The Hummingbird.

correction orders. MDH documents state 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 . . ." IMPOSITION OF FINES In accordance with Minn. Stat. § 144G.31, Subd. 4, fines and enforcement actions may be imposed based on the level and scope of the violations and may be imposed immediately with no opportunity to correct the violation first as follows: Level 1: no fines or enforcement; Level 2: a fine of $500 per violation, in addition to any enforcement mechanism authorized in § 144G.20; Level 3: a fine of $1,000 per incident, in addition to any enforcement mechanism authorized in § 144G.20; An equal opportunity employer. Letter ID: MX30_Revised 04/14/2023 The Hummingbird March 5, 2026 Page 2 Level 4: a fine of $3,000 per incident, in addition to any enforcement mechanism authorized in § 144G.20; Level 5: a fine of $5,000 per violation, in addition to any enforcement mechanism authorized in § 144G.20. MDH may ass es s fines ba sed on th e lev el and scope of the orde rs out lined bel ow; however, no immediate fines are assessed for this survey of your facility.: St - 0 - 0775 - 144g.45 Subd. 2. (a) - Fire Protection And Physical Environment - $500.00 St - 0 - 1640 - 144g.70 Subd. 4 (a-E) - Service Plan, Implementation And Revisions - $1,000.00 St - 0 - 1760 - 144g.71 Subd. 8 - Documentation Of Administration Of Medication - $3,000.00 St - 0 - 2310 - 144g.91 Subd. 4 (a) - Appropriate Care And Services - $1,000.00 The to ta l am ount of potenti a l fines that may be asses sed re la te d to the se correc tio n orde rs is $5,500 .00. MD H is not imposing these fines against your license at this time. 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 and immediately correct any reissued orders outlined on the state form ; ho wever, plans of correc tion are not requ ired to be subm itt ed for appr oval. If corrections are not made, MDH may impose fines as described above and in accordance with Minnesota Statutes 144G. 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). 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 CONDITIONA LLICENS EISSUED: MDH will issue The Hummingbird a conditional assisted living facility license for 90 calendar days, pending appeal. At an unannounced point in time, within the 90 calendar days, MDH will conduct a The Hummingbird March 5, 2026 Page 3 follow-up survey, as defined in Minn. Stat. § 144G.30, Subd. 6. Based on the results of the follow-up survey, MDH will determine if The Hummingbird is in substantial compliance. The following conditions apply on the conditional assisted living facility license: a. No new admis sio ns: The Hummingbird will not admit any new residents under its conditional assisted living facility license until MDH removes the “no new admissions” condition. The Hummingbird must provide the Department: i. A list of the names and birthdates of any individuals The Hummingbird is currently in the process of admitting. These individuals will be able to continue the admittance process. ii. A list of all current residents: 1. Name and birthdate of each resident 2. Current payment source for services 3. If Elderly Waiver, the name and contact information of the care coordinator/ case manager 4. If the resident is not able to make informed decisions, the name of their representative and how to contact the representative b. Consul ta nt: The Hummingbird will contract with an RN to provide consultation concerning all resident( s) to whom The Hummingbird provides licens ed assisted living services un der the cond it ional license. The consu lta nt must have access to all resident( s) receiving services from The Hummingbird. The consultant will conduct initial and ongoing evaluations of the provider. Direct resident observation may be required based on the consultant’ s judgement or at the discretion of MDH. The RN must not have any affiliation with The Hummingbird and MDH must review the RN’s credentials and approve the selection. The Hummingbird is responsible for the expense of the contract with the RN. The main purpose of the consultant is to provide guidance to The Hummingbird in an effort to help The Hummingbird align their practices with the requirements of Minn. Stat. §§ 144G.01 – 144G.9999 and to provide oral and written reports to MDH noting progress toward substantial compliance and/ or concerns about observations. The Hummingbird will develop and implement policies, procedures, and processes specific to the offered services in accordance with the guidance provided by the consultant to ensure ongoing monitoring and substantial compliance with statutory requirements. c. Report s: The RN consultant will provide MDH with regular reports at intervals specified by MDH. Reports will begin on a weekly basis until MDH notifies The Hummin gbird and th e RN consu lta nt abou t a chan ge. Each repor t will be The Hummingbird March 5, 2026 Page 4 elec tron ical ly sub mitt ed to: HRDConsultantReports.MDH@state. mn. us. Th e content of the reports will include information such as: i. Progress towards correction of orders; ii. Observations of staff delivering assisted living services and the level of competency observed; iii. Conversations with residents and family members about satisfaction with assisted living services; iv. Conversations with staff about their level of knowledge about the tasks they perform, the people they serve and the health professionals who delegate to them; v. Overall impressions about the quality of the assisted living services delivered; vi. Overall impressions about the dignity with which the residents and their family members are treated; vii. Concerns; and viii.Any other information requested by the Department or considered important by the RN consultant( s). d. Mon it ori ng visit s: MDH may make unannounced monitoring visits to assess the progress of The Hummingbird to correct the violations cited during the follow-up (remove if not LOF )survey as well as to determine the overall practice of The Hummingbird in meeting the needs of the people it serves. In addition, the Office of Ombudsman for Long-Term Care (OOLTC m) ay also make unannounced monitoring visits to determine the level of satisfaction of those people who receive licensed assisted living services. The OOLTC will share their findings with MDH. e. Follo w-up surve y: At the time of the follow-up survey, MDH may pursue additional enforcement actions, up to and including immediate temporary suspension or revocation of the license if MDH identifies any level 3, 4 or 5 violations or widespread care related violations. f. General Contr acto r: The Hummingbird must provide the following to Supervisor Name (Supvisor Email Address) via email within 21-days of the date of this notice: i. Name ii. License Number iii. Contact Information RESULT SOF FOLLOWU- P EVALUATIO DNURING THE CONDITIONA LLICENS EPERIOD: MDH will determine if The Hummingbird is in substantial compliance based on the results of the follow up survey.