Oak Park Place of Albert Lea.

correction orders and document the actions taken to comply in the facility's records. The Department reserves the right to return to the facility at any time should the Department receive a complaint or deem it necessary to ensure the health, safety, and welfare of residents in your care. STATE CORRECTIO NORDERS The enclosed State Form documents the state correction orders. MDH documents state licensing correction orders using federal software. Tag numbers are assigned to Minnesota state statutes for Assisted Living Facilities. The assigned tag number appears in the far left column entitled "ID Prefix Tag." The state statute number and the corresponding text of the state statute out of compliance are listed in the "Summary Statement of Deficiencies" column. This column also includes the findings that are in violation of the state statute after the statement, "This MN Requirement is not met as evidenced by . . ." IMPOSITION OF FINES In accordance with Minn. Stat. § 144G.31, Subd. 4, fines and enforcement actions may be imposed based on the level and scope of the violations and may be imposed immediately with no opportunity to correct the violation first as follows: Level 1: no fines or enforcement; Level 2: a fine of $500 per violation, in addition to any enforcement mechanism authorized in § 144G.20; Level 3: a fine of $1,000 per incident, in addition to any enforcement mechanism authorized in § 144G.20; An equal opportunity employer. Letter ID: IS7N REVISE D09/13/2021 Oak Park Place of Albert Lea January 15, 2026 Page 2 Level 4: a fine of $3,000 per incident, in addition to any enforcement mechanism authorized in § 144G.20; Level 5: a fine of $5,000 per violation, in addition to any enforcement mechanism authorized in § 144G.20. Therefore, in accordance with Minn. Stat. §§ 144G.01 to 144G.9999, the following fines are assessed pursuant to this survey: St - 0 - 0775 - 144g.45 Subd. 2. (a) - Fire Protection And Physical Environment - $500.00 The refor e, in accor danc e wit h Minn. Sta t. §§ 144G.01 to 144G.999 9, the total amount you are assessed is $500.00. You will be invoiced approximately 30 days after receipt of this notice, subject to appeal . DOCUMENTATIO ONF ACTION TO COMPLY In accorda nce with Min n. Stat. § 144G.30, Sub d. 5(c), th e lic ens ee mus t docum ent ac tions taken t o comply with the correction orders within the time period outlined on the state form; however, plans of correction are not required to be submitted for approval. The correction order documentation should include the following: Identify how the area( s) of noncompliance was corrected related to the · resident( s)/ employee( s) identified in the correction order. Identify how the area( s) of noncompliance was corrected for all of the provider’s · resident( s)/ employees that may be affected by the noncompliance. Identify what changes to your systems and practices were made to ensure compliance with · the specific statute( s). CORRECTIO NORDER RECONSIDERATIO PNROCESS In accordance with Minn. Stat. § 144G.32, Subd. 2, you may challenge the correction order( s) issued, including the level and scope, and any fine assessed through the correction order reconsideration process. The request for reconsideration must be in writing and received by MDH within 15 calendar days of the correction order receipt date. To submit a reconsideration request, please visit: https: / / forms. web. health. state. mn.us/ form/ HRDAppealsForm REQUESTIN GA HEARING Alternatively, in accordance with Minn. Stat. § 144G.31, Subd. 5(d), an assisted living provider that has been assessed a fine under this subdivision has a right to a reconsideration or a hearing under this section and chapter 14. Pursuant to Minn. Stat. § 144G.20, Subd. 14 and Subd. 18, a request for a hearing must be in writing and received by the Department of Health within 15 business days of the correction order receipt date. The request must contain a brief and plain statement describing each matter or issue contested and any new information you believe constitutes a defense or mitigating Oak Park Place of Albert Lea January 15, 2026 Page 3 factor. To submit a hearing request, please visit: https: / / forms. web. health. state. mn. us/ form/ HRDAppealsForm To appe al fi nes via re cons iderat ion , pl ease follow the procedu r e outl ined abo ve. Plea se no te tha t you may re que st a rec onside rati on or a hearing, bu t not bot h. If you wish to cont est ta gs with out fine s in a reconsideration and tags with the fines at a hearing, please submit two separate appeals forms at the website listed above. The MDH Health Regulation Division (HRD )values your feedback about your experience during the survey and/ or investigation process. Please fill out this anonymous provider feedback questionnaire at your conv enien ce at thi s link: https: / / forms. office.com/ g/ Bm5uQEpHVa. Your inpu t is import ant to us and will enable MDH to improve its processes and communication with providers. If you have any questions regarding the questionnaire, please contact Susan Winkelmann at susan. winkelmann@state. mn.us or call 651-201-5952. You are encouraged to retain this document for your records. It is your responsibility to share the information contained in the letter and state form with your organization’s Governing Body. If you have any questions, please contact me. Sincerely, Jodi Johnson, Supervisor State Evaluation Team Email: Jodi.Johnson@state. mn.us Telephone: 507-344-2730 Fax: 1-866-890-9290 HHH PRINTED: 01/ 15/ 2026 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/ SUPPLIER/ CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B. WING _____________________________ 