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September 23, 2022 Jeffery Feltz 26022 Main St Zimmerman, MN 55398 RE: Report No. 202206011 Community Living Options Hilltop/ Community Living Options License No. 1070488/1070470 Dear Mr. Feltz: CORRECTION ORDER An investigation of Community Living Options Hilltop/ Community Living Options was completed regarding report number 202206011 which alleged violation of Minnesota Statutes, section 626.557, and Minnesota Statutes, Chapter 245D. This maltreatment allegation concerned physical abuse. The disposition of the investigation report is substantiated. 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 245A.11, subdivision 10, paragraph (b), clause (15). Violation: On July 21, 2022, a staff person (SP1) did not treat a consumer (C) with courtesy and respect. SP1 pushed the C onto the floor and dragged him/her across the floor causing the C to sustain a rug burn. Corrective Action Ordered: Within 10 days from receipt of this order, submit written documentation to your licensor detailing how compliance has been achieved and how compliance will be maintained in the future. Submissions required as part of a corrective action ordered must be sent to your Licensor at: Commissioner, Department of Human Services ATTN: Diana Arnzen c/o Licensing Division PO Box 64242 St. Paul, MN 55164-0242 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,
Anna Parkin, Investigator Office of Inspector General Licensing Division 651-431-6225 Enclosure
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