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March 10, 2023 Emadeldin Omer Ibrahim, Authorized Agent Mercy Adult Day Care LLC Woodbury, Minnesota 55125 License Number: 1094960 (Rule 223) CORRECTION ORDER Dear Emadeldin Omer Ibrahim: On March 8, 2023, a licensing review of Mercy Adult Day Care LLC, located at 814 White Bear Avenue, Saint 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.65, subdivision 1, paragraph (c) and subdivision 2, paragraph (a). Violation: For one of three participants whose record was reviewed (P3), the license holder did not provide orientation to the license holder’s internal and external reporting procedures related to suspected or alleged maltreatment and the program abuse prevention plan (PAPP) as required. The license holder failed to provide orientation to P3 on the licensor holder’s internal and external reporting procedures and PAPP within 24 hours of admission. P3 was admitted to the center on June 1, 2022. The license holder provided orientation to P3 on their internal and external reporting procedures and PAPP on June 6, 2022. 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 most recently reviewed on July 6, 2021. · The license holder maintained documentation that P2’s IAPP was most recently reviewed on November 1, 2021. · The license holder maintained documentation that P3’s IAPP was most recently reviewed on June 1, 2022. Corrective Action Ordered: Within 30 days of receiving this order, you must: · review P1, P2, and P3’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. 3. Citation: Minnesota Rules, part 9555.9640. Violation: For one participant whose record was reviewed (P3), the license holder did not distribute policies, program information, and participants’ rights to participants and their caregivers upon admission as required. The license holder failed to distribute policies, program information, and participants’ rights to P3 upon the participant’s admission. P3 was admitted to the center on June 1, 2022. The license holder distributed policies, program information, and participants’ rights to P3 on June 6, 2022. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this part. 4. 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 maintain an application for P1 that included P1’s date of birth and source of referral. b. The license holder failed to include the following information in P2’s record: · an application form that included P2’s source of referral and the name and telephone of P2’s physician or medical provider; and · 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 November 1, 2020 and the license holder maintained a medical report for P2 on June 3, 2021. c. The license holder failed to maintain an application for P3 that included P3’s source of referral. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain all information detailed above in P1, P2, and P3’s participant records. On an ongoing basis, you must maintain compliance as required in this part. 5. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For one participant whose record were reviewed (P2), the license holder did not complete initial service planning as required. Although the license holder maintained a needs assessment in P2’s record, the license holder failed to document the date the needs assessment was conducted; therefore, it could not be determined if P2’s needs assessments were conducted within 30 days of P2’s admission to the center. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subpart. 6. 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; 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, P2, and P3 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. 7. Citation: Minnesota Rules, part 9555.9710, subparts 1, 4, 6 and 7. Violation: The license holder did not offer services as required. a. The license holder failed to offer a midmorning and midafternoon snack. b. The license holder failed to maintain documentation that the registered physical therapist provided consultation and review of the exercise program, at least quarterly. c. The center failed to provide a monthly plan of diversified daily program activities. d. The license holder failed to maintain family and social histories in P1, P2, and P3’s records. § Corrective Action Ordered: Immediately, you must offer a midmorning and midafternoon snack. Within 30 days of receiving this order, you must: · maintain documentation that the registered physical therapist provided consultation and review of the exercise program; · provide a monthly plan of diversified daily program activities; and · maintain family and social histories in P1, P2, and P3’s records. On an ongoing basis, you must maintain compliance as required in these subparts. 8. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (a). Violation: The license holder did not establish and enforce a written program abuse prevention plan (PAPP) as required. The license holder failed to review the PAPP at least annually using the assessment factors in the plan and any substantiated maltreatment findings that occurred since the last review. Corrective Action Ordered: Within 30 days of receiving this order, you must review your PAPP using the assessment factors in the plan and any substantiated maltreatment findings that occurred since the last review. On an ongoing basis, you must maintain compliance as required in this subdivision. 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 your licensor, Alexandra Devick, at 651-431-4626. Brittany Raddatz, Supervisor Licensing Division Office of Inspector General
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