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Nursing homesMinnesotaMinneapolis › Villas at Bryn Mawr LLC

Villas at Bryn Mawr LLC

275 Penn Avenue North, Minneapolis, MN 55405 · (612) 377-4723 · 105 certified beds

Overall★☆☆☆☆ 1/5
Health inspections★☆☆☆☆ 1/5
Staffing★★★★☆ 4/5
Quality measures★★★★☆ 4/5
Special Focus: CMS lists this facility as SFF Candidate — among the facilities with the most serious ongoing compliance problems in the country.
Abuse icon: CMS flags this facility for an abuse citation in recent inspections.

Ownership group

Per CMS filings, this facility is affiliated with Monarch Healthcare Management, a group operating 45 facilities in 1 state. Group record: average rating 2.2/5, 6 abuse citation icons, 1 facility on the Special Focus list, $1,558,347 in federal fines. This facility rates below its group average (2.2/5).

See all 45 facilities in this group →

Staffing (hours per resident per day)

Total nurse staffing: 2.73 (Minnesota median: 4.16). RN hours: 0.68. Weekend total: 2.54. Nursing staff turnover: 29%.

Inspection deficiencies

All-time on record: 57 deficiency citations, including 5 at immediate-jeopardy level. Below: citations from 2023 onward (severity letters explained in methodology).

Survey dateDeficiencySev.TypeStatus
2026-06-17Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. EHealthcorrected 2026-07-29
2026-06-17Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Ecomplaintcorrected 2026-07-29
2026-06-17Put firmly secured handrails on each side of hallways. Ecomplaintcorrected 2026-07-29
2026-06-17Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. DHealthcorrected 2026-07-29
2026-06-17Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. DHealthcorrected 2026-07-29
2026-06-17Honor 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. DHealthcorrected 2026-07-29
2026-06-17Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. DHealthcorrected 2026-07-29
2026-06-17Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. DHealthcorrected 2026-07-29
2026-06-17Ensure each resident receives an accurate assessment. DHealthcorrected 2026-07-29
2026-06-17Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. DHealthcorrected 2026-07-29
2026-06-17Provide appropriate treatment and care according to orders, resident’s preferences and goals. DHealthcorrected 2026-07-29
2026-06-17Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. DHealthcorrected 2026-07-29
2026-06-17Provide and implement an infection prevention and control program. DHealthcorrected 2026-07-29
2026-06-17Make sure that a working call system is available in each resident's bathroom and bathing area. Dcomplaintcorrected 2026-07-29
2026-03-13Provide appropriate treatment and care according to orders, resident’s preferences and goals. Jcomplaintcorrected 2026-04-07
2026-03-13Provide enough food/fluids to maintain a resident's health. Dcomplaintcorrected 2026-04-07
2026-02-27Provide appropriate pressure ulcer care and prevent new ulcers from developing. GcomplaintPast Non-Compliance
2025-09-29Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Jcomplaintcorrected 2025-10-15
2025-09-11Honor 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. JcomplaintPast Non-Compliance
2025-06-24Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Jcomplaintcorrected 2025-06-10
2025-06-24Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Dcomplaintcorrected 2025-07-18
2025-06-24Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Dcomplaintcorrected 2025-07-18
2025-06-24Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. Dcomplaintcorrected 2025-07-18
2025-06-24Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Dcomplaintcorrected 2025-07-18
2025-04-15Provide enough food/fluids to maintain a resident's health. Dcomplaintcorrected 2025-04-29
2025-03-27Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. FHealthcorrected 2025-04-29
2025-03-27Provide appropriate treatment and care according to orders, resident’s preferences and goals. EHealthcorrected 2025-04-29
2025-03-27Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. EHealthcorrected 2025-04-29
2025-03-27Ensure residents have reasonable access to and privacy in their use of communication methods. DHealthcorrected 2025-04-29
2025-03-27Assure that each resident’s assessment is updated at least once every 3 months. DHealthcorrected 2025-04-29
2025-03-27PASARR screening for Mental disorders or Intellectual Disabilities DHealthcorrected 2025-04-29
2025-03-27Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. DHealthcorrected 2025-04-29
2025-03-27Provide care and assistance to perform activities of daily living for any resident who is unable. DHealthcorrected 2025-04-29
2025-03-27Assist a resident in gaining access to vision and hearing services. DHealthcorrected 2025-04-29
2025-03-27Provide appropriate foot care. DHealthcorrected 2025-04-29
2025-03-27Provide 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. DHealthcorrected 2025-04-29
2025-03-27Ensure each resident must receive and the facility must provide necessary behavioral health care and services. Dcomplaintcorrected 2025-04-29
2025-03-27Implement 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. DHealthcorrected 2025-04-29
2025-03-27Provide and implement an infection prevention and control program. DHealthcorrected 2025-04-29
2025-03-27Keep residents' personal and medical records private and confidential. BHealthcorrected 2025-04-29

Federal penalties

DateTypeAmount
2026-02-27Fine$16,720
2024-08-12Fine$35,260

Ownership & control records (CMS filings)

NameRoleType%Since
MONARCH HEALTHCARE OPERATING XII LLC5% Or Greater Direct Ownership InterestOrganization100%since 01/01/2023
NIJ LLC5% Or Greater Indirect Ownership InterestOrganizationNO PERCENTAGE PROVIDEDsince 01/01/2023
SPARTAN HEALTHCARE LLC5% Or Greater Indirect Ownership InterestOrganizationNO PERCENTAGE PROVIDEDsince 01/01/2023
WBS HOLDINGS LLC5% Or Greater Indirect Ownership InterestOrganizationNO PERCENTAGE PROVIDEDsince 01/01/2023
YAZOMA HOLDINGS, LLC5% Or Greater Indirect Ownership InterestOrganizationNO PERCENTAGE PROVIDEDsince 01/01/2023
HALPERT, MARC5% Or Greater Indirect Ownership InterestIndividualNO PERCENTAGE PROVIDEDsince 01/01/2023
JAFFA, NOAM5% Or Greater Indirect Ownership InterestIndividualNO PERCENTAGE PROVIDEDsince 01/01/2023
LEGUM, JOSHUA5% Or Greater Indirect Ownership InterestIndividualNO PERCENTAGE PROVIDEDsince 01/01/2023
STERN, WILLIAM5% Or Greater Indirect Ownership InterestIndividualNO PERCENTAGE PROVIDEDsince 01/01/2023
JAFFA, NOAMCorporate DirectorIndividualNOT APPLICABLEsince 01/01/2023
HALPERT, MARCCorporate OfficerIndividualNOT APPLICABLEsince 01/01/2023
STERN, WILLIAMCorporate OfficerIndividualNOT APPLICABLEsince 01/01/2023
HALPERT, MARCOperational/Managerial ControlIndividualNOT APPLICABLEsince 01/01/2023

Compare nearby (Hennepin County)

How to cite this page: CareRecords, “Villas at Bryn Mawr LLC — compliance, penalty and ownership record” (CCN 245203), compiled from the CMS Provider Data Catalog, July 2026 release. https://carerecords.org/nursing-home/villas-at-bryn-mawr-llc-minneapolis-mn/

Source: CMS Provider Data Catalog (July 2026 release) — provider file, deficiency file, ownership file, penalty file. CCN 245203. Corrections: data@carerecords.org.