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January 23, 2023 Ismael Omer, Authorized Agent Apple Adult Day Care Inc. 1001 140th Lane Northwest Andover, Minnesota 55304 License Number: 1084043 (Rule 223) NOTICE OF NON-COMPLIANCE AND CORRECTION ORDER Dear Ismael Omer:
On September 26, 2022, as a result of a licensing review, a Correction Order was issued to Apple Adult Day Care Inc., located at 1900 Central Avenue Northeast, Minneapolis, Minnesota. You were ordered to take corrective action for violations determined under citations 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, and 13. On January 10, 2023, a follow-up licensing review was conducted to determine that correction action was achieved. For citations 3, 5, 7, 9, 10, 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 a 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 of state and federal laws and rules was 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. 3. Citation: Minnesota Rules, part 9555.0030. Violation: For one participant whose record was reviewed (P1), the license holder did not meet the requirements for positive support strategies and person-centered planning as required. The license holder failed to incorporate positive support strategies in writing into an existing treatment, service, or other individual plan required of the license holder for P1. §Corrective Action Ordered: Within 30 days of receiving this order, you must: · provide training to staff persons, as applicable, according to the requirements in part 9544.0090, subparts 1, and 2, and document the training according to the requirements in part 9544.0090, subpart 5; · ensure that staff persons can demonstrate competency through knowledge testing or observed skill assessment conducted by a trainer or instructor as required in part 9544.0090, subpart 4, and document the training according to the requirements in part 9544.0090, subpart 5; and · develop and implement support strategies for P1 according to the standards in part 9544.0030, subparts 2, 3, and 4. Additionally, you must: · at least every six months, evaluate with P1 whether the identified positive support strategies currently meet the standards in subpart 2. Based upon the results of the evaluation, you must determine whether changes are needed in the positive support strategies used, and, if so, you must make appropriate changes; · at least every six months, evaluate with P1 whether the services support P1’s preferences, daily needs and activities, and the accomplishment of P1’s goals in accordance with Minnesota Statutes, section 245D.07, subdivision 1a, paragraph (b), and whether the person-centered planning process compiles with Code of Federal Regulations, title 42, section 441.725, paragraph (a)(1)-(4). Based upon the results of the evaluation, you must determine whether changes are needed to enhance person-centeredness for the person, and, if so, make appropriate changes; · provide annual refresher training to all staff persons as required in part 9544.0090, subpart 3 and document the training according to part 9544.0090, subpart 5; and · maintain documentation and record keeping requirements as required in part 9544.0100. 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 failed to take corrective action in response to this citation. DHS Response: The license holder failed to incorporate positive support strategies in writing into an existing treatment, service, or other individual plan required of the license holder for P1. §Corrective Action Ordered: Within 15 days of receiving this order, you must: · provide training to staff persons, as applicable, according to the requirements in part 9544.0090, subparts 1, and 2, and document the training according to the requirements in part 9544.0090, subpart 5; · ensure that staff persons can demonstrate competency through knowledge testing or observed skill assessment conducted by a trainer or instructor as required in part 9544.0090, subpart 4, and document the training according to the requirements in part 9544.0090, subpart 5; and · develop and implement support strategies for P1 according to the standards in part 9544.0030, subparts 2, 3, and 4. Additionally, you must: · at least every six months, evaluate with P1 whether the identified positive support strategies currently meet the standards in subpart 2. Based upon the results of the evaluation, you must determine whether changes are needed in the positive support strategies used, and, if so, you must make appropriate changes; · at least every six months, evaluate with P1 whether the services support P1’s preferences, daily needs and activities, and the accomplishment of P1’s goals in accordance with Minnesota Statutes, section 245D.07, subdivision 1a, paragraph (b), and whether the person-centered planning process compiles with Code of Federal Regulations, title 42, section 441.725, paragraph (a)(1)-(4). Based upon the results of the evaluation, you must determine whether changes are needed to enhance person-centeredness for the person, and, if so, make appropriate changes; · provide annual refresher training to all staff persons as required in part 9544.0090, subpart 3 and document the training according to part 9544.0090, subpart 5; and · maintain documentation and record keeping requirements as required in part 9544.0100. On an ongoing basis, you must maintain compliance as required in this part. 5. 