Bridgewell Assisted 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 Statemen tof 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; Leve l4: a fine of $3,000 per incident, in addition to any enforcement mechanism authorized in An equal opportunity employer . Letter ID: IS7N REVISE 0D9/13/2021 Bridgewel lAssisted Living October 1, 2025 Page 2 § 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), the licensee must docum ent 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)/ employees( ) 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 factor. Bridgewel lAssisted Living October 1, 2025 Page 3 To submit a hearing request, please visit: https:/ / forms.web.health.state.mn.us/form/ HRDAppealsForm To appea lfines via reconside ration, please follow the pr ocedur e outlined above. Plea se 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, Jessie Chenze ,Supervisor State Evaluation Team Email: JessieC. henze@state.mn.us Telephone :218-332-5175 Fax :1-866-890-9290 AH PRINTED: 10/01/2025 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 _____________________________ 25904 08/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 410 WEST MAIN STREET BRIDGEWELL ASSISTED LIVING OSAKIS, MN 56360 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 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." issued pursuant to a survey. The 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. SL25904016-0 PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On August 11, 2025, through August 13, 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 14 residents; 14 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 ISSUED PURSUANT TO 144G.31 SUBDIVISION 1-3. 0 775 144G.45 Subd. 2. (a) Fire protection and physical 0 775 SS=F environment LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 ZC7611 If continuation sheet 1 of 18 PRINTED: 10/01/2025 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: 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), an unlicensed personnel (ULP), financially exploited the resident when she took a narcotic pain medication for her own personal use. Investigative Findings and Conclusion: The Minnesota Department of Health determined financial exploitation was inconclusive. Although the AP was responsible for medication administration and in possession of the keys for the narcotic box at the time the medication discrepancy occurred, there was not a preponderance of evidence to determine if the AP took the medication. A drug test completed after the allegation was reported was negative and the AP denied taking the medication. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigator also contacted law enforcement. The investigation included review of the resident record, facility internal investigation documentation, facility incident reports, personnel files, staff schedules, law enforcement reports, surveillance footage, and related facility policies and procedures. Also, the investigator observed narcotic storage and medication administration at the facility. The resident resided in an assisted living memory care unit with a diagnosis of Alzheimer’s disease. The resident’s service plan included assistance with dressing, grooming, toileting, and medication administration. The resident’s assessment indicated the resident had chronic pain and relied on staff to administer all medications. The resident had physician’s orders for Norco (a narcotic pain medication) twice daily, at 8:00 a.m. and 8:00 p.m., for chronic pain. During a routine narcotic count, a discrepancy was noted in the resident’s available Norco tablets and the last recorded entry in the narcotic count book. The discrepancy was reported, and facility administration initiated an internal investigation. Internal investigation documentation indicated the AP was responsible for medication administration and was in possession of the keys for the narcotic box at the time the discrepancy occurred. Surveillance footage showed the AP accessed the narcotic box and popping of a pill package was heard and fumbling with packaging was observed. The AP appeared to have a white pill in her left hand that she continued to hold until her coworker came into the office. It appeared that the AP then placed the pill in her left pocket. The AP was provided the opportunity to watch the video and could not explain what she was doing with the pill container in the video or where the medication went. The AP was suspended pending the results of the investigation and a urine drug test. The drug test indicated the missing narcotic was not present in the AP’s system. During an interview, a facility nurse stated they were suspicious of the amount of time the AP spent at the medication cart and that the AP did not follow facility protocol for medications that were found on the floor. The nurse stated it would not have been the employee’s responsibility to identify the medication they found; they were to place it in an envelope, lock it in the narcotic box, and notify the nurse. The nurse stated they had prior concerns about drug diversion related to the AP and based on her behavior at the medication cart and the unaccounted narcotic, the decision was made to terminate her employment. During an interview, the AP denied taking any narcotic medications or writing over the count in the narcotic logbook. The AP stated she was trying to match up the pill she found on the floor and was comparing it to other medications, including narcotics, to see if it was an essential medication that wasn’t given. The AP stated it was not in the facility policy to match the medication, but she had worked in healthcare for a while and that was just the way she did it. The AP stated she watched the surveillance footage and did not hear the popping of the pill package. The AP stated it was common practice for staff at the facility to write over a narcotic count if it was off, so it could have been anyone who wrote over the count. The AP stated she cooperated with the facility’s investigation and agreed to take the drug test, which came back negative, because she did not have anything to hide and did not take any narcotics. 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, due to cognitive impairment Family/Responsible Party interviewed: Yes Alleged Perpetrator interviewed: Yes Action taken by facility: The facility immediately investigated the discrepancy in narcotics and contacted law enforcement. 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: 11/18/2024 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 _____________________________ 25904 09/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 410 WEST MAIN STREET BRIDGEWELL ASSISTED LIVING OSAKIS, MN 56360 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 20, 2024, the Minnesota Department of Health initiated an investigation of complaint #HL259044641M/#HL259045980C. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 1GKH11 If continuation sheet 1 of 1