30707 12/ 19/ 2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1615 BRIDGE AVENUE OAK PARK PLACE OF ALBERT LEA ALBERT LEA, MN 56007 SUMMARY STATEMENT OF DEFICIENCIES PROVIDER' S PLAN OF CORRECTION (X4) ID ID (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS- REFERENCED TO THE APPROPRIATE DATE TAG TAG DEFICIENCY) 0 000 Initial Comments 0 000 *****ATTENTION***** Minnesota Department of Health is documenting the State Correction Orders ASSISTED LIVING PROVIDER LICENSING using federal software. Tag numbers have CORRECTION ORDER( S) been assigned to Minnesota State Statutes for Assisted Living Facilities. The In accordance with Minnesota Statutes, section assigned tag number appears in the 144G. 08 to 144G. 95, these correction orders are far-left column entitled "ID Prefix Tag. " The issued pursuant to a survey. state Statute number and the corresponding text of the state Statute out Determination of whether violations are corrected of compliance is listed in the "Summary requires compliance with all requirements Statement of Deficiencies" column. This provided at the Statute number indicated below. column also includes the findings which When Minnesota Statute contains several items, are in violation of the state requirement failure to comply with any of the items will be after the statement, "This Minnesota considered lack of compliance. requirement is not met as evidenced by." Following the evaluators ' findings is the INITIAL COMMENTS: Time Period for Correction. SL30707016- 0 PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On December 16, 2025, through December 19, STATES, "PROVIDER' S PLAN OF 2025, the Minnesota Department of Health CORRECTION. " THIS APPLIES TO conducted a full survey at the above provider and FEDERAL DEFICIENCIES ONLY. THIS the following correction orders are issued. At the WILL APPEAR ON EACH PAGE. time of the survey, there were 49 residents; 49 receiving services under the Assisted Living THERE IS NO REQUIREMENT TO Facility with Dementia Care license. SUBMIT A PLAN OF CORRECTION FOR VIOLATIONS OF MINNESOTA STATE STATUTES. THE LETTER IN THE LEFT COLUMN IS USED FOR TRACKING PURPOSES AND REFLECTS THE SCOPE AND LEVEL ISSUED PURSUANT TO 144G. 31 SUBDIVISION 1-3. 0 420 144G. 40 Subdivision 1 Responsibility for housing 0 420 SS= F and services LABORATORY DIRECTOR' S OR PROVIDER/ SUPPLIER REPRESENTATIVE' S SIGNATURE TITLE (X6) DATE STATE FORM 6899 TDTX11 If continuation sheet 1 of 49 PRINTED: 01/ 15/ 2026 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/ SUPPLIER/ CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B.

Finding: Not Substantiated Nature of Investigation: The Minnesota Department of Health investigated an allegation of maltreatment, in accordance with the Minnesota Reporting of Maltreatment of Vulnerable Adults Act, Minn. Stat. 626.557, and to evaluate compliance with applicable licensing standards for the provider type. Initial Investigation Allegation(s): The alleged perpetrators (AP#1 and AP#2) abused the resident when AP#1 was yelling at the resident and AP#2 threatened to hit the resident. Investigative Findings and Conclusion: AP#1: The Minnesota Department of Health determined abuse was not substantiated. Upon viewing body camera footage provided by law enforcement, AP#1 was witnessed using a normal tone of voice stating three times that the resident was going to be transported to the hospital but was not yelling or raising her voice. AP#2: The Minnesota Department of Health determined abuse was not substantiated. It was alleged that AP#2 threatened to hit the resident. This information was reported over a week later by an individual. There was no evidence by emergency medical services personnel onsite or other facility staff members, that AP#2 had made any threats to the resident. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigator contacted law enforcement for body camera footage which was reviewed. The investigation included review of the resident record(s), facility internal investigation, facility incident reports, personnel files, staff schedules, related facility policy and procedures. Also, the investigator made a visit to the facility and observed the resident interacting with staff and other residents. The resident resided in an assisted living memory care unit. The resident’s diagnoses included depression and recent behaviors. The resident’s service plan included assistance with medication administration. The resident is at risk for wandering/elopement, and falls. The resident’s abuse prevention plan indicated the resident was able to follow and understand directions, ambulates safely, a wandering risk, and requires staff to monitor for statements of wanting to leave. The resident was susceptible to abuse from other individuals and the facility was to monitor for concerns of self-abuse. The resident was alert, oriented to person, made poor decisions, has some memory loss and confusion, impulsive, and required a secured environment. Staff were to identify possible situations that may trigger aggression, including persons involved, time of day, and report any findings to nursing. A concern arose when the resident was upset as he wanted to leave the secured memory care unit to attend a community event. The resident became verbally aggressive, was physically pounding on doors, and opened an alarmed window. Staff members intervened and attempt interventions. An additional staff member from the assisted living side of the facility entered the memory care unit to assist and was pushed by the resident. The resident continued to swear at both staff and other residents in the unit. The nurse on-call directed the staff members to call emergency