Brookdale Eden Prairie.

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 resident fell several times in about one week. The resident sustained broken ribs and vertebrae. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. The facility sent the resident to the hospital for evaluation after the first fall when they suspected injury, and again when the resident’s agitation persisted for about a week. Facility staff administered as needed medications and communicated with the family and provider. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigator contacted family. The investigation included review of the resident record, death record, hospital records, facility internal investigation, facility incident reports, staff schedules, and related facility policy and procedures. Also, the investigator observed transfers and assistance with walking. 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, walking, bathing, and medication administration. The plan also indicated the resident demonstrated anxious, disruptive, or obsessive behaviors and required additional attention and redirection at times. The resident’s assessment indicated he needed help going to and from the dining room and activities, as well as wandering redirection. A progress note indicated a nurse held a care conference with the resident’s family members one day before the resident’s falls. The note indicated they discussed the resident’s behaviors over the previous weekend, including being agitated and impulsive and needing one-to-one supervision for safety reasons. The nurse explained the facility services did not include one-to-one service and suggested family hire a companion to sit with and monitor him for safety. A family member stated she could not afford that, so the nurse instructed family to provide the one-to-one service when agitated. Family agreed to provide the one-to-one service. An incident report indicated the resident fell one morning. The resident sustained a cut to his elbow. A progress note indicated staff found the resident on the floor near his bed. The resident reported he hit his head, and he had been experiencing pain. Staff obtained his vitals and sent the resident to the hospital after a nursing assessment. The note indicated the resident had been agitated prior to the fall, getting up on his own even though he required assistance of one staff member. The resident had also been noncompliant, impulsive, and at times unable to follow verbal cues and directions. The resident’s after visit summary (AVS) from the hospital indicated the resident had a closed head injury and skin tear of the left elbow from the fall. The hospital completed imaging of part of the resident’s spine, his head, and his elbow. A progress note indicated the resident returned from the hospital within about eight hours after the fall. Another progress note indicated family requested an as needed medication to help with the resident’s agitation during dinner. A second incident report indicated the resident fell about twelve hours after the first fall. The resident had no apparent injury after the unwitnessed fall. The resident’s record included several progress notes indicating the resident presented with agitation prior to and after his falls. Notes indicated the resident yelled, tried getting up and walking on his own, and at times became combative or aggressive. Notes also indicated the facility staff gave as needed medications to help with anxiety and agitation, reached out to the provider, and tried redirection. A progress note indicated the resident had been agitated and yelling for help most of the morning one day. The resident could not identify pain or explain what was wrong. Staff called 911 and sent him out for evaluation, then notified the family. A facility internal investigation included a summary timeline of events and behaviors from the resident. The resident became agitated and began screaming in the dining room the day he admitted to the facility. The resident’s family member stayed with the resident over the weekend. During the first few days of admission, the resident walked around in the dining room without clothing and had other behaviors of agitation, shouting, difficult to provide cares and attempting elopement. The next morning, approximately one week after admission, the resident fell in his room. He went to the emergency department (ED) and returned mid-afternoon. About twelve hours after the first fall, the resident had an unwitnessed fall in the living room with no apparent injury. During the days after the fall, the resident continued trying to walk unassisted, had increased anxiety with screaming and agitation with cares. On the fourth day, the resident had been screaming often, complaining of pain in his shoulder and side. The resident’s family visited much of the weekend. On the fifth day, the resident had been observed in the dining room on his hands and knees, without clothing, scaring other residents. The same day, the resident’s family assisted him to bed with an unlicensed personnel (ULP) and transfer belt. The resident went to his knees, and the ULP called for assistance from another ULP. Two days later, the resident screamed, did not want to get dressed, and needed three staff members to get ready. Staff called emergency medical services (EMS) and the resident went to the hospital. The next day, the hospital notified the facility the resident had fractured ribs and back. The investigation indicated the resident’s family believed the injuries occurred during his first fall. While at the facility, family asked for staff to get the resident up and get him to the dining room, while the resident appeared resistant and agitated, yelling and requiring two to three staff for transfers. The resident’s hospital record indicated he presented to the ED due to worsening agitation and concern for pain with a history of falling a week