Minnesota Department of Human Services

April 3, 2013

Douglas Breiland, Program Director

Arrowhead House

16 S 18th Ave. E

Duluth, MN 55812

License Number: 800121 (IRTS)

Licensing Investigation Report Number: 20130160


Dear Mr. Breiland:

Arrowhead House, located at 16 S 18th Ave. E, Duluth, MN 55812, is licensed under the variance governing the provision of adult intensive residential treatment services (IRTS) under Minnesota Rules, parts 9520.0500 through 9520.0670, (Rule 36). As a result of information obtained during an investigation into report numbered 20130160, regarding an incident that occurred on January 11, 2013 a Correction Order is being issued.

A. Reason for Correction Order

Pursuant to Minnesota Statutes, section 245A.06, if the Commissioner of the Department of Human Services (DHS) finds that an applicant or license holder has failed to comply with an applicable law or rule and this failure does not imminently endanger the health, safety, or rights of the persons served by the program, the Commissioner may issue a Correction Order to the applicant or license holder.

The following violation(s) of state or federal laws and rules were determined as a result of the licensing complaint investigation. Corrective action for each violation is required by Minnesota Statutes, section 245A.06 and is hereby ordered by the Commissioner of Human Services.

Citation: Minnesota Variance, part R36V.12, subdivision 1, paragraphs (j) and (k).

Violation: On January 11, 2012 recipient numbered 1 (R1) became fearful and felt attacked when s/he discussed cancelling a dietician appointment scheduled for that day. According to both written and verbal reports, a staff person with management responsibility (SP1) raised her/his voice when telling R1 s/he could not cancel the appointment. R1 became upset, began crying, and ran out of the building. Feelings of frustration and anxiety continued throughout the weekend, as R1 was fearful that s/he would be “kicked out” of the program and sent back to jail.

During an investigative interview conducted on April 1, 2013 SP1 informed a DHS licensor, that s/he was “not ok” with R1’s plan to cancel the appointment and go to the mall instead. SP1 stated it is possible that recipients and staff could easily perceive her/him as abrupt. SP1 also stated s/he has “a bit of a booming voice.” Information obtained during the investigation indicates that SP1 struggles with anger management at times and can be perceived as being volatile.

R1’s diagnosis includes Post Traumatic Stress Disorder and Anxiety and s/he suffers from low self-worth/esteem. Staff responsibilities identified in R1’s individual abuse prevention plan included assisting R1 with conflict resolution. One of R1’s treatment goals was to learn assertiveness, stress management and coping skills.

Investigative interviews conducted and documents reviewed identify that the license holder failed to ensure that R1 was treated with respect and courtesy and to permit R1 to refuse treatment. The license holder also failed to document, in R1’s recipient file, the circumstances surrounding the conversation had between R1 and SP1 on January 11, 2013 in such a way as to describe that R1 was informed of the likely impact of refusing treatment.

Corrective Action Ordered: Immediately and on an ongoing basis, the license holder must comply with all applicable recipient rights requirements.

If you fail to correct the violations specified in the Correction Order within the prescribed time lines the Commissioner may issue an Order of Conditional License or may impose a fine and order other licensing sanctions pursuant to Minnesota Statutes, sections 245A.06 and 245A.07.

Submissions required as part of a corrective action ordered must be sent to your Licensor at:

Commissioner, Department of Human Services

ATTN: Molly Schwanz

Licensing Division

PO Box 64242

St. Paul, MN 55164-0242

B. Recommendation

The following recommendation is not a requirement of Minnesota Rules or laws governing your services or facility. This recommendation is provided to call your attention to an area where your facility is in minimum compliance with the requirements of rules or laws, but it would be advisable to strengthen your efforts in this area.

Verbal reports identify there is a significant amount of upheaval within the program currently, as changes in the management structure and general programming are taking place. Staff report feelings of having their concerns dismissed by management and of being publicly chastised when they do something wrong. It is strongly recommended that the license holder contact Michael Landgren, DHS Adult Mental Health Division, to gain assistance in ensuring a positive and supportive atmosphere for all recipients and staff.

Failure to follow this recommendation will not result in a fine or action against your license at this time. However, should failure to follow recommendations result in a violation of rules or laws at a future date, you will be cited for noncompliance and may be subject to fines or action against your license.

C. Right to Request Reconsideration

If you believe any of the citations are in error, you have the right to request that the Commissioner of Human Services reconsider the parts of the Correction Order that you believe to be in error. The request for reconsideration must be in writing and received by the Commissioner within 20 calendar days after receipt of this report. Your request for reconsideration must be sent to:

Commissioner, Department of Human Services

ATTN: Legal Unit

Licensing Division

PO Box 64242

St. Paul, MN 55164-0242

Please note that a request for reconsideration does not stay any provisions or requirements of the Correction Order. The Commissioner’s disposition of a request for reconsideration is final and not subject to appeal under Minnesota Statutes, chapter 14.

If you have any questions regarding this Correction Order, please contact me as soon as possible.

Molly Schwanz, Human Services Senior Licensor

Licensing Division

Office of Inspector General


cc: Ann Busche, St. Louis County Social Service Director

PO Box 64242 • Saint Paul, Minnesota • 55164-0242 • An Equal Opportunity and Veteran Friendly Employer