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November 9, 2022 CERTIFIED MAIL Cathy Hanson, Authorized Agent Mary T, Inc. 1555 118th Lane Northwest Coon Rapids, MN 55448 License Number 1073042-HCBS (Home and Community-Based Services) License Number 1073045-H_CRS (Home and Community-Based Services-Community Residential Setting) Report Number 202206073 DETERMINATION OF MALTREATMENT AND ORDER TO PAY A FINE Dear Cathy Hanson: The Department of Human Services (DHS) determined that Mary T, Inc. located at 850 98th Avenuse Northwest, Coon Rapids, Minnesota, is responsible for serious maltreatment by neglect. Based on this determination, DHS is ordering you to pay a fine of $5000. Details of our findings are provided below and in the enclosed Investigation Memorandum for report 202206073. Our next steps and your options are also detailed. I. Determination of Maltreatment It was reported that a vulnerable adult (VA) presented at an emergency room with pain in his/her legs. At that time, healthcare professionals discovered maggots in wounds on the VA’s legs. The VA had been relying on facility staff persons to meet all of his/her medical needs. Based on the maltreatment investigation, DHS determined that Mary T, Inc. was responsible for neglect of the VA. See the enclosed Investigation Memorandum for more information. Legal Authority: Minnesota Statutes, section 626.557, subdivision 9c. Fine: $5000 Additional Citations Related to the Maltreatment Determination 1. Citation: Minnesota Statutes 245D.05, subdivision 1, paragraph (b), clause (2) Violation: For one person whose records were reviewed (P), the license holder did not maintain documentation on how the person's health needs will be met, including a description of the procedures the license holder will follow in order to monitor health conditions according to written instructions from a licensed health professional as required. The P’s instructions for staff regarding the application of medications to his/her legs included, “In the morning ask [the P] if [s/he] would like to take a shower. Please chart accordingly. If [the P] refuses you will also need to include that [s/he] refused a shower in your daily note.” For the daily notes reviewed from June 1 through July 31, 2022, staff documented that the P took a shower twice, June 2 and 22, 2022. However, there was no other documentation stating whether the P took a shower, whether staff asked if the P would like to take a shower, and/or whether the P “refused” to take a shower. Corrective Action Ordered: You must immediately review all health and medication records for each service recipient residing at CRS license number 1073045 and take any corrective action needed to attain compliance with theis subdivision. On an ongoing basis, you must maintain compliance as required with this subdivision. 2. Citation: Minnesota Statutes 245D.05, subdivision 4, paragraph (b), clause (2) Violation: For one person whose record was reviewed (P), the license holder did not report the refusal or failure to take or receive medication or treatment as required. The P’s Coordinated Service and Support Plan Addendum stated, “Notification will be made to [the P's] physician and [interdisciplinary team] after (3) three or more missed/refused/overdoses of a prescribed medication within a 7 day period ….” The P’s medication administration records (MARs) for May 1 through July 25, 2022, included 482 times when medications were not administered as prescribed, and the license holder failed to report this information as directed in the P’s coordinated service and support plan or the coordinated service and support plan addendum. Corrective Action Ordered:. Within 10 days of receipt of this order, you must notify the P’s legal representative and case manager of all medication refusals since May 2022. You must also review all medication records for other service recipient residing at CRS license number 1073045 and notify their legal representatives, if any, and case managers of all medication refusals since May 2022. On an ongoing basis, you must maintain compliance as required with this subdivision. 3. Citation: Minnesota Statutes 245D.11 subdivision 2, clause (3) Violation: The license holder did not implement policies and procedures that promoted health and welfare by ensuring safe medication assistance and administration according to the requirements in sections 245D.05, subdivisions 1a, 2, and 5, and 245D.051. a. The facility’s Medication-Treatment Event Corrective Action Policy stated that a “medication event” included “any reason for an individual not receiving a prescribed medication or treatment.” When this occurred, a site supervisor or program manager was responsible for ensuring a general event report (GER) was completed. The P’s MARs for May 1 through July 25, 2022, included 482 times when medications were not administered as prescribed, and there was no documentation or information provided that GERs were completed. b. The license holder’s Safe Medication Assistance and Administration stated that staff were supposed to document on the MAR the administration of the medication or treatment or the reason for not administering the medication or treatment. In addition, staff were supposed to report any concerns about the medication or treatment, including a pattern of the person refusing to take the medication or treatment as prescribed, to the prescriber or nurse. The P’s MARs for May 1 through July 25, 2022, included 482 times when medications were not administered as prescribed, and there was no documentation or information provided on the MAR regarding the reason for not administering the medication or treatment. In addition, regarding the same MAR timeframe, the license holder failed to report the P’s pattern of refusing medications (e.g. 482 times) to the prescriber or nurse. c. The license holder’s MAR Review Checklist stated that on a weekly basis, staff were to review the MAR and ensure that actions were taken to make necessary corrections, regarding 1) a person’s missed/refused medications, and 2) a staff’s documentation on the MAR and completion of a GER for medication events. The P’s MARs were not reviewed weekly as required. Instead, they were reviewed five times in May 2022, two times in June 2022, and zero times in July 2022. Despite there being 482 times when medications were not administered as prescribed, there was no documentation or information provided that there were any necessary corrections made. Corrective Action Ordered: On an ongoing basis, you must implement policies and procedures as required in this subdivision. 