The Glenn Minnetonka.

correction orders issued pursuant to the May 21, 2025 survey. In accordance with Minn. Stat. § 144G3. 1 Subd .4 (a), state correction orders issued pursuant to the last survey, completed on May 21, 2025, found not corrected at the time of the Augus t13, 2025, follow-up survey and/or subject to penalty assessmen at re as follows: 1290-Background Studies Required-144g.60 Subdivision 1 - $1,000.00 The details of the violations noted at the time of this follow-up survey completed on August 13, 2025 (listed above), are on the attached State Form. Brackets around the ID Prefix Tag in the left hand column, e.g., {2 ----} will identify the uncorrected tags. Therefore ,in accordance with Minn. Stat. §§ 144G0. 1 to 144G9. 999, the total amount you are assesse dis $1,000.00. 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), the licensee must document actions taken to comply with the correction orders outlined on the state form; however, plans of correction are not required to be submitted for approval. 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 enforcemen tmechanism authorized in § 144G2. 0; Leve l3: a fine of $1,000 per incident, in addition to any enforcemen tmechanism authorized in § 144G2. 0; Leve l4: a fine of $3,000 per incident, in addition to any enforcemen tmechanism authorized in § 144G2. 0; An equal opportunity employer . Letter ID: 8GKP Revised 04/14/2023 The Glenn Minnetonka Septembe r30, 2025 Page 2 Leve l5: a fine of $5,000 per violation, in addition to any enforcemen tmechanism authorized in § 144G2. 0. 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 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. We urge you to review these orders carefully. If you have questions ,please contact Jess Schoenecke ar t You are encouraged to retain this document for your records . It is your responsibility to share the information contained in the letter and/or state form with your organizations’ Governing Body. Sincerely, Jess Schoenecke rS, upervisor State Evaluation Team Email :JessS. choenecker@state.mn.us Telephone :651-201-3789 Fax :1-866-890-9290 CLN PRINTED: 09/30/2025 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ R B. WING _____________________________ 28261 08/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 5300 WOODHILL ROAD THE GLENN MINNETONKA MINNETONKA, MN 55345 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 Correction Orders ASSISTED LIVING PROVIDER FOLLOW UP using federal software. Tag numbers have SURVEY WITH RE-ISSUE OF ORDERS been assigned to Minnesota State Statutes for Assisted Living Facilities. The INITIAL COMMENTS assigned tag number appears in the SL28261016-1 far-left column entitled "ID Prefix Tag." The state Statute number and the On August 13, 2025, the Minnesota Department corresponding text of the state Statute out of Health conducted a follow-up survey at the of compliance is listed in the "Summary above provider to follow-up on orders issued Statement of Deficiencies" column. This pursuant to a survey completed on May 21, column also includes the findings which 2025. At the time of the survey, there were 174 are in violation of the state requirement residents; 100 receiving services under the after the statement, "This Minnesota Assisted Living Facility with Dementia Care requirement is not met as evidenced by." license. As a result of the follow-up survey, the Following the evaluators ' findings is the following orders were reissued and/or issued. Time Period for Correction. PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH STATES,"PROVIDER'S PLAN OF CORRECTION." THIS APPLIES TO FEDERAL DEFICIENCIES ONLY. THIS WILL APPEAR ON EACH PAGE. 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 SUBDIVISION 1-3. {0 730} 144G.43 Subd. 3 Contents of resident record {0 730} SS=D LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 D6V912 If continuation sheet 1 of 6 PRINTED: 09/30/2025 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ R B. WING _____________________________ 28261 08/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 5300 WOODHILL ROAD THE GLENN MINNETONKA MINNETONKA, MN 55345 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) {0 730} Continued From page 1 {0 730} Contents of a resident record include the following for each resident: (1) identifying information, including the resident's name, date of birth, address, and telephone number; (2) the name, address, and telephone number of the resident's emergency contact, legal representatives, and designated representative; (3) names, addresses, and telephone numbers of the resident's health and medical service providers, if known; (4) health information, including medical history, allergies, and when the provider is managing medications, treatments or therapies that require documentation, and other relevant health records; (5) the resident's advance directives, if any; (6) copies of any health care directives, guardianships, powers of attorney, or conservatorships; (7) the facility's current and previous assessments and service plans; (8) all records of communications pertinent to the resident's services; (9) documentation of significant changes in the resident's status and actions taken in response to the needs of the resident, including reporting to the appropriate supervisor or health care professional; (10) documentation of incidents involving the resident and actions taken in response to the needs of the resident, including reporting to the appropriate supervisor or health care professional; (11) documentation that services have been provided as identified in the service plan; (12) documentation that the resident has received and reviewed the assisted living bill of rights; STATE FORM 6899 D6V912 If continuation sheet 2 of 6 PRINTED: 09/30/2025 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ R 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 facility failed to seek medical care for the resident when the resident showed signs of cognitive decline and was unresponsive. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. The facility contacted emergency services to take the resident to the hospital the day the resident had change from her cognitive baseline. The facility also communicated with the residents provider during the days prior to the resident needing to be sent to the hospital. 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 records, death record, facility incident reports, staff schedules, related facility policy and procedures. Also, the investigator observed staff members providing care to and interacting with residents. The resident resided in an assisted living facility. The resident’s diagnoses included major depressive disorder, reduced mobility, and mild cognitive impairment. The resident’s service plan included assistance with medication management, mobility, repositioning, behavior management, and wellness checks. The resident also had every shift “care alert” service directing staff how to reassure and encourage the resident. The resident’s assessment indicated the resident was depressed following the death of her spouse and was previously hospitalized for failure to thrive. The resident needed the assistance of one staff member for mobility, however, the resident desired to stay in bed and declined to leave bed. Provider notes from seven and six days prior to the time in question indicated the facility contacted the provider because the resident was more weepy than usual and unable to explain what was wrong. The facility also reported the resident had swelling in her extremities with clear lung sounds and no coughing or shortness of breath. The provider indicated the resident had swelling that was due to positioning and limited mobility. The provider indicated the resident had failure to thrive and recommended a hospice evaluation that was dependent on the resident’s agreement to be evaluated. Provider notes from four days before the time in question indicated the resident reported feeling very tired due to not sleeping well. The provider noted the resident had swelling due to limited mobility and home care would be assisting to give extra time and attention and promote movement. On this day, the resident did not want to make any medication changes. Provider notes from two days before the time in question indicated the resident’s provider collaborated with psychiatric team members to change the resident’s mental health medication dose. Facility nurse progress notes three days before the resident was sent to the hospital indicated the resident would not participate in therapies and would close her eyes when asked to perform tasks. Facility nurse progress notes from the day the resident was sent to the hospital indicated staff reported the resident was “more lethargic and not rousable.” The note indicated the resident had a history of not opening her eyes when staff spoke to her, however the nurse assessed the resident and the resident only responded to pain. The nurse contacted emergency services to take the resident to the hospital. During separate interviews, multiple unlicensed personnel stated the resident was often weepy and sad and that the resident reported she wanted to die so she could be with her deceased spouse. The unlicensed personnel also stated they would try to console the resident and encourage her to move and get out of bed, but the resident would decline. During interview, a nurse stated the resident preferred to stay in bed and had that preference since admission to the facility. The day the resident was sent to the hospital, a staff member reported the resident was not doing well. The nurse went to check on the resident and a second nurse joined. The resident was not responding, the nurse ran to the nurses’ station to contact emergency services while the second nurse stayed with the resident. During interview, the second nurse stated approximately ten days before the resident was sent to the hospital, the resident was more weepy than usual and was not eating much. The second nurse stated the resident’s provider was made aware and continued to monitor the resident. The day the resident went to the hospital, the second nurse was conducting unit rounds when a staff member informed her the resident would not wake up and the second nurse and another nurse went to the resident’s room. The resident had a history of refusing to open her eyes at times, however, this morning the resident appeared pale on color and would not wake up when the second nurse rubbed her breastbone to stimulate a response. Emergency services were contacted and took the resident to the hospital. 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, deceased. Family/Responsible Party interviewed: No, interview declined. Alleged Perpetrator interviewed: Not Applicable. t Action taken by facility: Facility contacted the resident’s provider with medical changes and concerns and sent resident to hospital via emergency services when she became unresponsive. 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 _____________________________ 28261 08/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 5300 WOODHILL ROAD THE GLENN MINNETONKA MINNETONKA, MN 55345 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 12, 2024, the Minnesota Department of Health initiated an investigation of complaint #HL282616202C/#HL282614722M. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 XMKH11 If continuation sheet 1 of 1

