Lexington Pointe Senior Living.

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 necessar yto ensure the health, safety, and welfare of residents in your care. STATE CORRECTIO ONRDERS 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 Statemen tof Deficiencies "column. This column also includes the findings that are in violation of the state statute after the statement, "This MN Requiremen tis not met as evidenced by . . ." In accordance with Minn. Stat. § 144G3. 1 Subd .4, MDH may asses sfines based on the level and scope of the violations; however, no immediate fines are assesse dfor this survey of your facility. DOCUMENTATIO ONF ACTION TO COMPLY In accordance with Minn. Stat. § 144G3. 0, Subd .5(c), the licensee must docum ent 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: An equal opportunity employer . Letter ID: IS7N REVISE 0D9/13/2021 Lexington Pointe Senio rLiving Novembe r7, 2025 Page 2 x Identify how the area(s) of noncompliance was corrected related to the resident(s)/ employees( ) identified in the correction order. x 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. x Identify what changes to your systems and practices were made to ensure compliance with the specific statute(s). CORRECTIO ONRDER RECONSIDERATI OPRNOCESS In accordance with Minn. Stat. § 144G3. 2, Subd .2, you may challenge the correction order(s) issued, including the level and scope ,and any fine assesse dthrough 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 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 convenience at this link: https:/ / forms.office.com/g/ Bm5uQEpHV.a Your input is important to us and will enable MDH to improve its processe sand communication with providers . If you have any questions regarding the questionnaire ,please contact Susan Winkelmann at susanw. inkelmann@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 organizations’ Governing Body. If you have any questions ,please contact me. Sincerely, Jod iJohnson ,Supervisor State Evaluation Team Email: Jodi.Johnson@state.mn.us Telephone :507-344-2730 Fax :1-866-890-9290 CLN PRINTED: 11/07/2025 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 _____________________________ 36651 10/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 3385 DISCOVERY ROAD LEXINGTON POINTE SENIOR LIVING EAGAN, MN 55121 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 *****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." issued pursuant to a survey. The 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. SL36651016-0 PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On October 27, 2025, through October 29, 2025, STATES,"PROVIDER'S PLAN OF the Minnesota Department of Health conducted a CORRECTION." THIS APPLIES TO full survey at the above provider and the FEDERAL DEFICIENCIES ONLY. THIS following correction orders are issued. At the time WILL APPEAR ON EACH PAGE. of the survey, there were 184 residents; 66 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. 01640 144G.70 Subd. 4 (a-e) Service plan, 01640 SS=D implementation and revisions to LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 D02X11 If continuation sheet 1 of 17 PRINTED: 11/07/2025 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 _____________________________ 36651 10/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 3385 DISCOVERY ROAD LEXINGTON POINTE SENIOR LIVING EAGAN, MN 55121 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) 01640 Continued From page 1 01640 (a) No later than 14 calendar days after the date that services are first provided, an assisted living facility shall finalize a current written service plan. (b) The service plan and any revisions must include a signature or other authentication by the facility and by the resident documenting agreement on the services to be provided. The service plan must be revised, if needed, based on resident reassessment under subdivision 2. The facility must provide information to the resident about changes to the facility's fee for services and how to contact the Office of Ombudsman for Long-Term Care and the Office of Ombudsman for Mental Health and Developmental Disabilities. (c) The facility must implement and provide all services required by the current service plan. (d) The service plan and the revised service plan must be entered into the resident record, including notice of a change in a resident's fees when applicable. (e) Staff providing services must be informed of the current written service plan. This MN Requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee failed to ensure a written service plan was revised and signed by the resident or resident representative to reflect the current services provided for two of four residents (R2, R5). This practice resulted in a level two violation (a violation that did not harm a resident's health or safety but had the potential to have harmed a resident's health or safety, but was not likely to cause serious injury, impairment, or death), and STATE FORM 6899 D02X11 If continuation sheet 2 of 17 PRINTED: 11/07/2025 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.

