New Perspective Rosedale.

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 alleged perpetrators (AP1, AP2, AP3) financially exploited the resident when they stole money out of her wallet. Investigative Findings and Conclusion: The Minnesota Department of Health determined financial exploitation was not substantiated. AP1, AP2, and AP3 were observed on video going through the resident’s wallet. However, AP1, AP2, and AP3 did not take anything from the resident’s wallet and the resident did not incur a financial loss. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigator contacted law enforcement and family members. The investigation included review of the resident’s record, facility internal investigation, facility incident reports, personnel files, staff schedules, law enforcement report, and related facility policy and procedures. Also, the investigator observed staff interactions with residents. The resident resided in an assisted living facility. The resident’s diagnoses included spinal stenosis and chronic obstructive pulmonary disease. The resident’s services included assistance with activities of daily living, meals, and medication management. The resident’s assessment indicated she received assistance with finances from her family. The resident’s progress notes indicated the facility observed on a recorded video AP1, AP2, and AP3 going through the resident wallet in her room. A police report indicated AP1 was captured on camera looking through the resident’s wallet. The resident’s wallet was empty, so nothing was taken. AP 1 admitted looking through the resident’s wallet but denied ever stealing cash from the resident. A second police report indicated AP2 and AP3 had been fired from their positions for attempting to steal money from the resident. A facility manager stated the resident’s family member provided video footage of both AP2 and AP3 separately entering the resident’s apartment and searching through her wallet. The police report indicated it seemed AP2 and AP3 had deliberately entered the resident’s apartment with the intent to go through the resident’s wallet for money or other valuable items. The recorded video footage indicated a camera was placed inside an open drawer of the resident’s room. A staff member (identified by facility leadership and AP1) took the residents wallet out the drawer and rifled through it. AP1 returned the wallet to the drawer and closed the drawer without taking anything from the resident’s wallet. AP1’s face was clearly visible as she closed the drawer. On a different day, a staff member (identified as AP2 by the name tag) quickly opened the drawer. AP2 took out the resident’s wallet and rifled through it. The video then ended. On the same day, another staff member (identified as AP3 by the name tag) opened the resident’s drawer and started to go through it without removing it from the drawer. AP3 found nothing in the resident’s wallet and closed the drawer. The facility’s internal investigation indicated AP2 and AP3 were counselled regarding alleged “abuse of resident/financial exploitation.” AP2 did not provide a statement. AP3 said the resident asked her to help her find her keys. AP3 said the resident told her the keys might be in her wallet. AP3 searched the wallet and did not find the keys. A statement provided by the resident indicated the resident did not ask anyone to enter her room, she always had what she needed with her, and she did not want anyone in in her apartment if she was not there. AP1 did not provide a statement as she never returned to the facility. Personnel files for AP1, AP2, and AP3 indicated all three staff members received training in abuse and neglect prevention, and compliance and code of conduct. When interviewed, a facility administrator said the resident’s family member informed her they were putting cameras in the resident’s apartment because she was missing money. The family later provided video of AP1, AP2, and AP3 each looking through the resident’s wallet on two separate days. The three staff members were put on paid administrative leave pending investigation. AP1 quit and never returned to the facility. Although the wallet was empty and no money was taken, AP2 and AP3 were each counselled and their employment was terminated. When interviewed, AP2 said another resident lost his wallet and asked AP2 to help him find it. When AP2 entered the resident’s apartment to clean, she looked in an open drawer and saw a wallet. AP2 said she looked through the wallet to see if it belonged to the other resident. AP2 denied stealing or trying to steal anything from the resident or any other resident at the facility. When interviewed, AP3 said the resident asked her to help find the residents missing keys. AP3 said she looked through the resident’s wallet to see if her keys were in it. AP3 denied stealing from the resident. When interviewed, the resident said at one time she had $400 in a drawer, however, later that day she noticed she only had $200 left. The resident said she also won $500 at a casino, and a family member gave her $200 of it to keep. The resident could not remember when she noticed the money was missing, but the $200 was gone. The resident did not recall time frames when her money went missing but said a family member placed cameras in her room afterward. When interviewed, a family member stated they placed cameras in the resident’s apartment because she believed she was missing money, approximately $350. The family member said it was hard to pinpoint dates money went missing because there could have been a span of time between when the resident noticed money was missing and when it might have been taken. The family member also said they weren’t sure if the resident misplaced the money or lost it. At one time, the family member gave the resident $200, which eventually went missing. After that, the family member placed the cameras in the resident’s apartment. In conclusion, the Minnesota Department of Health determined financial exploitation 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. 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: Yes. Family/Responsible Party interviewed: Yes. Alleged Perpetrator interviewed: Yes, AP2 and AP3. AP1 did not respond to requests for interview. the Action taken by facility: The facility retrained staff regarding resident rights and boundaries. The three staff members involved no longer work at the facility. 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: 12/30/2024 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 _____________________________ 21410 11/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 2555 SNELLING AVENUE NORTH SUNRISE OF ROSEVILLE ROSEVILLE, MN 55113 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 November 19, 2024, the Minnesota Department of Health initiated an investigation of complaint #HL214107864C/#HL214105621M. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 B83V11 If continuation sheet 1 of 1

