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May 5, 2023 Mang Chu-Yang-Heu, Authorized Agent Hmong Minnesota Senior Center 2905 Country Drive Little Canada, Minnesota 55117 License Number: 1049124 (Rule 223) NOTICE OF NON-COMPLIANCE AND CORRECTION ORDER Dear Mang Chu-Yang-Heu: On January 26, 2023, as a result of a licensing review, a Correction Order was issued to Hmong Minnesota Senior Center, located at 2905 Country Drive, Little Canada, Minnesota. You were ordered to take corrective action for violations determined under citations 1 through 15. On May 2, 2023, a follow-up licensing review was conducted to determine that correction action was achieved. For citations 1, 4, 6, 7, and 13. 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 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.14, subdivision 14, paragraph (c). Violation: The license holder did not meet the requirements for attendance record documentation. The license holder failed to maintain documentation of actual attendance for each adult day service recipient for which the license holder was reimbursed by a governmental program that included: · the time of day that the recipient was dropped off; and · the time of day that the recipient was picked up. Corrective Action Ordered: Immediately, you must maintain documentation as required in this subdivision. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. License Holder Response: The license holder failed to take corrective action as ordered. DHS Response: The license holder failed to maintain documentation of actual attendance for each adult day service recipient for which the license holder was reimbursed by a governmental program that included: · the time of day that the recipient was dropped off; and · the time of day that the recipient was picked up. Corrective Action Ordered: Immediately, you must maintain documentation as required in this subdivision. On an ongoing basis, you must maintain compliance as required in this subdivision. 4. Citation: Minnesota Rules, part 9555.9660, subparts 1 and 3. Violation: For four participants whose records were reviewed (P1, P2, P3 and P4), 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: · an application form that included: o P1's date of admission or readmission and living arrangement; o the name and telephone number of the person to call in case of an emergency involving P1 and the name and number of another person to call if that person cannot be reached; and o the name and telephone number of P1's physician or medical provider; · a medical report, dated within the three months prior to or 30 days after P1’s admission to the center signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on a physical examination, updated annually; o a medical history of P1; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P1; o a release signed by the physician indicating whether P1 may engage in a structured exercise program; and o documentation that P1 was free of communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants; · P1's service agreement with the center that specified the responsibilities of P1 and the center with respect to payment for and provision of services and was signed by P1 or P1's caregiver and the center director; · attendance and participation reports and progress notes that are recorded at least monthly; · notes on special problems, medication changes, and need for medication assistance; and · a statement signed by the center director and P1 at the time of P1's admission specifying the basis on which P1 determined to be capable or not capable of taking appropriate action for self-preservation under emergency conditions. b. The license holder failed to include the following information in P2’s record: · an application form that included: o P2's date of admission or readmission and living arrangement; and o the name and telephone number of the person to call in case of an emergency involving P2 and the name and number of another person to call if that person cannot be reached; · a medical report, dated within the three months prior to or 30 days after P2’s admission to the center signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on a physical examination, updated annually; o a medical history of P2; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P2; o a release signed by the physician indicating whether P2 may engage in a structured exercise program; and o documentation that P2 was free of communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants; · 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 or P2's caregiver and the center director; · attendance and participation reports and progress notes that are recorded at least monthly; · notes on special problems, medication changes, and need for medication assistance; and · a statement signed by the center director and P2 at the time of P2's admission specifying the basis on which P2 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 or readmission and living arrangement; o the name and telephone number of the person to call in case of an emergency involving P3 and the name and number of another person to call if that person cannot be reached; and o the name and telephone number of P3's physician or medical provider; · a medical report, dated within the three months prior to or 30 days after P3’s admission to the center signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on a physical examination, updated annually; o a medical history of P3; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P3; o a release signed by the physician indicating whether P3 may engage in a structured exercise program; and o documentation that P3 was free of communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants; · 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 or P3's caregiver and the center director; · attendance and participation reports and progress notes that are recorded at least monthly; · notes on special problems, medication