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November 14, 2022 Mai Vang, Authorized Agent Harmony Adult Day Center LLC 1119 Hawthorne Avenue East St. Paul, Minnesota 55106 License Number: 1104184 (Rule 223) NOTICE OF NON-COMPLIANCE AND CORRECTION ORDER Dear Mai Vang: On August 22, 2022, as a result of a licensing review, a Correction Order was issued to Harmony Adult Day Center LLC, located at 475 Etna Street, St. Paul, Minnesota. You were ordered to take corrective action for violations determined under citations 1 through 13. On October 19, 2022, a follow-up licensing review was conducted to determine that correction action was achieved. For citations 4, 5, 6, and 11, it was determined that corrective action has not been achieved. As a result, this Notice of Noncompliance and 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. 4. Citation: Minnesota Rules, part 9555.9660. Violation: For two participants whose records were reviewed (P1 and P2), the license holder did not develop and maintain a written record as required. a. The license holder failed to maintain a record for P1, including: · an application form signed by P1 or P1’s caregiver that included: o P1’s name, address, date of birth, sex, date of admission, living arrangement, telephone number, and source of referral; o the name and telephone number of the person to call in case of emergency involving P1 and name and number of another person to call if that person cannot be reached; and o the name and telephone number of P1’s physician or medical provider; · a medical report, dated within the three months prior to or 30 calendar days after P1’s admission to the center, signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on physical examination; and o a release signed by the physician indicating whether P1 may engage in a structured exercise program; and · participation reports and progress notes that were recorded at least monthly. a. The license holder failed to maintain a medical report in P2’s record, dated within the three months prior to or 30 calendar days after P2’s admission to the center, signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: · a report on physical examination; and · a release signed by the physician indicating whether P2 may engage in a structured exercise program. Corrective Action Ordered: Within 30 days of receiving this order, you must: · maintain all required information detailed above in P1 and P2’s participant records; · complete an audit of all participants’ records to ensure requirements in Minnesota Rules, part 9555.9660 are maintained; and · for participants who do not have a complete participant record as required, you must develop a plan detailing how your program will maintain all required documentation 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 part. License Holder Response: The license holder maintained the following in P1’s record: · an application form; and · a medical report signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician that included a report on physical examination. Additionally, the license holder maintained a medical report in P2’s record signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician that included a report on physical examination. DHS Response: The license holder failed to maintain a record for P1, including: · an application form that included: o P1’s date of admission and source of referral; o the name and telephone number of the secondary person to call in case of emergency involving P1; and o the telephone number of P1’s physician or medical provider; · a medical report that included a release signed by the physician indicating whether P1 may engage in a structured exercise program; and · participation reports and progress notes that were recorded at least monthly. Additionally, the license holder failed to maintain a medical report in P2’s record that included a release signed by the physician indicating whether P2 may engage in a structured exercise program. Corrective Action Ordered: Within 15 days of receiving this order, you must maintain all required information detailed above in P1 and P2’s participant records. On an ongoing basis, you must maintain compliance as required in this part. 5. 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 conduct a needs assessment for P1 that included: · P1’s psychosocial status (for example, awareness level, personal care needs, need for privacy or socialization); · §P1’s functional status (for example, endurance and capability for ambulation, transfer, and managing activities of daily living); and · §P1’s physical status, determined by observation, from the intake screening interview, and from the medical report received from the P1’s physician. b. The license holder failed to develop a preliminary service plan for P1 that included the following information and specifications: · scheduled days of P1's attendance at the center; · transportation arrangements for getting P1 to and from the center; · P1's nutritional needs and, where applicable, dietary restrictions; · role of P1’s caregiver or caregivers in carrying out the service plan; and · services and activities in which P1 would take part immediately upon admission. c. The license holder failed to conduct a needs assessment for P2 that addressed the person’s physical status, determined from P2’s medical report. Corrective Action Ordered: Within 30 days of receiving this order, you must: · conduct a needs assessment for P1; · develop a preliminary service plan for P1 that includes the information and specifications detailed above; · 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 onsite. On an ongoing basis, you must maintain compliance as required in this subpart. License Holder Response: The license holder conducted a needs assessment and developed a preliminary service plan for P1. DHS Response: The license holder failed to develop a preliminary service plan for P1 that included the services and activities in which P1 would take part immediately upon admission. Corrective Action Ordered: Within 15 days of receiving this order, you must update P1’s preliminary service plan to include the services and activities in which P1 will take part. On an ongoing basis, you must maintain compliance as required in this subpart. 6. 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: · §an update of the preliminary service plan and additional services required by P1; · short and long-term objectives for P1 stated in concrete, measurable, and time specific outcomes; · the staff members responsible for implementing the individual plan of care; and · provisions for quarterly review and quarterly revision of the individual plan of care. 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 · provisions for quarterly review and quality revisions of the individual plan of care. §Corrective Action Ordered: Within 30 days of receiving this order, you must: · develop written plans of care for P1 and P2, with the person, that include the information listed above; · 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 onsite. On an ongoing basis, you must maintain compliance as required in this subpart. License Holder Response: The license holder developed written plans of care for P1 and P2. DHS Response: The license holder failed to develop a written plan of care for P1 that included: · §an update of the preliminary service plan and additional services required by P1; and · short and long-term objectives for P1 stated in concrete, measurable, and time specific outcomes. Additionally, 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 · provisions for quarterly review and quality revisions of the individual plan of care. Corrective Action Ordered: Within 15 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. 11. Citation: Minnesota Statutes, section 245A.65, subdivision 1, paragraph (d). Violation: The license holder did not post a copy of the internal and external reporting policies and procedures, including the telephone number of the common entry point as defined in section 626.5572, subdivision 5, in a prominent location in the program as required. Corrective Action Ordered: Immediately, you must post copy of the internal and external reporting policies and procedures 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. License Holder Response: The license holder did not complete corrective action as ordered. DHS Response: The license holder did not post a copy of the internal and external reporting policies and procedures, including the telephone number of the common entry point as defined in section 626.5572, subdivision 5, in a prominent location in the program. Corrective Action Ordered: Immediately, you must post copy of the internal and external reporting policies and procedures in a prominent location in the program. On an ongoing basis, you must maintain compliance 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, 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 regarding this Correction Order, please contact me as soon as possible. Brittany Raddatz, Human Services Licensor Licensing Division Office of Inspector General 651-431-6591
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