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November 4, 2022 CERTIFIED MAIL Gemene Burka Gelgelu, Authorized Agent Miracle Adult Foster Care 3409 West Park Drive Burnsville, MN 55306 License Number: 1104141 HCBS ORDER TO PAY A FINE FOR BACKGROUND STUDY VIOLATION Dear Gemene Burka Gelgelu: The Department of Human Services (DHS) is ordering you to pay a fine of $200 for one background study violation. Details of our findings are provided below. Our next steps and your options are also detailed. Reason for the Fine DHS is issuing this fine order based on your failure to comply with the following background study requirement: Background Study Violation Determined on October 19, 2022: As a result of a licensing review a DHS licensor determined that you failed to request background studies for one staff person before they began working in a position allowing direct contact with persons served. SP3 was hired and began working in a position allowing direct contact with persons served by your program on June 1, 2022. At the time of the licensing review on October 19, 2022, the license holder had not submitted a background study request to DHS for SP3. The failure to initiate background study requests on a staff person before they begin a position that allows direct contact with persons served by the program is a violation of background study requirements. Statute Violated: Minnesota Statutes, section 245C.04, subdivision 1, paragraph (g). Fine: $200 Corrective Action Required: You were sent a notice on October 21, 2022 that SP3 must be immediately removed from their position that allows direct contact. SP3 may not provide direct contact services until you have successfully submitted a background study for SP3. You must follow all supervision requirements for SP3 until the background study clearance notice is issued. On an ongoing basis you must comply with all background study requirements in Minnesota Statutes, chapter 245C. Billing and Payment of the Fine DHS will send you an invoice for the $200 fine. Payment must be made as directed on the invoice. If you request a contested case hearing, as described below, do not pay the fine at this time. Following the contested case hearing, the Commissioner of DHS will issue a final order on this matter. Please note, you may not avoid payment of this fine by closing, selling, or otherwise transferring the license to a third party. If this occurs, you are personally responsible for payment. Your Right to Appeal You have the right to appeal the fine. Your request must be in writing and clearly state that you are requesting a contested case hearing for this matter. Your request must be made before the deadlines provided below. If you do not meet this deadline, you lose your right to an administrative appeal. The timeline to appeal began when you received this order. If you are mailing your request, it must be sent by certified mail and postmarked within 10 calendar days from when you receive this order. Please send it to: Commissioner, Department of Human Services Office of Inspector General Licensing Division Attention: Legal Unit PO Box 64242 St. Paul, MN 55164-0242 If your request is being personally delivered, it must be received by DHS within 10 calendar days from when you receive this order. Please bring it to: Commissioner, Department of Human Services Office of Inspector General Licensing Division Attention: Legal Unit 444 Lafayette Road North St. Paul, MN 55155 Upon DHS’ receipt of your timely appeal, your case would be scheduled for a contested case hearing in front of an Administrative Law Judge. Following this hearing, the Commissioner of DHS will issue a final order. Legal representation at the contested case hearing You do not need a lawyer to appeal. However, a lawyer can help you with your appeal. The state or county will not get you a lawyer and will not pay for a lawyer. If you cannot afford a lawyer, you may be able to get free legal advice or help with your appeal. To find out if free help is available, contact: Volunteer Lawyers Network at 612-752-6677; Central Minnesota Legal Services at 612-332-8151; Southern Minnesota Legal Services at 651-222-4731; or go to www.justice4mn.org to find a local legal services program that may be able to help you. You can also find information on contested cases from the Office of Administrative Hearings website at https://mn.gov/oah/self-help. Click on Administrative Law Overview, then click on Administrative Law Contested Case Hearing Guide for a list of frequently asked questions. Legal Authority for this Licensing Action · DHS may impose a $200 fine for each background study violation under Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c)(4)(iv). · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c)(5) states that license holders may not avoid payment of a fine by closing, selling, or transferring a license. · License holders have a right to appeal licensing actions and request a contested case hearing, under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. Questions If you have any further questions regarding this matter, you may contact Christala Culhane, Supervisor, at 651-431-6541. Sincerely,
Jill Slaikeu, Unit Manager Licensing Division Office of Inspector General
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