changes, and need for medication assistance; and · a statement signed by the center director and P3 at the time of P3's admission specifying the basis on which P3 was determined to be capable or not capable of taking appropriate action for self-preservation under emergency conditions. d. The license holder failed to include the following information in P4’s record: · an application form that included P4’s date of admission; · a medical report, dated within the three months prior to or 30 days after P4’s admission to the center signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on a physical examination, updated annually; o a medical history of P4; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P4; and o documentation that P4 was free of communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants; · P4's service agreement with the center that specified the responsibilities of P4 and the center with respect to payment for and provision of services and was signed by P4 or P4's caregiver and the center director; · attendance and participation reports and progress notes that are recorded at least monthly; and · a statement signed by the center director specifying the basis on which P4 was determined to be capable or not capable of taking appropriate action for self-preservation under emergency conditions. e. The license holder failed to provide P1, P2, P3 and P4 with written notices that ensured the participant or their guardians or caregivers had been informed of the participant’s right to contest the accuracy and completeness of the data maintained in the record. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain all information detailed above in P1, P2, P3, and P4’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: P1 discharged from the center on January 1, 2023. The license holder failed to include a discharge summary in P1’s record. The license holder maintained the following in P2’s record: · an application form that included: o P2's date of admission or readmission and living arrangement; and o the name and telephone number of the person to call in case of an emergency involving P2 and the name and number of another person to call if that person cannot be reached; · a medical report, signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on a physical examination; o a medical history of P2; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P2; o a release signed by the physician indicating whether P2 may engage in a structured exercise program; and o documentation that P2 was free of communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants; · 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 or P2's caregiver and the center director; and · a statement signed by the center director and P2 at the time of P2's admission specifying the basis on which P2 determined to be capable or not capable of taking appropriate action for self-preservation under emergency conditions. The license holder maintained the following information in P3’s record: · an application form that included: o P3's date of admission or readmission and living arrangement; o the name and telephone number of the person to call in case of an emergency involving P3 and the name and number of another person to call if that person cannot be reached; and o the name and telephone number of P3's physician or medical provider; · a medical report, signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on a physical examination; o a medical history of P3; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P3; o a release signed by the physician indicating whether P3 may engage in a structured exercise program; and o documentation that P3 was free of communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants; · 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 or P3's caregiver and the center director; and · a statement signed by the center director and P3 at the time of P3's admission specifying the basis on which P3 was determined to be capable or not capable of taking appropriate action for self-preservation under emergency conditions. The license holder maintained the following information in P4’s record: · an application form that included P4’s date of admission; · P4's service agreement with the center that specified the responsibilities of P4 and the center with respect to payment for and provision of services and was signed by P4 or P4's caregiver and the center director; and · a statement signed by the center director specifying the basis on which P4 was determined to be capable or not capable of taking appropriate action for self-preservation under emergency conditions. Additionally, the license holder maintained written notices that ensured P2, P3 and P4 or their guardians or caregivers had been informed of the participant’s right to contest the accuracy and completeness of the data maintained in the record. DHS Response: P1 discharged from the center on January 1, 2023; therefore, P1’s record was not reviewed for corrective action. The license holder failed to include the following information in P2 and P3’s records: · participation reports and progress notes that are recorded at least monthly; and · notes on special problems, medication changes, and need for medication assistance. The license holder failed to include the following information in P4’s record: · a medical report, signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on a physical examination, updated annually; o a medical history of P4; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P4; and o documentation that P4 was free of communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants; and · participation reports and progress notes that are recorded at least monthly. Corrective Action Ordered: Within 15 days of receiving this order, you must maintain all information detailed above in P1, P2, P3, and P4’s participant records. On an ongoing basis, you must maintain compliance as required in this part.
6. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For four participants whose records were reviewed (P1, P2, P3 and P4), the license holder did not complete initial service planning as required. a. The license holder failed to conduct needs assessments for P1, P2, P3 and P4 that included: · the participant's psychosocial status (for example, awareness level, personal care needs, need for privacy or socialization);§ · the participant's functional status (for example, endurance and capability for ambulation, transfer, and managing activities of daily living); and · the participant's physical status, determined by observation, from the intake screening interview, and from the medical report received from the participant's physician. b. The license holder failed to develop preliminary service plans for P1, P2, and P3 that included: · §scheduled days of the participant’s attendance at the center; · transportation arrangements for getting the participant to and from the center; · the participant’s nutritional needs and, where applicable, dietary restrictions; · the role of the participant’s caregiver or caregivers in carrying out the service plan; and · services and activities in which the participant would take part immediately upon admission. §Corrective Action Ordered: Within 30 days of receiving this order, you must: · conduct needs assessments for P1, P2, P3 and P4 as detailed above; · develop preliminary service plans for P1, P2, and P3 that include the information and specifications detailed above; · complete an audit of all participants’ needs assessments and preliminary service plans to ensure the requirements in Minnesota Rules, part 9555.9700, subpart 2 are maintained; and · for participants who do not have needs assessments and preliminary service plans that include all requirements, you must develop a plan detailing how your program will maintain a complete needs assessment within 60 calendar 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 conducted needs assessments and developed preliminary service plans for P2, P3 and P4. DHS Response: Although the license holder conducted a needs assessment for P2 and P4, the license holder failed to conduct a needs assessment for P2 and P4 that included P2 and P4’s physical status, determined by observation, from the intake screening interview and from the medical report received from P2 and P4’s physicians. Corrective Action Ordered: Within 15 days of receiving this order, you must update P2 and P4’s needs assessment to include an assessment of P2 and P4’s physical status. On an ongoing basis, you must maintain compliance as required in this subpart. 7. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For four participants whose records were reviewed (P1, P2, P3 and P4), 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, P3 and P4 that included§: · an update of the preliminary service plan and additional services required by the participant; · short and long term objectives for the participant stated in concrete, measurable and time specific outcomes; · the staff members responsible for implementing the individual plan of care; · 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, P2, P3 and P4 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. 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 a written plans of care for P2, P3, and P4. DHS Response: Although the license holder developed written plans of care for P2 and P3, the license holder failed to include short and long term objectives for P2 and P3 stated in concrete, measurable and time specific outcomes. Corrective Action Ordered: Within 15 days of receiving this order, you must update P2 and P3’s plans of care to include short and long term objectives for P2 and P3 stated in concrete, measurable and time specific outcomes. On an ongoing basis, you must maintain compliance as required in this subpart. 13. Citation: Minnesota Rules, part 9555.9710, subparts 1, 4, and 7. Violation: The license holder did not offer services as required. a. The license holder failed to ensure menus for all meals and snacks were approved by a registered dietitian and met all applicable state rules and laws and United States Department of Agriculture regulations. b. The license holder failed to maintain a record indicating the menu for all meals served for at least six months. c. The license holder failed to ensure a registered physical therapist provided consultation and review of the exercise program, at least quarterly, in 2020, and 2021 and 2022. The only documented review of the license holder’s exercise program was dated January 29, 2020. d. The license holder failed to maintain family and social histories in P3 and P4’s records. § Corrective Action Ordered: Within 30 days of receiving this order, you must: · maintain menus for all meals and snacks that are approved by a dietician and meet all applicable state rules and laws and Unities States Department of Agriculture regulations; · ensure your physical therapist provides consultation and review of your exercise program; and · maintain family and social histories in P3 and P4’s records. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in these subparts. License Holder Response: The license holder maintained a record indicating the menu for all meals served for at least six months. Additionally, the license holder maintained a family and social history in P3 and P4’s records. DHS Response: The license holder failed to ensure menus for all meals and snacks were approved by a registered dietitian and met all applicable state rules and laws and United States Department of Agriculture regulations. Additionally, the license holder failed to ensure a registered physical therapist provided consultation and review of the exercise program. Corrective Action Ordered: Within 15 days of receiving this order, you must: · maintain menus for all meals and snacks were approved by a registered dietitian and met all applicable state rules and laws and United States Department of Agriculture regulations; and · ensure your registered physical therapist provides consultation and review of your exercise program. On an ongoing basis, you must maintain compliance as written in these subparts. The following citations were determined as a result of the licensing visit on May 2, 2023. 1. Citation: Minnesota Rules, part 9555.9650, subpart 1, item B. Violation: For one consultant whose record was reviewed, the license holder did not include all required information in the personnel record. 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. 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; · maintain documentation that your registered dietician meets licensure, registration, and certification requirements required to perform the services specified in the contract; and · submit evidence of the required information listed above to your licensor. On an ongoing basis, you must maintain compliance as required in this item. 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. Submissions required as part of a corrective action ordered must be sent to your Licensor at: 1. By secure email at desiree.b.tiller@state.mn.us; or 2. If you are unable to submit corrective action ordered securely through email, you can mail the information below: Commissioner, Department of Human Services ATTN: Desiree Tiller Licensing Division PO Box 64242 St. Paul, MN 55164-0242 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 Office of Inspector General Legal Counsel’s Office Attention: Licensing Legal Unit PO Box 64953 St. 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, please contact your licensor, Desiree Tiller, at 651-431-4622. Brittany Raddatz, Supervisor Licensing Division Office of Inspector General
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