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July 25, 2023 Irene Grudsky, Authorized Agent Dignity Adult Services 10550 Wayzata Boulevard Minnetonka, Minnesota 55305 License Number: 1075653 (Rule 223) CORRECTION ORDER Dear Irene Grudsky: On July 19, 2023, a licensing review of Dignity Adult Services, located at 10550 Wayzata Boulevard, Minnetonka, 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 four of four participants whose records were reviewed (P1-P4), 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 and P2’s records: · an application form that included the name and telephone number of a secondary person to call in case of an emergency involving the participant; · a medical report that included: o an indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to the participant; o a release signed by the physician indicating whether the participant may engage in a structured exercise program; and o documentation that the participant was free of communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants; · the participant's service agreement with the center that specified the responsibilities of the participant and the center with respect to payment for and provision of services and was signed by the participant or participant’s caregiver and the center director; and · notes on special problems, medication changes, and need for medication assistance. b. Although the license holder maintained a report on P3’s physical examination dated June 29, 2023, the license holder failed to maintain a report on P3’s physical examination that was updated annually in 2022. c. The license holder failed to include a medical report in P4’s record that included a report on a physical examination updated annually in 2021 and 2022. The most recent report on a physical examination that the license holder maintained for P4 was dated August 13, 2020. Corrective Action Ordered: Within 30 days of receiving this order, you must: · maintain all information detailed above in P1, P2, and P4’s participant records; · complete an audit of all participants’ records that evaluates if each participant’s written record includes all information detailed in Minnesota Rules, part 9555.9660; and · for participants whose records do not include all required information, you must develop a plan detailing how your program will maintain all required information in the participant’s record within 60 calendar days of receiving this order. On an ongoing basis, you must maintain compliance as required in this subpart. 2. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For three participants whose records were reviewed (P1-P3), the license holder did not complete initial service planning as required. a. The license holder failed to: · conduct needs assessments for P1 and P2 that included the participant’s physical status, determined by observation, from the intake screening interview, and from the medical report received from participant’s physician; and · develop preliminary service plans for P1 and P2 that included the participant’s nutritional needs and, where applicable, dietary restrictions. b. The license holder failed to: · conduct a needs assessment for P3 that addressed P3’s physical status determined from the medical report received from P3’s physician. The license holder conducted a needs assessment for P3 on November 10, 2021 but did not maintain a medical report from P3’s physician until November 15, 2021; and · develop a preliminary service plan for P3 that included P3’s nutritional needs and, where applicable, dietary restrictions. §Corrective Action Ordered: Within 30 days of receiving this order, you must: · conduct needs assessments for P1-P3 as detailed above; · develop preliminary service plans for P1-P3 that include the information and specifications detailed above; · complete an audit of all participants’ needs assessments and preliminary service plans to ensure the requirements in Minnesota Rules, part 9555.9700, subpart 2 are maintained; and · for participants who do not have needs assessments and preliminary service plans that include all requirements, you must develop a plan detailing how your program will maintain a complete needs assessment within 60 calendar days of receiving this order. On an ongoing basis, you must maintain compliance as required in this subpart. 3. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For three participants whose records were reviewed (P1-P3), the license holder did not develop a written plan of care as required. The license holder failed to develop written plans of care for P1-P3 that included§ short and long term objectives for the participant stated in concrete, measurable and time specific outcomes. §Corrective Action Ordered: Within 30 days of receiving this order, you must: · develop written plans of care for P1-P3 that include short and long term objectives for the participant stated in concrete, measurable and time specific outcomes; · 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 9555.9650, item B. Violation: For one consultant whose record was reviewed, the license holder did not include all required information in the personnel record. The license holder failed to maintain a copy of a signed contract or letter of appointment specifying conditions and terms of employment in the physical therapist’s personnel record. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain a copy of a signed contract or letter of appointment with your physical therapist specifying conditions and terms of employment. On an ongoing basis, you must maintain compliance as required in this item. 5. Citation: Minnesota Rules, part 9555.9710, subparts 1 and 4. Violation: The license holder did not offer services as required. a. The license holder failed to offer a midafternoon snack. b. The license holder failed to ensure a registered physical therapist provided consultation and review of the exercise program, at least quarterly in 2021 and 2022. The license holder maintained documentation that a review of the exercise program was conducted on June 30, 2023. § Corrective Action Ordered: Immediately, you must offer a midmorning snack. On an ongoing basis, you must maintain compliance as required in these subparts. 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 your licensor, Desiree Tiller, at 651-431-4622. Brittany Raddatz, Supervisor Licensing Division Office of Inspector General
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