Millers Landing 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 necessar yto ensure the health, safety, and welfare of residents in your care. STATE CORRECTIO ONRDERS 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 Requiremen tis not met as evidenced by . . ." IMPOSITION OF FINES In accordance with Minn. Stat. § 144G3. 1, 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: Leve l1: no fines or enforcement; Leve l2: a fine of $500 per violation, in addition to any enforcement mechanism authorized in § 144G2. 0; Leve l3: a fine of $1,000 per incident, in addition to any enforcement mechanism authorized in § 144G2. 0; An equal opportunity employer . Letter ID: IS7N REVISE 0D9/13/2021 Millers Landing Senio rLiving Novembe r6, 2025 Page 2 Leve l4: a fine of $3,000 per incident, in addition to any enforcement mechanism authorized in § 144G2. 0; Leve l5: a fine of $5,000 per violation, in addition to any enforcement mechanism authorized in § 144G2. 0. Therefore ,in accordance with Minn. Stat. §§ 144G0. 1 to 144G9. 999, the following fines are assessed pursuant to this survey: St - 0 - 0775 - 144g.45 Subd. 2. (a) - Fire Protection And Physica lEnvironment - $500.00 Therefore ,in accordance with Minn. Stat. §§ 144G0. 1 to 144G9. 999, the total amount you are assesse dis $500.00. You will be invoiced approximately 30 days after receipt of this notice, subject to . appeal DOCUMENTATIO ONF ACTION TO COMPLY In accordance with Minn. Stat. § 144G3. 0, Subd .5(c), t he 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: x Identify how the area(s) of noncompliance was corrected related to the resident(s)/ employee(s) identified in the correction order. x 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. x Identify what changes to your systems and practices were made to ensure compliance with the specific statute(s). CORRECTIO ONRDER RECONSIDERATI OPRNOCESS In accordance with Minn. Stat. § 144G3. 2, Subd .2, you may challenge the correction order(s) issued, including the level and scope ,and any fine assesse dthrough 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 REQUESTIN AG HEARING Alternatively, in accordance with Minn. Stat. § 144G3. 1, Subd .5(d), an assisted living provider that has been assesse da fine under this subdivision has a right to a reconsideration or a hearing under this section and chapter 14. Pursuan tto Minn. Stat. § 144G2. 0, Subd .14 and Subd .18, a request for a hearing must be in writing and received by the Department of Health within 15 business days of the correction order receipt date. The request must contain a brief and plain statement describing each matter or issue contested and any new information you believe constitutes a defense or mitigating Millers Landing Senio rLiving Novembe r6, 2025 Page 3 factor. To submit a hearing request, please visit: https:/ / forms.web.health.state.mn.us/form/ HRDAppealsForm To appea lfines via reconsideration ,please follow the procedure outlined above. Please note that you may request a reconsideration or a hearing, but not both. If you wish to contest tags without fines in a reconsideration and tags with the fines at a hearing, please submit two separate appeals forms at the website listed above. 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/Bm5uQEpHV.a Your input is important to us and will enable MDH to improve its processe sand communication with providers. If you have any questions regarding the questionnaire ,please contact Susan Winkelmann at susanw. inkelmann@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 organizations’ Governing Body. If you have any questions ,please contact me. Sincerely, Renee L. Anderson ,Supervisor State Evaluation Team Email: ReneeL. .Anderson@state.mn.us Telephone :651-201-5871 Fax :1-866-890-9290 HHH PRINTED: 11/06/2025 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 _____________________________ 34712 10/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 155 5TH AVENUE SOUTH MILLERS LANDING SENIOR LIVING MINNEAPOLIS, MN 55401 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 *****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. SL34712016-0 PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On October 13, 2025, through October 16, 2025, STATES,"PROVIDER'S PLAN OF the Minnesota Department of Health conducted a CORRECTION." THIS APPLIES TO full survey 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 survey, there were 74 residents; 74 receiving services under the Assisted Living THERE IS NO REQUIREMENT TO Facility with 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 pursuant to 144G.31 Subd. 1, 2 and 3. 0 480 144G.41 Subdivision 1 Subd. 1a (a-b) Minimum 0 480 SS=F requirements; required food services (a) Except as provided in paragraph (b), food must be prepared and served according to the LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 RMH311 If continuation sheet 1 of 20 PRINTED: 11/06/2025 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.

