Uniform Disclosure of Assisted Living Services & Amenities(UDALSA)This is a required document per 144G.40 Subd. 2 (www.revisor.mn.gov/statutes/cite/144G.40) of all assisted
living facilities to describe the services, supports, and amenities available at the assisted living facility.
Prospective residents and their families can use this tool to determine if the assisted living facility can meettheir needs, allow them to compare options among various settings, and make informed decisions about
selecting an assisted living facility setting. The information presented here may be important for a resident’s
ability to age in place. Assisted living facilities are not required to provide all the services listed, and available
services are subject to change. The facility will indicate which services are provided and any limitations thatmay pertain to the service.
You are also encouraged to tour facilities, talk with other residents, residents’ family members, or meet oneon-one with facility staff during the selection process. The disclosure checklist is not a substitute for theassisted living contract, which is a separate document that will include the specific services to be provided tothe individual resident and the fees per services.

General Information

This information is current as of (MM/DD/YYYY): 02/20/2024
Name of Assisted Living: Three Links Health Services
HFID: 30702
Unique building/unit description (if applicable): Reflections Care Suites
Facility Address: 809 Forest Ave, Northfield MN 55057
If services are provided at more than one building (on the assisted living campus), please list all locations
below.
 No additional buildings
Additional Building:
Building Name (if applicable): Cottages on Forest - HFID: 26073
Physical Address (if different than above): 811 Forest Ave. Northfield MN 55057
Additional Building:
Building Name (if applicable): Cottages West - HFID 20342
Physical Address (if different than above): 804 5th St. West, Northfield MN 55057
Additional Building:
Building Name (if applicable): Cottages East - HFID: 20137
Physical Address (if different than above): 802 5th St. West, Northfiled MN 55057
Facility/Campus listed above has the following license; Check one:1

UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA) Assisted Living Facility License Assisted Living Facility with Dementia Care License
Availability of Unlicensed Staff (ULP); check one:
 Unlicensed staff are in the building and available to respond to resident requests 24/7
 Unlicensed staff may either be in the building, in an attached building, or within the campus and available
to respond to resident requests 24/7
Availability of Licensed (RN/LPN) Staff (in addition to an RN who is required to be accessible to the staff 24/7);
check one if applicable: Licensed staff are on site 24/7
 Licensed staff are either in the building, an attached building, or within the campus and available torespond to resident requests 24/7
Number of unlicensed direct care staff typically scheduled per shift:
Day Shift: 1Evening Shift: 1
Night shift: 1

Payment Options
The facility will indicate by placing an “X” in the “Accepted” column if the payment option is accepted (maycheck more than one). The facility may indicate in the “Comments” column if a pre-determined length ofprivate funds payment source is required before acceptance of Medicaid or waivered service funds as well as
the number of months required.

Payment Options for Housing Contract
Payment Option
Private Pay

AcceptedX

Sliding Scale
Housing Support (formerly Minnesota
Group Residential Housing) Payments

X

Federal rent subsidy
Other; explain:

2Comments

UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

Payment Options for Services
Payment Option

Accepted

Waivered Services (EW, CADI, BI); specify
any limitations

X

Private Pay

XLong Term Care Insurance

X

Comments

Other; explain:

Services and Amenities Available
Below is a list of services that are available to assisted living residents. The facility will indicate by placing a“yes” or “X” in the “Available” column if the service is provided or available at/on the campus/unit of thelocation listed above. If the “Available” column is blank, the facility does not provide that service.

Section 1: Dementia Care
Pertains only to facilities with an Assisted Living with Dementia Care license
Check each service available at the location(s) listed above.

Dementia Care Services Available
ServiceAvailable

Secured unit or building for wandering or
exit-seeking behavior
Secured outdoor grounds on facilitypremises

X

Individualized digital/alarm monitoring forwandering or exit-seeking behavior
Prepared to manage challenging behaviors
Other; specify:

3Comments

UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

Section 2: Medication Management
Check each service available at the location(s) listed above.