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 CORRECTION ORDERS 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 the violations; h owever, 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: An equal opportunity employer. Letter ID: IS7N REVISED 09/13/2021 Sunrise Of Roseville February 6, 2025 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). 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 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 convenience at this link: h ttps://forms.office.com/g/Bm5uQEpHVa. Your input is important 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, Renee L. Anderson, Supervisor State Evaluation Team Email: Renee.L.Anderson@state.mn.us Telephone: 651-201-5871 Fax: 1-866-890-9290 HHH PRINTED: 02/06/2025 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 _____________________________ 21410 12/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 2555 SNELLING AVENUE NORTH SUNRISE OF ROSEVILLE ROSEVILLE, MN 55113 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 been assigned to Minnesota State Statutes for Assisted Living License In accordance with Minnesota Statutes, section Providers. The assigned tag number 144G.08 to 144G.95 this correction order(s) has appears in the far-left column entitled "ID been issued pursuant to a survey. Prefix Tag." The state Statute number and the corresponding text of the state Statute Determination of whether a violation has been out of compliance is listed in the corrected requires compliance with all "Summary Statement of Deficiencies" requirements provided at the Statute number column. This column also includes the indicated below. When Minnesota Statute findings which are in violation of the state contains several items, failure to comply with any requirement after the statement, "This of the items will be considered lack of Minnesota requirement is not met as compliance. evidenced by." Following the surveyors' findings is the Time Period for Correction. INITIAL COMMENTS: SL21410016-0 PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On December 9, 2024, through December 11, STATES,"PROVIDER'S PLAN OF 2024, the Minnesota Department of Health CORRECTION." THIS APPLIES TO conducted an initial survey at the above provider, FEDERAL DEFICIENCIES ONLY. THIS and the following correction orders are issued. At WILL APPEAR ON EACH PAGE. the time of the survey, there were 62 residents; 62 receiving services under the provider's THERE IS NO REQUIREMENT TO Assisted Living 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. 0 480 144G.41 Subdivision 1 Subd. 1a (a-b) Minimum 0 480 SS=F requirements; required food services LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 L2ZB11 If continuation sheet 1 of 36 PRINTED: 02/06/2025 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 _____________________________ 21410 12/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 2555 SNELLING AVENUE NORTH SUNRISE OF ROSEVILLE ROSEVILLE, MN 55113 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) 0 480 Continued From page 1 0 480 (a) Except as provided in paragraph (b), food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626. (b) For an assisted living facility with a licensed capacity of ten or fewer residents: (1) notwithstanding Minnesota Rules, part 4626.0033, item A, the facility may share a certified food protection manager (CFPM) with one other facility located within a 60-mile radius and under common management provided the CFPM is present at each facility frequently enough to effectively administer, manage, and supervise each facility's food service operation; (2) notwithstanding Minnesota Rules, part 4626.0545, item A, kick plates that are not removable or cannot be rotated open are allowed unless the facility has been issued repeated correction orders for violations of Minnesota Rules, part 4626.1565 or 4626.1570; (3) notwithstanding Minnesota Rules, part 4626.0685, item A, the facility is not required to provide integral drainboards, utensil racks, or tables large enough to accommodate soiled and clean items that may accumulate during hours of operation provided soiled items do not contaminate clean items, surfaces, or food, and clean equipment and dishes are air dried in a manner that prevents contamination before storage; (4) notwithstanding Minnesota Rules, part 4626.1070, item A, the facility is not required to install a dedicated handwashing sink in its existing kitchen provided it designates one well of a two-compartment sink for use only as a handwashing sink; (5) notwithstanding Minnesota Rules, parts 4626.1325, 4626.1335, and 4626.1360, item A, existing floor, wall, and ceiling finishes are STATE FORM 6899 L2ZB11 If continuation sheet 2 of 36 PRINTED: 02/06/2025 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 _____________________________ 21410 12/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 2555 SNELLING AVENUE NORTH SUNRISE OF ROSEVILLE ROSEVILLE, MN 55113 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) 0 480 Continued From page 2 0 480 allowed provided the facility keeps them clean and in good condition; (6) notwithstanding Minnesota Rules, part 4626.