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December 9, 2022 Rodney Carlson, Authorized Agent Living Well Disability Services 1168 Northland Drive Mendota Heights, MN 55120 RE: Report No. 202208577 Living Well Disability Services-Cloman License No. 1109538/1070299 Dear Mr. Carlson: CORRECTION ORDER An investigation of Living Well Disability Services-Cloman was completed regarding report number 202208577 which alleged violation of Minnesota Statutes, section 626.557, and Minnesota Statutes, Chapter 245D. This maltreatment allegation concerned neglect. The dispositions of the investigation report are inconclusive. Two violations were noted. VIOLATIONS AND CORRECTION ORDERS The following violations of state and (or) federal laws and rules were observed. Corrective action for each violation is required by Minnesota Statutes, section 245A.06, and is hereby ordered by the Commissioner of Human Services. Failure to correct the violations within the prescribed amount of time may result in fines and/or action against your license, as provided for in Minnesota Statutes, sections 245A.06 and 245A.07. 1. Citation: Minnesota Statutes section 245D.09, subdivision 4a, paragraph (c) Violation: The license holder did not ensure that staff providing direct support review and receive instruction on the person's support plan or support plan addendum as it relates to the responsibilities assigned to the license holder, and when applicable, the person's individual abuse prevention plan, to achieve and demonstrate an understanding of the person as a unique individual, and how to implement those plans. On October 15, 2022, a staff person (S) worked at the facility for at least three hours and provided direct care services to four individuals during that time. The S had not received training on the individuals’ support plans and support plan addendums prior to providing direct care services. Corrective Action Ordered: Correct immediately and maintain compliance with this licensing requirement on a continuing basis throughout the program. 2. Citation: Minnesota Statutes section 245D.05, subdivision 1, clause (b), items (1) and (2) Violation: 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 provide medication administration; and in order to monitor health conditions according to written instructions from a licensed health professional. On October 25, 2022, a person serviced (P) was prescribed medication as needed for pain following a hospitalization for a burn injury, in which the P sustained burns to 2.8% of his/her body surface area. Staff failed to take into account that the P did not communicate verbally and had a history of not always indicating that s/he was in pain. Staff persons were unable to determine the P’s pain level, did not seek additional guidance, and did not administer the pain medication at any point following his/her hospitalization. Corrective Action Ordered: Correct immediately and maintain compliance with this licensing requirement on a continuing basis throughout the program. If you believe any of the citations are in error, you may ask the Commissioner of Human Services to reconsider the parts of the correction order that you believe to be in error. If you choose to exercise this right, your request for reconsideration must be in writing and received by the Commissioner within 20 calendar days after receipt of this letter. Your request for reconsideration must be sent to: Commissioner Minnesota Department of Human Services c/o Licensing Division PO Box 64242 St. Paul, MN 55164-0242 You must include any and all information, documentation, or other evidence you have to support your request for reconsideration. Please note that a request for reconsideration does not stay any provisions of the correction order.
If you have any questions regarding the investigation, contact me immediately. If you have any questions regarding the maltreatment investigation, contact me; and if you have questions regarding compliance with this Correction Order or applicable rules, contact your licensor, Tiffany Solano at 651-431-6649. Sincerely,
Beth Virden, Senior Investigator Office of Inspector General Licensing Division 651-431-6572 Enclosure
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