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 perpetrator (AP), a facility staff member neglected the resident when the resident fell during a transfer, which resulted in a tibia (shinbone) fracture. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. Although the AP was present during the fall, the resident self-transferred from a chair according to the resident’s care plan when the fall occurred. The AP assisted the resident to the ground when the resident became off balance. It was determined the fall was an unforeseen event. After the fall, the resident was transported to a hospital for an evaluation. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigation included review of the resident records, hospital records, facility incident reports, personnel files, staff schedules, and related facility policy and procedures. Also, the investigator observed interactions between the staff and residents. The resident resided in an assisted living memory care unit. The resident’s diagnoses included Alzheimer’s disease, arthritis, and osteoporosis (a condition that weakens bones, making them more likely to break). The resident’s service plan indicated the resident used a walker when walking and with transfers and a wheelchair for longer distances. The resident’s assessment indicated the resident was a fall risk and had impaired cognition. The facility investigation indicated during a self-transfer, the resident lost her balance and fell backwards. The AP removed the wheelchair, got behind the resident, and guided the resident to the floor. The AP immediately reported the fall to nursing. After the fall, the resident had pain in her leg and was unable to bend her knee. Facility staff arranged for the resident to be evaluated at a hospital. Hospital records indicated the resident presented to the emergency room for an evaluation of an injury after a fall. The resident complained of pain in the left hip and thigh area. An x-ray was completed and showed no signs of an acute (sudden) fracture. A magnetic resonance imaging (MRI) was completed to evaluate for an occult fracture (a fracture that can be difficult to see on conventional imaging due to various factors). The MRI revealed the resident sustained a knee injury and a left tibia fracture. The fracture did not require surgery. The resident was hospitalized for five days and was transferred to a higher level of care. During an interview, the AP stated she entered the resident’s apartment, asked the resident if she wanted to join an activity and the resident agreed. The bedside table in front of the resident was removed and the resident’s wheelchair was positioned in front of the resident. The resident used her walker to stand up and pivoted 180 degrees. Once pivoted the resident looked back over her shoulder, tripped and fell backwards. The AP stated she attempted to guide the resident to the floor. The resident landed on her butt, with her legs straight out and knees slightly elevated. Once the resident was on the floor, other staff were alerted for assistance with the resident. During an interview, nursing leadership stated the resident used a walker to stand and walk from her recliner to her bathroom. The resident required a wheelchair for longer distances. After the resident fell, emergency services were notified, and the resident was transported to the hospital for an evaluation. The resident was transferred to a higher level of care. 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: No. The resident no longer resided at the facility. Family/Responsible Party interviewed: Yes. Alleged Perpetrator interviewed: Yes. Action taken by facility: After the resident fell, the facility notified emergency services and had the resident transported to the hospital for an evaluation. 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: 06/10/2025 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 _____________________________ 36651 05/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 3385 DISCOVERY ROAD LEXINGTON POINTE SENIOR LIVING EAGAN, MN 55121 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 28, 2025, the Minnesota Department of Health initiated an investigation of complaint #HL366512082M/#HL366513588C. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 T3RX11 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(s): The alleged perpetrator (AP), a facility staff. neglected the resident when the resident was given the wrong medications resulting in hospitalization. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. Although a medication error occurred, the error was an isolated incident. Upon discovery of the error, staff notified the facility nurses, emergency medical services, and the resident was sent to the hospital for evaluation. The resident returned to their baseline health condition. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigator contacted law enforcement. The investigation included review of the resident record, hospital records, facility internal investigation, facility incident reports, personnel files, staff schedules, and related facility policy and procedures. Also, the investigator observed interactions between staff and residents. The resident resided in an assisted living memory care unit. The resident’s diagnoses included Alzheimer’s Disease and heart disease. The resident’s service plan included assistance with medication administration. The resident’s assessment indicated the resident was orientated to self with forgetfulness and confusion. An incident report indicated a facility staff member set up medications and requested the AP administer them to the resident. The AP administered the resident the