Prairie Cottages of Albert Lea.

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 it failed to respond to the resident’s change in symptoms and possible urinary tract infection which led to catheter occlusion for two days and hospitalization. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. The facility followed provider’s orders for catheter irrigation, contacted the provider for symptoms of infection and collected a sample for urinary testing. When the resident had no urinary output overnight, a catheter change was attempted. The resident was hospitalized, treated with continuous bladder irrigation (CBI) and antibiotics and returned to the facility at his baseline. The investigator conducted interviews with facility staff members, including nursing staff, and unlicensed staff. The investigation included review of the resident record, hospital records, facility incident reports, staff schedules, related facility policy and procedures Also, the investigator observed the care team provide catheter care for the resident during a recent visit to the facility. The resident resided in an assisted living memory care unit. The resident’s diagnoses included dementia, atrial fibrillation, history of stroke and a foley catheter for urinary retention. The resident’s service plan included medication and catheter care management as well as assistance with all activities of daily living. The resident’s assessment indicated for mobility he used a wheelchair. The resident was alert and verbal but confused and required redirection. A concern arose one morning when the resident was found pale, had a distended abdomen, and his catheter had been occluded for two days. Home care nursing attempted a catheter change. During removal of the catheter, a large amount of dark blood and pus drained out of the urethra. The resident was sent to the emergency room for evaluation. An incident note indicated the resident had uncontrollable bleeding from the urethra following catheter removal performed by the home health nurse. 911 was called and the resident was transferred to the hospital. Nursing progress notes indicated that morning the resident had no output “since last night.” The facility nurse requested a home health nurse make a visit to change out the resident’s catheter. During the catheter removal, a significant amount of blood drained and bleeding could not be controlled so 911 was called. Progress notes indicated that nine days prior, the resident’s urine had a “very foul odor” without other symptoms. When the resident showed increased confusion, nursing requested a visit from the provider and orders were placed to collect a urine sample. At that time, the facility nurse could irrigate the catheter without difficulty but there was a large amount of sediment. An antibiotic order for a UTI was not received until the morning the resident was transferred to the hospital. The resident’s service delivery record indicated the last measured urine output was the in the previous afternoon and the resident emptied it twice during the night, but it was not measured. The resident’s medication record indicated he was on a blood thinning medication. The resident’s hospitalization summary note indicated the resident was admitted for urinary retention and treated with continuous bladder irrigation (CBI) for hematuria (blood in urine) and intravenous fluids for acute kidney injury (AKI). Antibiotics were started for urinary infection. Bladder imaging showed a partial occluded urethra with chronic bladder wall thickening. The resident returned to the facility with continued antibiotic orders with recommendations to follow up with outpatient urology for recurrent UTIs. During an interview, a nurse manager stated the resident’s lack of output started the evening before and supported by the documentation and per staff report. The nurse stated the need for catheter irrigations have increased over the last year. 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: Resident was unable to discuss the incident. Family/Responsible Party interviewed: Yes. Alleged Perpetrator interviewed: Not Applicable. Action taken by facility: No action required. 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: 04/ 16/ 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: ______________________ C B. WING _____________________________ 29690 02/ 20/ 2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1602 FOUNTAIN STREET PRAIRIE SENIOR COTTAGES OF AL 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 February 20. 2026, the Minnesota Department of Health initiated an investigation of complaint #HL296902283C/ #HL296908922M. No correction orders are issued. LABORATORY DIRECTOR' S OR PROVIDER/ SUPPLIER REPRESENTATIVE' S SIGNATURE TITLE (X6) DATE STATE FORM 6899 20SL11 If continuation sheet 1 of 1

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 . . ." In accordance with Minn. Stat. § 144G.31 Subd. 4, MDH may assess fines based on the level and scope of the vio la tio ns ; however, no immediate fines are assessed for this survey of your facility. DOCUMENTATIO ONF ACTION TO COMPLY In accordance with Minn. Stat. § 144G.30, Subd. 5(c), the licensee must document actions taken to 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). An equal opportunity employer. Letter ID: IS7N REVISE D09/13/2021 Prairie Senior Cottages of Albert Lea December 9, 2025 Page 2 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 factor. To submit a hearing request, please visit: https: / / forms. web. health. state. mn. us/ form/ HRDAppealsForm To appea l fines via rec onsiderati o n, ple ase fol lo w the pro cedure outlined abo ve. Please no te tha t you may reques t a reco ns ide ratio n or a he aring, but no t bo th. If you wish to conte st tags witho ut fines 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 enienc e at this link: https: / / forms. office.com/ g/ Bm5uQEpHVa. Your input is imp o rtant to us and wi ll 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 CLN PRINTED: 12/ 09/ 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: ______________________ B. WING _____________________________ 29690 11/20/ 2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1602 FOUNTAIN STREET PRAIRIE SENIOR COTTAGES OF AL 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. SL29690016- 0 PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On November 18, 2025, through November 20, 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 21 residents; 21 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. 0 470 144G. 41 Subdivision 1 Minimum requirements 0 470 SS= C (11) develop and implement a staffing plan for LABORATORY DIRECTOR' S OR PROVIDER/ SUPPLIER REPRESENTATIVE' S SIGNATURE TITLE (X6) DATE STATE FORM 6899 0JM911 If continuation sheet 1 of 14 PRINTED: 12/ 09/ 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: ______________________ B.