prior. The ED completed imaging and found two broken ribs and two age-indeterminate mild compression deformities of the spine. A hospital provider noted the spine fractures had an acute or subacute appearance. During the hospitalization, the resident appeared agitated, yelling out, pulling at his intravenous (IV) access, and required one-to-one staffing at his bedside. The hospital record indicated the resident required several medications to help his agitation. The resident’s delirium had most likely been secondary to pain, although other contributing factors included medications, poor nutritional status, and a previous stroke. The resident had been struggling with increasing agitation and delirium following the stroke a couple of months prior. The resident’s hospital diagnoses included altered mental status, agitation due to dementia, and fractures of the spine and ribs. The record indicated the resident admitted to hospice and died in the hospital. The resident’s death record identified the resident’s cause of death as terminal delirium. The death record did not identify the resident’s broken spine or ribs as contributing to death. During an interview, a nurse stated the resident fell twice in one day. After the first fall, the facility sent him in for evaluation. He did not have any apparent injury with the second fall from him getting up without help. Facility staff tried redirection, keeping him in public spaces to keep an eye on him, utilized as needed medication, got an order for increasing a medication, and encouraged him to gain strength, walking as much as possible. The resident had an order for therapy, but therapy determined they would not do therapy with him because he would not follow their plan. Prior to the resident admitting to the hospital and discharging from the facility, the nurse wanted him to be seen by the medical provider and could tell something seemed wrong, but family objected. The nurse stated although his prior facility did not describe any behaviors, the resident presented with behaviors after admitting to the facility which became increasingly more difficult to care for. They had a conversation with the resident’s family member, explaining he needed one-to-one monitoring which the facility did not provide. Family declined but spent a lot of time at the facility. During an interview, the licensed assisted living director (LALD) stated the resident had been screaming a lot from the day he arrived. The family spent a lot of time at the facility.

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 provide supervision, the resident exited the building, fell, and fractured her wrist. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. Although the resident did exit through a secured exit and fell, staff responded immediately and according to facility protocol. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigator contacted a family member. The investigation included review of the resident’s assessments, service plan, internal investigation and elopement policy. Also, the investigator completed an onsite visit to observe staff to resident interactions in the secured memory care as well as how the exit door functions in the facility. The resident resided in an assisted living memory care unit. The resident’s diagnoses included Alzheimer’s disease and chronic pain syndrome. The resident’s service plan included verbal cues for dressing, and toileting assistance. The resident’s assessment indicated the resident walked independently without any devices. The resident wandered throughout the community and required redirection and often set off door alarms attempting to leave the facility. The resident was verbal but did not always communicate her needs. One day the resident exited the facility without supervision. Meanwhile, the facility alarm-system alerted caregivers an exterior exit door had been opened who immediately responded. The resident was found a short distance from the door on the ground having sustained a wrist fracture from an apparent fall. Three caregivers responded to the alarm. Facility documents indicated the staff members stayed with the resident, obtained, vital signs, called the on-call nurse, and contacted the resident’s family. Initially, the staff members were directed to assist resident off the ground and back into the facility where ice was applied to her wrist. Later, the resident was diagnosed with a wrist fracture from the fall. Facility characteristics and fire exits The facility was licensed for assisted living with dementia care and was a secured memory-care building. To enter or exit, the building, a visitor required a facility staff member to allow passage through either the main or the back service-door. The facility included two “neighborhoods” (units) which each included three secured fire exits (six total), which were alarmed at the end of each wing. Each secured fire exit included a two-door system which meant to exit a person passed through one door into a small entry area to reach the second door. If or when a person opened the first door an alarm was triggered and continued to sound until and unless the alarm was deactivated using a key carried only by employees. The second door had a bar that required being pushed for 15 consecutive seconds to open which also caused a second alarm to sound. Inside the facility at multiple locations the alarm system included a panel which displayed which door had been breached so that staff could readily know which door to go check if an alarm went off. Training records indicated the facility trained it staff members on how to monitor the alarm system and how to respond quickly to any alarms indicating someone had left the building. The investigation included an unannounced onsite visit which included a test of the facility response to the fire exit alarm system during which multiple staff members responded within a short period