Inver Glen 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 necessary to ensure the health, safety, and welfare of residents in your care. STATE CORRECTIO NORDERS The enclosed State Form documents the state correction orders. MDH documents state licensing correction orders using federal software. Tag numbers are assigned to Minnesota state statutes for Assisted Living Facilities. The assigned tag number appears in the far left column entitled "ID Prefix Tag." The state statute number and the corresponding text of the state statute out of compliance are listed in the "Summary Statement of Deficiencies" column. This column also includes the findings that are in violation of the state statute after the statement, "This MN Requirement is not met as evidenced by . . ." In accordance with Minn. Stat. § 144G.31 Subd. 4, MDH may assess fines based on the level and scope of t he violati ons ; however, no immediate fines are assessed for this survey of your facility. DOCUMENTATIO ONF ACTION TO COMPLY In accorda nce with Min n. Stat. § 144G.30, Sub d. 5(c), th e lic ens ee mus t docum ent ac tions taken t o 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 D09/13/2021 Inver Glen Senior Living March 31, 2026 Page 2 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). CORRECTIO NORDER RECONSIDERATIO PNROCESS In accordance with Minn. Stat. § 144G.32, Subd. 2, you may challenge the correction order( s) issued, including the level and scope, and any fine assessed through the correction order reconsideration process. The request for reconsideration must be in writing and received by MDH within 15 calendar days of the correction order receipt date. To submit a reconsideration request, please visit: https: / / forms. web. health. state. mn.us/ form/ HRDAppealsForm The MDH Health Regulation Division (HRD )values your feedback about your experience during the survey and/ or investigation process. Please fill out this anonymous provider feedback questionnaire at your conv enien ce at thi s link: https: / / forms. office.com/ g/ Bm5uQEpHVa. Your inpu t is import ant 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, Jodi Johnson, Supervisor State Evaluation Team Email: Jodi.Johnson@state. mn.us Telephone: 507-344-2730 Fax: 1-866-890-9290 HHH PRINTED: 03/ 31/ 2026 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/ SUPPLIER/ CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B. WING _____________________________ 30647 03/ 11/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 7260 SOUTH ROBERT TRAIL INVER GLEN SENIOR LIVING INVER GROVE HEIGHTS, MN 55077 SUMMARY STATEMENT OF DEFICIENCIES PROVIDER' S PLAN OF CORRECTION (X4) ID ID (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE REGULATORY OR LSC IDENTIFYING INFORMATION) CROSS- REFERENCED TO THE APPROPRIATE DATE TAG TAG DEFICIENCY) 0 000 Initial Comments 0 000 *****ATTENTION***** Minnesota Department of Health is documenting the State Correction Orders ASSISTED LIVING PROVIDER LICENSING using federal software. Tag numbers have CORRECTION ORDER( S) been assigned to Minnesota State Statutes for Assisted Living Facilities. The In accordance with Minnesota Statutes, section assigned tag number appears in the 144G. 08 to 144G. 95, these correction orders are far-left column entitled "ID Prefix Tag. " The issued pursuant to a survey. state Statute number and the corresponding text of the state Statute out Determination of whether violations are corrected of compliance is listed in the "Summary requires compliance with all requirements Statement of Deficiencies" column. This provided at the Statute number indicated below. column also includes the findings which When Minnesota Statute contains several items, are in violation of the state requirement failure to comply with any of the items will be after the statement, "This Minnesota considered lack of compliance. requirement is not met as evidenced by." Following the evaluators' findings is the INITIAL COMMENTS: Time Period for Correction. SL30647016- 0 PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On March 9, 2026, through March 11, 2026, 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 107 residents; 54 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 SUBDIVISION 1-3. 0 510 144G. 41 Subd. 3 Infection control program 0 510 SS= D (a) All assisted living facilities must establish and LABORATORY DIRECTOR' S OR PROVIDER/ SUPPLIER REPRESENTATIVE' S SIGNATURE TITLE (X6) DATE STATE FORM 6899 GB5F11 If continuation sheet 1 of 3 PRINTED: 03/ 31/ 2026 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/ SUPPLIER/ CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B. WING _____________________________ 30647 03/ 11/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 7260 SOUTH ROBERT TRAIL INVER GLEN SENIOR LIVING INVER GROVE HEIGHTS, MN 55077 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) 0 510 Continued From page 1 0 510 maintain an infection control program that complies with accepted health care, medical, and nursing standards for infection control. (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. (c) The facility must maintain written evidence of compliance with this subdivision. This MN Requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee failed to establish and maintain an effective infection control program that complies with accepted health care, medical and nursing standards for infection control related to glove use and handwashing during treatment and medication administration for one of five employees (unlicensed personnel (ULP)-J) . 