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 the following information in P1’s record: · a report on a physical examination, updated annually. The license holder maintained reports on P1’s physical examination dated April 13, 2021 and May 18, 2022; and · participation reports and progress notes that were recorded at least monthly. b. The license holder failed to include the following information in P2’s record: · an application form that included: o P2's address, date of admission, and source of referral; and o the name and telephone number of P2's physician or medical provider; · a medical report dated within the three months prior to or 30 days after P2’s admission to the center. P2 was admitted to the center on April 11, 2022 and the license holder maintain a medical report for P2 dated May 19, 2022; · P2's service agreement with the center that specified the responsibilities of P2 and the center with respect to payment for and provision of services and was signed by P2 and the center director; · participation reports and progress notes that were recorded at least monthly; and · a statement signed by the center director and P2 at the time of P2's admission specifying the basis on which P2 was determined to be capable or not capable of taking appropriate action for self-preservation under emergency conditions. c. The license holder failed to include the following information in P3’s record: · an application form that included: o P3’s date of admission and telephone number; and o the name and telephone number of P3’s physician or medical provider; · a medical report that included: o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P3; and o a release signed by the physician indicating whether P3 may engage in a structured exercise program; · P3's service agreement with the center that specified the responsibilities of P3 and the center with respect to payment for and provision of services and was signed by P3 and the center director; · participation reports and progress notes that were recorded at least monthly; · notes on special problems or on changes needed in medication and on the need for medication assistance; and · a statement signed by the center director specifying the basis on which P3 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 and P3’s participant records. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this part. License Holder Response: The license holder maintained the following in P2’s record: · an application form that included: o P2's address and date of admission; and o the name and telephone number of P2's physician or medical provider; · P2's service agreement with the center that specified the responsibilities of P2 and the center with respect to payment for and provision of services and was signed by P2 and the center director; · participation reports and progress notes that were recorded at least monthly; and · a statement signed by the center director and P2 specifying the basis on which P2 was determined to be capable or not capable of taking appropriate action for self-preservation under emergency conditions. The license holder maintained the following in P3’s record: · an application form that included: o P3’s date of admission and telephone number; and o the name and telephone number of P3’s physician or medical provider; · P3's service agreement with the center that specified the responsibilities of P3 and the center with respect to payment for and provision of services and was signed by P3 and the center director; · participation reports and progress notes that were recorded at least monthly; and · a statement signed by the center director specifying the basis on which P3 was determined to be capable or not capable of taking appropriate action for self-preservation under emergency conditions. DHS Response: The license holder failed to maintain an application form for P2 that included P2’s source of referral. The license holder failed to maintain the following information in P3’s record: · a medical report that included: o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P3; and o a release signed by the physician indicating whether P3 may engage in a structured exercise program; and · notes on special problems or on changes needed in medication and on the need for medication assistance. §Corrective Action Ordered: Within 15 days of receiving this order, you must maintain all required information detailed above in P2 and P3’s record. On an ongoing basis, you must maintain compliance as required in this subdivision. 7. 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. a. The license holder failed to develop written plans of care for P1 and P2 that included§ short and long term objectives for the participant stated in concrete, measurable and time specific outcomes. b. The license holder failed to develop a written plan of care for P3 that included§: · short and long term objectives for P3 stated in concrete, measurable and time specific outcomes; and · provisions for quarterly review and quarterly revisions of the individual plan of care. The license holder documented reviews dated October 20, 2021, April 25, 2022, and July 2022. §Corrective Action Ordered: Within 30 days of receiving this order, you must: · develop written plans of care for P1, P2, and P3 that include short and long term objectives for the participant stated in concrete, measurable and time specific outcomes; · 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 on site. 