Finding: Not Substantiated Nature of the 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 did not provide adequate wound care leading to in the resident’s hospitalization due to a wound infection. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. While the resident did develop a wound infection and required hospitalization, the facility provided appropriate assessment and wound cares leading up to this hospitalization. The resident received antibiotic treatment and returned to the facility after four days. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigator contacted the resident's family member. The investigation included review of resident's records, facility's policies and procedures and An equal opportunity employer. the resident's external medical record. The investigation included an onsite visit, observations, and interactions between current residents and facility staff. The resident resided in an assisted living facility. The resident’s diagnoses include quadriplegia and stage 3 pressure ulcer of sacral region. The resident's care plan required the assistance of two persons and the use of a hoyer lift for all transfers, dressing changes, and toileting. The resident’s care plan included tilting the electric chair 30-45 degrees for a minimum of 30 minutes every 2-3 hours to prevent pressure sores, as well as laying the resident down for 1-2 hours after lunch. The resident's assessment also indicated he had wounds on the coccyx and upper posterior thigh, the resident would need to be repositioning every 2 hours by the staff. The medical provider's orders indicated wound care was required provided three times a week by the outside agency. The home health agency provided wound care twice a week and a wound care specialist one a week. The facility staff would provide wound care as needed. The wound care specialist's notes from one week before the incident occurred indicated the wound was deteriorating. Five days before the resident was sent to the hospital, the wound underwent debridement, and it was noted that there was "no change in progression" with no signs of infection at that time. The primary goal for the resident's wound care was the removal or debridement of nonviable tissue and the prevention of infection. The resident's progress notes indicated the dressing for the wound was changed one day before the resident was sent to the hospital, as well as on the day when the resident was transferred to the hospital. During an interview, nurse #1 stated she had been caring for the resident for over a year and a half. She mentioned that a recurring pattern was observed with his wounds: as one would start to heal, another would develop. Throughout the entire time she worked with him, the resident was unable to reposition himself and required the use of a hoyer lift for transfers. The nurse confirmed she had seen the wound just four days before the resident was sent to the hospital. At that time, the tissue appeared to be in good condition, displaying a healthy pink color, and it was covered with a 3x3 foam dressing. However, she mentioned that she received a call four days later indicating the dressing was running out, which was unexpected because she had provided the staff with a 10-week supply of dressings. Upon visiting the resident, she found the wound had quadrupled in size, with the debrided area turning black due to necrotic tissue. A foam-like substance had developed on top of the wound. Additionally, redness extended 8 cm above and 10 cm below the wound and all the way to the back of the resident's hip. It was reported multiple bandages had been applied over the weekend, ranging from 3 to 4 layers at a times. During an interview, nurse #2 reported she worked on that weekend but did not personally observe the resident's wound. She stated the direct care staffs followed the protocol of turning the resident every 2 hours, and it was the responsibility of the direct care staffs to notify the nurse if the dressing appeared to be saturated and needed changing. During an interview, nurse #3 stated he worked the weekend when the resident’s wound changed. Since he had not previously cared for the resident, he was unaware of how the wound was supposed to appear. He explained the facility's nurse was responsible for providing care as needed, especially since the resident received wound care services from an outside agency. Nurse #3 confirmed he had called and discussed the resident's rapidly deteriorating wound with the outside agency staff. Additionally, he acknowledged changing the dressing twice during the night due to excessive drainage. Nurse #3 also made a call to the medical provider to provide updates on the worsening condition of the wound in the morning on the day the resident was sent to the hospital. During an interview, unlicensed caregiver #1 mentioned she did not recall specific details from that particular weekend, but she was aware the resident had a wound on his buttocks. She explained the nurse would change the wound dressing whenever it became saturated or soiled. Additionally, she mentioned the direct care staff took turns repositioning the resident every 2 hours as part of their routine care duties. During an interview, unlicensed caregiver #2 stated she did not provide direct care to the resident that weekend. However, she observed other direct care staff members entering the resident's room and repositioning him every 2 hours as per the care plan. During the investigation, despite making multiple attempts, the investigator was unable to reach the family members. 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 was deceased. Family/Responsible Party interviewed: No, attempted but did not reach. Alleged Perpetrator interviewed: Not Applicable. 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: 10/12/2023 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 _____________________________ 28261 10/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 5300 WOODHILL ROAD THE GLENN MINNETONKA MINNETONKA, MN 55345 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 September 7th 2023, the Minnesota Department of Health initiated an investigation of complaints #HL282611905C/HL282616263M. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 DA1G11 If continuation sheet 1 of 1