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November 17, 2022 Blia Vang, Authorized Agent Tso Siab Adult Daycare Center LLC 5660 Julep Way Lake Elmo, Minnesota 55042 License Number: 1097769 (Rule 223) CORRECTION ORDER Dear Blia Vang: On November 9, 2022, a licensing review of Tso Siab Adult Daycare Center LLC, located at 2090 11th Avenue East, North 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 Statutes, section 245A.14, subdivision 14, paragraph (c). Violation: The license holder did not meet the requirements for attendance record documentation. The license holder failed to maintain documentation of actual attendance for each adult day service recipient for which the license holder was reimbursed by a governmental program that included: · the time of day that the recipient was dropped off; and · the time of day that the recipient was picked up. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b). Violation: For three of three participants whose records were reviewed (P1, P2, and P3), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). The license holder failed to review P1, P2, and P3’s IAPPs quarterly as part of the review of the program plan or service plan. · The license holder maintained documentation that P1’s IAPP was reviewed on September 28, 2021, March 08, 2022, June 15, 2022, and September 13, 2022. · The license holder maintained documentation that P2’s IAPP was reviewed on March 24, 2022 and August 23, 2022. · The license holder maintained documentation that P3’s IAPP was reviewed on February 14, 2022, July 26, 2022, and October 20, 2022. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For three participants whose records were reviewed (P1, P2, and P3), the license holder did not include information in the participant’s written record as required. a. The license holder failed to include a medical report in P1’s record dated within the three months prior to or 30 days after P1’s admission to the center. P1 was admitted to the center on October 1, 2021 and the license holder maintained a medical report for P1 on December 27, 2021. 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 March 31, 2022 and the license holder maintained a medical report for P2 on August 26, 2022. c. The license holder failed to include a medical report in P3’s record, dated within the three months prior to or 30 days after P3’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 a physical examination, updated annually; · a medical history of P3; · indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P3; · a release signed by the physician indicating whether P3 may engage in a structured exercise program; and · documentation that P3 was free of communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain a medical report in P3’s participant record. On an ongoing basis, you must maintain compliance as required in this part. 4. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For two participants whose records were reviewed (P2 and P3), the license holder did not complete initial service planning as required. The license holder failed to develop preliminary service plans for P2 and P3 that included the role of the participant’s caregiver or caregivers in carrying out the service plan. Corrective Action Ordered: Within 30 days of receiving this order, you must update P2 and P3’s preliminary service plans to include the role of the participant’s caregiver or caregivers in carrying out the service plan. On an ongoing basis, you must maintain compliance as required in this subpart. 5. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For three participants whose records were reviewed (P1, P2, and P3), the license holder did not develop a written plan of care as required. The license holder failed to develop written plans of care for P1, P2, and P3 that included§ an update of the preliminary service plan and additional services required by the participant. §Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subpart. 6. Citation: Minnesota Rules, part 9555.9720, subpart 5. Violation: The license holder did not ensure safety as required. The license holder failed to store chemicals that were poisonous when swallowed or inhaled or that were damaging to eyes or skin in an area not accessible to the participants. Chemicals were stored accessible to participants in restrooms. Corrective Action Ordered: Immediately, you must store chemicals that are poisonous when swallowed or inhaled or that are damaging to eyes or skin in an area not accessible to the participants. 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 questions regarding this Correction Order, 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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