Medication Management Services Available
Service

Available

Verbal or visual reminders to take regularlyscheduled medications; specify any limit tofrequency in comments

X

Communication with physician/pharmacy
about ordering or refill requests

XMedication administration by licensed or
unlicensed personnel

X

Delivery of medication to resident
previously set up by the facility nurse

XMedications set up by nurse for resident toself-administer
Delivery of medication from the originalcontainers to resident

X

Delivery of liquid or food to resident if
required to ingest medication

X

Delegation of medication management
services by licensed health professional tounlicensed staff

X

Central storage of medication

X

Diabetic Care: insulin pen dosing

X

Diabetic Care: insulin pump management
Diabetic Care: insulin syringe dosing
Diabetic Care: sliding scale insulinmanagement
Clinical monitoring of labs related tomedications

X

Anticoagulant medication management

X

B-12 injections

4Comments

UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

Service
Nutritional supplement administration

Available

Comments
Provided by resident

X(IV) Intravenous management
PICC lines (Peripherally Inserted CentralCatheter)
Injections; specify types or limits incomments (IM, SQ)X

Nebulizers

X

Inhalers

X

Ear dropsX

Eye drops

X

TopicalsX

Patches

X

SQ

Medication delivery via enteral (feeding)tubePain pump managementMedical cannabis administration (pill form)
for certified patients
Medical Cannabis storage for certifiedpatients
Cannabidiol oil administration for certifiedpatients
Other; specify:

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UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

Section 3: Treatments & Therapies
Check each service available at the location(s) listed above.

Treatments & Therapies Available
ServiceAvailable

Verbal or visual reminders to perform
regularly scheduled treatments or exercises

X

Wound care: basicX

Comments

Wound care: complex
Diabetic care: blood glucose monitoringXDiabetic care: foot/nail careX

C-PAPX

Bi-PAPX

Oxygen Management; specify any delivery
system limitations

X

Oxygen saturation checks

XØ Liquid O2Ventilators
Suctioning
Tracheostomy Care: cleaning of site andtube
Tracheostomy Care: showering assistanceTracheostomy Care: suctioning assistance
Pacemaker Checks

X

Arrange for On-Site Dialysis
Arrange for/set-up Off-Site Dialysis

X
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UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

Service

Available

Comments

Peritoneal Dialysis (on-site)
Compression stockings

X

Lymphedema wrapsFall Prevention: balance assessments

X

Fall Prevention: exercise programs

X

Fall Prevention: strength training

X

PT/OT
PT/OT

PT/OT

Integrative Health Services: acupuncture
Integrative Health Services: aromatherapy

X

Integrative Health Services: healing touch
Integrative Health Services: massage
Blood pressure checks

X

Daily weight checkX

Indwelling urinary catheter care; emptyingand bag changes

X

Indwelling urinary catheter replacement bynurse
Straight (intermittent) catheter assistance
Suprapubic catheter care

X

Ostomy care

X

Arrangements for and coordination withhospice careX

End-of-life palliative care

X7

UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

ServiceAvailable

Comments

Access to and training on use of automaticelectronic defibrillators (AED)
Training of and use of Cardiopulmonary
Resuscitation (CPR)
Other; specify:

Section 4: Assistance with Activities of Daily Living
Check each service available at the location(s) listed above.

Assistance with Daily Living Activities Available
Service

Available

Dressing

X

Bathing: shower

X

Bathing: bathtub

X

Oral hygiene

X

Denture care

X

Cuing/reminders for self-caresX

Use of special utensils

X

Feeding assistance for residents withcomplicated eating problems

X

Set-up and cut food at meals

X

Manual Feeding; specify limits in comments

X

Provided by resident

Tube Feeding; specify limits in comments
Feeding in common area with one staff
member per resident

Comments

X

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UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

Service

Available

Comments

Feeding in resident’s apartment with one
staff member per resident
Grooming: hair care, make-up, shaving,
application of lotion, etc.

X

Nail care: toenails, fingernails

X

Toileting: standby assistance/supervision

X

Changing incontinence products; perinealcare

X

Ordering replacement incontinence
products

XAssistance with bowel and bladder control,devices, and training programs
Other; specify:

Section 5: Mobility Support
Check each service available at the location(s) listed above.

