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June 23, 2023 Sheltonn Johnson, Authorized Agent Thrive Youth Services 1710 Douglas Drive N, Suite 224D Golden Valley, Minnesota, 55422 License Number: 1093608 (245D – HCBS) CORRECTION ORDER Dear Sheltonn Johnson: On May 16, 2023 – May 17, 2023, a licensing review of Thrive Youth Services, located at 1710 Douglas Drive N, Suite 224D, Golden Valley, Minnesota, was conducted to determine compliance with state and federal laws and rules governing the provision of home and community-based services to persons with disabilities and age 65 and older under Minnesota Statutes, Chapter 245D. 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 245D.07, subdivision 1a. Violation: For one of three persons whose record was reviewed (P3), the license holder did not provide services in response to the person’s identified needs and preferences as required. The license holder maintained a document in P3’s record titled “Incident Report and Internal Review” that detailed an incident that occurred on January 23, 2023. The report documented that P3 was informed they were not able to use the “staff bathroom” due to “sanitary issues” and that P3 would need to use the other bathroom in the home. The “staff bathroom” was in a common area of the home that the persons receiving services are able to access. P3 became upset and made threats to the staff person and engaged in property destruction. The staff responded by telling P3 to stop and that management would be called. The “staff bathroom” was in a common area of the home that the persons receiving services are able to access. The license holder failed to provide services in response to P3’s identified needs and preferences during this incident. Repeat Violation: In a Conditional License that DHS issued on November 5, 2021, you were previously found in violation of this same statute. Corrective Action Ordered: Immediately and ongoing, you must provide services in response to P3’s identified preferences. Within 30 days of receiving this order you must: · train SP4 on P3’s identified positive support strategies and plans; and · maintain documentation of the training specific to P3 in SP4’s file. On an ongoing basis, you must maintain compliance as required in this subdivision and subpart. 2. Citation: Minnesota Statutes, section 245D.11, subdivision 2, clause (7). Violation: The license holder did not enforce policies and procedures related to the review of incidents as required. Regarding an incident involving P3 that occurred on January 23, 2023, the license holder failed to ensure the incident report included the name of the staff persons who responded to the incident. Additionally, the license holder completed a review of the incident and documented that corrective action was not necessary based on the results of the review. However, this incident could have been avoided had the license holder ensured the persons served positive support strategies were followed as documented in P3’s support plan addendum. The license holder failed to identify and implement the need for corrective action when necessary. Corrective Action Ordered: Reference the corrective action in citation 1 of this order, to ensure an implementation of the corrective action related to P3’s incident. On an ongoing basis, you must maintain compliance as required in this subdivision. 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. 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 regarding this Correction Order, please contact me as soon as possible. Liz Schiefelbein, Senior Human Services Licensor Licensing Division Office of Inspector General 651-431-2738
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