Benedict Homes.

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 provide the resident supervision and as a result, the resident attempted suicide and sustained multiple self-inflicted wounds and was involved in a resident-to-resident altercation. In addition, the resident resided in memory care unit and did not have memory problems. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. Prior to the self-harm incident, the resident did not voice to staff any suicidal thoughts, ideation, or have a history of self-inflicted wounds. The resident had hidden a razor blade in the sole of his shoe. The resident had no history of resident-to-resident altercations. During one altercation, staff immediately intervened and separated the residents without injury. The resident’s admission to the memory care unit was appropriate and approved by his provider for his diagnoses of major neurocognitive disorder (deficit in cognitive functioning.) 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, law enforcement report, and related facility policy and procedures. Also, the investigator observed the resident and staff interactions with the resident. The resident resided in an assisted living memory care unit. The resident’s diagnoses included major neurocognitive disorder and major depressive disorder. The resident’s service plan included assistance with bathing and medication administration. The resident’s assessment indicated the resident was alert, oriented, independent with dressing, toileting, and walked with a cane. The facility’s internal investigation indicated one day, staff had found cuts on the resident’s wrists and forearms of both arms. Licensed staff assessed the wounds and provided wound care. The resident admitted to self-infliction of the cuts with a razor blade and agreed to treatment for the wounds and his mental health. Nursing staff stayed with the resident until the resident left the facility for an evaluation at a hospital. The law enforcement report indicated the facility contacted law enforcement, reported the incident, and spoke to law enforcement. Hospital Records indicated the resident had a history of neurocognitive disorder, executive function deficit (disrupts ability to manage thoughts, emotions, and actions,) and major depressive disorder. The resident had stated the day prior to staff finding the wounds, he tried to kill himself by cutting his arms using a razor blade that he had purchased over a month ago while being “checked out” of the facility. The resident had superficial lacerations (cuts) throughout both upper extremities with deeper wounds to both his antecubital spaces (area between the arm and forearm) with one side having adipose (fat) tissue exposed. The deeper wounds were not able to be sutured closed as it had been over 24 hours since the injury. The resident stated in the last few weeks he had begun experiencing suicidal ideation and was having difficulty living in a locked unit and his lack of independence. The resident had no history of suicide attempts or self-harming behavior and no current suicidal ideation. The resident transferred to an inpatient mental health unit. The resident’s hospital discharge records indicated the resident reported long standing cognitive difficulties, particularly with his memory, and described notable memory loss. The resident discharged back to the facility five days later. Prior to the incident, the resident’s record indicated the resident had no history of suicidal ideation or other incidents of self-harm. After the incident, records indicated interventions were added including behavior monitoring for self-injurious behaviors, daily room checks, socialization tasks, exploration of companion services, and arranging for a psychiatry provider for the resident. Two weeks after the hospital discharge, records indicated the resident had sworn at another resident about placement of the other resident’s coffee cup and pushed the coffee cup towards the other resident. Staff were able to separate and redirect the resident. Later that same day, when checking the resident’s room, staff found items including a scissor and the resident had expressed intent to harm himself. The facility arranged for an evaluation of the resident at a hospital. Emergency room records indicated the resident stated the scissor and two razors found in his room at the facility today were the items he had hidden before his first hospitalization. The resident denied obtaining any new razors since his hospitalization, denied suicidal ideation, and a suicidal intent or plan. The following day, the resident discharged back to the facility. The resident also reported he did not like his current living situation and wanted to find a place where he could come and go as he wanted. The resident’s record indicated upon return from the emergency room, the resident said he had no intent to harm himself and was upset that another resident got into his space. Facility staff developed Interventions to keep the two residents separated to reduce agitation. The resident’s provider notes indicated during a follow-up visit for his hospitalization and recent emergency room (ER) visit, the resident stated the ER visit was a misunderstanding and regarding his depression symptoms stated he felt “much better” and denied any suicidal ideation. Provider notes indicated the resident had several memory/cognitive tests completed that determined the resident struggled with memory and executive functioning (problem solving, managing tasks and achieving goals.) The provider indicated the resident benefited from a supervised setting such as a memory care assisting living. During an interview, an unlicensed personnel stated the incident of the resident self-inflicted arm wounds was a big shock to staff as the resident always reported to staff he was doing okay. The resident would be seen out of his room, at times participated in activities, and he would be out in the communal living room. During an interview, another unlicensed personnel stated she provided medications to the resident the day the resident’s self-inflicted arm wounds were noticed. The unlicensed personnel stated that morning, during medication administration, there was nothing different with the resident, he was the same that he was every day. The resident took his medications and said he may be down for breakfast