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June 29, 2022 Jeffrey Feltz 26022 Main Street Zimmerman, MN 55398 RE: Report No. 202203064 Community Living Options South Park II License No. 1070500/1070470 Dear Mr. Feltz: CORRECTION ORDER An investigation of Community Living Options South Park II was completed regarding report number 202203064 which alleged violation of Minnesota Statutes, section 626.557, and Minnesota Statutes, Chapter 245D. This maltreatment allegation concerned neglect. The disposition of the investigation report was an error in the provision of therapeutic conduct. One violation was noted. VIOLATIONS AND CORRECTION ORDERS The following violation of state and (or) federal laws and rules was observed. Corrective action for the violation is required by Minnesota Statutes, section 245A.06, and is hereby ordered by the Commissioner of Human Services. Failure to correct the violations within the prescribed amount of time may result in fines and/or action against your license, as provided for in Minnesota Statutes, sections 245A.06 and 245A.07. Citation: Minnesota Statutes, section 245D.095, subdivision 5, paragraph (a), clause (2): Violation: The license holder did not maintain a personnel record for two staff persons (P1 and P2) as required. The license holder failed to maintain documentation that P1 and P2 each received training on a consumer’s (C’s) coordinated service and support plan or coordinated service and support plan addendum as it relates to the responsibilities assigned to the license holder and on sections 245A.65, 245A.66, and 626.557 and chapter 260E governing maltreatment reporting and service planning for children and vulnerable adults, and staff responsibilities related to protecting persons from maltreatment and reporting maltreatment. This orientation must be provided within 72 hours of first providing direct contact services and annually thereafter according to section 245A.65, subdivision 3. The license holder failed to record the date of the training, the number of hours, and the name of the instructor for this training. Corrective Action Ordered: Beginning immediately and on an ongoing basis you must maintain compliance as required in this subdivision. If you believe any of the citations are in error, you may ask the Commissioner of Human Services to reconsider the parts of the correction order that you believe to be in error. If you choose to exercise this right, your request for reconsideration must be in writing and received by the Commissioner within 20 calendar days after receipt of this letter. Your request for reconsideration must be sent to: Commissioner Minnesota Department of Human Services c/o Licensing Division PO Box 64242 St. Paul, MN 55164-0242 You must include any and all information, documentation, or other evidence you have to support your request for reconsideration. Please note that a request for reconsideration does not stay any provisions of the correction order. If you have any questions regarding the investigation, contact me immediately. If you have any questions regarding compliance with this Correction Order or applicable rules, contact your licensor, Diana Arnzen, at (651) 431-6638. Sincerely,
Scott Broady, Investigator Office of Inspector General Licensing Division 651-431-6557 Enclosure
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