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February 22, 2023 CERTIFIED MAIL Jacob Margarit, Authorized Agent Lutheran Social Service of Minnesota 2485 Como Avenue Saint Paul, MN 55108 License Number 1069963-HCBS (Home and Community-Based Services) License Number 1069980-H_CRS (Home and Community-Based Services-Community Residential Setting) Report Number 202208947 DETERMINATION OF MALTREATMENT AND ORDER TO PAY A FINE Dear Jacob Margarit: The Department of Human Services (DHS) determined that LSS-Gateway located at 2110 Castle Avenue, North Saint Paul, Minnesota is responsible for maltreatment by emotional abuse and neglect. Based on this determination, DHS is ordering you to pay a fine of $3000. Details of our findings are provided below and in the enclosed Investigation Memorandum for report 202208947. Our next steps and your options are also detailed. I. Determination of Maltreatment It was reported that a lack of staffing at the facility resulted in vulnerable adult’s (VA1 and VA2) being left in bed for most hours of the day with little activities and engagement; and vulnerable adult (VA3) not receiving necessary supervision for his/her seizure disorder. DHS investigated the report as alleged maltreatment by emotional abuse and neglect. Based on the maltreatment investigation, DHS determined that LSS-Gateway was responsible for emotional abuse and neglect of three vulnerable adults. See the enclosed Investigation Memorandum for more information. Legal Authority: Minnesota Statutes, section 626.557, subdivision 9c. Fine: $3,000 Citations Related to the Maltreatment Determination 1. Citation: Minnesota Statutes section 245D.09, subdivision 5, paragraph (a), clause (2). Violation: The license holder did not maintain documentation of staff training as required under section 245D.09, subdivisions 3 to 5, including the date the training was completed, the number of hours per subject area, and the name of the trainer or instructor. For six of six personnel files reviewed, there was no documentation that staff persons (S1-S6) reviewed and/or received instruction on the persons’ (P1’s-P3’s) support plan or support plan addendum as it related 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. 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 2, paragraph (b). Violation: The license holder did not implement medication administration procedures to ensure a person takes medications and treatments as prescribed. For one person (P1), information was provided that staff did not administer his/her acid reflux medication as prescribed and in accordance with his/her medication administration record. P1 relied on staff to meet all of his/her health needs, including medication administration. Corrective Action Ordered: Correct immediately and maintain compliance with this licensing requirement on a continuing basis throughout the program. 3. Citation: Minnesota Statutes section 245D.05, subdivision 1. Violation: The license holder did not meet a person’s health service needs as assigned in the person’s support plan and support plan addendum, consistent with the person’s health needs. For two people (P1 and P2), information was provided that they each missed an unknown number of their respective appointments. P1 and P2 each relied on staff to meet all of their respective health needs, including scheduling and attending appointments. Corrective Action Ordered: Correct immediately and maintain compliance with this licensing requirement on a continuing basis throughout the program. 4. Citation: Minnesota Statutes section 245D.07, subdivision 1a, paragraph (a). Violation: The license holder did not ensure services were provided in response to a person's identified needs as specified in the coordinated service and support plan and the coordinated service and support plan addendum. One person (P2) required 12 hours of 1:1 staffing, which, in part, was to monitor him/her for seizure activity. This level of staffing was not provided at all times by the facility. Corrective Action Ordered: Correct immediately and maintain compliance with this licensing requirement on a continuing basis throughout the program. II. Order to Pay a Fine Because DHS determined that LSS-Gateway is responsible for maltreatment, you must pay a $3000 fine. Legal Authority: Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), subparagraph (4). III. Billing and Payment of the Fine DHS will send you an invoice for the $3000 fine. Payment must be made as directed on the invoice. If you request a contested case hearing, as described below, do not pay the fine at this time. After the contested case hearing, the Commissioner of DHS will issue a final order. Please note, you may not avoid payment of this fine by closing, selling, or otherwise transferring the license to a third party. If this occurs, each controlling individual is personally and jointly responsible for payment. If you do not pay the fine on or before the date specified on the invoice and you did not request a contested case hearing, as described below, the Commissioner may issue a second fine, may not issue or reissue a license, or may suspend the license until the license holder pays the fine. IV. YOUR RIGHT TO APPEAL You have right to appeal the maltreatment determination and/or fine. Please see options below. Should you exercise your rights to appeal send: 1.
