The Meadows of Wadena.

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) neglected the resident when she failed to provide services as directed by the service plan. The AP only checked on the resident once during her shift instead of every two hours and the resident did not receive prescribed pain medication. The resident experienced excruciating pain. Investigative Findings and Conclusion: The Minnesota Department of Health determined neglect was inconclusive. The resident had scheduled services including turning and repositioning, toileting, and oral cares, that the AP did not perform. The AP documented they had been completed but camera footage did not show the AP performing the scheduled services. There was not a preponderance of evidence neglect occurred as it was unable to be determined when the resident’s pain started. The prescribed medication was not scheduled, only to be given PRN and it was unable to be determined if the AP would have administered a PRN medication during her shift. The investigator conducted interviews with facility staff members, including administrative staff, nursing staff, and unlicensed staff. The investigator contacted hospice. The investigation included review of the resident record, facility internal investigation, facility incident reports, personnel files, staff schedules, and related facility policy and procedures. Also, the investigator observed medication administration at the facility. The resident resided in an assisted living memory care unit. The resident’s diagnoses included hypertension (high blood pressure) and heart failure. The resident’s service plan included assistance with activities of daily living and medication administration. The resident’s assessment completed a few hours before the AP’s shift started, indicated the resident had a change in condition and was now bed bound due to his decline. The resident depended on staff to perform all cares and had cognitive impairment. The resident was also receiving hospice services. The resident’s record indicated he was receiving end of life care and a few hours before the AP’s shift started, it was noted the resident had a change in condition. The registered nurse (RN) noted he had increased knee pain, difficulty transferring, and was expected to remain bed bound due to his decline. The RN updated the hospice nurse about his change in condition and increased pain. The resident’s PRN oxycodone pain medication was changed by the hospice nurse to be given every two hours instead of every four hours. The resident had several scheduled services overnight. Staff were to check and change his incontinence product every two hours, perform oral care every two hours, position and reposition every two hours, and complete a safety check every two hours. Instructions for the safety check included to check on the resident to make sure they were safe and their needs were met and to provide assistance if needed. The AP documented that services had been completed at 11:00 p.m., midnight, 1:00 a.m., 2:00 a.m., 3:00 a.m., 4:00 a.m., and 5:00 a.m. Progress notes indicated the RN was notified at 6:50 a.m. by day shift staff who reported the resident had ten out of ten pain. The RN looked at the resident’s medication administration record (MAR) and noted he had not received PRN pain medication for ten hours. Hospice was notified after two PRN medications were not effective and new orders for increased pain medications were given. By 1:00 p.m., the resident’s pain decreased to a five out of ten. Facility staff continued updating hospice and administering additional PRN pain medications. The resident passed away the next day. During an interview, the AP stated when she came onto the overnight shift, the evening shift did not communicate anything related to changes with the resident or anything about giving additional PRN medications. The AP stated she had worked several days in a row and had not been feeling well that night. The AP stated she and a ULP from the assisted living side changed the resident and offered him morphine at that time but the resident declined. The AP stated the other ULP checked on the resident for her when she was on a break. During an interview, the ULP who worked the overnight shift on the assisted living side that night stated she came over to memory care to help the AP provide cares if a resident needed an assist of two staff. The ULP stated she came over to memory care twice that shift, and they changed the resident’s brief once around the middle part of their shift and checked his brief and it was dry towards the end of the shift. The ULP stated she knew the resident was on end-of-life care but wasn’t sure how often he had services scheduled as she was not assigned to work on that side. The ULP did not indicate the resident was in pain during their interactions with the resident that evening. During an interview, the RN stated the resident began to decline and have a change in condition a few hours before the AP’s shift started. The RN stated she requested for hospice to schedule the PRN medications so they could ensure his pain was managed, but it was not hospice’s policy to have the medication scheduled as it had to be given PRN first. The RN stated she sent a communication out to staff, including the AP, that informed them of the change in his condition and with his PRN medications and that staff should anticipate pain and administer the PRN medications when they checked on the resident. The RN stated the AP should have followed that guidance and if there were questions, she was trained to contact the RN. The RN stated after reviewing camera footage, it was confirmed the AP only entered the resident’s room once on her shift and spent seven minutes in his room, despite documenting she performed all scheduled services. In conclusion, the Minnesota Department of Health determined neglect 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. 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: Yes Alleged Perpetrator interviewed: Yes Action taken by facility: When the resident had uncontrolled pain, management investigated what medications he had been given. Upon discovering he hadn’t been given PRN medications for several hours, they reviewed security camera footage and only observed the AP entering the room once. The AP was terminated and a MAARC report was filed. Facility staff were retrained. 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: 04/ 08/ 2026 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 _____________________________ 33310 03/ 20/ 2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 110 HEMLOCK AVENUE NW THE MEADOWS OF WADENA WADENA, MN 56482 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 March 20, 2026, the Minnesota Department of Health initiated an investigation of complaint #HL333101740M/ #HL333106762C No correction orders are issued. LABORATORY DIRECTOR' S OR PROVIDER/ SUPPLIER REPRESENTATIVE' S SIGNATURE TITLE (X6) DATE STATE FORM 6899 FFKO11 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 CORRECTIO NORDERS 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 t he violati ons ; however, no immediate fines are assessed for this survey of your facility. DOCUMENTATIO ONF ACTION TO COMPLY In accorda nce with Min n. Stat. § 144G.30, Sub d. 5(c), th e lic ens ee mus t docum ent ac tions taken t o 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 REVISE D09/13/2021 The Meadows of Wadena March 24, 2026 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). CORRECTIO NORDER RECONSIDERATIO PNROCESS 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 conv enien ce at thi s link: https: / / forms. office.com/ g/ Bm5uQEpHVa. Your inpu t is import ant 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, Jess Schoenecker, Supervisor State Evaluation Team Email: Jess.Schoenecker@state. mn.us Telephone: 651-201-3789 Fax: 1-866-890-9290 CLN PRINTED: 03/ 24/ 2026 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 _____________________________ 33310 02/ 20/ 2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 110 HEMLOCK AVENUE NW THE MEADOWS OF WADENA WADENA, MN 56482 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( 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. " The issued pursuant to a survey. 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. SL33310016- 0 PLEASE DISREGARD THE HEADING OF THE FOURTH COLUMN WHICH On February 17, 2026, through February 20, STATES, "PROVIDER' S PLAN OF 2026, 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 40 residents; 40 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 P2RO11 If continuation sheet 1 of 19 PRINTED: 03/ 24/ 2026 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 _____________________________ 33310 02/ 20/ 2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE 110 HEMLOCK AVENUE NW THE MEADOWS OF WADENA WADENA, MN 56482 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 P2RO11 If continuation sheet 2 of 19 PRINTED: 03/ 24/ 2026 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.