medical services for transport to the emergency department. During an interview, emergency medical personnel stated upon arrival at the facility the resident was in the living area, was agitated, and yelling. A female caregiver [name unknown but later identified as AP #1) was present and screaming at the resident. This emergency medical personnel stated she requested the female caregiver to leave the area immediately. The resident refused transportation to the emergency department, had calmed down and first responders could not forcibly transport him. The same person also stated there was a male caregiver present who was acting as a liaison to emergency medical services to provide information regarding the resident and was calmly talking to the resident. Upon viewing body camera footage provided by law enforcement, AP#1 was witnessed using a normal tone of voice stating three times that the resident was going to be transported to the hospital but was not yelling or raising her voice. During an interview, the guardian stated the male caregiver has been called over to the memory care unit in the past as he has a calming effect and seems to help the resident. During an interview, the nurse stated she was contacted by management on the night of the incident. The nurse stated no reports of staff abuse directed at the resident were brought to her attention at that time. The nurse stated the report was regarding the resident’s behavior and the interventions. The resident’s behavior was documented in his chart as he had a history of behaviors. The nurse stated over a week after the incident had occurred, an unlicensed caregiver reported to this nurse on the night of the incident AP#2 threatened to hit the resident after the resident had pushed AP#2. The nurse stated at that point she investigated the incident more closely including conducting interviews. The nurse stated that after a more in-depth investigation due to lack of evidence it could not be determined AP#2 had made a threat to the resident. During an interview, AP#1 stated on the night of the incident she did not witness or hear any verbal or physical threats made by AP#2. AP#1 stated she was on the phone with emergency medical services and management and could not hear all the conversations at the time. In conclusion, the Minnesota Department of Health determined abuse was not substantiated regarding AP#1 and not substantiated regarding AP#2. “Not Substantiated” means: An investigatory conclusion indicating the preponderance of evidence shows that an act meeting the definition of maltreatment did not occur. Abuse: Minnesota Statutes section 626.5572, subdivision 2. "Abuse" means: (b) Conduct which is not an accident or therapeutic conduct as defined in this section, which produces or could reasonably be expected to produce physical pain or injury or emotional distress including, but not limited to, the following: (1) hitting, slapping, kicking, pinching, biting, or corporal punishment of a vulnerable adult. (2) use of repeated or malicious oral, written, or gestured language toward a vulnerable adult or the treatment of a vulnerable adult which would be considered by a reasonable person to be disparaging, derogatory, humiliating, harassing, or threatening. Vulnerable Adult interviewed: Yes Family/Responsible Party interviewed: Yes Alleged Perpetrator interviewed: Yes Action taken by facility: The facility conducted an internal investigation at which time they suspended the AP#2 until the investigation was concluded. Action taken by the Minnesota Department of Health: No further action taken at this time. cc: The Office of Ombudsman for Long Term Care The Office of Ombudsman for Mental Health and Developmental Disabilities PRINTED: 10/24/2025 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ C B. WING _____________________________ 30707 08/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1615 BRIDGE AVENUE OAK PARK PLACE OF ALBERT LEA ALBERT LEA, MN 56007 SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X4) ID ID (X5) (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE PREFIX PREFIX REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE TAG TAG DEFICIENCY) 0 000 Initial Comments 0 000 On August 5, 2025, the Minnesota Department of Health initiated an investigation of complaint #HL307079627C/#HL307074682M. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 C6FG11 If continuation sheet 1 of 1

Finding: Not Substantiated Nature of Investigation: The Minnesota Department of Health investigated an allegation of maltreatment, in accordance with the Minnesota Reporting of Maltreatment of Vulnerable Adults Act, Minn. Stat. 626.557, and to evaluate compliance with applicable licensing standards for the provider type. Initial Investigation Allegation: The facility neglected the resident when he left the facility one night. The resident was found lying in the street and found by a citizen. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. The resident admitted to the facility on the day of the incident and although he expressed, he wanted to return to his home, there was no indication that he was going to leave the facility without staff knowledge or in an unsafe manner. The resident was not injured. The resident was moved to the facility’s memory care unit after the elopement. The investigator conducted interviews with facility staff members, including administrative staff and nursing staff. The investigator contacted the case worker. The investigation included review of the resident record, hospital records, facility incident reports, staff schedules, and related facility policy and procedures. Also, the investigator observed resident daily activities and resident/staff interactions both in the general AL and the memory care. The resident resided in an assisted living and admitted to an apartment in the assisted living part of the facility. The resident’s diagnoses included depression, heart valve stenosis with recent valve replacement and a pacemaker. The resident’s service plan included assistance with medications. The resident’s assessment indicated he was independent with mobility and personal cares. The resident was disoriented to place and time, impulsive, and had poor decision-making skills and at times was resistive to redirection. Review of a facility report indicated the resident eloped from the assisted living facility six hours after he was admitted. A taxicab driver brought him back after finding him lying in the road. The resident was moved into the locked memory care unit. Review of the resident’s discharge summary records from a skilled rehab facility indicated he was discharged from the skilled facility to the assisted living with fall risk precautions, cognitive deficits and pacemaker. Prior to the rehab stay, the resident presented to the emergency room after a fall and consequently found to have severe aortic stenosis. He was transferred to a higher-level hospital for surgical aortic valve replacement as well as pacemaker placement. The resident was noted to have very poor short-term memory and could not recall his time in the hospital. A doctor recommended a nursing facility as the best option. The nursing discharge summary indicated the resident had diabetes, a recent fall, cognitive impairment, depression and an appointed guardian. During an interview, the nurse stated he had completed an in-person pre-admission screening while the resident was in the hospital. On the day of admission to the facility, the resident was oriented to self only, was restless and agitated and made statements that he did not want to be there and wanted to leave. The nurse stated he was able to comfort him with food and other necessities. The transfer paperwork indicated the resident verbalized wanting to leave the skilled rehab facility but was able to be redirected. During interview, a manager stated the hospital referral indicated the resident needed medication management and that he had been malnourished living at home. The transfer paperwork from the skilled rehab facility indicated the resident was exit-seeking and a wander guard was placed on him. The manager stated they were not aware of this until they read it in the transfer paperwork. The resident arrived alone without anyone with him until the guardian showed up later. He wanted to go home but was agreeable to stay. The manager stated the resident walked around outside a couple of times and came back in to eat supper. Then a little while later, a taxi driver came and said he knew the resident and found him lying in the middle of the road (approximately eight blocks away). The resident said he was tired and did not know where he was. The resident was interviewed and stated he did not know why he was at the facility and wanted to return to his home. During interview a family member stated the resident cannot return to his home. The family member stated the resident is a little higher-level functioning than the other residents in the memory care and would like to find a place more suitable for him. The family member also stated the day the resident left the facility, he was sitting on the curb and denied being found lying in the road. The family member stated the incident was exaggerated and believes the resident was not found in such an unsafe manner. In conclusion, the Minnesota Department of Health determined neglect was not substantiated. “Not Substantiated” means: An investigatory conclusion indicating the preponderance of evidence shows that an act meeting the definition of maltreatment did not occur. Neglect: Minnesota Statutes, section 626.5572, subdivision 17 “Neglect” means neglect by a caregiver or self-neglect. (a) "Caregiver neglect" means the failure or omission by a caregiver to supply a vulnerable adult with care or services, including but not limited to, food, clothing, shelter, health care, or supervision which is: (1) reasonable and necessary to obtain or maintain the vulnerable adult's physical or mental health or safety, considering the physical and mental capacity or dysfunction of the vulnerable adult; and (2) which is not the result of an accident or therapeutic conduct. Vulnerable Adult interviewed: Yes. Family/Responsible Party interviewed: Yes. Alleged Perpetrator interviewed: Not Applicable. Action taken by facility: After the incident and the resident returned to the facility, the facility provided one to one supervision to the resident for the remainder of the night. The facility admitted the resident to the secured memory care unit with elopement precautions. Action taken by the Minnesota Department of Health: No action taken at this time. cc: The Office of Ombudsman for Long Term Care The Office of Ombudsman for Mental Health and Developmental Disabilities PRINTED: 07/14/2025 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ C B. WING _____________________________ 30707 05/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1615 BRIDGE AVENUE OAK PARK PLACE OF ALBERT LEA ALBERT LEA, MN 56007 SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X4) ID ID (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE TAG TAG DEFICIENCY) 0 000 Initial Comments 0 000 On May 21, 2025, the Minnesota Department of Health initiated an investigation of complaint #HL307072348C/#HL307071501M. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 J6RF11 If continuation sheet 1 of 1