New Perspective Eagan.

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 the facility failed to follow multiple aspects of the resident’s plan of care, including eating assistance, which resulted in the resident losing a significant amount of weight. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. The resident’s meal intake was not consistently tracked and the amount of eating assistance provided to the resident varied between staff. However, there was no indication the resident lost weight due to neglect. Additional concerns including lack of staff assistance with showering, grooming, dressing, and apartment cleaning were reviewed. Corresponding licensing orders were issued regarding the facility’s non-compliance. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigator contacted the case worker, ombudsman, and provider. The investigation included review of resident photos and video, the resident records, facility internal investigation, facility incident reports, staff schedules, and related facility policy and procedures. Also, the investigator observed eating assistance, scheduled unit activity, apartments for appearance of cleanliness, and staff providing care to the resident and other residents. The resident resided in an assisted living memory care unit. The resident’s diagnoses included dementia, depression, and insomnia. The resident’s service plan included assistance with activities, weekly bathing, cues, extensive eating assistance, dressing twice per day, upper denture assistance, monthly weights, and medication. The resident’s assessment indicated the resident had impaired speech and verbal expression, was forgetful, wandered, and could be uncooperative with care. Review of recent monthly facility weights over a seven-month period indicated the resident weighed 173.2 pounds, 171.2 pounds, 173 pounds, 173.6 pounds, 175.4 pounds, 179 pounds, and 178 pounds. During an onsite observation the resident was first observed participating in a unit painting activity. During mealtime, staff were observed guiding the resident back to the dining table three separate times and handed the resident a drink while waiting for his food. The resident waved away the first plate of food, and a staff brought out a cut of sandwich and encouraged the resident to eat. The resident pushed the sandwich away and put up his hands and declined the sandwich. The resident sat at the table and another staff member brought the resident a different type of sandwich and handed the resident a piece of the sandwich, the resident declined to eat it and set the portion down. A third staff member then approached the resident, handed him a portion of the sandwich and asked him to eat. The resident ate the first half of the sandwich and the third staff member returned and sat with the resident. The third staff encouraged the resident to eat and handed food to the resident. The resident finished the sandwich, ate a cookie, and drank a glass of juice. After lunch, the resident stayed in the common area and used colored pencils to color pictures of birds. Observation of the resident’s apartment indicated the resident’s floor and toilet appeared dirty. No foul odors were noted in the apartment. During interview, several unlicensed staff stated the resident needed to be encouraged to eat and at times he would not want to eat meals. When that happened, staff would attempt to provide the resident other options to eat. The unlicensed staff stated there were times staff were able to encourage the resident to eat or get dressed, but at other times encouragement did not work. During interview, a leadership member stated it often took five to seven attempts to get the resident to sit and eat a meal. The leadership member stated the resident was difficult to redirect at times, and the resident was very active and protective of his space which could be intimidating to staff. The leadership member stated meetings and educations sessions were held with staff to implement better ways to redirect and assist the resident. During interview, a provider stated in the prior four months the resident was seen twice by the provider. The provider stated concerns were reported about the resident’s lack of variety and amount of food the resident received. However, the resident’s weights were stable and there were no specific nutritional concerns the provider was aware of. During interview, the resident’s family members stated the resident’s clothing was becoming too large for him. Family also stated the facility staff did not ensure the residents cares were completed so family had to assist the resident with cares which included feeding, showering, grooming, dressing, and apartment cleaning. 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: Review of care concerns, education of care staff. Action taken by the Minnesota Department of Health: The facility was found to be in noncompliance. To view a copy of the Statement of Deficiencies and/or correction orders, please visit: https://www.health.state.mn.us/facilities/regulation/directory/provcompselect.html If you are viewing this report on the MDH website, please see the attached Statement of Deficiencies. You may also call 651-201-4200 to receive a copy via mail or email. 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 _____________________________ 23505 12/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 3810 ALDER LANE NEW PERSPECTIVE - EAGAN EAGAN, MN 55122 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 144G.08 to 144G.95, these correction orders are far-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. #HL235051146C/#HL235056706M PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On December 18, 2024, the Minnesota STATES,"PROVIDER'S PLAN OF Department of Health conducted a complaint CORRECTION." THIS APPLIES TO investigation 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 complaint investigation, there were 134 residents receiving services under the provider's THERE IS NO REQUIREMENT TO Assisted Living with Dementia Care license. SUBMIT A PLAN OF CORRECTION FOR VIOLATIONS OF MINNESOTA STATE The following correction orders are issued for STATUTES.