which was normal for him. The unlicensed personnel stated she did not see his arm wounds when administering medications. The resident was lying in bed, was covered up, and had long sleeves on. Later that day, the resident was sitting in a living room. Another unlicensed personnel noticed the scratches on the resident’s wrists. The unlicensed personnel stated the resident reported a dog had scratched him. Staff immediately reported the wounds to a nurse. The unlicensed personnel stated there were no prior occasions of the resident stating he wanted to hurt or harm himself. During an interview, a nurse stated it was reported by staff that the resident had scratches on his wrist and hands caused by a dog. The nurse stated she assessed the resident and questioned the resident about what happened. The nurse stated the marks were not scratches or a bite from a dog; they were cuts. The nurse stated the resident had cuts up and down both his arms and in the creases of his arms. The nurse stated the resident admitted to cutting himself. The nurse stated the cuts were not actively bleeding and the wounds were cleansed and dressed. The nurse updated leadership, the provider, and coordinated a transfer of the resident to the hospital for an evaluation. The nurse stated prior to the incident, the resident had never showed self-injurious behaviors at the facility or made any comments of wanting to harm himself. Upon return from the hospital, services were added for the resident’s safety. The nurse stated after the resident returned from the hospital, there was an occasion when the resident had a verbal outburst towards another resident regarding a coffee cup, which was abnormal behavior for the resident. Due to this behavior, the resident’s room was searched again, and a scissor and razor blades were found. The nurse stated the facility again arranged for the resident to be evaluated at a hospital and he discharged back to the facility the next day.

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 Benedict Homes December 13, 2024 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, Kelly Thorson, Supervisor State Evaluation Team Email: kelly.thorson@state.mn.us Telephone: 320-223-7336 Fax: 1 -866-890-9290 JMD PRINTED: 12/13/2024 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B. WING _____________________________ 20286 11/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1340 MINNESOTA BOULEVARD SE BENEDICT HOMES SAINT CLOUD, MN 56304 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 ASSISTED LIVING PROVIDER LICENSING Minnesota Department of Health is CORRECTION ORDER(S) documenting the State Correction Orders using federal software. Tag numbers have In accordance with Minnesota Statutes, section been assigned to Minnesota State 144G.08 to 144G.95, these correction orders are Statutes for Assisted Living Facilities. The issued pursuant to a survey. assigned tag number appears in the far left column entitled "ID Prefix Tag." The Determination of whether violations are corrected state Statute number and the requires compliance with all requirements corresponding text of the state Statute out provided at the Statute number indicated below. of compliance is listed in the "Summary When Minnesota Statute contains several items, Statement of Deficiencies" column. This failure to comply with any of the items will be column also includes the findings which considered lack of compliance. are in violation of the state requirement after the statement, "This Minnesota INITIAL COMMENTS: requirement is not met as evidenced by." Following the evaluators ' findings is the SL# 20286016 Time Period for Correction. On November 4, 2024, through November 6, PLEASE DISREGARD THE HEADING OF 2024, the Minnesota Department of Health THE FOURTH COLUMN WHICH conducted a full survey at the above provider. At STATES,"PROVIDER'S PLAN OF the time of the survey, there were 20 resident(s); CORRECTION." THIS APPLIES TO 20 receiving services under the Assisted Living FEDERAL DEFICIENCIES ONLY. THIS Facility with Dementia Care license. 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. 0 480 144G.41 Subd 1 (13) (i) (B) Minimum 0 480 SS=F requirements LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 2WCR11 If continuation sheet 1 of 4 PRINTED: 12/13/2024 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B. WING _____________________________ 20286 11/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1340 MINNESOTA BOULEVARD SE BENEDICT HOMES SAINT CLOUD, MN 56304 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 (13) offer to provide or make available at least the following services to residents: (B) food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626; and This MN Requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee failed to ensure food was prepared and served according to the Minnesota Food Code. 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 the residents). The findings include: Please refer to the document titled, Food and Beverage Establishment Inspection Report (FBEIR) dated November 4, 2024, for the specific Minnesota Food Code violations. The Inspection Report was provided to the licensee within 24 hours of the inspection. TIME PERIOD FOR CORRECTION: Please refer to the FBEIR for any compliance dates. 01620 144G.70 Subd. 2 (c-e) Initial reviews, 01620 SS=D assessments, and monitoring (c) Resident reassessment and monitoring must be conducted no more than 14 calendar days STATE FORM 6899 2WCR11 If continuation sheet 2 of 4 PRINTED: 12/13/2024 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B. WING _____________________________ 20286 11/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1340 MINNESOTA BOULEVARD SE BENEDICT HOMES SAINT CLOUD, MN 56304 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) 01620 Continued From page 2 01620 after initiation of services. Ongoing resident reassessment and monitoring must be conducted as needed based on changes in the needs of the resident and cannot exceed 90 calendar days from the last date of the assessment. (d) For residents only receiving assisted living services specified in section 144G.08, subdivision 9, clauses (1) to (5), the facility shall complete an individualized initial review of the resident's needs and preferences. The initial review must be completed within 30 calendar days of the start of services.

