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July 5, 2023 Ibrahim Hussein, Authorized Agent Quality Home Health Care Inc. 120 West Broadway Street Suite 104 Owatonna, Minnesota 55060 License Number: 1105354 (245D – HCBS) CORRECTION ORDER Dear Ibrahim Hussein: On May 3, 2023, a licensing review of Quality Home Health Care Inc, located at 120 West Broadway Street Suite 104, Owatonna, 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 245A.65, subdivision 2, paragraph (b). Violation: For two of three persons whose records were reviewed (P1 and P2), the license holder did not develop an individual abuse prevention plan (IAPP) as required. a. The license holder failed to develop an IAPP for P1 that included an individualized assessment of P1’s susceptibility of abuse according to Minnesota Statutes, section 626.557, subdivision 14. P1’s IAPP indicated that P1 was not susceptible to abuse or at risk of abusing other vulnerable adults, however, this assessment was not consistent with other information in P1’s record. b. The license holder failed to develop an IAPP for P2 that included an individualized assessment of P2’s susceptibility of abuse according to Minnesota Statutes, section 626.557, subdivision 14. P2’s IAPP indicated P2 was susceptible to self-abuse and financial exploitation. However, P2’s record included information that identified additional areas of risk for P2 that were not identified in P2’s IAPP. Additionally, the license holder failed to include statements of measures with specific actions the program would take to minimize the risk of abuse within the scope of the licensed services. Corrective Action Ordered: Within 30 days of receiving this order, you must: · review and revise P1 and P2’s IAPP to include: o an assessment of the person's susceptibility to abuse by other individuals, including other vulnerable adults and the person's risk of abusing other vulnerable adults; and o statements of measures, with specific actions, your program will take to minimize the risk of abuse within the scope of the licensed service(s); · review P1 and P2’s revised IAPP with the person, their legal representative, if applicable, and their case manager; · maintain documentation of this review in P1 and P2’s service recipient records; and · submit P1 and P2’s IAPP to your licensor. On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section 245D.04, subdivision 1. Violation: For two persons whose records were reviewed (P2 and P3), the license holder did not provide the service recipient rights as required. 245A.02, subdivision 2b defines “annual” or “annually” to mean prior to or within the same month of the subsequent calendar year. a. The license holder failed to provide P2 with a written notice that identified the service recipient rights in subdivisions 2 and 3, and an explanation of those rights annually in 2022. The license holder last provided P2 with this written notice and explanation on July 2, 2021. b. P3’s services were initiated on October 18, 2021. The license holder failed to provide P3 with a written notice that identified the service recipient rights in subdivisions 2 and 3, and an explanation of those rights within five working days of service initiation and annually thereafter. Corrective Action Ordered: Within 30 days of receiving this order, you must provide P2 and P3 with a written notice that identifies the service recipient rights in subdivisions 2 and 3, and an explanation of those rights. Additionally, you must maintain documentation of P2 and P3’s receipt of a copy and an explanation of these rights in their service recipient records. On an ongoing basis, you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Statutes, section 245D.07, subdivision 1. Violation: For one person whose record was reviewed (P2), the license holder did not provide services in compliance with the requirements of the federal waiver plan. The license holder provided respite services to P2 and employed SP3 as the staff person to provide this service to P2. SP3 is P2’s parent and primary caregiver. According to the federal waiver plan, respite services are short-term care services provided to a person when their primary caregiver is absent or needs relief. The federal waiver plan defines “primary caregiver” as the person or people principally responsible for the care and supervision of the person who receives services. P2’s support plan documented the following: · P2 resides in their parental home; · P2’s parents ensure P2 has the appropriate supervision to maintain their health and safety; · P2’s parents are planning on seeking legal guardianship of P2; · P2 is vulnerable to all forms of abuse or neglect and requires 24 hour supervision to ensure their safety; · P2 relies on the support of staff and family to identify dangerous situations, respond to emergency situations, and maintain their health and personal safety. By definition, respite services are to be provided to a person when their primary caregiver is absent or needs relief, therefore, the primary caregiver cannot be the person providing the service. Due to the license holder employing SP3 to be the staff person to provide respite services to P2, the license holder failed to provide respite services in compliance with the requirements of the federal waiver plan. Corrective Action Ordered: Immediately upon receipt of this order, you must: · meet with P2 and their case manager to discuss their services to ensure services provided to P2 are in compliance with the requirements of the federal waiver plan; and · maintain documentation of this meeting that includes any decisions made to come into and maintain compliance with these requirements; and · submit this documentation to your licensor. On an ongoing basis, you must maintain compliance as required in this subdivision. 4. Citation: Minnesota Statutes, section 245D.07, subdivisions 2 and 3. Violation: For three persons whose records were reviewed (P1-P3), the license holder did not meet service planning requirements for basic support services and provide written reports as required. a. P1’s services were initiated on March 1, 2023. The license holder failed to review and revise P1’s preliminary support plan addendum to document when services will be provided and the person responsible for overseeing the delivery and coordination of services within 60 calendar days of service initiation. b. P2’s services were initiated on September 2, 2020. The license holder failed to review and revise P2’s preliminary support plan addendum to document how, when, and by whom services will be provided within 60 calendar days of service initiation. Additionally, P2’s support plan addendum required the license holder to provide progress reports to P2’s support team annually. The license holder failed to provide these reports to P2’s case manager annually in 2021 and 2022. At the time of the licensing review, the license holder had not provided a progress report to P2’s case manager. c. P3’s services were initiated on October 18, 2021. The license holder failed to review and revise P3’s preliminary support plan addendum to document how, when, and by whom services will be provided, and the person responsible for overseeing the delivery and coordination of services within 60 calendar days of service