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September 26, 2022 Ismael Omer, Authorized Agent Apple Adult Day Care Inc. 1001 140th Lane Northwest Andover, Minnesota 55304 License Number: 1084043 (Rule 223) CORRECTION ORDER Dear Ismael Omer: On September 20, 2022, a licensing review of Apple Adult Day Care Inc., located at 1900 Central Avenue Northeast, Minneapolis, 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 1, paragraph (c) and subdivision 2, paragraph (a). Violation: For one of three participants whose record was reviewed (P2), the license holder did not provide orientation to the license holder’s internal and external reporting procedures related to suspected or alleged maltreatment and the program abuse prevention plan (PAPP) as required. P2 was admitted to the center on April 11, 2022. Although the license holder maintained documentation that P2 was provided orientation to the licensor holder’s internal and external reporting procedures and PAPP, the license holder failed to document the date of the orientation; therefore, it was unable to be determined if P2 was provided the required orientation within 24 hours of P2’s admission to the center. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in these subdivisions. 2. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b). Violation: For three participants whose records were reviewed (P1, P2, and P3), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). The license holder failed to review P1, P2, and P3’s IAPPs quarterly as part of the review of the program plan or service plan. · The license holder maintained documentation that P1’s IAPP was most recently reviewed on September 19, 2018. · The license holder maintained documentation that P2’s IAPP was most recently reviewed on April 11, 2022. · The license holder maintained documentation that P3’s IAPP was most recently reviewed on October 5, 2021. Corrective Action Ordered: Within 30 days of receiving this order, you must: · review P1, P2, and P3’s IAPPs with the person’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. 3. Citation: Minnesota Rules, part 9555.0030. Violation: For one participant whose record was reviewed (P1), the license holder did not meet the requirements for positive support strategies and person-centered planning as required. The license holder failed to incorporate positive support strategies in writing into an existing treatment, service, or other individual plan required of the license holder for P1. Corrective Action Ordered: Within 30 days of receiving this order, you must: · provide training to staff persons, as applicable, according to the requirements in part 9544.0090, subparts 1, and 2, and document the training according to the requirements in part 9544.0090, subpart 5; · ensure that staff persons can demonstrate competency through knowledge testing or observed skill assessment conducted by a trainer or instructor as required in part 9544.0090, subpart 4, and document the training according to the requirements in part 9544.0090, subpart 5; and · develop and implement support strategies for P1 according to the standards in part 9544.0030, subparts 2, 3, and 4. Additionally, you must: · at least every six months, evaluate with P1 whether the identified positive support strategies currently meet the standards in subpart 2. Based upon the results of the evaluation, you must determine whether changes are needed in the positive support strategies used, and, if so, you must make appropriate changes; · at least every six months, evaluate with P1 whether the services support P1’s preferences, daily needs and activities, and the accomplishment of P1’s goals in accordance with Minnesota Statutes, section 245D.07, subdivision 1a, paragraph (b), and whether the person-centered planning process compiles with Code of Federal Regulations, title 42, section 441.725, paragraph (a)(1)-(4). Based upon the results of the evaluation, you must determine whether changes are needed to enhance person-centeredness for the person, and, if so, make appropriate changes; · provide annual refresher training to all staff persons as required in part 9544.0090, subpart 3 and document the training according to part 9544.0090, subpart 5; and · maintain documentation and record keeping requirements as required in part 9544.0100. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this part. 4. Citation: Minnesota Rules, part 9555.9640. Violation: For one participant whose record was reviewed (P2), the license holder did not distribute policies and program information to participants and their caregivers upon admission as required. P2 was admitted to the center on April 11, 2022. Although the license holder maintained documentation that the required policies, program information, and participants’ rights were distributed to P2, the license holder failed to document the date of the distribution; therefore, it was unable to be determined if P2 received the policies, program information, and participants’ rights upon P2’s admission to the center. § Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this part. 5. 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 the following information in P1’s record: · a report on a physical examination, updated annually. The license holder maintained reports on P1’s physical examination dated April 13, 2021 and May 18, 2022; and · participation reports and progress notes that were recorded at least monthly. b. The license holder failed to include the following information in P2’s record: · an application form that included: o P2's address, date of admission, and source of referral; 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 was admitted to the center on April 11, 2022 and the license holder maintain a medical report for P2 dated May 19, 2022; · P2's service agreement with the center that specified the responsibilities of P2 and the center with respect to payment for and provision of services and was signed by P2 and the center director; · participation reports and progress notes that were recorded at least monthly; and · a statement signed by the center director and P2 at the time of P2's admission specifying the basis on which P2 was determined to be capable or not capable of taking appropriate action for self-preservation under emergency conditions. c. The license holder failed to include the following information in P3’s record: · an application form that included: o P3’s date of admission and telephone number; and o the name and telephone number of P3’s physician or medical provider; · a medical report that included: o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P3; and o a release signed by the physician indicating whether P3 may engage in a structured exercise program; · P3's service agreement with the center that specified the responsibilities of P3 and the center with respect to payment for and provision of services and was signed by P3 and the center director; · participation reports and progress notes that were recorded at least monthly; · notes on special problems or on changes needed in medication and on the need for medication assistance; and · a statement signed by the center director specifying the basis on which P3 was determined to be capable or not capable of taking appropriate action for self-preservation under emergency conditions. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain all information detailed above in P2 and P3’s participant records. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this part. 6. 