preset-up medications; however, the preset-up medications were another resident’s medications. A progress note indicated the AP reported to a facility nurse that she administered the resident the wrong medications and requested the nurses assess the resident. When facility nurses arrived, the resident was alert, but had low respirations. Emergency medical services and family was notified. The resident was sent to the hospital for treatment. Hospital Records indicated the resident was “inadvertently” administered a different resident’s medications. While at the hospital the resident did not receive medical intervention and was discharged back to the facility with a family member when the resident was more alert. During an interview, the AP stated a coworker asked her to administer medications to a resident. The AP stated there was miscommunication and she administered the medication to the wrong resident. The incident was a mistake. After the incident, the facility provided education to the AP and no additional medication errors have occurred since the incident. During an interview, a facility nurse stated the AP called and requested the resident be assessed after she administered the wrong medications. A facility nurse stated the resident was sent to the hospital and returned that evening and later returned back to her baseline health condition. After the incident, the AP was re-educated and there have been no additional concerns with care provided by the AP. During an interview, a family member stated she was notified of the incident, the resident was evaluated in the emergency room and discharged back to the facility. A family member stated the resident returned to her baseline health condition after approximately one week. 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: Yes. Action taken by facility: The facility investigated the incident and completed education to all facility staff including staff involved in the incident. 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: 02/11/2025 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 _____________________________ 36651 01/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 3385 DISCOVERY ROAD LEXINGTON POINTE SENIOR LIVING EAGAN, MN 55121 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 January 13, 2025, the Minnesota Department of Health initiated an investigation of complaint #HL366519739C/#HL366516524M. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 EH7511 If continuation sheet 1 of 1

Finding: Substantiated, individual responsibility 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 perpetrator (AP) abused the resident when the AP handled the resident roughly during cares and caused bruising. Investigative Findings and Conclusion: The Minnesota Department of Health determined abuse was substantiated. The AP was responsible for the maltreatment. The AP restrained the resident when he pinned the resident’s arms to his chest during a brief change while the resident struggled. Following the incident, the resident had a bleeding skin tear on his arm resulting from his struggle to free himself from the AP’s grasp. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigator also contacted a family member. The investigation included review of the resident records, death record, facility internal investigation, facility incident reports, personnel files, staff schedules, and related facility policy and procedures. Also, the investigator observed staff interactions with residents. The resident resided in an assisted living memory care unit. The resident’s diagnoses included dementia and polyosteoarthritis (widespread degenerative joint disease). The resident’s service plan included assistance with activities of daily living. The resident was an assist of two when weak, using a mechanical lift. Staff were instructed to redirect if the resident was agitated or upset. Staff were instructed to speak to the resident using slow, kind, and direct speech, and to use very direct instructions when providing cares. The resident’s assessment indicated the resident was forgetful and no longer ambulatory. The resident would be unable to report abuse or neglect. The facility’s internal investigation indicated a staff member was twice called by the AP to assist with changing the resident’s brief. The first time the staff member arrived, she saw the AP had already started to change the resident’s brief, and the resident was halfway off the bed. The AP restrained the resident’s arms across his chest as the resident struggled to get free. The AP was putting pressure and full force into pinning the resident to the bed. The staff member said the AP also used disparaging language toward the resident such as, “…you made me do this,” and “this is why nobody wants to help you.” The staff said the second time she helped the AP with the resident’s brief change, she entered the room, and the AP was again restraining the resident to his bed. The resident appeared stressed and tried to defend himself by breaking out of the AP’s restraint. After the staff and AP completed cares, the AP “whipped” the resident off the bed, and he slid off the bed. The resident sustained a skin tear on his left arm. The internal investigation did not include a written statement from the AP but did include a termination report, due to suspected/reported abuse. When interviewed, a supervisor said the resident required the assistance of two staff for cares. A staff member reported she felt uncomfortable with how the AP repositioned the resident. The AP held the resident’s hands to his chest and was aggressive turning the resident from side to side. The staff member said the AP was