Finding: Inconclusive 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) neglected a resident when the AP failed to place foot pedals on the resident’s wheelchair before pushing the resident’s wheelchair. The resident sustained a neck fracture when his foot caught under the wheelchair, and he fell. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was inconclusive. There was inconsistent information as to if the resident’s foot pedals were in place on the wheelchair at the time of the incident. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigation included review of medical records, employee files, and policy and procedure. Also, the investigator observed staff providing assistance to residents in wheelchairs. An equal opportunity employer. The resident resided in an assisted living memory care unit. The resident’s diagnoses included Parkinson’s disease (a condition affecting the brain, nerves, and body parts controlled by nerves that causes issues with movement, balance, and coordination) and a history of bone fractures. The resident’s care plan included assistance with mobility and transfers. and the resident used an assistive device for mobility. The resident’s assessment indicated the resident required an assist of one person for transfers and used a wheelchair. Progress notes approximately two weeks before the fall indicated the resident was a high fall risk and used a wheelchair with assistance of one person. Progress notes from the day of the fall indicated the resident was lying on the floor, bleeding from the nose with visible injuries to his face and reported pain when the nurse arrived at the incident. The resident reported he fell because his foot hit the wheelchair wheel while he was being pushed and the wheelchair flipped. The nurse contacted emergency services and the resident went to the hospital. Progress notes also indicated the hospital updated the facility later the same day and reported the resident had a neck fracture. During interviews, three unlicensed staff members who assisted the resident directly after the incident could not recall if the resident’s foot pedals were on his wheelchair. During interview, a nurse stated staff members called her to come assist after the resident fell from his wheelchair. The nurse stated after reviewing the scene she noted foot pedals were not on the resident’s wheelchair. During an interview, the AP stated she received training foot pedals should always be in place when assisting residents in wheelchairs. The AP stated she always made sure foot pedals were in place before assisting a resident in a wheelchair but did not recall if the resident had foot pedals on his wheelchair at the time of the incident. The AP stated the resident was in the common area when she went to assist him to wheel him to the dining room for lunch. When the AP began moving the resident’s wheelchair, the resident toppled out of the wheelchair. The AP stated she did not know why the resident fell. Review of the AP’s file indicated she completed education regarding wheelchair use and residents. During interview a family member stated the resident usually had foot pedals on his wheelchair and that the resident needed assistance positioning his feet on the pedals. In conclusion, the Minnesota Department of Health determined neglect was inconclusive. Inconclusive: Minnesota Statutes, section 626.5572, Subdivision 11. "Inconclusive" means there is less than a preponderance of evidence to show that maltreatment did or 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, unable due to cognition. Family/Responsible Party interviewed: Yes. Alleged Perpetrator interviewed: Yes. Action taken by facility: Care staff re-educated regarding the use of foot pedals when assisting residents in wheelchairs. 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: 12/06/2023 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 _____________________________ 23505 10/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 3810 ALDER LANE NEW PERSPECTIVE - EAGAN EAGAN, MN 55122 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 October 30, 2023, the Minnesota Department of Health initiated an investigation of complaint #HL235052066C/#HL235056344M. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 R2DB11 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 nurse, neglected a resident when the AP readmitted the resident to the facility with the use of a sit-to-stand device for transferring that the resident was not able to physically use properly. The resident experienced a fall and was sent to the hospital. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. The resident’s physician wrote an order for the sit-to-stand device and the incident was not related to use of the device. The investigator conducted interviews with facility staff members, including administrative staff and nursing staff. The investigation included review of medical records and policy and procedure. Also, the investigator observed staff providing care to residents. An equal opportunity employer. The resident resided in an assisted living facility. The resident’s diagnoses included heart disease and kidney failure. The resident’s service plan included assistance with transfers and mobility. The resident’s assessment indicated the resident needed the assistance of two staff for transfers with the use of a sit-to-stand device. Review of documentation indicated the resident readmitted to the assisted living facility from a transitional care facility the day before the incident. Correspondence between the facilities indicated the resident used a four wheeled walker and the assistance of one to two staff to walk at the transitional care facility. The assisted living facility indicated it would not have variable transfer assistance and would need to plan for the highest need for transferring the resident, which would be an assist of two staff members. The assisted living facility correspondence also indicated that all two staff member transfers required a mechanical lift, such as a sit-to-stand device, to safely meet the resident’s varying abilities to transfer. Review of transitional care facility discharge orders written by a physician indicated the resident was approved to admit to the assisted living facility and use a sit-to-stand device for mobility. During an interview, the AP stated she conducted an admission assessment for the resident the day he arrived back to the assisted living facility. The AP stated she transferred the resident with another staff member using a sit-to-stand device and did not have concerns at the time of the resident’s readmission. During an interview, a nurse stated she went to the resident’s apartment the day after he was readmitted to assist with an emergency. The nurse stated staff reported the resident began to lose consciousness and was not able to bare weight on his legs while transferring in the sit-to-stand device. The nurse stated when she arrived at the resident’s apartment, the resident was able to talk and was sitting down with his legs still on the sit-to-stand device. The nurse stated emergency services came and took the resident to the hospital for further evaluation due to his loss of consciousness. 