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September 13, 2022 Tracy Vangh, Authorized Agent North Star Health Alliance LLC 388 Western Avenue North Suite B Saint Paul, Minnesota 55103 License Number: 1095876 (Rule 223) CORRECTION ORDER Dear Tracy Vangh: On September 6, 2022, a licensing review of North Star Health Alliance LLC, located at 388 Western Avenue North, St. Paul, Minnesota, was conducted to determine compliance with Minnesota Statutes and Rules governing adult day care services under Minnesota Rules, parts 9555.9600 through 9555.9730 (Rule 223). As a result of this licensing review, 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 the 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 license holder. The following violation(s) of state or federal laws and rules were determined as a result of the licensing review. Corrective action for each violation is required by Minnesota Statutes, section 245A.06 and is hereby ordered by the Commissioner of Human Services. 1. Citation: Minnesota Statutes, section 245A.14, subdivision 14, paragraph (c). Violation: The license holder did not meet the requirements for attendance record documentation. The license holder failed to maintain documentation of actual attendance for each adult day service recipient for which the license holder was reimbursed by a governmental program that included: · the time of day that the recipient was dropped off; and · the time of day that the recipient was picked up. Corrective Action Ordered: Immediately, you must maintain documentation as required in this subdivision. On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For three participants whose records were reviewed (P1, P2, and P3), the license holder did not include information in the participant’s written record as required. a. The license holder failed to include an application form in P1 and P2 participant records that included P1 and P2’s source of referral. b. The license holder failed to include the following information in P3’s record: · an application form that included the name and telephone number of the secondary person to call in case of an emergency involving P3; and · a medical report dated within the three months prior to or 30 days after P3’s admission to the center that included: o a report on a physical examination, updated annually; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P3; o a release signed by the physician indicating whether P3 may engage in a structured exercise program; and o documentation that P3 was free of communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain all information detailed above in P1, P2, and P3’s participant records. On an ongoing basis, you must maintain compliance as required in this part. 3. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For two participants whose records were reviewed (P2 and P3), the license holder did not complete initial service planning as required. The license holder failed to develop preliminary service plans for P2 and P3 that included the services and activities in which P2 and P3 would take part immediately upon admission. Corrective Action Ordered: Within 30 days of receiving this order, you must update P2 and P3’s preliminary service plans to include the information and specifications detailed above. On an ongoing basis, you must maintain compliance as required in this subpart. 4. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For two participants whose records were reviewed (P1 and P2), the license holder did not develop a written plan of care as required. The license holder failed to develop written plans of care for P1 and P2 that included the anticipated duration of the individual plan of care as written. Corrective Action Ordered: Within 30 days of receiving this order, you must update P1 and P2’s written plans of care to include the information detailed above. On an ongoing basis, you must maintain compliance as required in this subpart. 5. Citation: Minnesota Rules, part 9555.9690, subpart 1, item A and subpart 2, item C. Violation: The license holder did not meet staff ratio standards and provide staff coverage of the center as required. a. The license holder failed to maintain a minimum staff to participant ratio of one staff member present for every eight participants present. On September 6, 2022, between 10:45am and 11:00am, there were three staff members and 26 participants present at the center. b. The license holder failed to have a person trained in basic first aid and certified in cardiopulmonary resuscitation, and the treatment of obstructed airways present at all times in the center when participants were present. At the time of the licensing review on September 6, 2022, the center did not have any staff persons trained in based first aid and certified in cardiopulmonary resuscitation. Corrective Action Ordered: Immediately, you must: · maintain a minimum staff to participant ratio as required in Minnesota Rules, part 9555.9690, subpart 1; and · have a person trained in basic first aid and certified in cardiopulmonary resuscitation, and the treatment of obstructed airways present at all times in the center when participants were present. On an ongoing basis, you must maintain compliance as required in these subparts. 6. Citation: Minnesota Rules, part 9555.9720, subpart 9. Violation: The license holder did not ensure safety as required. The license holder failed to have written plans for emergencies caused by fire that included instructions on closing off the fire area. Corrective Action Ordered: Immediately, you must develop written plans for emergencies caused by fire that include instructions on closing off the fire area. On an ongoing basis, you must maintain compliance as required in this subpart. 7. Citation: Minnesota Statutes, section 245A.65, subdivision 3. Violation: For two staff persons whose records were reviewed (SP1 and SP2), the license holder did not provide annual review to a mandated reporter as required. The license holder failed to provide SP1 and SP2 annual review in 2020 to the reporting requirements and definitions in sections 626.557 and 626.5572, the requirements of this section, the license holder's program abuse prevention plan, and all internal policies and procedures related to the prevention and reporting of maltreatment of individuals receiving services. SP1 and SP2 were provided the required training on October 26, 2019, December 19, 2020, and October 15, 2021. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 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. B. 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. Brittany Raddatz, Human Services Senior Licensor Licensing Division Office of Inspector General 651-431-6591
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