Ecumen Prairie Hill.

correction orders and document the actions taken to comply in the facility's records .The Department reserves the right to return to the facility at any time should the Department receive a complaint or deem it necessar yto ensure the health, safety, and welfare of residents in your care. STATE CORRECTIO ONRDERS The enclosed State Form documents the state correction orders. MDH documents state licensing correction orders using federal software. Tag numbers are assigned to Minnesota state statutes for Assisted Living Facilities .The assigned tag number appears in the far left column entitled "ID Prefix Tag". The state statute number and the corresponding text of the state statute out of compliance are listed in the "Summary Statement of Deficiencies "column. This column also includes the findings that are in violation of the state statute after the statement, "This MN Requiremen tis not met as evidenced by . . ." IMPOSITION OF FINES In accordance with Minn. Stat. § 144G3. 1, Subd .4, fines and enforcement actions may be imposed based on the level and scope of the violations and may be imposed immediately with no opportunity to correct the violation first as follows: Leve l1: no fines or enforcement; Leve l2: a fine of $500 per violation, in addition to any enforcement mechanism authorized in § 144G2. 0; Leve l3: a fine of $1,000 per incident, in addition to any enforcement mechanism authorized in § 144G2. 0; An equal opportunity employer . Letter ID: IS7N REVISE 0D9/13/2021 Ecumen Prairie Hill October 17, 2025 Page 2 Leve l4: a fine of $3,000 per incident, in addition to any enforcement mechanism authorized in § 144G2. 0; Leve l5: a fine of $5,000 per violation, in addition to any enforcement mechanism authorized in § 144G2. 0. Therefore ,in accordance with Minn. Stat. §§ 144G0. 1 to 144G9. 999, the following fines are assessed pursuant to this survey: St - 0 - 0775 - 144g.45 Subd. 2. (a) - Fire Protection And Physica lEnvironment - $500.00 Therefore ,in accordance with Minn. Stat. §§ 144G0. 1 to 144G9. 999, the total amount you are assesse dis $500.00. You will be invoiced approximately 30 days after receipt of this notice, subject to . appeal DOCUMENTATIO ONF ACTION TO COMPLY In accordance with Minn. Stat. § 144G3. 0, Subd .5(c), t he licensee must document actions taken to comply with the correction orders within the time period outlined on the state form; however, plans of correction are not required to be submitted for approval. The correction order documentation should include the following: x Identify how the area(s) of noncompliance was corrected related to the resident(s)/ employee(s) identified in the correction order. x Identify how the area(s) of noncompliance was corrected for all of the provider’s resident(s)/ employees that may be affected by the noncompliance. x Identify what changes to your systems and practices were made to ensure compliance with the specific statute(s). CORRECTIO ONRDER RECONSIDERATI OPRNOCESS In accordance with Minn. Stat. § 144G3. 2, Subd .2, you may challenge the correction order(s) issued, including the level and scope ,and any fine assesse dthrough the correction order reconsideration process .The request for reconsideration must be in writing and received by MDH within 15 calendar days of the correction order receipt date. To submit a reconsideration request, please visit: https:/ / forms.web.health.state.mn.us/form/ HRDAppealsForm REQUESTIN AG HEARING Alternatively, in accordance with Minn. Stat. § 144G3. 1, Subd .5(d), an assisted living provider that has been assesse da fine under this subdivision has a right to a reconsideration or a hearing under this section and chapter 14. Pursuan tto Minn. Stat. § 144G2. 0, Subd .14 and Subd .18, a request for a hearing must be in writing and received by the Department of Health within 15 business days of the correction order receipt date. The request must contain a brief and plain statement describing each matter or issue contested and any new information you believe constitutes a defense or mitigating Ecumen Prairie Hill October 17, 2025 Page 3 factor. To submit a hearing request, please visit: https:/ / forms.web.health.state.mn.us/form/ HRDAppealsForm To appea lfines via reconsideration ,please follow the procedure outlined above. Please note that you may request a reconsideration or a hearing, but not both. If you wish to contest tags without fines in a reconsideration and tags with the fines at a hearing, please submit two separate appeals forms at the website listed above. The MDH Health Regulation Division (HRD )values your feedback about your experience during the survey and/or investigation process .Please fill out this anonymous provider feedback questionnaire at your convenience at this link: https:/ / forms.office.com/g/Bm5uQEpHV.a Your input is important to us and will enable MDH to improve its processe sand communication with providers. If you have any questions regarding the questionnaire ,please contact Susan Winkelmann at susanw. inkelmann@state.mn.us or call 651-201-5952. You are encouraged to retain this document for your records. It is your responsibility to share the information contained in the letter and state form with your organizations’ Governing Body. If you have any questions ,please contact me. Sincerely, Jod iJohnson ,Supervisor State Evaluation Team Email: Jodi.Johnson@state.mn.us Telephone :507-344-2730 Fax :1-866-890-9290 HHH PRINTED: 10/17/2025 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 _____________________________ 30785 09/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1305 MARSHALL STREET ECUMEN PRAIRIE HILL SAINT PETER, MN 56082 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. SL30785016-0 PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On September 22, 2025, through September 24, STATES,"PROVIDER'S PLAN OF 2025, the Minnesota Department of Health CORRECTION." THIS APPLIES TO conducted a full survey at the above provider and FEDERAL DEFICIENCIES ONLY. THIS the following correction orders are issued. At the WILL APPEAR ON EACH PAGE. time of the survey, there were 65 residents; 43 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. 