The Landmark of Fridley.

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 administer physician ordered Parkinson’s medication or treat a urinary tract infection (UTI), resulting in a fall and hospitalization. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. Although the resident fell and sustained fractures, the resident’s service plan, and medication administration records were followed at the time the incident occurred. Additionally, when the resident showed signs of a UTI, the medical provider was updated, and the resident was treated with antibiotics. The investigator conducted interviews with facility staff members, including administrative staff and nursing staff. The investigation included review of the resident record(s), hospital records, pharmacy records, facility incident reports, personnel files, staff schedules and related facility policy and procedures. Also, the investigator observed the facility’s physical plant, observed medication administrations, cares and staff interaction with the residents. The resident resided in an assisted living facility. The resident’s diagnoses included Parkinson’s disease, osteoarthritis and a history of UTIs. The resident’s service plan included dressing, toileting, transfers, safety checks and medication management. The resident’s assessment indicated the resident was alert and orient with forgetfulness, confusion and impaired decision-making skills. Additionally, the assessment indicated the resident had a history of multiple falls, including falls associated with UTIs, balance problems and used a walker and wheelchair for mobility. An incident report indicated the resident had pressed her emergency pendent and staff found the resident laying down on her side in the kitchen bleeding from her nose. The resident reported she was walking with her 4-wheeled walker when she tripped and fell forward. 911 was notified and the resident was sent to the hospital for evaluation. Hospital records indicated the resident sustained multiple fractures, including fractures to her face and right wrist. Hospital records indicated the resident was diagnosed with orthostatic hypotension [a condition where blood pressure drops significantly when a person stands up from a sitting or lying position]and was treated with an antibiotic for a UTI then discharged to a new facility. Review of the resident’s medical records indicated facility staff administered the resident’s medications per the medical providers orders. The resident’s pharmacy completed a medication review for the date of the incident. The medication review indicated the resident’s Parkinson’s medication administered prior to the fall would have been active in the resident’s body at the time of the incident and was administered within the time sensitive parameters. During an interview, a facility administrative nurse stated the resident had frequent falls and new interventions were put in place to prevent reoccurrence. The resident was on Parkinson’s medication that was needed to be given at precise times so the facility placed the parameters on the resident’s medication administration to remind the facility staff that those medications were a priority for the resident. During an interview, the resident stated she felt safe at the facility but had past concerns regarding her medication not being administered when she needed them but had since been resolved. The resident recalled having fallen multiple times during her stay at the facility with one fall resulting a fall landing on her face. The resident stated that after that fall occurred, she used her call light for assistance and has not fallen since. During an interview, the resident’s family member stated he had concerns with the resident’s urinary tract infections, falls and medication administration. The resident was moved to a different facility after the hospitalization. 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: The facility completed incident reports. The facility reported all documented incidents to the resident’s family member(s). The facility reported, assessed and treated urinary tract infections. Action taken by the Minnesota Department of Health: No further action taken at this time. cc: The Office of Ombudsman for Long Term Care The Office of Ombudsman for Mental Health and Developmental Disabilities PRINTED: 10/23/2025 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 _____________________________ 28887 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 6490 CENTRAL AVENUE NE THE LANDMARK OF FRIDLEY FRIDLEY, MN 55432 SUMMARY STATEMENT OF DEFICIENCIES PROVIDER'S PLAN OF CORRECTION (X4) ID ID (X5) (EACH DEFICIENCY MUST BE PRECEDED BY FULL (EACH CORRECTIVE ACTION SHOULD BE COMPLETE PREFIX PREFIX REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS-REFERENCED TO THE APPROPRIATE DATE TAG TAG DEFICIENCY) 0 000 Initial Comments 0 000 On September 11, 2025, the Minnesota Department of Health initiated an investigation of complaint #HL288872720C/#HL288875402M. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 VXVD11 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. MDH documents state licensing correction orders using federal software. Tag numbers are assigned to Minnesota state statutes for Assisted Living Facilities. The assigned tag number appears in the far left column entitled "ID Prefix Tag." The state statute number and the corresponding text of the state statute out of compliance are listed in the "Summary Statement of Deficiencies" column. This column also includes the findings that are in violation of the state statute after the statement, "This MN Requirement is not met as evidenced by . . ." In accordance with Minn. Stat. § 144G.31 Subd. 4, MDH may assess fines based on the level and scope of the 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 • An equal opportunity employer. Letter ID: IS7N REVISED 09/13/2021 The Landmark of Fridley August 20, 2025 Pa ge 2 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). 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 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/Bm5uQEpHVa . Your input is important to us and will enable MDH to improve its processes and communication with providers. If you have any questions regarding the questionnaire, please contact Susan Winkelmann at susan.winkelmann@state.mn.us or call 651-201-5952. You are encouraged to retain this document for your records. It is your responsibility to share the information contained in the letter and state form with your organization’s Governing Body. If you have any questions, please contact me. Sincerely, Kelly Thorson, Supervisor State Evaluation Team Email: Kelly.Thorson@state.mn.us Telephone: 320-223-7336 Fax: 1-866-890-9290 KKM PRINTED: 08/20/2025 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 _____________________________ 28887 07/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 6490 CENTRAL AVENUE NE THE LANDMARK OF FRIDLEY FRIDLEY, MN 55432 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. SL28887016 PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On July 14, 2025, through July 16, 2025, the STATES,"PROVIDER'S PLAN OF survey at the above provider and the following FEDERAL DEFICIENCIES ONLY. THIS correction orders are issued. At the time of the WILL APPEAR ON EACH PAGE. survey, there were 72 residents; 68 receiving services under the Assisted Living Facility with THERE IS NO REQUIREMENT TO 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 subd. 1, 2, and 3. 0 470 144G.41 Subdivision 1 Minimum requirements 0 470 SS=F (11) develop and implement a staffing plan for determining its staffing level that: LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 LYK211 If continuation sheet 1 of 10 PRINTED: 08/20/2025 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 _____________________________ 28887 07/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 6490 CENTRAL AVENUE NE THE LANDMARK OF FRIDLEY FRIDLEY, MN 55432 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) 0 470 Continued From page 1 0 470 (i) includes an evaluation, to be conducted at least twice a year, of the appropriateness of staffing levels in the facility; (ii) ensures sufficient staffing at all times to meet the scheduled and reasonably foreseeable unscheduled needs of each resident as required by the residents' assessments and service plans on a 24-hour per day basis; and (iii) ensures that the facility can respond promptly and effectively to individual resident emergencies and to emergency, life safety, and disaster situations affecting staff or residents in the facility; (12) ensure that one or more persons are available 24 hours per day, seven days per week, who are responsible for responding to the requests of residents for assistance with health or safety needs. Such persons must be: (i) awake; (ii) located in the same building, in an attached building, or on a contiguous campus with the facility in order to respond within a reasonable amount of time; (iii) capable of communicating with residents; (iv) capable of providing or summoning the appropriate assistance; and (v) capable of following directions; This MN Requirement is not met as evidenced by: Based on interview and record review, the licensee failed to develop and implement a written staffing plan that included an evaluation completed by the clinical nurse supervisor (CNS) (as indicated in Minnesota Administrative Rule 4659.0180) at least twice a year 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 STATE FORM 6899 LYK211 If continuation sheet 2 of 10 PRINTED: 08/20/2025 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 facility neglected the resident when the resident fell and sustained multiple fractures. Subsequently, the resident died. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. The facility completed rounds on the resident, followed her plan of care, and called 911 after finding her on the floor. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigation included review of the resident’s medical record, fall incident reports, and policies including vulnerable adult, adverse events, and rounding on residents. The investigation also included review of the resident’s hospital medical records and death certificate. Also, the investigator observed staff interactions with residents, toileting, and medication administration. An equal opportunity employer. The resident resided in an assisted living memory care unit. The resident’s diagnoses included dementia and osteoporosis. The resident’s service plan included assistance with transfers, safety checks, and incontinence care. The resident’s assessment indicated the resident used a wheelchair and required assistance with transfers due to recently breaking her leg, being unsteady on her feet, and impaired memory. An internal investigation indicated staff found the resident unresponsive on the floor, lying on her back next to her bed. The resident’s vitals signs were taken, and staff called 911. The resident’s neck appeared slightly displaced. Staff found the resident on the ground approximately one and a half to two hours after the last time she checked on the resident. Hospital records indicated the resident sustained multiple fractures and may have experienced a heart attack. The resident remained in the hospital on palliative care for four days before dying. The death certificate identified the resident’s cause of death as complications of multiple blunt force injuries due to a fall. During an interview, an unlicensed personnel (ULP), stated she had delivered laundry to the resident’s room and checked on the resident earlier. At that time, the resident remained in bed. Later, when the ULP went to check on the resident again, she walked into the resident’s room, and the resident laid on the floor. ULP notified the nurse on duty came to assist. During an interview, a nurse stated the resident had a history of falls, even prior to living at the facility. The resident would transfer herself often. Most of the time prior to her death, the resident used a wheelchair but would come out of her room walking without assistance or a walker. In memory care, residents did not have call lights, but staff completed hourly rounds. The nurse stated she completed an internal investigation of the fall and thought was just an unfortunate incident. A staff member had been completing rounds and found the resident on the floor. Due to the resident being impulsive, sometimes staff could not catch her before her attempt to self-transfer. The nurse stated none of the staff on duty heard the fall. During an interview, the resident’s family member stated the resident had a history of falls at this facility and her previous facility, some of which resulted in broken bones. The resident would try to get up without assistance. The family member stated the facility did the best they could in the situation. The resident never expressed feeling unsafe or that her needs were not being met at the facility. 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 is deceased. Family/Responsible Party interviewed: Yes. Alleged Perpetrator interviewed: Not Applicable. Action taken by facility: The facility sent the resident to the hospital and completed an internal investigation. 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: 09/07/2023 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 _____________________________ 28887 06/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 6490 CENTRAL AVENUE NE THE LANDMARK OF FRIDLEY FRIDLEY, MN 55432 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 Tag numbers have been assigned to Minnesota State Statutes for Assisted In accordance with Minnesota Statutes, section Living Facilities. The assigned tag 144G.08 to 144G.95, these correction orders are number appears in the far left column issued pursuant to a complaint investigation. entitled "ID Prefix Tag." The state Statute number and the corresponding text of the Determination of whether a violation is 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 a Minnesota Statute contains several findings which are in violation of the state items, failure to comply with any of the items will requirement after the statement, "This be considered lack of compliance. Minnesota requirement is not met as evidenced by." Following the evaluators' INITIAL COMMENTS: findings is the Time Period for Correction. #HL288871600C/#HL288876145M PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On June 8, 2023, the Minnesota Department of STATES,"PROVIDER'S PLAN OF Health conducted a complaint investigation at the CORRECTION." THIS APPLIES TO above provider, and the following correction FEDERAL DEFICIENCIES ONLY. THIS orders are issued. At the time of the complaint WILL APPEAR ON EACH PAGE. investigation, there were 70 residents receiving services under the provider's Assisted Living with THERE IS NO REQUIREMENT TO Dementia Care license. SUBMIT A PLAN OF CORRECTION FOR VIOLATIONS OF MINNESOTA STATE The following correction order is issued for STATUTES. ##HL288871600C/#HL288876145M, tag identification 0460. THE LETTER IN THE LEFT COLUMN IS USED FOR TRACKING PURPOSES AND REFLECTS THE SCOPE AND LEVEL ISSUED PURSUANT TO 144G.31 SUBDIVISION 1-3. 0 460 144G.41 Subdivision 1 Minimum requirements 0 460 SS=F (5) provide a means for residents to request LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 PYPD11 If continuation sheet 1 of 4 PRINTED: 09/07/2023 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.