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December 20, 2022 Mohamed Sahal, Authorized Agent Ultimate Adult Daycare Inc. 1304 East Lake Street Suite 106 Minneapolis, Minnesota 55407 License Number: 1110402 (Rule 223) CORRECTION ORDER Dear Mohamed Sahal: On December 14, 2022, a licensing review of Ultimate Adult Daycare Inc., located at 1304 East Lake Street, Minneapolis, 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.65, subdivision 2, paragraph (b). Violation: For two of two participants whose records were reviewed (P1 and P2), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). The license holder failed to develop IAPPs for P1 and P2 as part of the person’s initial individual program plan or service plan and failed to review P1 and P2’s IAPPs quarterly as part of the review of the program plan or service plan. The license holder failed to document dates on P1 and P2’s IAPPs; therefore, it was unable to be determined the date that IAPPs were developed and when IAPPs were reviewed. Corrective Action Ordered: Within 30 days of receiving this order, you must: · review P1 and P2’s IAPPs with the person’s interdisciplinary team and document the review; · complete an audit of all participants’ IAPPs to ensure the requirements in Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b) are maintained; and · for participants whose IAPPs are not developed and reviewed as required, you must develop a plan detailing how your program will maintain IAPPs as required within 60 calendar days of receiving this order. On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Rules, part 9555.9640. Violation: For one participant whose record was reviewed (P2), the license holder did not distribute policies and program information to participants upon admission as required. The license holder failed to distribute the following policies and program information to P2 upon P2’s admission: · a statement that center admission and employment practices and policies comply with Minnesota Statutes, chapter 363, the Minnesota Human Rights Act; · the terms and conditions of the center's licensure by the department, including a description of the population the center is licensed to serve under part 9555.9730; and · the telephone number of the department's licensing division. Corrective Action Ordered: Immediately, you must distribute the policies and program information listed above to P2 and document the distribution of the policies and program information in P2’s record. On an ongoing basis, you must maintain compliance as required in this part. 3. 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 the following information in P1’s record: · a medical report dated within the three months prior to or 30 days after P1’s admission to the center. P1 was admitted to the center on November 1, 2021 and the license holder maintained medical reports for P1 dated April 4, 2021 and April 4, 2022; and · participation reports and progress notes that are recorded at least monthly. The most recent progress note in P1’s record was dated August 23, 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 P2's physician or medical provider; · P2's service agreement with the center that was signed by the center director; · participation reports and progress notes that are recorded at least monthly; 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: Within 30 days of receiving this order, you must maintain all information detailed above in P2’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 (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 P2 that included: · P2's psychosocial status (for example, awareness level, personal care needs, need for privacy or socialization); · §P2's functional status (for example, endurance and capability for ambulation, transfer, and managing activities of daily living); and · §P2's physical status, determined by observation, from the intake screening interview, and from the medical report received from P2's physician. b. The license holder failed to develop a preliminary service plan for P1 that included P1’s accurate nutritional needs and, where applicable, dietary restrictions. The license holder documented in P1’s preliminary service plan that P1 had a “low sugar and sodium” diet; however, P1’s medical report indicated P1 had no dietary restrictions. c. The license holder failed to develop a preliminary service plan for P2 that included: · P2’s accurate nutritional needs and, where applicable, dietary restrictions. The license holder documented in P2’s preliminary service plan that P1 had no nutritional needs or dietary restrictions; however, P2’s medical report indicated a dietary restriction of “no pork”; · 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: · conduct a needs assessment for P2; and · update P1 and P2’s preliminary service plans to include the information detailed above. On an ongoing basis, you must maintain compliance as required in this subpart. 5. 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; · the anticipated duration of the individual plan of care as written; and · provisions for quarterly review and quarterly 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 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. 6. Citation: Minnesota Rules, part 9555.9710, subparts 1, 3, and 7. Violation: The license holder did not offer services as required. a. The license holder failed to: · offer a midafternoon snack; · ensure menus for all meals and snacks were approved by a registered dietician; and · maintain a record indicating the menu for all meals served for at least six months. b. The license holder failed to ensure a registered nurse provided consultation and review of health services at least monthly prior to June 2022. c. The license holder failed to maintain a family and social history in P1’s record that was updated annually. The license holder maintained documentation that P1’s family and social history was most recently reviewed on November 1, 2021. § Corrective Action Ordered: Immediately, you must: · offer a midafternoon snack; and · ensure your menus for all meals and snacks have been approved by a registered dietician. Within 30 days of receiving this order, you must document the review of P1’s family and social history and update P1’s family and social history, if applicable. On an ongoing basis, you must maintain compliance as required in these subparts. 7. Citation: Minnesota Rules, part 9555.9650, item A. Violation: For one of two staff persons whose record was reviewed (SP1), the license holder did not maintain a personnel record as required. The license holder failed to maintain documentation of an annual performance evaluation in SP1’s personnel record. Corrective Action Ordered: Within 30 days of receiving this order, you must complete a performance evaluation for SP1 and maintain documentation of the evaluation in SP1’s personnel record. On an ongoing basis, you must maintain compliance as required in this item. 8. Citation: Minnesota Rules, part 9555.9650, item B. Violation: For three consultants whose records were reviewed, the license holder did not include all required information in the personnel record. a. 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. b. The license holder failed to maintain a copy of a signed contract or letter of appointment specifying conditions and terms of employment in the registered nurse and physical therapist’s personnel records. Corrective Action Ordered: Within 30 days of receiving this order, you must: · maintain a copy of a signed contract or letter of appointment with your registered nurse, physical therapist, and registered dietician specifying conditions and terms of employment; and · maintain documentation that your registered dietician meet 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. 9. Citation: Minnesota Statutes, section 245A.65, subdivision 3. Violation: For one staff person whose record was reviewed (SP1), the license holder did not provide annual review to a mandated reporter as required. The license holder failed to provide SP1 annual review in 2022 to the reporting requirements and definitions in sections 626.557 and 626.5572, the requirements of this section, the license holder's program abuse prevention plan, and all internal policies and procedures related to the prevention and reporting of maltreatment of individuals receiving services. SP1 was most recently provided this review in October 2021. Corrective Action Ordered: Immediately, you must provide the required annual review detailed above to SP1. On an ongoing basis, you must maintain compliance as required in this subdivision. 10. Citation: Minnesota Rules, part 9555.9690, subpart 4. Violation: For one staff person whose record was reviewed (SP1), the license holder did not provide in-service training annually as required. The license holder failed to provide SP1 a minimum of eight hours of in-service training annually in areas related to care of center participants, including provision of medication assistance, and review of parts 9555.9600 to 9555.9730. Corrective Action Ordered: Within 30 days of receiving this order, you must provide the required in-service training detailed above to SP1. On an ongoing basis, you must maintain compliance as required in this subpart. 11. Citation: Minnesota Rules, part 9555.9720, subpart 8. Violation: The license holder did not ensure safety as required. The license holder failed to ensure the areas used by participants were free from loose plaster and peeling paint. Corrective Action Ordered: Immediately, you must ensure all areas used by participants are free from loose plaster and peeling paint. 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 any questions regarding this Correction Order, please contact me as soon as possible. Brittany Raddatz, Human Services Senior Licensor Licensing Division Office of Inspector General 651-431-6591
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