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, P2, and P3 that included short and long-term objectives for the participant stated in concrete, measurable and time specific outcomes. DHS Response: Although the license holder developed a written plan of care for P2 that included short and long-term objectives, the license holder failed to include the anticipated duration of the individual plan of care and provisions for quarterly review and quarterly revisions of the individual plan of care. Corrective Action Ordered: Within 15 days of receiving this order, you must develop a written plan of care for P2 that includes the anticipated duration of the individual plan of care and provisions for quarterly review and quarterly revisions of the individual plan of care. On an ongoing basis, you must maintain compliance as required in this subpart. 9. Citation: Minnesota Rules, part 9555.9650, item B. Violation: For two 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 physical therapist’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 documentation that the registered dietician met any licensure, registration, or certification requirements required to perform services. 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 physical therapist specifying conditions and terms of employment; and · maintain documentation that your physical therapist and registered dietician meet licensure, registration, and certification requirements required to perform the services specified in the contract. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this item. License Holder Response: The license holder maintained a copy of a signed contract with a physical therapist specifying condition and terms of employment. DHS Response: The license holder failed to maintain documentation that the physical therapist and registered dietician met any licensure, registration, and certification requirements required to perform services. The license holder maintained a license for the physical therapist that expired December 31, 2022 and a license for the registered dietician that expired November 30, 2022. Corrective Action Ordered: Within 15 days of receiving this order, you must maintain documentation that the physical therapist and registered dietician meet licensure requirements required to perform services. On an ongoing basis, you must maintain compliance as required in this item. 9. Citation: Minnesota Rules, part 9555.9690, subpart 4. Violation: For one of three staff persons whose record was reviewed (SP2), the license holder did not provide in-service training annually as required. The license holder failed to provide SP2 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 SP2. 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 provided SP2 eight hours of in-service training. DHS Response: The license holder failed to provide SP2 training 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 15 days of receiving this order, you must provide SP2 training in areas related to care of center participants, including provision of medication assistance and review of parts 9555.9600 to 9555.9730. On an ongoing basis, you must maintain compliance as required in this subpart. 10. Citation: Minnesota Rules, part 9544.0070. Violation: The license holder did not meet the requirements for the emergency use of manual restraint as required. The license holder failed to develop, document, and implement a policy and procedures that promoted service recipient rights and protect health and welfare during the use of manual restraints as required in Minnesota Statutes, section 245D.061, subdivision 9. Corrective Action Ordered: Within 30 days of receiving this order, you must: · develop a policy and procedures on the emergency use of manual restraint as stated above; · provide notice to P1 of your policy and procedures on the emergency use of manual restraint as required in part 9544.0080. The notice must: o inform P1 of their rights under Minnesota Statutes, section 245D.04; and o be in writing; and · obtain written acknowledgement from P1’s legal representative that P1 has been notified. 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 failed to take corrective action in response to this citation. DHS Response: The license holder failed to develop, document, and implement a policy and procedures that promoted service recipient rights and protect health and welfare during the use of manual restraints as required in Minnesota Statutes, section 245D.061, subdivision 9. Corrective Action Ordered: Within 15 days of receiving this order, you must: · develop a policy and procedures on the emergency use of manual restraint as stated above; · provide notice to P1 of your policy and procedures on the emergency use of manual restraint as required in part 9544.0080. The notice must: o inform P1 of their rights under Minnesota Statutes, section 245D.04; and o be in writing; and · obtain written acknowledgement from P1’s legal representative that P1 has been notified. On an ongoing basis, you must maintain compliance as required in this subpart. 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: Commissioner, Department of Human Services ATTN: Legal Unit Licensing Division PO Box 64242 St. Paul, MN 55164-0242 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 Desiree Tiller, Senior Licensor, at 651-431-4622.
Sincerely, Brittany Raddatz, Senior Licensor Licensing Division Office of Inspector General
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