findings which items, failure to comply with any of the items will are in violation of the state requirement be considered lack of compliance. after the statement, "This Minnesota requirement is not met as evidenced by." INITIAL COMMENTS: Following the evaluators ' findings is the Time Period for Correction. HL347122067C PLEASE DISREGARD THE HEADING OF On September 11, 2024, the Minnesota THE FOURTH COLUMN WHICH Department of Health conducted a complaint STATES,"PROVIDER'S PLAN OF investigation at the above provider, and the CORRECTION." THIS APPLIES TO following correction orders are issued. At the time FEDERAL DEFICIENCIES ONLY. THIS of the complaint investigation, there were 68 WILL APPEAR ON EACH PAGE. residents receiving services under the provider's Assisted Living with Dementia Care license. THERE IS NO REQUIREMENT TO SUBMIT A PLAN OF CORRECTION FOR The following correction order is issued for VIOLATIONS OF MINNESOTA STATE HL347122067C, tag identification 1760. 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. 01760 144G.71 Subd. 8 Documentation of 01760 SS=F administration of medication LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 325V11 If continuation sheet 1 of 9 PRINTED: 09/23/2024 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 _____________________________ 34712 09/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 155 5TH AVENUE SOUTH MILLERS LANDING SENIOR LIVING MINNEAPOLIS, MN 55401 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) 01760 Continued From page 1 01760 Each medication administered by the assisted living facility staff must be documented in the resident's record. The documentation must include the signature and title of the person who administered the medication. The documentation must include the medication name, dosage, date and time administered, and method and route of administration. The staff must document the reason why medication administration was not completed as prescribed and document any follow-up procedures that were provided to meet the resident's needs when medication was not administered as prescribed and in compliance with the resident's medication management plan. This MN Requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee failed to document medication administration in resident records, for three of three residents (R1, R2, R3) with records reviewed. In addition, R2's medication administration record (MAR) had a transcription error with an oxycodone and oxycontin prescriptions, where staff documented they provided double doses. 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 of the residents). The findings include: R2 R2 was admitted October 1, 2019. R2's STATE FORM 6899 325V11 If continuation sheet 2 of 9 PRINTED: 09/23/2024 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 _____________________________ 34712 09/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 155 5TH AVENUE SOUTH MILLERS LANDING SENIOR LIVING MINNEAPOLIS, MN 55401 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) 01760 Continued From page 2 01760 diagnoses included paranoid schizophrenia, prediabetes, and neuralgia and neuritis. R2's service plan dated June 10, 2022, indicated the licensee provided medication administration assistance. TRANSCRIPTION ERROR R2's MAR dated February 1, 2024, through February 29, 2024, included an order for oxycodone 5 milligrams (mg) daily at 3:00 p.m. with a start date was January 4, 2024 and stop date of February 2, 2024. R2's MAR also had an order for oxycodone 5 mg daily at 3:00 p.m. with a start date of February 1, 2024 and stop date of February 26, 2024. R2's MAR had two oxycodone 5 mg administrations at 3:00 p.m. for February 1, 2024, and staff documented providing both doses. R2's MAR dated February 1, 2024, through February 29, 2024, included an order for OxyContin 20 mg twice daily at 8:00 a.m. and 6:00 p.m. with a start date was January 4, 2024 and stop date of February 2, 2024. R2's MAR also had an order for OxyContin 20 mg twice daily at 8:00 a.m. and 6:00 p.m. with a start date of February 1, 2024 and stop date of February 26, 2024. R2's MAR had two OxyContin 20 mg administrations at 8:00 a.m. and 6:00 p.m. for February 1, 2024, and staff documented providing both doses both doses at 6:00 p.m. Staff documented holding one of the 8:00 a.m. administrations for "double" dose. R2's MAR dated February 1, 2024, through February 29, 2024, indicated the following the licensee failed to document administration of the following medications: Oxycodone 5 mg tablet (for chronic pain): Take STATE FORM 6899 325V11 If continuation sheet 3 of 9 PRINTED: 09/23/2024 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 _____________________________ 34712 09/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 155 