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 an isolated scope (when one or a limited number of residents are affected or one or a limited number of staff are involved, or the situation has occurred only occasionally) . The findings include: On March 11, 2026, at 8:15 a. m., the surveyor observed ULP-J washing their hands and applying gloves prior to assisting R4 transfer into a chair. ULP-J did not wash or sanitize their hands after removing their gloves. STATE FORM 6899 GB5F11 If continuation sheet 2 of 3 PRINTED: 03/ 31/ 2026 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/ SUPPLIER/ CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ 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 AP abused a resident when she forced her to shower against her will. The resident had bruising on her wrists and forearms. Investigative Findings and Conclusion: The Minnesota Department of Health determined abuse was not substantiated. Although the resident’s behavior indicated she did not want to shower, she had a history of yelling out and resisting cares. The resident had dementia (memory loss) and did not have insight into her care needs. The actions of the AP did not meet statute requirements for abuse, and no harm occurred to the resident. Providing a shower was in the best of interest of the resident. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigator contacted hospice staff. The investigation included review of the resident’s medical records, hospice records, physician records, facility internal investigation, facility incident reports, personnel files, and related facility policy and procedures. Also, the investigator toured the facility and observed facility staff provide personal cares and repositioning. The resident resided in an assisted living memory care unit. The resident’s diagnoses included mood disorder, cognitive impairment (memory loss), diabetes, and coronary artery disease (heart disease). The resident’s service plan included assistance with bathing, dressing, oral care, toileting, grooming, medications, and meals. The resident’s nursing assessment indicated staff members needed to anticipate her needs because she had memory loss. The resident was dependent upon staff members for mobility and required a wheelchair. The assessment indicated the resident had agitation, delusions, hallucinations, verbal aggression toward staff and others. The resident was incontinent (no control) of bowel and bladder. The assessment indicated the resident had ecchymosis (bruising) to her lower extremities. Through investigative process, it was determined there were two separate concerns regarding this incident. The first, was bruising of the resident’s skin, found to be a separate issue from second concern regarding the resident’s shower. First Concern: During an interview, a hospice nurse said she observed small bruises on the resident’s wrists consistent with “thumb prints.” The hospice nurse said she believed this bruising was consistent with caregivers pulling on the resident’s arms to try to get her to stand. The hospice nurse said the resident never complained of pain, and she did not observe other skin injuries such as skin tears or swelling. The hospice nurse said she told the nurse manager about these bruises and the nurse manger told her she would re-educate their caregivers how to transfer the resident. The nurse manager said the bruises did resolve. During an interview, a nurse manager said hospice staff informed her the resident had bruising on her wrists, so she observed the bruising, and it looked consistent with a “thumb print” as if someone pulled the resident up by her wrists. The nurse manager said she spoke to all the staff who provided care to the resident about how to safely transfer her; this included the AP. During an interview, the AP said could not stand on her own and she was dependent upon staff for mobility. At times, the resident required multiple staff to stand her, or even use a mechanical lift. The AP said because the resident had memory loss, she did not use the call light and would hit the wall next to her bed or hit the wheelchair and she had bruising on her hands and legs. The MAR indicated the resident received two blood thinning medications daily, putting her at an increased risk of bruising. Physician visit notes indicated the resident’s skin was thin and atrophic (loss of thickness) with ecchymosis on her forearms. Second Concern: During an interview, the hospice nurse said, she received a call from the hospice aide who told her the AP was weak and confused and not safe to get into the shower. The hospice nurse then told the hospice aide to give the resident a bed bath. Shortly after, the hospice aide called the hospice nurse back and said the AP “forced” the resident to take a shower and the resident screamed for the AP to “get away.” The hospice nurse said the hospice aide did not provide further description of the incident. The hospice nurse said this behavior was not unusual for the resident, but the AP should not have showered the resident. During an interview, the manager said she received a call from a hospice nurse who told her the AP was “forcing” the resident to shower. The nurse manager said she was not at the facility when this occurred, so she called a nurse who was at the facility and had her go to the resident’s room. The manager said when she arrived at the facility, the AP completed the resident’s shower and dressed her. The manager said the resident appeared to be free from distress or injury. The manger said generally the hospice aide calls the facility prior to her arrival and tells the staff to give the resident an anti-anxiety medication prior to the hospice aide providing a shower, but this did not occur. The nurse manager said typically the hospice aide would tell them the resident refused a shower, so the facility staff would end up giving her the shower. The nurse manger said the resident could be “feisty” and her typical behavior included yelling and screaming. The nurse manager said memory care residents who have behaviors and incontinence cannot sit in urine; staff must change them and get cares completed. During an interview, a facility nurse said she worked at the time of the incident and received a call from the nurse manager who