0 480 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 CRH511 If continuation sheet 1 of 10 PRINTED: 10/17/2025 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 _____________________________ 30785 09/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1305 MARSHALL STREET ECUMEN PRAIRIE HILL SAINT PETER, MN 56082 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) 0 480 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.

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: The facility neglected the resident when an unlicensed caregiver left the resident standing alone without assistance to get a chair for her to sit on and she fell. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. The resident was being assisted by an unlicensed caregiver and became weak ambulating to the dining room. The caregiver left the resident’s side to retrieve a chair for her to sit on when the resident fell before staff could get her safely to the chair. There were no other staff members nearby to assist. The resident sustained a thoracic compression fracture and rib fracture. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed caregiver staff. The investigation included review of the resident record, facility internal investigation, facility incident reports, personnel files, staff schedules, related facility policy and procedures. Also, the investigator observed residents and staff interactions during a visit to the facility. The resident resided in an assisted living facility and diagnoses included a history of a previous fall, osteoarthritis, and lower extremity weakness. The resident’s service plan included assistance with personal cares and medication administration. The resident’s assessment indicated she was at high risk for falls and required a physical assistance of one staff person for transfers and ambulation. The resident was oriented and could verbalize her needs. The facility incident report indicated the unlicensed caregiver was walking the resident to the dining room when the resident lost her balance and fell. The report indicated the unlicensed caregiver stated he left the resident’s side to retrieve a chair at the time of the fall. The resident was evaluated for injury and emergency services were called. During interview, the unlicensed caregiver stated he was walking with the resident to supper using the walker and gait belt when she became tired just outside the dining room area. The caregiver stated he reached for a nearby chair when the resident fell. The caregiver stated there were no other staff nearby to assist at the time. During an interview, a facility manager stated the unlicensed caregiver re-enacted the incident. The resident was assisted by the caregiver and using a walker and gait belt per her care plan. The manager stated there were no witnesses or cameras capturing the incident. During interview, a nurse stated she interviewed the resident and the resident stated that the caregiver asked if she could stand a minute and then left. The resident did not know the caregiver was retrieving a chair for her at the time. During interview, a family member stated the resident did sustain injury with the fall. The family member was pleased with the care the facility provided. 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 out of the building at the time of the visit. Family/Responsible Party interviewed: Yes. Alleged Perpetrator interviewed: Yes. Action taken by facility: The facility investigated the incident and was re-evaluated by physical therapy. Action taken by the Minnesota Department of Health: No 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: 11/12/2024 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 _____________________________ 30785 09/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1305 MARSHALL STREET ECUMEN PRAIRIE HILL SAINT PETER, MN 56082 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 30, 2024, the Minnesota Department of Health initiated an investigation of complaint #HL307856563C/#HL307854981M. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 PFGU11 If continuation sheet 1 of 1

Finding: Substantiated, facility responsibility Nature of Visit: 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 a resident when they failed to follow-up and implement recommendations to heal the residents pressure ulcers. The facility failed to complete consistent skin checks, did not complete cares as assessed, and failed to address the residents’ individual needs. The resident acquired a pressure ulcer. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was substantiated. The facility was responsible for the maltreatment. The facility failed to have a system in place to ensure recommendations to promote healing and prevent further pressure ulcers were followed up on and implemented. The resident developed a pressure ulcer. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigation included review of medical records, facility incidents, consultant reports/recommendations, policies, and procedures related to resident bill An equal opportunity employer. of rights, plan of care, maltreatment of vulnerable adults. Also, the investigator observed staff/resident interactions. The resident lived in an assisted living facility. The resident’s diagnoses included multiple sclerosis. The resident’s service plan included assistance with bathing, toileting, repositioning, and transfers. The resident’s assessment indicated the resident was confined to his bed and/or wheelchair and was dependent on staff for all transfers. The resident was admitted to the facility with a pressure ulcer. The facility obtained outside skilled nursing to provide the residents wound care. The facility nurse also requested orders for a pressure relieving mattress, a catheter, and a urology appointment. An internal investigation document indicated the nurse reached out multiple times for the mattress, catheter, and urology appointment until the resident’s pressure ulcer healed. The nurse left employment at the facility and there was no system in place for follow up on the recommended mattress, catheter, or urology appointment. The investigation indicated about two and a half months later, a second nurse observed a pressure ulcer on the resident’s bottom. During an interview the second nurse stated she was not aware the resident did not want to reposition or transfer out of his bed. The nurse stated there were no interventions written into the service plan for staff to address non-compliance, so staff documented the resident refused assistance or write nothing at all. The nurse stated she covered six additional facility’s and did not review service completion or monitor wounds as part of her job duties. During investigative interviews, multiple staff members stated the resident was very pleasant about his refusals and would tell staff he did not want to trouble staff with having to change his wet linens or use a lift to transfer him out of bed. During an interview, the resident stated the pressure ulcer was in the same spot as the original pressure ulcer and reopened. The resident stated a facility nurse tried to place a catheter, but it was too uncomfortable, so they took it out. The resident stated the facility wanted him to go to a urologist to place the catheter, but he would have to rent a handicapped transportation vehicle. The resident stated the facility did not follow through and get him a different mattress. The resident stated he made sure to get out of bed at least every other day. The resident stated there was a lot of staff turnover, and they did not know how to work with him until they got to know him. The resident stated some staff were good, but he was moving to another facility. In conclusion, neglect is substantiated. Substantiated: Minnesota Statutes, section 626.5572, Subdivision 19. “Substantiated” means a preponderance of evidence shows that an act that meets the definition of maltreatment occurred. 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: Yes Family/Responsible Party interviewed: No, per resident. Alleged Perpetrator interviewed: Not Applicable Action taken by facility: The facility started weekly skin checks for all residents. The facility started having the nurse assess/document any skin concerns for all residents. The facility put behavior interventions in the service plan for resident refusal of cares. The facility began using a wound rounding form and checklist. The facility began documenting/reviewing all pending referrals, appointments, and equipment needs for all seven facilities in morning stand-up meeting with administration. Action taken by the Minnesota Department of Health: The responsible party will be notified of their right to appeal the maltreatment finding. The facility was found to be in noncompliance. To view a copy of the Statement of Deficiencies and/or correction orders, please visit: https://www.health.state.mn.us/facilities/regulation/directory/provcompselect.html If you are viewing this report on the MDH website, please see the attached Statement of Deficiencies. You may also call 651-201-4200 to receive a copy via mail or email. cc: The Office of Ombudsman for Long Term Care The Office of Ombudsman for Mental Health and Developmental Disabilities Dakota County Attorney Rosemount City Attorney Rosemount Police Department PRINTED: 02/16/2024 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ R-C B. WING _____________________________ 27389 01/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 12591 SHANNON PARKWAY BEACON HOME OF ROSEMOUNT ROSEMOUNT, MN 55068 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 January 9, 2023, the Minnesota Department of Health conducted a licensing order follow-up related to correction orders issued for complaint #HL273895311C/ #HL273898147M and #HL273892279C/ #HL273896564M. The following correction orders are re-issued for #HL273895311C/ #HL273898147M and #HL273892279C/ #HL273896564M, tag identification 0250, 0470, 1290, and 2310. Complaint investigation: #HL273897682C/#HL273899725M On January 9, 2023, the Minnesota Department of Health also conducted a complaint investigation #HL273897682C/#HL273899725M, at the above provider, and the following correction order is issued. At the time of the complaint investigation, there were 6 residents receiving services under the provider's Assisted Living license. The following correction order is issued for #HL273897682C/#HL273899725M, tag identification 2310 and 2360. {0 250} 144G.20 Subdivision 1 Conditions {0 250} SS=I (a) The commissioner