of time to the correct door. Interviews During an interview, a nurse stated the resident was constantly walking and wandering about the facility. The nurse stated staff members were able to visually observe the resident due to her constant wandering in the main common areas. The resident’s attempts to leave the facility were increased during periods of anxiety and after phone calls with family. The nurse stated initially the resident did not seem injured based on the update over the phone, however when the nurse assessed the resident in-person the next morning she requested an x-ray and further evaluation. During an interview, a family member stated they chose the facility as it was secured and for the location. The family member stated approximately six months before the incident the resident had discovered if she pressed on the bar long enough the alarm signals, but the door eventually would open. The family member stated the nurse requested medication to help with the resident’s anxiety as the resident had elopement attempts but not always out the same door. During an interview, a manager stated resident elopement attempts had increased three months prior to the incident. The manager stated the resident was able to explain how to exit the building so the facility staff members were on high alert when they heard the alarm go off. During an interview, a staff member from maintenance stated the facility conducted monthly elopement drills. The staff member stated the doors are checked weekly to ensure they are functioning properly. During an interview, multiple unlicensed caregivers, who had been working the day the resident exited, stated she was doing her normal roaming of going up and down the hallways. Three caregivers heard the alarm and responded to the alarm with the resident being found already on the ground outside the exit. 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 Family/Responsible Party interviewed: Yes Alleged Perpetrator interviewed: NA the 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: 09/16/2024 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. WING _____________________________ 30691 08/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 7513 MITCHELL ROAD BROOKDALE EDEN PRAIRIE EDEN PRAIRIE, MN 55344 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 19, 2024,, the Minnesota Department of Health initiated an investigation of complaint #HL306913061C/#HL306913042M. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 7TE811 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 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; however, 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 Brookdale Eden Prairie July 14, 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, Jess Schoenecker, Supervisor State Evaluation Team Email: jess.schoenecker@state.mn.us Telephone: 651‐201‐3789 Fax: 651‐215‐6894 / 651‐281‐9796 HHH PRINTED: 07/14/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ 30691 B. WING _____________________________ 06/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 7513 MITCHELL ROAD BROOKDALE EDEN PRAIRIE EDEN PRAIRIE, MN 55344 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE 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 License In accordance with Minnesota Statutes, section Providers. The assigned tag number 144G.08 to 144G.95, these correction orders are appears in the far left column entitled "ID issued pursuant to a survey. Prefix Tag." The state Statute number and the corresponding text of the state Statute Determination of whether violations are corrected out of compliance is listed in the requires compliance with all requirements "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. SL30691015 PLEASE DISREGARD THE HEADING OF On June 12, 2023, through June 13, 2023, the THE FOURTH COLUMN WHICH 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 thirty-one (31) active residents WILL APPEAR ON EACH PAGE. receiving services under the Assisted Living with Dementia Care 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 issued 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 LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 QN1X11 If continuation sheet 1 of 27 PRINTED: 07/14/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ 30691 B. WING _____________________________ 06/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 7513 MITCHELL ROAD BROOKDALE EDEN PRAIRIE EDEN PRAIRIE, MN 55344 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) 0 480 Continued From page 1 0 480 following services to residents: (B) food must be prepared and served according 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 had the potential to affect all 31 residents in the Assisted Living with Dementia Care facility. 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 13, 2023, for the specific Minnesota Food Code deficiencies. TIME PERIOD FOR CORRECTION: Twenty-one (21) days 0 510 144G.41 Subd. 3 Infection control program 0 510 SS=D (a) All assisted living facilities must establish and maintain an infection control program that complies with accepted health care, medical, and nursing standards for infection control. STATE FORM 6899 QN1X11 If continuation sheet 2 of 27 PRINTED: 07/14/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ 30691 B. WING _____________________________ 06/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 7513 MITCHELL ROAD BROOKDALE EDEN PRAIRIE EDEN PRAIRIE, MN 55344 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSS-REFERENCED TO THE APPROPRIATE DATE DEFICIENCY) 0 510 Continued From page 2 0 510 (b)The facility's infection control program must be consistent with current guidelines from the national Centers for Disease Control and Prevention (CDC) for infection prevention and control in long-term care facilities and, as applicable, for infection prevention and control in assisted living facilities.