Mobility Services Available
Service

Available

Standby Assistance

X

Transfers with assist of one staff

X

Transfers with assist of two staff

X

Transfers utilizing sit-to-stand lifts

X

Transfers utilizing sliding boards

X

Transfers utilizing bariatric equipment
Ceiling lift transfers9Comments

UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

ServiceAvailable

Non-mechanical transfers (trapeze)

Comments

X

Mechanical lift: assist of 1 transfer
Mechanical lift: assist of 2 transfer

X

Ambulation with assist of 1X

Bed mobility

X

Assistance with chair mobility

X

Chair Glide System
Mechanical Stair Lift System
Handrails; in personal space

X

Elevators
Other; specify:

Section 6: Security & Monitoring
Check each service/option available at the location(s) listed above.

Security and Monitoring Services
ServiceAvailable

Every 15-minutes safety checks

X

Every 30-minutes safety checks

X

Hourly safety checks

X

Every two-hours safety checks

X

Comments
No greater than 24 hours
No greater than 24 hours

No greater than 3 days

Than greater than 3 days

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UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

Service
Daily safety checks

Available

Comments

X

Emergency call system; specify type incomments
Non-emergency call system; specify type incomments

Reflections private bathrooms

X

Digital wander alert device on resident
Wander alert system at facility exits
Staff monitoring at facility exits; specify
method in comments
Visitor check-in/check-out at facility main
entranceX

Bed alarms or movement sensing
technology
Door sensors: specify locations (unit,resident room, exits, etc.)
Security Guard
Security cameras in common spaces
Key card/fob access: specify locations (unit,resident room, exits, etc.)
Other lock systems: specify locations (unit,resident room, exits, etc.)
Emergency generator(s) to power thefacility during power outages

Forest & Reflections

X

Other; specify:

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UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

Section 7: Dining and Nutrition
Check each service/option available at the location(s) listed above.

Dining and Nutrition Services
ServiceAvailable

Three meals available, plus snacks

Comments

Required

Breakfast available in community space

X

Breakfast available; delivered to apartment

X

Lunch available in community space

X

Lunch available; delivered to apartment

X

Dinner available in community space

X

Dinner available; delivered to apartment

X

Meal tray delivery and pick-up from resident’s unit

X

Meal preparation in resident’s unit
Thickened Liquids; specify limits in comments

XXModified Texture Diets; specify limits in comments
Therapeutic Diets: cardiac
Therapeutic Diets: diabetic or calorie controlled
Therapeutic Diets: gluten-free
Therapeutic Diets: high fiber
Therapeutic Diets: low fat/low cholesterol
Therapeutic Diets: low sodium
12If ordered by physician before 2/20/2024
Mechanical Soft Only

UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

ServiceAvailable

Comments

Therapeutic Diets: no added salt
Therapeutic Diets: renal diet
Other special diets: kosher
Other special diets: (vegetarian, vegan, etc.) specify incomments
Dietitian or Nutritionist Services
Carbohydrate intake/tracking
Meal consumption tracking

XOther; specify:

Section 8: Supportive Services
Check each service available at the location(s) listed above.

Supportive Services Available
ServiceDaily “I’m okay” checks service; specify
procedure in comments

Available

Comments

X

Assistance with meals or food preparation
Daily Social and Recreational Services

RequiredHousekeeping: bed making

X

Housekeeping: defrost and clean
refrigerator

X

Housekeeping: dustingX

Available for an additional charge
Available for an additional charge
Available for an additional charge

Housekeeping: organize closets anddrawers
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UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

Service
Housekeeping: trash removal; specify
frequency in comments
Housekeeping: weekly general cleaning(clean floors, sinks, shower/tub, toilet, andvacuum)

Available

Comments
Daily and as neededXX

1 time weekly

Housekeeping: other; specify in comments
Laundry: linen (change bed, launder sheets,towels)

X

Laundry: wash, dry, and fold clothing;specify loads per week in comments

X

Linen service

Laundry: other; specify in comments
Schedule offsite social and recreational
activities

X

Schedule medical and social service
appointments

X

Assistance with arranging transportation for Required
personal, social, and recreational activities
Assistance with arranging transportation to Required
medical and social services appointments
Provide transportation to social andrecreational activities
Provide transportation to medical and social
service appointments
Assistance accessing community resources
and social services

Required

Shopping: facility sponsoredSpiritual Care/Religious Services; on-site

X

Assistance with bill paying/budgeting
Communication boards or othersupplemental communication devicesX

Primary languages spoken by staff

X

English is primary language. We do employ bilingual staff,
not a condition of employment.

