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October 24, 2022 Gemene Gelgelu, Authorized Agent Miracle Adult Foster Care 3409 West Park Drive Burnsville, MN 55306-6984 License Number: 1104141 (245D - HCBS) CORRECTION ORDER Dear Gemene:
On October 19, 2022, a licensing review of Miracle Adult Foster Care, located at 3409 West Park Drive, Burnsville, Minnesota, was conducted to determine compliance with state and federal laws and rules governing the provisions of home and community-based services to persons with developmental disabilities and age 65 and older under Minnesota Statutes, Chapter 245D. 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 a 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 of state and federal laws and rules was 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 (a), clause (4). Violation: For one person whose record was reviewed (P1), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP) as required. The license holder failed to review P1’s IAPP annually in 2022. Corrective action ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section 245D.04, subdivision 1, paragraph (1). Violation: For one person whose record was reviewed (P1), the license holder did not provide the person with a written notice that identified the service recipient rights and an explanation of those rights as required. The license holder failed to provide P1 with a written notice that identifies the service recipient rights, and an explanation of those rights annually in 2022. Corrective action ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Statutes, section 245D.05, subdivision 2. Violation: For one person whose record was reviewed (P1), the license holder was assigned responsibility for medication setup in the coordinated service and support plan (CSSP). The license holder did not implement medication procedures to ensure P1 takes medications and treatments as prescribed as required. The license holder failed to ensure the following information was documented in P1’s medication administration record: · the information on the current prescription label or the prescriber's current written or electronically recorded order or prescription that includes the person's name, description of the medication or treatment to be provided, and the frequency and other information needed to safely and correctly administer the medication or treatment to ensure effectiveness; · information on any risks or other side effects that are reasonable to expect, and any contraindications to its use; · the possible consequences if the medication or treatment is not taken or administered as directed; · instruction on when and to whom to report the following: o if a dose of medication is not administered or treatment is not performed as prescribed, whether by error by the staff or the person or by refusal by the person; and o the occurrence of possible adverse reactions to the medication or treatment; · notation of any occurrence of a dose of medication not being administered or treatment not performed as prescribed, whether by error by the staff or the person or by refusal by the person, or of adverse reactions, and when and to whom the report was made; and · notation of when a medication or treatment is started, administered, changed, or discontinued. Corrective action ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 4. Citation: Minnesota Statutes, section 245D.05, subdivision 4. Violation: For one person whose record was reviewed (P1), the license holder was assigned responsibility for administration of medication in the coordinated service and support plan (CSSP). The license holder did not ensure that the medication administration record was reviewed as required. At a minimum, the license holder was required to conduct medication administration record reviews every three months to ensure that the information maintained in the medication administration record was current and to identify any medication administration errors. The license holder failed to conduct medication administration record reviews for P1. Corrective action ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 5. Citation: Minnesota Statutes, section 245D.051, subdivision 1. Violation: For one person whose record was reviewed (P1), that was prescribed a psychotropic medication and the license holder was assigned responsibility for administration of medication in the CSSP, the license holder did not maintain documentation in P1’s CSSP addendum as required. The license holder failed to maintain a description of the target symptoms that each psychotropic medication was to alleviate in P1’s CSSP addendum. Corrective action ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 6. Citation: Minnesota Rules, part 9544.0030, subpart 1. Violation: For one person whose record was reviewed (P1), the license holder did not evaluate positive support strategies as required. The license holder failed to evaluate with P1, at least every six months, whether any positive support strategies used, needed changes, and, if so, make appropriate changes. Corrective Action Ordered: On an ongoing basis, you must evaluate with the person, at least every six months, whether the identified positive support strategies currently meet the standards in subpart 2 and determine whether changes are needed in the positive support strategies used based upon the results of the evaluation, and if so, make appropriate changes. 7. Citation Minnesota Statutes, section 245D.071, subdivision 3. Violation: For one person whose record was reviewed (P1), the license holder did not conduct an annual self-management assessment as required. For P1, the license holder failed to conduct a self-management annually in 2022. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 8. Citation: Minnesota Statutes, section 245D.071, subdivision 5. Violation: For one person whose record was reviewed (P1), the license holder did not meet the service plan review and evaluation requirements. a. The license holder failed to meet with the P2, the case manager, and other people as identified by the person or the person's legal representative to conduct a service plan review meeting at a minimum of once per year. b. The license holder failed to make available a progress review report that summarized P2’s status and progress toward achieving identified outcomes and make recommendations and identify the rationale for changing, continuing, or discontinuing implementation of supports and methods identified at the time of the progress review meeting. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 9. Citation: Minnesota Statutes, section 245D.09, subdivision 4. Violation: For two of two staff persons whose records were reviewed (SP1-SP2), the license holder did not provide orientation training as required. a. For SP1-SP2, the license holder failed to provide orientation training on basic first aid within 60 days of hire. b. Additionally, for SP2, the license holder failed to provide orientation training on the program abuse prevention plan within 60 days of hire. Corrective Action Ordered: Within 30 days of receipt this order, you must provide SP1-SP1 with the above mentioned training. On an ongoing basis, you must ensure that all staff persons receive orientation training as required in this subdivision. 10. Citation: Minnesota Statutes, section 245D.09, subdivision 5. Violation: For two staff persons whose records were reviewed (SP1-SP2), the license holder did not provide annual training as required. 245A.02, subdivision 2b defines “annual” or “annually” to mean prior to or within the same month of the subsequent calendar year. The license holder failed to provide the following training for SP1-SP2 on an annual basis in 2022: · the program abuse prevention plan according to the requirements in 245A.65, subdivision 3; and · basic first aid. Corrective Action Ordered: Within 30 days of receipt this order, you must provide SP1-SP2 with the above mentioned training. On an ongoing basis, you must ensure that all staff persons receive annual training as required in this subdivision. 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, section 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 regarding this Correction Order, please contact Missy Loveday, HCBS Licensor, at 651-431-6542.
Sincerely, Missy Loveday, Senior HCBS Licensor Licensing Division Office of Inspector General 651-431-6542
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