Right to appeal the fine and maltreatment determination You have the right to appeal the fine and maltreatment determination. Your request must be in writing and clearly state that you are requesting a contested case hearing for this matter. Your request must be made before the deadlines provided below. If you do not meet this deadline, you lose your right to an administrative appeal. The timeline to appeal began when you received this order. If you are mailing your request, it must be sent by certified mail and postmarked within 15 calendar days from when you received this order. See address, section IV. If your request is being personally delivered, it must be received by DHS within 15 calendar days from when you received this order. See address, section IV. Upon DHS’ receipt of your timely appeal, your case would be scheduled for a contested case hearing in front of an Administrative Law Judge. After this hearing, the Commissioner of DHS will issue a final order. 2. Request for reconsideration of the maltreatment determination only If you do not appeal the fine, you may still request reconsideration of the maltreatment determination. Your request must be made before the deadlines provided below. If you do not meet this deadline, you lose your right to request reconsideration. The timeline to request reconsideration began when you received this order. Your request must: · Be in writing · Clearly state that you are requesting reconsideration of the maltreatment determination · Identify what is inaccurate or incomplete about the information in the Investigation Memorandum · Supply information that is accurate or more complete · State why you believe the finding of maltreatment should be changed · Be made before the deadlines provided below. Your request must be postmarked within 15 calendar days from when you received this order. See address, section IV. A response to your reconsideration request will be mailed within 15 working days after DHS receives your request. You have the right to request a fair hearing if a response is not mailed within 15 working days. 3. Right to appeal the order to pay a fine only You have the right to only appeal the fine. Your request must be in writing and clearly state that you are requesting a contested case hearing for this matter. Your request must be made before the deadlines provided below. If you do not meet this deadline, you lose your right to an administrative appeal. The timeline to appeal began when you received this order. If you are mailing your request, it must be sent by certified mail and postmarked within 10 calendar days from when you received this order. See address, section IV. If your request is being personally delivered, it must be received by DHS within 10 calendar days from when you received this order. See address, section IV. Upon DHS’ receipt of your timely appeal, your case would be scheduled for a contested case hearing in front of an Administrative Law Judge. After this hearing, the Commissioner of DHS will issue a final order. 4. Legal representation at the contested case hearing You do not need a lawyer to appeal. However, a lawyer can help you with your appeal. The state or county will not get you a lawyer and will not pay for a lawyer. If you cannot afford a lawyer, you may be able to get free legal advice or help with your appeal. To find out if free help is available, contact: Volunteer Lawyers Network at 612-752-6677; Central Minnesota Legal Services at 612-332-8151; Southern Minnesota Legal Services at 651-222-4731; or go to www.justice4mn.org to find a local legal services program that may be able to help you. You can also find information on contested cases from the Office of Administrative Hearings website at https://mn.gov/oah/self-help. Click on Administrative Law Overview, then click on Administrative Law Contested Case Hearing Guide for a list of frequently asked questions. Legal authority for this licensing action · This action is taken under Minnesota Statutes, section 245A.07, subdivision 1, paragraph (a), which describes under which conditions DHS may impose a fine against a license. · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (4), item (i) provides that DHS may impose a $1000 fine for each determination of maltreatment of a vulnerable adult under section 626.557 for which the license holder is determined responsible. · In determining whether the facility, an individual, or both are responsible for substantiated maltreatment, DHS must consider the mitigating factors provided in Minnesota Statutes, section 626.557, subdivision 9c, paragraph (c). · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (5) states that license holders may not avoid payment of a fine by closing, selling, or transferring a license. · License holders have a right to appeal licensing actions and request a contested case hearing, under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. · License holders have a right to request reconsideration of a maltreatment determination, under Minnesota Statutes, section 626.557, subdivision 9d. · Minnesota Statutes, section 245A.04, subdivision 7, paragraph (d), clause (4), states that DHS shall not issue or reissue a license if the applicant, license holder, or controlling individual has an outstanding debt related to a license fee, licensing fine, or settlement agreement for which payment is delinquent. · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (2), states that that the license holder shall pay the fine assessed on or before the payment date specified, and if the license holder does not do so the commissioner may issue a second fine or suspend the license until the license holder complies. Questions If you have any further questions regarding this matter, you may contact Melanie Daniel, Supervisor, at 651-431-6559. Sincerely,
Alyssa Dotson, Deputy Inspector General Licensing Division Office of Inspector General Enclosure cc: Carlton Linton, Ramsey County Adult Foster Care Licensor
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