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October 20, 2022 Vong Lor, Authorized Agent Hmong Adult Day Center Inc. 1459 Rice Street Suite 1 St. Paul, Minnesota 55117 License Number: 1102886 (Rule 223) CORRECTION ORDER Dear Vong Lor: On October 20, 2022, a licensing review of Hmong Adult Day Center Inc., located at 1459 Rice Street, 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 Rules, part 9555.9660, subpart 1. Violation: For two of 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 an application form in P1’s record that included the name and number of a secondary person to call in case of an emergency involving P1. b. The license holder failed to include a medical report in P2’s record dated within the three months prior to or 30 days after P2’s admission to the center. P2 was admitted to the center on May 3, 2021 and the license holder maintained a medical report for P2 on August 18, 2021. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this part. 2. 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 develop a preliminary service plan for P1 that included: · P1’s nutritional needs and, where applicable, dietary restrictions; and · the role of P1’s caregiver or caregivers in carrying out the service plan. b. The license holder failed to develop a preliminary service plan for P2 that included the role of P1’s caregiver or caregivers in carrying out the service plan. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subpart. 3. 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. a. The license holder failed to develop a written plan of care for P1 that included§ short and long term objectives for P1 stated in concrete, measurable and time specific outcomes. b. The license holder failed to develop a written plan of care for P2 that included§: · short and long term objectives for P2 stated in concrete, measurable and time specific outcomes; and · the anticipated duration of the individual plan of care as written. P2’s written plan of care stated the anticipated duration of the plan was April 30, 2022. §Corrective Action Ordered: Within 30 days of receiving this order, you must develop written plans of care for P1 and P2 that include the information listed above. On an ongoing basis, you must maintain compliance as required in this subpart. 4. Citation: Minnesota Rules, part 9555.9710, subpart 7. Violation: The license holder did not offer services as required. 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 May 2021. § Corrective Action Ordered: Within 30 days of receiving this order, you must document the review of P2’s family and social history and update P2’s family and social history, if applicable. On an ongoing basis, you must maintain compliance as required in this subpart. 5. Citation: Minnesota Rules, part 9555.9720, subpart 7. Violation: The license holder did not ensure safety as required. The license holder failed to ensure furniture was in good repair. The license holder had a couch in the private space that had a torn seat cushion. Corrective Action Ordered: Immediately, you must ensure all furniture is in good repair within the center. 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: Office of Inspector General Legal Counsel’s Office Attention: Licensing Legal Unit P.O. Box 64953 Saint Paul, MN 55164-0953 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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