5TH AVENUE SOUTH MILLERS LANDING SENIOR LIVING MINNEAPOLIS, MN 55401 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) 01760 Continued From page 3 01760 one tablet by mouth daily. The licensee failed to document medication administration 2 of 29 days. Oxycontin 20 mg tablet (for chronic pain): Take one tablet by mouth twice daily. The licensee failed to document medication administration 2 of 29 days. Sodium Fluoride PST 1.1% (for mouth sore): Brush teeth once daily. The licensee failed to document medication administration 2 of 29 days. On September 13, 2024, at 2:10 p.m., registered nurse (RN)-B said the oxycontin was a documentation error. R2 was only supposed to receive 20 mg and not 40 mg although it was documented twice. On September 11, 2024, the licensee's narcotic book record was reviewed. Documentation indicated staff did not double dose R2 due to the transcription error. R1 R1 was admitted November 9, 2022. R1's diagnoses included major depressive disorder, diabetes type II, and chronic inflammatory demyelinating polyneuritis. R1's assisted living contract dated November 9, 2022, indicated the licensee provided medication administration assistance. R1's MAR dated February 1, 2024, through February 29, 2024, indicated the licensee failed to document administration of the following medications: Advair HFA AER 115/21 (for asthma): Inhale two puffs into the lungs twice daily. The licensee failed to document medication STATE FORM 6899 325V11 If continuation sheet 4 of 9 PRINTED: 09/23/2024 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 _____________________________ 34712 09/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 155 5TH AVENUE SOUTH MILLERS LANDING SENIOR LIVING MINNEAPOLIS, MN 55401 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) 01760 Continued From page 4 01760 administration 4 of 29 days. Aspirin 81 mg chew tablet: Take one tablet by mouth once daily. The licensee failed to document medication administration 5 of 29 days. Lipitor 40 mg tablet (for hyperlipidemia): Take one tablet by mouth daily. The licensee failed to document medication administration 1 of 29 days Blood sugar check three times daily. The licensee failed to document medication administration 11 of 29 days. Brilinta 90 mg tablet (for stent replacement): Take two tablets by mouth daily.

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) financially exploited residents when controlled medications from discharged or deceased residents went missing from the nurse’s office. Investigative Findings and Conclusion: The Minnesota Department of Health determined financial exploitation was inconclusive. While it was true three residents’ controlled medications went missing from the nurse’s office, it could not be determined who took the medications. The investigation found at least three other staff members besides the AP had access to these medications and the facility system for tracking narcotics for discharged or deceased residents was insufficient. The facility was issued a compliance correction order to address the medication storage concerns. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigation included review of facility records, resident An equal opportunity employer. records, policies and procedures. Also, the investigator observed facility layout including nursing and leadership offices, staff interactions with other staff, residents, and visitors. All three residents resided in an assisted living facility with memory care. Resident #1 diagnoses included chronic leukemia, kidney failure, and heart failure. The residents service plan indicated he was on hospice and needed assistance with bathing, toileting, medications, and meals. Resident #2’s diagnoses included chronic heart disease, chronic obstructive pulmonary disease, cerebral infarction (stroke), with hemiplegia (paralysis of one side of the body) and diabetes. The residents service plan indicated the resident was on hospice and needed assistance with bathing, toileting, medications, and meals. Resident #3’s diagnosis included bipolar disorder and chronic pain. The residents service plan indicated the resident received help with dressing, bathing, medication administration and behavior management. The facility’s internal investigation indicated a facility registered nurse (RN) was setting up the weekly Medi planner for resident #3 when she realized a full card of tramadol, a strong medication used for pain, was missing. The missing would have contained 30 pills. The RN notified the facility leadership of this missing medication and a search for the missing medications was undertaken but the tramadol was not found. During the search, the facility discovered that controlled medications for two discharged residents (resident #1 and resident #2) that had been stored in the nurse’s office were also missing. The facility found resident #1 was missing 7 morphine tablets and resident 2 was missing 1 oxycodone and 16 Ativan pills. The facility had bagged up these residents’ medications for family to pick up or to be given to the hospice service when these residents had been discharged or deceased weeks earlier. It was not determined when these medications went missing. During an interview, a member of the facility management stated they had reason to believe one nurse in particular may have taken the medications. However, the manager stated that three nurses plus the assisted living director all had keys to the office where the medications were stored and therefore had access to these medications. The manager also acknowledged the facility was unable to pinpoint a day when the medications went missing. During an interview an interview, the RN stated it was the practice to bag up all medications when a resident was discharged and then give to the family. Once these medications are bagged, they do not count the meds or check them daily. The RN stated the bag was in a locked area but acknowledged that the medications were not tracked daily. An internal audit was done on all the medication carts and no other medications were missing. Review of resident #1 records indicated the resident took the medication for pain while on hospice care. The medication went missing after the resident had passed away. Review of resident #2 records indicated the resident took the medications for pain and agitation while on hospice. The medication went missing after the resident passed away. Review of resident #3 records indicated the resident took the medications for pain. The facility had more of the medication and the resident was able to continue taking the medication uninterrupted. In conclusion, the Minnesota Department of Health determined financial exploitation 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. Financial exploitation: Minnesota Statutes, section 626.5572, subdivision 9 "Financial exploitation" means: (b) In the absence of legal authority a person: (1) willfully uses, withholds, or disposes of funds or property of a vulnerable adult; (2) obtains for the actor or another the performance of services by a third person for the wrongful profit or advantage of the actor or another to the detriment of the vulnerable adult; (3) acquires possession or control of, or an interest in, funds or property of a vulnerable adult through the use of undue influence, harassment, duress, deception, or fraud; or (4) forces, compels, coerces, or entices a vulnerable adult against the vulnerable adult's will to perform services for the profit or advantage of another. Vulnerable Adult interviewed: no, deceased Family/Responsible Party interviewed: unsuccessful Alleged Perpetrator interviewed: unsuccessful the Action taken by facility: The AP is no longer employed by the facility. 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 Minnesota Board of Nursing PRINTED: 01/25/2024 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 _____________________________ 34712 12/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 155 5TH AVENUE SOUTH MILLERS LANDING SENIOR LIVING MINNEAPOLIS, MN 55401 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****** Assisted Living Provider 144G. HOME CARE PROVIDER/ASSISTED LIVING documenting the State Correction Orders PROVIDER CORRECTION ORDER using federal software. Tag numbers have been assigned to Minnesota State In accordance with Minnesota Statutes, Statutes for Assisted Living Facilities. The section144G.08 to 144G.95, these correction assigned tag number appears in the far orders are issued pursuant to a complaint left column entitled "ID Prefix Tag." The 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. HL347123222C/HL347126944M & PLEASE DISREGARD THE HEADING OF HL347128324M/HL347125502C THE FOURTH COLUMN WHICH STATES,"PROVIDER'S PLAN OF On December 5,2023, the Minnesota Department CORRECTION." THIS APPLIES TO of Health conducted a complaint investigation at FEDERAL DEFICIENCIES ONLY. THIS the above provider, and the following correction WILL APPEAR ON EACH PAGE. orders are issued. At the time of the complaint investigation, there were 68 residents receiving THERE IS NO REQUIREMENT TO services under the provider'sAssisted Living with SUBMIT A PLAN OF CORRECTION FOR Dementia Care license. VIOLATIONS OF MINNESOTA STATE STATUTES. The following correction order is issued/orders are issued for THE LETTER IN THE LEFT COLUMN IS #HL347123222C/#HL347126944M, tag USED FOR TRACKING PURPOSES AND identification 1910. REFLECTS THE SCOPE AND LEVEL ISSUED PURSUANT TO 144G.31 No orders are issued for SUBDIVISION 1-3. HL347128324M/HL347125502C.