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November 23, 2022 Yorn Yan, Authorized Agent United Cambodian Association of Minnesota 1385 Mendota Heights Road #500 Mendota Heights, Minnesota 55120 License Number: 1066340 (Rule 223) CORRECTION ORDER Dear Yorn Yan: On November 17, 2022, a licensing review of United Cambodian Association of Minnesota, located at 1385 Mendota Heights Road, Mendota Heights, 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 Rules, part 9555.9640. Violation: For one of two participants whose record was reviewed (P2), the license holder did not distribute policies and program information to participants as required. The license holder failed to distribute the correct telephone number of the department’s licensing division to P2. The license holder informed P2 that the department’s licensing division telephone number was (651) 296-3971; however, the correct telephone number is (651) 431-6500. Corrective Action Ordered: Immediately, you must distribute the correct telephone number of the department’s licensing division to P2. On an ongoing basis, you must maintain compliance as required in this part. 2. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For two participants whose records were reviewed (P1 and P2), 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 that included a report on a physical examination updated annually in 2021. The license holder only maintained a report on P1’s physical examination dated February 2022. b. The license holder failed to include the following information in P2’s record: · an application form that included the name and telephone number of the secondary person to call in case of an emergency involving P2; · a medical report dated within the three months prior to or 30 days after P2’s admission to the center that included indication of dietary restrictions and medication regimen, including the need for medication assistance, that applied to P2. P2 was admitted to the center on September 1, 2021 and the license holder maintained a medical report for P2 in July 2022; and · a statement signed by the center director specifying the basis on which P2 was determined to be capable or not capable of taking appropriate action for self-preservation under emergency conditions. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subpart. 3. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For one participant whose record was reviewed (P2), the license holder did not complete initial service planning as required. The license holder failed to develop a preliminary service plan for P2 that included: · the role of P2’s caregiver or caregivers in carrying out the service plan; and · services and activities in which P2 would take part immediately upon admission. Corrective Action Ordered: Within 30 days of receiving this order, you must update P2’s preliminary service plan to include the information and specifications detailed above. On an ongoing basis, you must maintain compliance as required in this subpart. 4. 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. The license holder failed to develop written plans of care for P1 and P2 that included§: · an update of the preliminary service plan and additional services required by the participant; and · the anticipated duration of the individual plan of care as written. Repeat Violation: You were cited for a similar violation in a Correction Order issued on November 6, 2020. §Corrective Action Ordered: Within 30 days of receiving this order, you must: · develop written plans of care for P1 and P2 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. On an ongoing basis, you must maintain compliance as required in this subpart. 5. Citation: Minnesota Rules, part 9555.9710, subpart 1. Violation: The license holder did not offer services as required. The license holder failed to offer a midmorning snack. § Corrective Action Ordered: Immediately, you must offer a midmorning snack. On an ongoing basis, you must maintain compliance as required in this subpart. 6. Citation: Minnesota Rules, part 9555.9650, item B. Violation: For one consultant whose record was reviewed, the license holder did not include all required information in the personnel record. The license holder failed to maintain the following in the registered dietician’s personnel record: · a copy of a signed contract or letter of appointment specifying conditions and terms of employment; and · documentation that the consultant met any licensure, registration, or certification requirements required to perform services. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain the following in your registered dietician’s personnel record: · a copy of a signed contract or letter of appointment specifying conditions and terms of employment; and · documentation that your registered dietician meets licensure, registration, and certification requirements required to perform the services specified in the contract. On an ongoing basis, you must maintain compliance as required in this item. 7. Citation: Minnesota Statutes, section 245A.65, subdivision 1, paragraph (d) and subdivision 2, paragraph (a). Violation: The license holder did not post a copy of the internal and external reporting policies and procedures and the program abuse prevention plan in a prominent location in the program as required. Corrective Action Ordered: Immediately, you must post a copy of your internal and external reporting policies and procedures and your program abuse prevention plan in a prominent location in the program. On an ongoing basis, you must maintain compliance as required in these subdivisions. 8. Citation: Minnesota Statutes, part 9555.9720, subparts 2 and 5. Violation: The license holder did not ensure safety as required. a. The license holder failed to post a list of emergency numbers next to a non-coin operated telephone. b. The license holder failed to store chemicals that were poisonous when swallowed or that were damaging to eyes or skin in an area not accessible to participants. At the time of the licensing review, chemicals were being stored accessible to participants in both restrooms. Corrective Action Ordered: Immediately, you must: · post emergency phone numbers next to a non-coin operated telephone; and · store chemicals in an area that is not accessible to participants. On an ongoing basis, you must maintain compliance as required in these subparts. 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, 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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