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, vulnerable adult deceased. Family/Responsible Party interviewed: Yes. Alleged Perpetrator interviewed: Not Applicable Action taken by facility: No action taken. 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: 09/12/2023 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 _____________________________ 23505 08/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 3810 ALDER LANE NEW PERSPECTIVE - EAGAN EAGAN, MN 55122 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 August 9, 2023, the Minnesota Department of Health initiated an investigation of complaint #HL235056092C/#HL235053708M. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 L0PY11 If continuation sheet 1 of 1

CORRECTION ORDERS The enclosed State Form documents the state correction orders. The 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 and enforcement actions based on the level and scope of the violations; h owever, no immediate fines are assessed for this survey of your facility. DOCUMENTATION OF 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 REVISED 09/13/2021 New Perspective - Eagan July 25, 2023 Page 2 CORRECTION ORDER RECONSIDERATION PROCESS 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 the MDH within 15 calendar days of the correction order receipt date. A state correction order under Minn. Stat. § 144G.91, Subd. 8, Free from Maltreatment is associated with a maltreatment determination by the Office of Health Facility Complaints. If maltreatment is substantiated, you will receive a separate letter with the reconsideration process under Minn. Stat. § 626.557. Please email reconsideration requests to: Health.HRD.Appeals@state.mn.us. Please attach this letter as part of your reconsideration request. Please clearly indicate which tag(s) you are contesting and submit information supporting your position(s). Please address your cover letter for reconsideration requests to: Reconsideration Unit 85 East Seventh Place St. Paul, MN 55164-0970 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, Jonathan Hill, Supervisor State Evaluation Team Email: jonathan.hill@state.mn.us Telephone: 651-201-3993 Fax: 6 51-281-9796 JMD PRINTED: 07/25/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B. WING _____________________________ 23505 06/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 3810 ALDER LANE NEW PERSPECTIVE - EAGAN EAGAN, MN 55122 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 Licensing ASSISTED LIVING PROVIDER LICENSING Correction Orders using federal software. CORRECTION ORDER(S) Tag numbers have been assigned to Minnesota State Statutes for Assisted In accordance with Minnesota Statutes, section Living License Providers. The assigned 144G.08 to 144G.95, these correction orders are tag number appears in the far left column issued pursuant to a survey. entitled "ID Prefix Tag." The state Statute number and the corresponding text of the Determination of whether violations are corrected state Statute out of compliance is listed in requires compliance with all requirements the "Summary Statement of Deficiencies" provided at the Statute number indicated below. column. This column also includes the When Minnesota Statute contains several items, findings which are in violation of the state failure to comply with any of the items will be requirement after the statement, "This considered lack of compliance. Minnesota requirement is not met as evidenced by." Following the surveyors' INITIAL COMMENTS: findings is the Time Period for Correction. SL23505015-0 PLEASE DISREGARD THE HEADING OF On June 20th, 2023, through June 22nd, 2023, THE FOURTH COLUMN WHICH the Minnesota Department of Health conducted a STATES,"PROVIDER'S PLAN OF survey at the above provider, and the following CORRECTION." THIS APPLIES TO correction orders are issued. At the time of the FEDERAL DEFICIENCIES ONLY. THIS survey, there were 73 residents receiving WILL APPEAR ON EACH PAGE. services under the provider's Assisted Living/Dementia Care Facility license. THERE IS NO REQUIREMENT TO 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 pursuant to 144G.31 Subd. 1, 2 and 3. 0 480 144G.41 Subd 1 (13) (i) (B) Minimum 0 480 SS=F requirements (13) offer to provide or make available at least the following services to residents: (B) food must be prepared and served according LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 X0IN11 If continuation sheet 1 of 7 PRINTED: 07/25/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B. WING _____________________________ 23505 06/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 3810 ALDER LANE NEW PERSPECTIVE - EAGAN EAGAN, MN 55122 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) 0 480 Continued From page 1 0 480 to the Minnesota Food Code, Minnesota Rules, chapter 4626; and This MN Requirement is not met as evidenced by: Based on observation, interview and record review, the licensee failed to ensure food was prepared and served according to the Minnesota Food Code. 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) and was issued at a widespread scope (when problems are pervasive or represent a systemic failure that has affected or has the potential to affect a large portion or all the residents). The findings include: Please refer to the included document titled, Food and Beverage Establishment Inspection Report dated June 21, 2023, for the specific Minnesota Food Code deficiencies. TIME PERIOD FOR CORRECTION: Twenty-one (21) days 0 970 144G.50 Subd. 5 Waivers of liability prohibited 0 970 SS=C The contract must not include a waiver of facility liability for the health and safety or personal property of a resident. The contract must not include any provision that the facility knows or should know to be deceptive, unlawful, or unenforceable under state or federal law, nor include any provision that requires or implies a lesser standard of care or responsibility than is STATE FORM 6899 X0IN11 If continuation sheet 2 of 7 PRINTED: 07/25/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B. WING _____________________________ 23505 06/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 3810 ALDER LANE NEW PERSPECTIVE - EAGAN EAGAN, MN 55122 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) 0 970 Continued From page 2 0 970 required by law. This MN Requirement is not met as evidenced by: Based on interview and record review, the facility failed to ensure the contract did not include language waiving the facility's liability for health, safety, or personal property of a resident. This had the potential to affect all 73 residents living at the facility.