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. a. The license holder failed to conduct needs assessments for P2 and P3 within 30 days of the participant’s admission that included: · the participant’s psychosocial status (for example, awareness level, personal care needs, need for privacy or socialization); · §the participant’s functional status (for example, endurance and capability for ambulation, transfer, and managing activities of daily living); and · §the participant’s physical status, determined by observation, from the intake screening interview, and from the medical report received from the participant’s physician. b. Although the license holder maintained a preliminary service plan for P2, the license holder failed to document the date that P2’s preliminary service plan was developed; therefore, it was unable to be determined if P2’s preliminary service plan was developed within 30 days of P2’s admission. Additionally, the license holder failed to develop a preliminary service plan for P2 that included the role of P2’s caregiver or caregivers in carrying out the service plan. c. The license holder failed to develop a preliminary service plan for P3 that included the role of P3’s caregiver or caregivers in carrying out the service plan. Corrective Action Ordered: Within 30 days of receiving this order, you must: · conduct needs assessments for P2 and P3; · update P2 and P3’s preliminary service plans to include the role of the participant’s caregiver or caregivers in carrying out the service plan; · 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. 7. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For three participants whose records were reviewed (P1, P2, and P3), the license holder did not develop a written plan of care as required. a. The license holder failed to develop written plans of care for P1 and P2 that included§ short and long term objectives for the participant stated in concrete, measurable and time specific outcomes. b. The license holder failed to develop a written plan of care for P3 that included§: · short and long term objectives for P3 stated in concrete, measurable and time specific outcomes; and · provisions for quarterly review and quarterly revisions of the individual plan of care. The license holder documented reviews dated October 20, 2021, April 25, 2022, and July 2022. §Corrective Action Ordered: Within 30 days of receiving this order, you must: · develop written plans of care for P1, P2, and P3 that include short and long term objectives for the participant stated in concrete, measurable and time specific outcomes; · 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. 8. Citation: Minnesota Rules, part 9555.9710, subpart 3 and 7. Violation: The license holder did not offer services as required. a. The license holder failed to offer health services developed in consultation with a registered nurse, and reviewed by the registered nurse at least monthly, that included: · monitoring participants' health status and reporting changes to the participant's caregiver and physician and the center director; · educating and counseling participants on good health practices; · maintaining a listing of professional health resources available for referrals as needed by participants; · developing policies and monitoring procedures for participant self administration of medications for training unlicensed personnel who provide medication assistance; and · supervising staff distribution of medication and assistance with participant self administration of medication and ensuring compliance with part 9555.9680, subpart 2, item C. b. The license holder failed to maintain a family and social history in P1, P2, and P3’s records. § Corrective Action Ordered: Within 30 days of receiving this order, you must: · offer health services as detailed above; and · maintain a family and social history in P1, P2 and P3’s records. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in these subparts. 9. Citation: Minnesota Rules, part 9555.9650, item B. Violation: For two consultants whose records were reviewed, the license holder did not include all required information in the personnel record. a. The license holder failed to maintain the following in the physical therapist’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. b. The license holder failed to maintain documentation that the registered dietician met any licensure, registration, or certification requirements required to perform services. Corrective Action Ordered: Within 30 days of receiving this order, you must: · maintain a copy of a signed contract or letter of appointment with your physical therapist specifying conditions and terms of employment; and · maintain documentation that your physical therapist and registered dietician meet 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. 10. Citation: Minnesota Rules, part 9555.9690, subpart 4. Violation: For one of three staff persons whose record was reviewed (SP2), the license holder did not provide in-service training annually as required. The license holder failed to provide SP2 a minimum of eight hours of in-service training annually 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 SP2. 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 9544.0070. Violation: The license holder did not meet the requirements for the emergency use of manual restraint as required. The license holder failed to develop, document, and implement a policy and procedures that promoted service recipient rights and protect health and welfare during the use of manual restraints as required in Minnesota Statutes, section 245D.061, subdivision 9. Corrective Action Ordered: Within 30 days of receiving this order, you must: · develop a policy and procedures on the emergency use of manual restraint as stated above; · provide notice to P1 of your policy and procedures on the emergency use of manual restraint as required in part 9544.0080. The notice must: o inform P1 of their rights under Minnesota Statutes, section 245D.04; and o be in writing; and · obtain written acknowledgement from P1’s legal representative that P1 has been notified. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this part. 12. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (a). Violation: The license holder did not post a copy of the program abuse prevention plan in a prominent location in the program as required. Corrective Action Ordered: Immediately, you must post a copy of the program abuse prevention plan 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 Rules, part 9555.9720, subparts 1 and 8. Violation: The license holder did not ensure safety as required. a. The license holder failed to include an ice bag or cold pack in their first aid kit. b. The license holder failed to ensure the areas used by participants were free from debris, loose plaster, and peeling paint. At the time of the licensing review, the following was observed: · peeling paint, loose plaster, and scuffs in the drywall throughout the center and program space; · dirty walls; · vents that were not secured and were resting against the wall; and · broken baseboard trim that exposed peeling paint and plaster. Corrective Action Ordered: Immediately, you must: · maintain an ice bag or cold compress in your first aid kit; and · ensure all areas used by participants are free from debris, loose plaster, and peeling paint. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in these subparts. 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 questions regarding this Correction Order, 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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