabilitation.

The investigation notes that facility suffers from extremely high turnover and its staff are stretched thin. A survey conducted by MDH in early May found the facility to be out of compliance with state statutes on a number of fronts. They included poor food preparation, a failure to keep employee records up to date and to do annual performance reviews, a lack of protocols in place to stop the spread of infectious diseases like tuberculosis, no emergency disaster or fire safety and evacuation plans, and more.

Several of the violations were categorized as level 2, which has the potential to be lethal for a resident. St. Cloud Carefree Living can host over 40 residents at any given time.

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