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. The 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. An equal opportunity employer. Letter ID: IS7N REVISED 09/13/2021 Benedict Homes December 7, 2023 Page 2 The correction order documentation should include the following: Identify how the area(s) of noncompliance was corrected related to the resident(s)/employee(s) identified in the correction order. Identify how the area(s) of noncompliance was corrected for all of the provider’s resident(s)/employees that may be affected by the noncompliance. Identify what changes to your systems and practices were made to ensure compliance with the specific statute(s). 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 the MDH within 15 calendar days of the correction order receipt date. A state correction order under Minn. Stat. § 144G.91, Subd. 8, Free from Maltreatment is associated with a maltreatment determination by the Office of Health Facility Complaints. If maltreatment is substantiated, you will receive a separate letter with the reconsideration process under Minn. Stat. § 626.557. To submit a reconsideration request, please visit: https://www.web.health.state.mn.us/form/HRD-Appeals-Form 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, Kelly Thorson, Supervisor State Evaluation Team Email: k elly.thorson@state.mn.us Telephone: 3 20-223-7336 Fax:1-866-890-9290 HHH PRINTED: 12/07/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B. WING _____________________________ 20286 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1340 MINNESOTA BOULEVARD SE BENEDICT HOMES SAINT CLOUD, MN 56304 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 Licensing ASSISTED LIVING PROVIDER LICENSING Correction Orders using federal software. CORRECTION ORDER(S) Tag numbers have been assigned to Minnesota State Statutes for Home Care In accordance with Minnesota Statutes, section Providers. The assigned tag number 144G.08 to 144G.95, these correction orders are appears in the far-left column entitled "ID issued pursuant to a survey. Prefix Tag." The state Statute number and the corresponding text of the state Statute Determination of whether violations are corrected out of compliance is listed in the requires compliance with all requirements "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. SL20286015 PLEASE DISREGARD THE HEADING OF On November 6, 2023, through November 8, THE FOURTH COLUMN WHICH 2023, the Minnesota Department of Health STATES,"PROVIDER'S PLAN OF conducted a survey at the above provider, and CORRECTION." THIS APPLIES TO the following correction orders are issued. At the FEDERAL DEFICIENCIES ONLY. THIS time of the survey, there were 14 residents WILL APPEAR ON EACH PAGE. receiving services under the Assisted Living with Dementia license. 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 144A.474 SUBDIVISION 11 (b)(1)(2). 0 480 144G.41 Subd 1 (13) (i) (B) Minimum 0 480 SS=F requirements LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 4XSP11 If continuation sheet 1 of 20 PRINTED: 12/07/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B. WING _____________________________ 20286 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1340 MINNESOTA BOULEVARD SE BENEDICT HOMES SAINT CLOUD, MN 56304 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 (13) offer to provide or make available at least the following services to residents: (B) food must be prepared and served according to the Minnesota Food Code, Minnesota Rules, chapter 4626; and This MN Requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee failed to ensure food was prepared and served according to the Minnesota Food Code. 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, but was not likely to cause serious injury, impairment, or death), and was issued at a widespread scope (when problems are pervasive or represent a systemic failure that has affected or has potential to affect a large portion or all of the residents). The findings include: Please refer to the document titled, Food and Beverage Establishment Inspection Report (FBEIR) dated November 6, 2023, for the specific Minnesota Food Code violations. The Inspection Report was provided to the licensee within 24 hours of the inspection. TIME PERIOD FOR CORRECTION: Please refer to the FBEIR for any compliance dates. 0 485 144G.41 Subdivision 1. (13)(i)(A)and(C) Minimum 0 485 SS=C Requirements (13) offer to provide or make available at least the STATE FORM 6899 4XSP11 If continuation sheet 2 of 20 PRINTED: 12/07/2023 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ B. WING _____________________________ 20286 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1340 MINNESOTA BOULEVARD SE BENEDICT HOMES SAINT CLOUD, MN 56304 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) 0 485 Continued From page 2 0 485 following services to residents: (i) at least three nutritious meals daily with snacks available seven days per week, according to the recommended dietary allowances in the United States Department of Agriculture (USDA) guidelines, including seasonal fresh fruit and fresh vegetables. The following apply: (A) menus must be prepared at least one week in advance and made available to all residents. The facility must encourage residents' involvement in menu planning. Meal substitutions must be of similar nutritional value if a resident refuses a food that is served.