Supervision of smoking
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UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

ServiceAvailable

Comments

Other; specify:

Section 9: Staffing
Check each option available at the address location(s) listed above.

Staffing Available
Staffing

Available

Comments

One-to-One staffing available
One-to-One staffing for special
circumstances
Overnight companion
Registered Nurse: on-site “part time”
Registered Nurse: on-site “full time”

X

8a-4p M-F: based out of Forest and responds to East,West, Forest and Reflections.

X

8a-4p M-F: based out of Forest and responds to East,
West, Forest and Reflections.

X

8a-4p M-F: based out of Forest and responds to East,
West, Forest and Reflections.

Licensed Practical Nurse: on site “part time”
Licensed Practical Nurse: on-site “full time”
Assisted Living Director: on-site “part time”
Assisted Living Director: on site “full time”
Advanced Practice Registered Nurse: onsite “part time”
Advanced Practice Registered Nurse: on site“full time”
Activities Director: Part Time
Activities Director: Full TimeX

Dietician/Nutritionist consultant available
or can be arranged

X15

UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

Staffing

Available

Physical Therapist available or can bearranged

Comments
Third party provider

X

Respiratory Therapist available or can bearranged
Occupational Therapist available or can bearranged

X

Speech Language Pathologist available orcan be arranged

X

Social Worker available or can be arranged

X

Other Licensed Professional available;
specify type in commentsXThird party provider
Third party provider

On-site primary care, podiatry, audiology, dentistry

Other; specify:

Section 10: Amenities
Check each option available at the location(s) listed above.

Amenities Available
Amenity

Available

Accessible bathrooms; specify
limits in comments

X

Private units

X

Comments

Semi-private units
Studio/efficiency units
One-bedroom unitsX

Two-bedroom units
Kitchen/Kitchenettes in units
Internet access16

UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

Amenity
Cable (television)

Available
X

Comments
IncludedPets allowedPet care; specify in comments
PoolWhirlpool

X

Exercise Room
LibraryActivity RoomX

Garden/outdoor spaces

X

ChapelX

Enclosed courtyard

Private entertaining space
Communal Dining room

X

Beauty/Barber Shop

X

Parking available for residents

X

Parking available for guests

X

Guest accommodations
Laundry Room accessible toResidents
Washer-Dryer in units
Central Air Conditioning

X

Fully sprinklered building

X

Reflections & Forest

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UNIFORM DISCLOSURE OF ASSISTED LIVING SERVICES & AMENITIES (UDALSA)

Amenity

Available

Comments

Designated smoking area inside(not apartment space)
Designated smoking area outside
Other; specify:

Additional Information
Sixty days before the facility plans to reduce or eliminate the availability of one or more services, the facility
must provide written notice of the reduction. Refer to 144G.55 Subd. 1(d)(www.revisor.mn.gov/statutes/cite/144G.55).
Residents may choose to obtain services from an outside service provider at their own cost. Residents may
also obtain services from an outside service provider if the resident’s assessed needs exceed the scope ofservices the facility can provide as agreed upon in the contract and are not included in the checklist. If thisoccurs and the resident is not able to obtain services from an outside service provider, then the facility may
require the resident move to another facility or care setting that is able to meet the resident’s needs. In theevent this occurs, the facility will assist in a coordinated move of the resident to a safe and appropriate
location.
Prospective Residents need to call the Senior LinkAge Line to discuss their housing options before signing acontract with a licensed assisted living facility. The Senior LinkAge Line is available Monday through Friday
from 8am to 4:30pm at 1-800-333-2433.
You can get further information, at no cost, about advocacy or care options from:▪

Office of Ombudsman for Long Term Care (https://mn.gov/board-on-aging/direct-services/ombudsman/);1-800-657-3591▪

Office of Ombudsman for Mental Health and Developmental Disabilities (https://mn.gov/omhdd/); 1-800657-3506▪

Minnesota Directory for community resources: www.MinnesotaHelp.Info▪

Minnesota Senior LinkAge Line (www.seniorlinkageline.com/); 1-800-333-2433(Optional) By signing below, I acknowledge that I have reviewed this document.
This is NOT a contract to receive services.
______________________________________________________________

Received Date

Individual or Legal/Designated Representative

18