holding the resident’s arms down and restraining the resident. At one point, the resident developed a skin tear on his left forearm and bruising to his knee. The staff also reported the AP made disparaging remarks to the resident. When interviewed, a staff member said on one shift she assisted the AP twice with changing the resident’s brief. The staff said the AP was aggressive with the resident during cares and restrained the resident to the bed. The AP restrained the resident by standing over the bed and boosting himself up over the resident so he would have more control as the resident continued to struggle. The AP held the resident’s arms across his chest as if in restraint, and the resident struggled to free himself. The staff member said the AP told the resident, “…this is the reason other people don’t want to work with you, cause you’re so hard to work with.” The staff member said the resident fell halfway off the bed during the struggle with the AP, and then the staff member noticed a bleeding skin tear on the resident’s arm. The staff told the AP to leave the room and she would manage the rest of the resident’s cares. The AP left the room briefly, but then returned and yelled something unintelligible at the resident, and the resident began to cry. The staff member said the resident was crying and very upset throughout the cares. When interviewed, the AP said he grabbed the resident forcefully to prevent him from falling during a brief change. The AP said the resident would get angry, so staff would have to grab him “a little forcefully” while completing cares. The AP denied hurting the resident. When interviewed, a family member said staff needed to approach the resident mindfully and explain in detail what they were doing for him when providing cares. Due to the residents dementia, the resident could become anxious, angry, and would lash out. If staff approached the resident appropriately, it would help prevent the resident from becoming combative out of fear. In conclusion, the Minnesota Department of Health determined abuse was substantiated. Substantiated: Minnesota Statutes, section 626.5572, Subdivision 19. “Substantiated” means a preponderance of evidence shows that an act that meets the definition of maltreatment occurred. Abuse: Minnesota Statutes section 626.5572, subdivision 2. "Abuse" means: (a) An act against a vulnerable adult that constitutes a violation of, an attempt to violate, or aiding and abetting a violation of: (1) assault in the first through fifth degrees as defined in sections 609.221 to 609.224; (2) the use of drugs to injure or facilitate crime as defined in section 609.235; (3) the solicitation, inducement, and promotion of prostitution as defined in section 609.322; and (4) criminal sexual conduct in the first through fifth degrees as defined in sections 609.342 to 609.3451. A violation includes any action that meets the elements of the crime, regardless of whether there is a criminal proceeding or conviction. (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: No, deceased. Family/Responsible Party interviewed: Yes. Alleged Perpetrator interviewed: Yes. the Action taken by facility: The facility completed an investigation, and retrained staff. The AP is no longer employed at the facility. Action taken by the Minnesota Department of Health: The facility was issued a correction order regarding the vulnerable adult’s right to be free from maltreatment. You may also call 651-201-4200 to receive a copy via mail or email. The responsible party will be notified of their right to appeal the maltreatment finding. If the maltreatment is substantiated against an identified employee, this report will be submitted to the nurse aide registry for possible inclusion of the finding on the abuse registry and/or to the Minnesota Department of Human Services for possible disqualification in accordance with the provisions of the background study requirements under Minnesota 245C. cc: The Office of Ombudsman for Long Term Care The Office of Ombudsman for Mental Health and Developmental Disabilities Dakota County Attorney Eagan City Attorney Eagan Police Department PRINTED: 04/17/2024 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.

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 facility neglected the resident when staff failed to provide adequate incontinence care and as a result the resident developed a groin rash. In addition, the facility failed to provide interventions to prevent the resident from falling. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. The facility staff provided toileting, incontinence care, and services according to the resident’s service plan. While the resident did develop a groin rash, a protective cream was ordered, and staff provided the treatment. Two weeks later, the rash improved. The resident was experiencing a decline in health and was on hospice services. The facility nurse assessed the resident after each fall, put interventions in place to decrease the risks of falls, and updated the resident’s hospice and medical providers. An equal opportunity employer. The investigator conducted interviews with facility staff members, including nursing staff. The investigation included review of resident’s record, assessments, service delivery records, incident reports, hospice records, and policies and procedures. The investigator toured the facility, the resident’s memory care unit, and observed staff interactions with other residents. The resident resided in an assisted living memory care unit. The resident’s diagnoses included dementia. The resident’s service plan included assistance with toileting, incontinence cares, and one to two staff assist