asked her to check on the resident. The nurse said when she went into the room, the resident was out of the shower, and the AP was getting her dressed. The resident was smiling and appeared to be her normal self. The nurse asked the AP about the resident’s screaming and the AP told her the resident always screamed getting into the shower but was fine once she was in there. The nurse said she did not see anything unusual and was confused about what the concern was. The nurse said the AP was a fantastic caregiver. During an interview, the AP said the hospice aide did not call the facility prior to her arrival, so the resident did not receive medication prior to the shower. The AP said the hospice aide told her the resident refused to shower. The AP said the overnight shift told her the resident had a large incontinent bowel movement, therefore the resident needed a shower. The AP said the resident also soiled her bedding with stool. The AP said she told the hospice aide she would help her give the resident a shower. The AP said she got a mechanical lift to get the resident out of bed, while the hospice aide was in the room watching her. The AP said the hospice aide left the room when the resident sat in the shower chair. The AP said the resident screamed at her to leave her alone during the transfer but stopped screaming once the shower started. The AP said the resident’s behavior was not unusual. The AP said she washed the resident and got her dressed. The AP said the resident could not stay in bed because the bedding had stool on it, and she did not want the resident to get an infection. The AP said after the incident the nurse manager told her to make sure to give the resident medication prior to her showers. The AP said the hospice aide accused her of abuse because she did not like her. The AP said the hospice aide often skipped resident showers, but residents only received one shower a week, and she wanted the resident to be clean. The resident’s medication administration record (MAR) indicated the resident received antibiotic medication for a urinary tract infection approximately three weeks prior to the incident. The MAR indicated the resident received scheduled (routinely given) psychotropic medication (medications affecting the brain and the central nervous system which alter mood and behavior).

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 Inver Glen Senior Living July 6, 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: 651‐281‐9796 JMD PRINTED: 07/06/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ 30647 B. WING _____________________________ 06/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 7260 SOUTH ROBERT TRAIL INVER GLEN SENIOR LIVING INVER GROVE HEIGHTS, MN 55077 (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 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 with Dementia Care license 144G.08 to 144G.95, these correction orders are providers. The assigned tag number issued pursuant to a survey. appears in the far left column entitled "ID Prefix Tag." The state Statute number and Determination of whether violations are corrected the corresponding text of the state Statute requires compliance with all requirements out of compliance is listed in the provided at the Statute number indicated below. "Summary Statement of Deficiencies" When Minnesota Statute contains several items, column. This column also includes the failure to comply with any of the items will be findings which are in violation of the state considered lack of compliance. requirement after the statement, "This Minnesota requirement is not met as INITIAL COMMENTS: evidenced by." Following the surveyors' SL30647015 findings is the Time Period for Correction. On June 12, 2023, through June 14, 2023 2023, PLEASE DISREGARD THE HEADING OF the Minnesota Department of Health conducted a THE FOURTH COLUMN WHICH survey at the above provider, and the following STATES,"PROVIDER'S PLAN OF correction orders are issued. At the time of the CORRECTION." THIS APPLIES TO survey, there were 94 active residents; 52 FEDERAL DEFICIENCIES ONLY. THIS receiving services under the Assisted Living with WILL APPEAR ON EACH PAGE. 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 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: LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 JNLO11 If continuation sheet 1 of 10 PRINTED: 07/06/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ 30647 B. WING _____________________________ 06/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 7260 SOUTH ROBERT TRAIL INVER GLEN SENIOR LIVING INVER GROVE HEIGHTS, MN 55077 (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 (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 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 0 810 144G.45 Subd. 2 (b)-(f) Fire protection and 0 810 SS=F physical environment (b) Each assisted living facility shall develop and maintain fire safety and evacuation plans. The plans shall include but are not limited to: (1) location and number of resident sleeping rooms; (2) employee actions to be taken in the event of STATE FORM 6899 JNLO11 If continuation sheet 2 of 10 PRINTED: 07/06/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ 30647 B. WING _____________________________ 06/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 7260 SOUTH ROBERT TRAIL INVER GLEN SENIOR LIVING INVER GROVE HEIGHTS, MN 55077 (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) 0 810 Continued From page 2 0 810 a fire or similar emergency; (3) fire protection procedures necessary for residents; and (4) procedures for resident movement, evacuation, or relocation during a fire or similar emergency including the identification of unique or unusual resident needs for movement or evacuation. (c) Employees of assisted living facilities shall receive training on the fire safety and evacuation plans upon hiring and at least twice per year thereafter.