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 staff failed to administer the resident’s medications according to physician orders and in accordance with the resident’s service agreement. The resident was given his roommate’s medications, which included a medication to treat high blood pressure. The resident was found unresponsive a few hours later and was taken to the emergency room where he was treated for shock and low blood pressure. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. Although the resident was given the wrong medications, the error was an isolated incident. The resident was hospitalized and later discharged to a long-term care facility. The resident returned to his baseline health condition. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigation included review of the resident records, hospital records, facility internal investigation documentation, facility incident reports, personnel files, staff schedules, and related facility policies and procedures. Also, the investigator observed care and services provided in the facility. The resident resided in an assisted living memory care unit. The resident’s diagnoses included dementia. The resident’s service plan included assistance with dressing, grooming, bathing, and medication administration. The resident’s assessment indicated the resident had impaired cognition and required assistance with medication administration. The resident’s medication administration record (MAR) indicated the resident’s morning medications included vitamin D (supplement), an allergy medication, an antibiotic, and Tylenol. A medication error report indicated the resident was given another resident’s medications which included two medications for high blood pressure, a medication to treat high blood sugar for people with diabetes, two diuretics to reduce extra fluid in the body, and two medications to prevent blood clots. The resident’s medical record indicated staff notified the nurse around 10:30 a.m. that the resident wasn’t feeling well, and he had thrown up. The resident was noted to be “cold, clammy, and diaphoretic (sweating).” The resident’s family was notified. About half an hour later, a nurse went to the resident’s room and observed the resident had poor color, was drooling, and unable to take a sip of water. The resident was not responsive to verbal stimuli but moaned with sternal rub. The resident’s blood pressure was 56/48 (normal blood pressure is 120-80). Emergency medical services (EMS) was called at 11:10 a.m. and the resident was taken to the emergency room. At 12:05 p.m., the nurse was notified the resident may have been given the wrong medications and updated the hospital and the resident’s family. Hospital records indicated the resident arrived at the emergency room with low blood pressure and required the use of supplemental oxygen. The resident was given intravenous (IV) fluids, a blood transfusion, and admitted to the hospital for further monitoring. The resident later discharged to a long-term care facility. Employee records indicated the unlicensed personnel (ULP) who made the medication error had received appropriate training and supervision related to administering medications. The facility’s internal investigation indicated ULP did not follow facility procedure when she dished up two resident medications at the same time and administered them to the wrong residents. The ULP completed additional education including re-education with the RN on medication administration and re-training with other ULP for two shifts. The ULP was placed on an improvement plan for six months to monitor and mitigate any additional medication errors or safety issues. During an interview, the facility nurse stated she had checked on the resident after staff reported he wasn’t feeling well. When the resident had a change in condition, she had called 911 and when she went back in the resident’s room, the ULP was crying and said she thought this was her fault. She asked the ULP to clarify why she thought it was her fault and the ULP admitted to having dished up medications for two residents at the same time, which was not the facility’s process. The nurse stated they identified what medications may have been given to the resident and updated the hospital so he could be treated appropriately. The nurse stated after the incident, they worked with the ULP to provide additional training and supervision and changed several of their internal processes to reduce the risk of a similar occurrence. During an interview, the ULP stated she was running late that morning and felt behind and knew she shouldn’t have administered medications that way. The ULP stated it was not her intention to hurt someone and when she figured out she gave the wrong medications, she was terrified and notified the nurse right away. 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, due to cognitive impairment Family/Responsible Party interviewed: Yes Alleged Perpetrator interviewed: Not Applicable Action taken by facility: The facility reported and investigated the incident. Additional training was provided to the ULP and the facility reviewed their medication administration process. 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: 07/01/2024 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 _____________________________ 25904 05/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 410 WEST MAIN STREET BRIDGEWELL ASSISTED LIVING OSAKIS, MN 56360 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 May 10, 2024, the Minnesota Department of Health initiated an investigation of complaint #HL259042102M/#HL259049948C. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 0UFR11 If continuation sheet 1 of 1