for transfers, used a walker to ambulate, and had hourly safety checks. The resident’s assessment indicated the resident was incontinent of bowel and bladder. The same assessment indicated the resident had a history of falls. The resident received hospice services. The resident’s services delivered record indicated facility staff provided the resident toileting and incontinence care services twelve times a day. The residents progress notes indicated the resident developed a groin rash. The facility received orders to apply Z Guard cream (cream to treat and prevent skin irritation) to the resident’s groin twice daily and as needed until rash resolved. The resident’s medication administration record indicated the resident had a cream treatment scheduled and indicated staff applied the cream. The resident’s hospice records indicated the resident had groin dermatitis (skin irritation that causes dry itchy skin.) Two weeks later, the rash had improved. Four days after that, records indicated there was “barely any rash left in the groin area.” The resident’s incident report indicated during an overnight shift staff found the resident on his apartment floor without injury. Following an assessment, the facility added a bed sensor (alarm to alert when attempting to leave bed) and hourly safety checks to the resident’s services as fall prevention interventions. The resident’s services delivered record indicated staff provided the resident hourly safety checks. Six weeks later, when ambulating in his room using his walker, the resident said he was tired and sat on the floor without injury. Following an assessment, the facility added a mechanical lift for all transfers as a fall prevention intervention. After both falls, the facility nurse updated the resident’s hospice and medical providers. During an interview, a nurse stated staff provided the resident with toileting and incontinence care. The resident developed a rash, and Z-guard was ordered and applied by staff. A nurse stated the resident was experiencing a decline in health and was on hospice services. The nurse stated after the resident fell, a nurse assessed the resident and interventions were added to the service plan. Additional concerns were identified in the complaint. There was a concern the resident was not receiving his oral medications. The resident’s medication administration record indicated the resident received medications as ordered. There was a concern with lack of staffing and availability of a nurse on call. Review of the staff schedule indicated the facility consistently staffed the resident’s memory care unit according to their staffing plan. During an onsite visit, staff members were observed working on the unit as indicated on the schedule. The facility also had licensed nursing staff scheduled and a nurse on call 24/7. Another concern was a resident on the unit went into other resident rooms and appeared threatening. Review of facility records did not identify a resident who went into other resident rooms and threatened them. A nurse stated the memory care unit did have a couple of residents who wandered but had not received reports from staff of concerns for a resident’s safety. 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: No. The resident was deceased. Family/Responsible Party interviewed: No. Attempted but did not reach. Alleged Perpetrator interviewed: Not Applicable. the Action taken by facility: The facility staff provided services according to the resident’s service plan, provided treatment for the resident’s rash, and added interventions after the resident falls. 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: 08/29/2023 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 _____________________________ 36651 07/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 3385 DISCOVERY ROAD LEXINGTON POINTE SENIOR LIVING EAGAN, MN 55121 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 CORRECTION using federal software. Tag numbers have ORDER been assigned to Minnesota State Statutes for Assisted Living Facilities. The In accordance with Minnesota Statutes, section assigned tag number appears in the far 144G.08 to 144G.95, these correction orders are left column entitled "ID Prefix Tag." The issued pursuant to a complaint investigation. state Statute number and the corresponding text of the state Statute out Determination of whether a violation is 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 a Minnesota Statute contains several are in violation of the state requirement items, failure to comply with any of the items will after the statement, "This Minnesota be considered lack of compliance. requirement is not met as evidenced by." Following the evaluators' findings is the INITIAL COMMENTS: Time Period for Correction. #HL366514956C/#HL366513042M PLEASE DISREGARD THE HEADING OF #HL366516004C/#HL366513664M THE FOURTH COLUMN WHICH STATES,"PROVIDER'S PLAN OF On July 5, 2023 through July 6, 2023, the CORRECTION." THIS APPLIES TO complaint investigation at the above provider, and WILL APPEAR ON EACH PAGE. the following correction orders are issued. At the time of the complaint investigation, there were THERE IS NO REQUIREMENT TO 163 active residents, 43 of whom received SUBMIT A PLAN OF CORRECTION FOR services under the Assisted Living with Dementia VIOLATIONS OF MINNESOTA STATE Care license. STATUTES. No correction orders are issued for THE LETTER IN THE LEFT COLUMN IS #HL366514956C/#HL366513042M. USED FOR TRACKING PURPOSES AND REFLECTS THE SCOPE AND LEVEL The following correction order is issued for ISSUED PURSUANT TO 144G.31 #HL366516004C/#HL366513664M, tag SUBDIVISION 1-3. identification 2360. 02360 144G.91 Subd.