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September 16, 2022 David Backus, Authorized Agent Evergreen Recovery Inc 1400 Energy Park Dr, Suite 21 St Paul, MN 55108 License Number: 1079365 Licensing Investigation Number: 202205359
CORRECTION ORDER Dear David Backus, A licensing investigation of Evergreen Recovery, located at 1400 Energy Park Dr Suite 21, St Paul, MN 55108, was conducted to determine compliance with state and federal laws and rules governing the provision of substance use disorder treatment services under Minnesota Statutes 245G. As a result of this licensing investigation 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 review. Corrective action for each violation is required by Minnesota Statutes, section 245A.06 and is hereby ordered by the Commissioner of Human Services. Resident Files 1. Citation: Minnesota Statutes, section 245A.04, subdivision 16. Violation: The license holder failed to report 5 client deaths from March 2002 to September 9, 2022 within receiving knowledge of the death of an individual served by the program. Corrective Action Ordered: Immediately and on an ongoing basis, the license holder must ensure all practices for reporting a death meets all applicable requirements. Within 15 days, all staff must receive training on the reporting a death policy and license holder must submit documentation of training completion by all staff. If you fail to correct the violations specified in the Correction Order within the prescribed timelines 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 Ginny Benson: 1. By secure email to: ginny.benson@state.mn.us; or 2. By mail to: Commissioner, Department of Human Services ATTN: Ginny Benson Licensing Division PO Box 64242 St. Paul, MN 55164-0242 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 Ginny Benson, Human Services Licensor at 651-431-6957, as soon as possible. Ginny Benson, MH/CRF/SUD Senior Licensor Licensing Division Office of Inspector General
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