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May 9, 2023 Sahro Mohamed, Authorized Agent Mubarak Senior Center Inc 3550 East 46th Street Apt 201 Minneapolis, Minnesota 55406 License Number: 1108712 (Rule 223) CORRECTION ORDER Dear Sahro Mohamed: On April 20, 2023, a licensing review of Mubarak Senior Center Inc, located at 1840 East 38th 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 Rules, part 9555.9660, subpart 1. Violation: For two of 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: · an application form signed by P1 or P1’s caregiver that included: o P1’s telephone number and source of referral; and o the name and telephone number of the person to call in case of emergency involving P1 and name and number of another person if that person cannot be reached; · 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 January 11, 2023 and the license holder maintained a medical report dated March 11, 2023; · P1’s service agreement with the center that specified the responsibilities of the person and the with respect to payment for and provision of services and signed by the person or the person’s caregiver and the center director; · participation reports and progress note that are recorded at least monthly; and · a copy of the center’s statement on the person’s rights signed by the person or the person’s caregiver. b. The license holder failed to include the following in P2’s record: · an application form signed by P2 or P2’s caregiver that included: o P2’s telephone number and source of referral; and o the name and telephone number of the person to call in case of emergency involving P2 and name and number of another person to call if that person cannot be reached; · a medical report dated with the 3 months prior to or 30 calendar days after the person’s admission to the center. P2 was admitted to the center on February 6, 2023 and the license holder maintained a medical report dated April 4, 2023; · P2’s service agreement with the center that specified the responsibilities of the person and the center with respect to payment for and provision of services and signed by the person or the person’s caregiver and the center director; and · a copy of the center’s statement on the person’s rights signed by the person or the person’s caregiver. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain all information detailed above in P1 and P2’s participant records. On an ongoing basis, you must maintain compliance as required in this part. 2. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For two participants whose records were reviewed (P1 and P2), the license holder did not develop a preliminary service plan as required. The license holder failed to develop preliminary service plans for P1 and P2 that included the role of the participant’s caregiver or caregivers in carrying out the service plan. §Corrective Action Ordered: Within 30 days of receiving this order, you must update P1 and P2’s the preliminary service plans to include the role of the participant’s caregiver or caregivers in carrying out the service plan. On an ongoing basis, you must maintain compliance as required in this subpart. 3. 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. a. The license holder failed to develop a written plan of care for P1 that included: · short- and long-term objectives for the person stated in concrete, measurable, and time specific outcomes; and · provisions for quarterly review and quarterly revisions of the individual plan of care. b. The license holder failed to develop a written plan of care for P2 that included: · short- and long-term objectives for the person stated in concrete, measurable, and time specific outcomes; and · the anticipated duration of the individual plan of care as written. §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. 4. Citation: Minnesota Rules, part 9555.9710, subpart 3. The license holder failed to ensure a registered nurse provided consultation and review of the health services at least monthly since June 2022. Corrective Action Ordered: Within 30 days, you must ensure a registered nurse provides consultation and review of the health services. On an ongoing basis, you must maintain compliance as required in this subpart. 5. Citation: Minnesota Rules, part 9555.9720, subpart 8. 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 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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