initiation. Additionally, P3’s support plan addendum required the license holder to provide progress reports to P3’s support team quarterly. The license holder failed to provide these reports to P3’s case manager quarterly. At the time of the licensing review, the license holder had not provided a progress report to P3’s case manager. Corrective Action Ordered: Within 30 days of receiving this order, you must: · review and revise P1’s support plan addendum to document when services will be provided and the person responsible for overseeing the delivery and coordination of services; · review and revise P2’s support plan addendum to document how, when, and by whom services will be provided; · provide P2’s case manager with a progress review report and maintain documentation of how and when this report was provided; · review and revise P3’s support plan addendum to document how, when, and by whom services will be provided, and the person responsible for overseeing the delivery and coordination of services; and · provide P3’s case manager with a progress review report and maintain documentation of how and when this report was provided. On an ongoing basis, you must maintain compliance as required in this subdivision. 5. Citation: Minnesota Statutes, section 245D.095, subdivision 3, paragraph (b), clause (11). Violation: For three persons whose records were reviewed (P1-P3), the license holder did not maintain progress or daily notes that are recorded by the program in the person’s record as required. Corrective Action Ordered: Immediately upon receipt of this order, you must begin documenting progress or daily notes for each person receiving services under this license and maintain these in the person’s service recipient record. On an ongoing basis, you must maintain compliance as required in this subdivision. 6. Citation: Minnesota Statutes, section 245D.10, subdivision 4, paragraph (b). Violation: For three persons whose records were reviewed (P1-P3), the license holder did not inform and provide copies of the policies and procedures affecting a person’s rights under section 245D.04, as required. The license holder failed to inform and provide copies of the following policies and procedures affecting a person’s rights under section 245D.04 to P1-P3’s case managers within five working days of service initiation: · grievance policy and procedure; · service suspension policy and procedure; · service termination policy and procedure; and · emergency use of manual restraints policy and procedure. Corrective Action Ordered: Within 30 days of receiving this order, you must inform and provide copies of the policies identified in this citation to P1-P3’s case managers. On an ongoing basis, you must maintain compliance as required in this subdivision. 7. Citation: Minnesota Rules, part 9544.0030, subpart 1. Violation: For three persons whose records were reviewed (P1-P3), the license holder did not incorporate and evaluate positive support strategies as required. Minnesota Rules, part 9544.0020, subpart 41 defines “positive support strategy” to mean a strengths-based strategy based on an individualized assessment that emphasizes teaching a person productive and self-determined skills or alternative strategies and behaviors without the use of restrictive interventions. The license holder failed to incorporate, in writing, positive support strategies to an existing treatment, service, or other individual plan for P1-P3. Additionally, the license holder failed to evaluate these strategies with P2 and P3 at least every six months. Corrective Action Ordered: Within 30 days of receiving this order, you must: · identify positive support strategies for P1-P3 according to the standards in subpart 2; and · incorporate the positive support strategies, in writing, to an existing treatment, services, or other individual plan for P1’P3. Additionally, at least every six months, you must evaluate with the identified positive support strategies with P1-P3, and based upon the results of that evaluation, determine whether changes are needed in the positives support strategies used, and, if so, make appropriate changes. On an ongoing basis, you must maintain compliance as required in these subparts. 8. Citation: Minnesota Statutes, section 245D.09, subdivisions 4 and 5. Violation: For two of four staff persons whose records were reviewed (SP1 and SP2), the license holder did not provide orientation and annual training as required. a. SP1 was hired on December 20, 2020. SP2 was hired on October 20, 2022. The license holder failed to provide SP1 and SP2 with training and instruction on the strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities, within 60 days of hire. b. The license holder failed to provide SP1 with annual training on the following topics in 2021 and 2022: · data privacy requirements according to sections 13.01 to 13.10 and 13.46, the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff responsibilities related to complying with data privacy practices; · the service recipient rights and staff responsibilities related to ensuring the exercise and protection of those rights according to the requirements in section 245D.04; · sections 245A.65, 245A.66, 626.556, and 626.557, governing maltreatment reporting and service planning for children and vulnerable adults, and staff responsibilities related to protecting persons from maltreatment and reporting maltreatment; · the principles of person-centered service planning and delivery as identified in section 245D.07, subdivision 1a, and how they apply to direct support service provided by the staff person; · the safe and correct use of manual restraint on an emergency basis according to the requirements in section 245D.061 or successor provisions, and what constitutes the use of restraints, time out, and seclusion, including chemical restraint; · staff responsibilities related to prohibited procedures under section 245D.06, subdivision 5, or successor provisions, why such procedures are not effective for reducing or eliminating symptoms or undesired behavior, and why such procedures are not safe; · basic first aid; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities. Corrective Action Ordered: Within 30 days of receiving this order, you must: · provide SP1 with training and instruction on the strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities; · provide SP2 with training and instruction on the topics identified in part “b” of this violation; · maintain documentation of the training provided to SP1 and SP2 in their personnel records as required in Minnesota Statutes, section 245D.095, subdivision 5. 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. Submissions required as part of a corrective action ordered must be sent to your Licensor at: 1. By secure email at Krista.Hastings@state.mn.us; or 2. If you are unable to submit corrective action ordered securely through email, you can mail or fax using the information below: Commissioner, Department of Human Services ATTN: Krista Hastings 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 regarding this Correction Order, please contact me as soon as possible. Krista Hastings, Senior Human Services Licensor Licensing Division Office of Inspector General 651-431-4825
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