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September 14, 2022 Artemio Alvarado, Authorized Agent House of Knowledge Adult Day Care 6063 Hudson Road Suite 270 Woodbury, Minnesota 55125 License Number: 1065511 (Rule 223) CORRECTION ORDER Dear Artemio Alvarado: On September 13, 2022, a licensing review of House of Knowledge Adult Day Care, located at 6063 Hudson Road, Woodbury, 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.65, subdivision 2, paragraph (b). Violation: For one of two participants whose records were reviewed (P2), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). a. The license holder failed to develop an IAPP for P2 as part of P2’s initial individual program plan or service plan. The license holder maintained an IAPP in P2’s record; however, there was no participant name or date documented on the IAPP. b. The license holder failed to review P2’s IAPP quarterly as part of the review of the program plan or service plan. The license holder maintained an IAPP for P2 that was not dated; therefore, it was unable to be determined whether reviews of P2’s IAPP were completed. Corrective Action Ordered: Within 30 days of receiving this order, you must: · review P2’s IAPP with P2’s interdisciplinary team and document the review; · complete an audit of all participants’ IAPPs to ensure the requirements in Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b) are maintained; and · for participants whose IAPPs are not developed and reviewed as required, you must develop a plan detailing how your program will maintain IAPPs as required within 60 calendar days of receiving this order. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For two participants whose records were reviewed (P1 and P2), the license holder did not include information in the participant’s written record as required. a. The license holder failed to include the following information in P1’s record: · an application form that included the name and telephone number of the secondary person to call in case of an emergency involving P1; · a medical report, dated within the three months prior to or 30 days after P1’s admission to the center. P1’s admission date was March 8, 2022; however, the license holder maintained a medical report for P1 dated April 28, 2022; and · P1’s service agreement with the center, that specified the responsibilities of P1 and the center with respect to payment for the provision of services and signed by the person or the person’s caregiver and the center director. b. The license holder failed to include the following information in P2’s record: · an application form that included: o P2’s sex, date of admission or readmission, and source of referral; o the name and telephone number of the person to call in case of emergency involving P2 and name and number of another person to call if that person cannot be reached; and o the name and telephone number of P2’s physician or medical provider; · a medical report, dated within the three months prior to or 30 days after P2’s admission to the center. P2’s admission date was July 1, 2021; however, the license holder maintained a medical report for P2 dated September 16, 2021; · attendance and participation reports and progress notes that are recorded at least monthly; and · notes on special problems, medication chances, and needs for medication assistance. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain the information detailed above in P1 and P2’s records. Compliance with this order will be reviewed on site. 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 (P1 and P2), the license holder did not complete initial service planning as required. a. The license holder failed to: · conduct a needs assessment for P1 that addressed P1’s physical status using information from the medical report received from P1’s physician. The license holder conducted P1’s needs assessment on March 8, 2022; however, the license holder did not receive the medical report from P1’s physician until April 28, 2022; and · develop a preliminary service plan for P1 within 30 days of P1’s admission. The license holder maintained a preliminary service plan for P1 that was not dated; therefore, the date the preliminary service plan was developed was unable to be determined. b. The license holder failed to: · conduct a needs assessment for P2 within 30 days of P2’s admission. The license holder maintained a needs assessment for P2 that was not dated; therefore, the date the needs assessment was conducted was unable to be determined. Additionally, the license holder failed to conduct a needs assessment for P2 that included P2’s physical status, determined by observation, from the intake screening interview and from the medical report received from P2’s physician; and · develop a preliminary service plan for P2 based on the assessment in item A and coordinated with other plans of service for P2 within 30 days of P2’s admission that included: o scheduled days of P2’s attendance at the center; o transportation arrangements for getting P2 to and from the center; o P2’s nutritional needs and, where applicable, dietary restrictions; o role of P2’s caregiver or caregivers in carrying out the service plan; and o services and activities in which P2 would take part immediately upon admission. Corrective Action Ordered: Within 30 days of receiving this order, you must: · conduct a needs assessment for P1 and P2 that includes the information detailed above; · develop preliminary service plans for P1 and P2 that include the information and specifications detailed above; · complete an audit of all participants’ needs assessments and preliminary service plans to ensure the requirements in Minnesota Rules, part 9555.9700, subpart 2 are maintained; and · for participants who do not have needs assessments and preliminary service plans that include all requirements, you must develop a plan detailing how your program will maintain a complete needs assessment within 60 calendar days of receiving this order. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. 4. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For one participant whose record was reviewed (P2), the license holder did not develop a written plan of care as required. The license holder failed to develop a written plan of care for P2 that included§: · an update of the preliminary service plan and additional services required by the participant; · short and long term objectives for the participant stated in concrete, measurable and time specific outcomes; · the staff members responsible for implementing the individual plan of care; · the anticipated duration of the individual plan of care as written; and · provisions for quarterly review and quarterly revisions of the individual plan of care. Corrective Action Ordered: Within 30 days of receiving this order, you must: · develop a written plan of care for P2 that includes the information listed above; · complete an audit of all participants’ written plans of care to ensure the requirements in Minnesota Rules, part 9555.9700, subpart 3 are maintained; and · for participants who do not have a written plan of care that includes all required information, you must develop a plan detailing how your program will maintain a complete written plan of care within 60 days of receiving this order. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. 5. Citation: Minnesota Rules, part 9555.9710, subparts 1, 6, and 7. Violation: The license holder did not offer services as required. a. The license holder failed to ensure the refrigerator had a temperature of 40 degrees Fahrenheit or less. At 9:13am on September 13, 2022, DHS licensors observed the refrigerator had a temperature of 50 degrees Fahrenheit. b. The license holder failed to offer a midafternoon snack. c. Although the license holder had a plan for diversified daily program activities, the license holder failed to offer and implement the plan. The license holder’s activity calendar listed the following activities on Tuesdays: • 8:00am-9:00am – Breakfast • 9:00am-10:00am – Watch TV/News • 10:00am – 10:30am – Let’s move! Chair exercise • 10:30a-12:00pm – Table game DHS licensors observed the following on September 13, 2022: • 9:13a – participants played bingo and did word search puzzles • 10:10a – participants continued playing bingo and coloring • 10:26a – participants played pool table, colored, and played bingo • 10:33a – participants continued playing bingo and staff began offering midmorning snack • 11:17a – participants played bingo, colored, and did word search puzzles d. The license holder failed to maintain a family and social history in P2’s record that was updated annually. The license holder maintained documentation that P2’s family and social history was most recently reviewed in July 2021. e. The license holder failed to offer social services, including referring participants to community services when the license holder observed financial factors related to participants’ achieving objectives specified in the participant's plan of care. At the time of the licensing review, SP3 was observed to be assisting a participant with financial matters rather than referring the participant to community services to assist with financial factors. § Corrective Action Ordered: Immediately, you must: • ensure your refrigerator has a temperature of 40 degrees Fahrenheit or less; • offer a midafternoon snack; • offer and implement your plan for diversified daily program activities; and • offer social services, including referring participants to community services when you observe and record psychological, emotional, social, financial, legal, employment, transportation, and other living situation factors related to participants' achieving objectives specified in the participant's plan of care. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in these subparts. 6. Citation: Minnesota Rules, part 9555.9650, item A. Violation: For two of three staff persons whose records were reviewed (SP2 and SP3), the license holder did not maintain a personnel record as required. a. The license holder failed to maintain the following in SP2’s personnel record: · SP2’s job description; and · accurate documentation that SP2 completed the orientation to the center required in part 9555.9690, subpart 3. The license holder maintained documentation that SP2 was provided 13 hours of training on June 13, 2022; however, SP2 was not provided this length of training on June 13, 2022. b. The license holder failed to maintain documentation of annual performance evaluations in 2020 and 2021 in SP3’s personnel record. Corrective Action Ordered: Within 30 days of receiving this order, you must: · maintain a job description in SP2’s personnel record; and · complete a performance evaluation for SP3 and maintain documentation of the evaluation in SP3’s personnel record. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this item. 7. Citation: Minnesota Rules, part 9555.9650, item B. Violation: For one consultant whose record was reviewed, the license holder did not include all required information in the personnel record. The license holder failed to maintain the following in the registered dietician’s personnel record: · a copy of a signed contract or letter of appointment specifying conditions and terms of employment; and · documentation that the consultant met any licensure, registration, or certification requirements required to perform services. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain the following in your registered dietician’s personnel record: · a copy of a signed contract or letter of appointment specifying conditions and terms of employment; and · documentation that your registered dietician meets licensure, registration, and certification requirements required to perform the services specified in the contract. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this item. 8. Citation: Minnesota Statutes, section 245A.65, subdivision 3. Violation: For two staff persons whose records were reviewed (SP1 and SP3), the license holder did not provide orientation and annual review to a mandated reporter as required. a. The license holder failed to provide SP1 orientation 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 within 72 hours of first providing direct contact. SP1 provided direct contact on June 21, 2022 and the license holder provided SP1 the required orientation on June 27, 2022. b. The license holder failed to provide SP3 annual review in 2022 and 2021 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. Corrective Action Ordered: Immediately, you must provide the required annual review detailed above to SP3. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. 9. Citation: Minnesota Rules, part 9555.9690, subpart 3. Violation: For one staff person whose record was reviewed (SP2), the license holder did not provide orientation to the center as required. The license holder failed to provide SP2 with 20 hours of orientation to the center within SP2’s first 40 hours of employment at the center, including at least four hours of supervised orientation before SP2 worked directly with persons at the center. Corrective Action Ordered: Within 30 days of receiving this order, you must provide the required orientation training detailed above to SP2. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subpart. 10. Citation: Minnesota Rules, part 9555.9690, subpart 4. Violation: For one staff person whose record was reviewed (SP3), the license holder did not provide in-service training annually as required. The license holder failed to provide SP3 a minimum of eight hours of in-service training in 2020 and 2021 in areas related to care of center participants, including provision of medication assistance, and review of parts 9555.9600 to 9555.9730. Corrective Action Ordered: Within 30 days of receiving this order, you must provide the required in-service training detailed above to SP3. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subpart. 11. Citation: Minnesota Rules, part 9555.9690, subpart 2, item C. Violation: The license holder did not provide staff coverage of the center as required. 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 13, 2022, the center had one staff person (SP4) trained in basic first aid and certified in cardiopulmonary resuscitation; however, DHS licensors observed SP4 leave the center multiple times between 9:00am and 11:30am, leaving participants without a person trained in basic first aid and certified in cardiopulmonary resuscitation. Corrective Action Ordered: Immediately, you must 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. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subpart. 12. Citation: Minnesota Statutes, section 245A.65, subdivision 1, paragraph (b). Violation: The license holder did not establish policies and procedures related to suspected or alleged maltreatment as required. The license holder’s policy and procedures related to suspected or alleged maltreatment failed to: · identify the secondary person or position to whom internal reports may be made and the secondary person or position responsible for forwarding internal reports to the common entry point as defined in section 626.5572, subdivision 5; · identify the secondary person or position who will ensure that, when required, internal reviews are completed. The person identified in the policy and procedures was no longer employed with the center. Corrective Action Ordered: Immediately, you must ensure the policy and procedures listed above are established as required in this subdivision. A copy of the policies and procedures must be posted in a prominent location in the program. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. 13. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (a). Violation: The license holder did not establish a PAPP as required. The license holder failed to establish a written PAPP, including: · an assessment of the population, including the need for specialized programs of care for clients; and · an assessment of the environment, including the type of internal programming. Additionally, the license holder failed to review the PAPP at least annually. The most recent review of the PAPP that the license holder documented was March 26, 2021. Corrective Action Ordered: Within 30 days of receiving this order, you must establish a PAPP that includes the information detailed above. A copy of the PAPP must be posted in a prominent location in the program. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. 14. 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 procedures for the quarterly fire drill. Corrective Action Ordered: Immediately, you must develop written plans for emergencies caused by fire that include the information detailed above. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subpart. 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, please contact your licensor, Desiree Tiller, at 651-431-4622. Brittany Raddatz, Human Services Senior Licensor Licensing Division Office of Inspector General
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