4. Citation: Minnesota Statutes section 245D.095, subdivision 5, paragraph (a), clause (2) Violation: For nine of nine staff persons whose records were reviewed (S1 – S9), the license holder did not provide orientation to individual needs as required. The license holder failed to document S1’s – S9’s training on the P’s coordinated service and support plan or the coordinated service and support plan addendum prior to having unsupervised direct contact with the P. Corrective Action Ordered: Within 10 days of receipt of this order, you must provide S1 – S9 with the above mentioned training. On an ongoing basis, you must provide orientation to individual needs as required in this subdivision. II. Order to Pay a Fine Because DHS determined that Mary T, Inc. is responsible for serious maltreatment, you must pay a $5000 fine. The act of maltreatment was determined to be serious because after almost three month of neglect for the VA’s health care needs, the VA developed an infestation of maggots in his/her leg wounds, which required hospitalization Legal Authority: Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), subparagraph (4). Billing and Payment of the Fine DHS will send you an invoice for the $5000 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. After the contested case hearing, the Commissioner of DHS will issue a final order. 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, each controlling individual is personally and jointly responsible for payment. If you do not pay the fine on or before the date specified on the invoice and you did not request a contested case hearing, as described below, the Commissioner may issue a second fine, may not issue or reissue a license, or may suspend the license until the license holder pays the fine. III. YOUR RIGHT TO APPEAL You have right to appeal the maltreatment determination and/or fine. Please see options below. Should you exercise your rights to appeal send: 1.
Right to appeal the fine and maltreatment determination You have the right to appeal the fine and maltreatment determination. 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 15 calendar days from when you received this order. See address in this section. If your request is being personally delivered, it must be received by DHS within 15 calendar days from when you received this order. See address in this section. Upon DHS’ receipt of your timely appeal, your case would be scheduled for a contested case hearing in front of an Administrative Law Judge. After this hearing, the Commissioner of DHS will issue a final order. 2. Request for reconsideration of the maltreatment determination only If you do not appeal the fine, you may still request reconsideration of the maltreatment determination. Your request must be made before the deadlines provided below. If you do not meet this deadline, you lose your right to request reconsideration. The timeline to request reconsideration began when you received this order. Your request must: · Be in writing · Clearly state that you are requesting reconsideration of the maltreatment determination · Identify what is inaccurate or incomplete about the information in the Investigation Memorandum · Supply information that is accurate or more complete · State why you believe the finding of maltreatment should be changed · Be made before the deadlines provided below. Your request must be postmarked within 15 calendar days from when you received this order. See address in this section. A response to your reconsideration request will be mailed within 15 working days after DHS receives your request. You have the right to request a fair hearing if a response is not mailed within 15 working days. 3. Right to appeal the order to pay a fine only You have the right to only 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 received this order. See address in this section. If your request is being personally delivered, it must be received by DHS within 10 calendar days from when you received this order. See address in this section. Upon DHS’ receipt of your timely appeal, your case would be scheduled for a contested case hearing in front of an Administrative Law Judge. After this hearing, the Commissioner of DHS will issue a final order. 4. 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 · This action is taken under Minnesota Statutes, section 245A.07, subdivision 1, paragraph (a), which describes under which conditions DHS may impose a fine against a license. · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (4), item (iI) provides that DHS may impose a $5000 fine for each determination of maltreatment of a vulnerable adult under section 626.557 which meets the definition of serious maltreatment for which the license holder is determined responsible. · In determining whether the facility, an individual, or both are responsible for substantiated maltreatment, DHS must consider the mitigating factors provided in Minnesota Statutes, section 626.557, subdivision 9c, paragraph (c). · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (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. · License holders have a right to request reconsideration of a maltreatment determination, under Minnesota Statutes, section 626.557, subdivision 9d. · Minnesota Statutes, section 245A.04, subdivision 7, paragraph (d), clause (4), states that DHS shall not issue or reissue a license if the applicant, license holder, or controlling individual has an outstanding debt related to a license fee, licensing fine, or settlement agreement for which payment is delinquent. · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (2), states that that the license holder shall pay the fine assessed on or before the payment date specified, and if the license holder does not do so the commissioner may issue a second fine or suspend the license until the license holder complies. Questions If you have any further questions regarding this matter, you may contact Melanie Daniel, Supervisor, at 651-431-6559. Sincerely,
Alyssa Dotson, Deputy Inspector General Licensing Division Office of Inspector General Enclosure
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