may refuse to grant a provisional license, refuse to grant a license as a result of a change in ownership, refuse to renew a license, suspend or revoke a license, or impose a conditional license if the owner, controlling individual, or employee of an assisted living facility: (1) is in violation of, or during the term of the license has violated, any of the requirements in this chapter or adopted rules; LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 364G12 If continuation sheet 1 of 19 PRINTED: 02/16/2024 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ R-C 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 provide supervision and medical care to the resident after the resident fell and lodged an arm between her mattress and a side rail attached to her bed. The resident was found unresponsive and sent to the hospital where she later died. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was not substantiated. The facility staff followed the resident’s plan of care and called for emergency medical care when the staff found the resident. The resident was independent and required minimal services. The resident had the pendant call button attached to her but never pressed the button to call for help. Staff found stool on the bathroom floor, which was unusual because the resident had been continent. It was likely the resident suffered from an unforeseen medical event that prevented her from pressing her call pendant. 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, hospital records, facility internal investigation, facility incident report, personnel files, staff schedules, and related facility policies and procedures. Also, the investigator toured the facility and observed resident safety checks, medication administration, and a meal. The resident resided in an assisted living facility The resident’s diagnoses included a recent urinary tract infection, fainting, and cardiac pacemaker. The resident’s service plan included safety checks once per day, assistance with bathing, and two meals per day. The resident was independent with walking with her walker, using the bathroom and able to use her call pendant to make her needs known. According to the internal investigation, unlicensed personnel (ULP)-2 found the resident on her apartment floor with one arm lodged between the mattress and her approved siderail. The resident was breathing but unresponsive. Staff called emergency services and the resident went to the hospital. The resident’s only scheduled service that day was a safety check scheduled at 9:00 a.m. Unlicensed personnel (ULP)-1 observed the resident in the hallway around 8:00 a.m. Per dining staff, the resident does not come to the dining room for breakfast; she usually attended lunch and dinner. ULP-2 checked on the resident after she failed to attend dinner and found her on the floor next to her bed. The hospital staff initiated life saving measures but were unsuccessful. During an interview, a nurse said the ULP checked on the resident after failing to attend supper. Staff reported the resident’s pendant light was attached to her, but the resident never called for help. The resident’s services included two meals per day, lunch and supper, assistance with bathing once weekly, and one safety check at 9:00 a.m., hence why the 9:00 a.m. safety check was her only scheduled service that day. During an interview, ULP-1 said she saw the resident outside her apartment door around 8:00 a.m. She said the only service the resident received that day was a 9:00 a.m. safety check. That was only time ULP-1 observed the resident. During an interview, ULP-2 said after the resident failed to attend supper, she checked on her and found the resident laying on the floor with her arm wedged between the mattress and the floor. They called emergency medical assistance immediately. She said the resident was breathing at the time but was unresponsive. According to the resident’s pendant push log, the resident’s pendant light was not activated on the day of the incident. According to the hospital record, the facility staff found the resident on the floor, unresponsive. She had a heartbeat and was breathing. Her arm was lodged between the bed and siderail. The resident was incontinent of stool. Staff reported seeing stool on the bathroom floor in her apartment. The resident was in respiratory failure upon hospital arrival and went into cardiac arrest. Life saving measures were unsuccessful. According to the resident’s death record, the resident died of natural causes. 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, family member never returned interview request. Alleged Perpetrator interviewed: Not Applicable. Action taken by facility: The facility conducted an internal investigation and provided education to all staff. The facility implemented a protocol for dining room staff to alert nursing staff when a resident does not attend a meal. 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: 08/13/2024 FORM APPROVED STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. BUILDING: ______________________ C B. WING _____________________________ 30785 07/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 1305 MARSHALL STREET ECUMEN PRAIRIE HILL SAINT PETER, MN 56082 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 July 18, 2024, the Minnesota Department of Health initiated an investigation of complaint HL307859612C/ HL307851900M, HL307854227C/ HL307853781M. No correction orders are issued. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE STATE FORM 6899 YE4511 If continuation sheet 1 of 1