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June 26, 2023 Pay Soung, Authorized Agent Twin Cities Adult Day Services LLC 848 Aspen Circle Little Canada, MN 55109 License Number: 1076130 (Rule 223) CORRECTION ORDER Dear Pay Soung: On June 6, 2023, a licensing review of Twin Cities Adult Day Services LLC, located at 2231 11th Avenue East, 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 Rules, part 9555.9700, subpart 3. Violation: For one of five participants whose record was reviewed (P5), the license holder did not develop a written plan of care as required. The license holder failed to develop a written plan of care for P5 that included the anticipated duration of the individual plan of care as written. §Corrective Action Ordered: Within 30 days of receiving this order, you must develop a written plan of care for P5 that includes the anticipated duration of the individual plan of care as written. On an ongoing basis, you must maintain compliance as required in this subpart. 2. Citation: Minnesota Rules, part 9555.9650, item A. Violation: For one of two staff persons whose records were reviewed (SP2), the license holder did not maintain personnel records as required. The license holder failed to maintain documentation of an annual performance evaluation in SP2’s personnel record in 2023. The most recent documentation of an annual performance evaluation in SP2’s personnel record was dated May 2, 2022. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as written in this item. 3. 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. 4. 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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