Minnesota Department of Human Services

May 15, 2013

Sally Mumm

Sally Mumm Adult Foster Care

1003 North Labree Ave

Thief River Falls, MN 56701

RE: Report Number 20121580

License Number 1037645 (Adult Foster Care)

CERTIFIED MAIL

DETERMINATION OF MALTREATMENT

AND ORDER TO PAY A FINE

Dear Ms. Mumm:

You are hereby notified that the Department of Human Services (DHS) has made a determination of substantiated maltreatment (neglect) of a vulnerable adult by you and the adult foster care facility located at 1003 North Labree Avenue, Thief River Falls, Minnesota. Based on the determination of substantiated maltreatment by the facility, the Commissioner of Human Services is ordering that you pay a $1,000 fine.

Under Minnesota Statutes, section 626.557, subdivision 9c, paragraph (d), when substantiated maltreatment is determined to have been committed by an individual who is also the facility license holder, both the individual and the facility must be determined responsible for the maltreatment, and the licensing actions under section 245A.07 apply.

Under Minnesota Statutes, section 13.46, subdivision 4, (b)(1)(iii), when a sanction under 245A.07 is based on a determination that the license holder is responsible for maltreatment under section 626.556 or 626.557, the identity of the license holder as the individual responsible for maltreatment is public data at the time of the issuance of the license sanction.

I. DETERMINATION OF MALTREATMENT

Allegation four: During the course of the investigation it was reported that the SP gave VA1 an antibiotic, which was prescribed for a dental ailment, for cold symptoms.

DHS investigated the allegation as maltreatment under Minnesota Statutes, section 626.557, subdivision 9c, paragraph (b), and Minnesota Statutes, section 626.5572, subdivision 15, and subdivision 17, paragraph (a):

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 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 which is not the result of an accident or therapeutic conduct.

Based on the maltreatment investigation (report number 20121580), DHS has substantiated maltreatment under allegation number four and has determined that you were responsible for the maltreatment. You are the SP in report 20121580. See the conclusion to allegation number four in report number 20121580. A copy of the Investigation Memorandum for report 20121580 is enclosed.

You have the right to request reconsideration of the determination of maltreatment where you and the facility were found responsible for the maltreatment. See Section III of this letter for your reconsideration / appeal rights.

II. ORDER TO PAY A FINE

A. Reason for the Fine

Pursuant to Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (4), the license holder shall forfeit $1,000 for each determination of maltreatment of a vulnerable adult under section 626.557. The Commissioner of Human Services is ordering that you pay a $1,000 fine based on a determination of substantiated maltreatment by the adult foster care facility.

B. Statutory Citation and Maltreatment Determination

Citation: Minnesota Statutes, section 626.5572, subdivision 17, paragraph (a).

Violation: A determination of substantiated maltreatment (neglect) of a vulnerable adult by the adult foster care facility. See the conclusion to allegation number four in report number 20121580. A copy of report number 20121580 is enclosed.

Corrective Action Taken by the Facility: The facility conducted an internal review of the allegations.

Corrective Action Ordered by DHS: No additional corrective actions are being ordered by DHS.

Fine: $1,000 ($1,000 for each determination of maltreatment – one determination)

C. Total Fine to be paid: $1,000

D. Billing and Payment of the Fine

DHS will send you an invoice for the $1,000 fine. Payment must be made as directed on the invoice.

A timely request for a contested case hearing under Section III item A or C shall stay the payment of the fine until the Commissioner issues a final order. If you decide to exercise your right to a contested case hearing, do not pay the fine. Following the contested case hearing, the Commissioner will issue a final order on this matter.

Under Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (5), when a fine has been assessed, the license holder may not avoid payment by closing, selling, or otherwise transferring the licensed program to a third party. In such an event, the license holder will be personally liable for payment. In the case of a corporation, each controlling individual is personally and jointly liable for payment.

E. Right to Request a Contested Case Hearing to Appeal the Fine

You have the right to request a contested case hearing to appeal the fine under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. See Section III of this letter for your right to appeal the fine.

III. RECONSIDERATION OF THE MALTREATMENT DETERMINATION; APPEAL OF THE ORDER TO FORFEIT A FINE

A. Right to Request a Contested Case Hearing to Appeal the Fine and Maltreatment Determination

You have the right to request a contested case hearing under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612 to appeal the fine and maltreatment determination. If you choose to exercise this right, your request must be made in writing by certified mail or personal service. If mailed, the appeal must be postmarked and sent to the Commissioner within 15 calendar days after you receive this order. If a request is made by personal service, it must be received by the Commissioner within 15 calendar days after you receive this order.

Your request for a contested case hearing must be sent to:

Commissioner, Department of Human Services

ATTN: Legal Unit

c/o Licensing Division

PO Box 64242

St. Paul, MN 55164-0242

B. Reconsideration of only the Maltreatment Determination

You have the right to request reconsideration of the determination of maltreatment where you and the facility were found responsible for the maltreatment. If you choose to exercise this right, your request must be submitted in writing within 15 calendar days after you receive this notice. In your request, you must identify what is inaccurate or incomplete about the information in the investigation memorandum, supply the information that is accurate or more complete, and state why the finding of maltreatment should be changed.

If your request for reconsideration is mailed, the request for reconsideration must be postmarked and sent to DHS within 15 calendar days of your receipt of the final determination. If the request for reconsideration is made by personal service, it must be received by DHS within 15 calendar days after your receipt of the final determination.

Your request for reconsideration of the final determination of maltreatment must be sent to:

Commissioner, Department of Human Services

ATTN: Legal Unit

c/o Licensing Division

PO Box 64242

St. Paul, MN 55164-0242

A response to your request for reconsideration of the maltreatment determination will be mailed within 15 working days after the Division of Licensing receives your request. If a response is not mailed within 15 working days, you are entitled to request a fair hearing.

C. Right to Appeal only the Order to Pay a Fine

You have the right to request a contested case hearing under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612 to only appeal the fine.  If you choose to exercise this right, your request must be made in writing by certified mail or personal service.  If mailed, the appeal must be postmarked and sent to the Commissioner within 10 calendar days after you receive this order.  If a request is made by personal service, it must be received by the Commissioner within 10 calendar days after you receive this order.

Your request for a contested case hearing must be sent to:

Commissioner, Department of Human Services

ATTN:  Legal Unit

c/o Licensing Division

PO Box 64242

St. Paul, MN 55164-0242

If you have any questions regarding the maltreatment determination or fine, please contact Alyssa Dotson, Unit Manager, at (651) 431-6560.

Sincerely,

DHS

Maura McNellis-Kubat, Supervisor

Licensing Division

Office of Inspector General

Enclosure

cc: Julie Sjostrand, Pennington County Social Services Supervisor

PO Box 64242 Saint Paul, Minnesota 55164-0242 An Equal Opportunity and Veteran Friendly Employer
http://www.dhs.state.mn.us/licensing