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July 17, 2023 Korme Uka Koji, Authorized Agent Entrusted Home Healthcare LLC 3141 132nd Avenue Northeast Blaine, Minnesota 55449 License Number: 1092600 (245D - HCBS) CORRECTION ORDER Dear Korme Uka Koji: On June 28, 2023, a licensing review of Entrusted Home Healthcare LLC, located at 3141 132nd Avenue Northeast, Blaine, 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 one of two persons whose record was reviewed (P2), the license holder did not review the individual abuse prevention plan as required. The license holder failed to review P2’s individual abuse prevention plan annually in 2023. Corrective Action Ordered: Within 30 days of receiving this order, you must review an individual abuse prevention plan for P2. On an ongoing basis, you must maintain compliance as required in this subdivision.
2. Citation: Minnesota Statutes, section 245D.071, subdivision 4. Violation: For one person whose record was reviewed (P1), the license holder did not develop support and outcomes as required. The license holder failed to develop and document the supports and methods to be implemented for P1 to support the person and accomplish outcomes related to acquiring, retaining, or improving skills and physical, mental, and emotional health and well-being, including the measurable and observable criteria for identifying when the desired outcome had been achieved and how data would be collected. Corrective Action Ordered: Within 30 days of receipt of this order, you must develop the above mentioned information for P1. On an ongoing basis, you must maintain develop supports and as required in this subdivision. 3. Citation: Minnesota Statutes, section 245D.09, subdivision 4. Violation: For one of two staff persons whose record was reviewed (SP1), the license holder did not provide orientation training as required. The license holder failed to provide orientation training for SP1 to the person including the coordinated service and support plan, coordinated service and support plan addendum as it relates to the responsibilities assigned to the license holder, the person’s individual abuse prevention plan to achieve and demonstrate an understanding of the person as a unique individual and how to implement those plans within 60 days of hire. Corrective Action Ordered: Within 30 days of receiving this order, you must provide SP1 with the above mentioned training. On an ongoing basis, you must provide orientation training as required in this subdivision. 4. Citation: Minnesota Statutes, section 245D.09, subdivision 5. Violation: For one staff person whose record was reviewed (SP2), the license holder did not provide annual training as required. The license holder failed to provide SP2 with basic first aid annually in 2023. Corrective Action Ordered: Within 30 days of receiving this order, you must provide SP2 with the above annual training. On an ongoing basis, you must provide annual training as required in this subdivision. 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 Lindsay Norris at 651-431-5752 as soon as possible. Lindsay Norris, Senior Licensor-Home and Community Based Services Licensing Division Office of Inspector General
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