August 22, 2023

Hayad A Mohamud, Authorized Agent

Jiicle Care Inc

1821 University Avenue West Suite 107-18

Saint Paul, Minnesota 55104

License Number: 1106728 (245D – HCBS)

CORRECTION ORDER

Dear Hayad A Mohamud

On April 26, 2023 a licensing review of Jiicle Care Inc located at 1821 University Avenue West, Suite 107-18, Saint Paul, 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.

Violation: For two persons whose record was reviewed (P1 and P2), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP) as required.

Minnesota Statutes, section 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 include an individualized assessment of P1’s susceptibility to abuse by others and a statement of the specific measures that would be taken to minimize the risk of abuse. P1’s IAPP states that P1 is not susceptible to abuse, however, this assessment was not consistent with information reviewed elsewhere in P1’s record. Additionally, the license holder failed to review P1’s IAPP annually.

b. The license holder failed to include an individualized assessment of P2’s susceptibility to abuse by others and a statement of the specific measures that would be taken to minimize the risk of abuse. P2’s IAPP states that P2 is not susceptible to abuse, however, this assessment was not consistent with information reviewed elsewhere in P2’s record.

Corrective Action Ordered: Within 30 days of receiving this order, you must:

· review and revise P1 and P2’s IAPP to meet the requirements of this subdivision;

· submit P1 and P2’ revised IAPP to your licensor;

· audit the IAPPs for all persons served by the program and ensure all IAPPs include an individual assessment and statement of specific measures as required; and

· maintain documentation of the audit results.

On an ongoing basis, you must maintain compliance as required in this subdivision.

2.  Citation: Minnesota Statutes, section 245D.04, subdivision 1.

Violation: For one person whose record was reviewed (P1), the license holder did not meet service recipient rights as required.

Minnesota Statutes, section 245A.02, subdivision 2b defines “annual” or “annually” to mean prior to or within the same month of the subsequent calendar year.

The license holder failed to provide P1 with a written notice that identified the service recipient rights and explanation of those rights annually.

Corrective Action Ordered: Within 30 days of receiving this order you must:

· provide P1 with a written notice that identifies the service recipient rights and an explanation of those rights and maintain documentation of the receipt of the rights;

· audit all persons served records to ensure the written notice that identifies the service recipient rights and an explanation of those rights was provided to persons served or their legal representatives and ensure the written notice was provided annually; and

· maintain documentation of the audit results.

On an ongoing basis, you must maintain compliance as required in this subdivision.

3.   Citation: Minnesota Statutes, section 245D.07, subdivision 2.

Violation: For one person whose record was reviewed (P2), the license holder did not meet service planning requirements for basic support services as required.

P2’s services were initiated September 6, 2022. The license holder failed to complete a preliminary support plan addendum based on the support plan within 15 calendar days of P2’s service initiation.

Corrective Action Ordered: Within 30 days of receiving this order, you must:

· complete a preliminary support plan addendum for P2;

· review and revise the preliminary support plan addendum to document the services that will be provided including how, when, and by whom services will be provide and the person responsible for overseeing the delivery and coordination of services; and

· submit this to your licensor.

On an ongoing basis you must maintain compliance as required in this subdivision.

4.   Citation: Minnesota Statutes, section 245D.071, subdivision 3, paragraphs (b) and (c).

Violation: For one person whose record was reviewed (P1), the license holder did not complete assessments for intensive service planning as required.

  The license holder failed to complete assessments for P1 in the following areas:

· the person’s ability to self-manage health and medical needs to maintain or improve physical, mental, and emotional well-being, including, when applicable, allergies, seizures, choking, special dietary needs, chronic medical conditions, self-administration or treatment orders, preventative screening, and medical and dental appointments;

· the person’s ability to self-manage personal safety to avoid injury or accident in the service setting, including, when applicable, risk of falling, mobility, regulating water temperature, community survival skills, water safety skills, and sensory disabilities;

· the person’s ability to self-manage symptoms or behavior that may otherwise result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to (7), suspension or termination of services by the license holder, or other symptoms or behaviors that may jeopardize the health and welfare of the person or others; and

· the assessments must produce information about the person that describes the person’s overall strengths, functional skills and abilities, and behaviors or symptoms.

Additionally, the license holder failed to meet with P1, P1’s case manager, and other members of the support team or expanded support team within 45 days of service initiation to determine:

· the scope of the services to be provided to support the person’s daily needs and activities;

· the person’s desired outcomes and the supports necessary to accomplish the person’s desired outcomes;

· the person’s preferences for how services and supports are provided, including how the provider will support the person to have control of the person’s schedule;

· whether the current service setting is the most integrated setting available and appropriate for the person;

· opportunities to develop and maintain essential and life-enriching skills, abilities, strengths, interests, and preferences;

· opportunities for community access, participation, and inclusion in preferred community activities;

· opportunities to develop and strengthen personal relationships with other persons of the person’s choice in the community;

· opportunities to seek competitive employment and work at competitively paying jobs in the community;

· how services must be coordinated across other providers licensed under this chapter serving the person and members of the support team or expanded support team to ensure continuity of care and coordination of services for the person; and

· a discussion of how technology might be used to meet the person’s desired outcomes. The support plan or support plan addendum must include a summary of this discussion. The summary must include:

o a statement regarding any decision that is made regarding the use of technology; and

o a description of any further research that needs to be completed before a decision regarding the use of technology can be made.

Corrective Action Ordered: Within 30 days of receiving this order, you must:

· complete the required assessments for P1 that produces information about the person that describes the person’s overall strengths, functional skills, and abilities;

•  review the results of the assessments with P1 and P1’s case manager and members of the support team; and

· you must document the review and submit this to your licensor.

Within 60 days of receiving this order, you must:

· complete an audit of all persons served receiving intensive support services to ensure the above has been completed; and

· maintain documentation of the audit results.

On an ongoing basis, you must maintain compliances as required in this subdivision and complete these assessments annually at a minimum and the results of the assessments must be reviewed by the support team as part of a service plan review.

5.   Citation: Minnesota Statutes, section 245D.071, subdivision 4.

Violation: For one person whose record was reviewed (P1), the license holder did not develop a service plan that documents the service outcomes and supports based on the assessments completed under subdivision 3 and the requirements in section 245D.07, subdivision 1a, as required.

The license holder failed to document the following supports and methods to accomplish the outcomes for P1:

· the methods or actions that will be used to support the person and to accomplish the service outcomes, including information about:

o any changes or modifications to the physical and social environments necessary when the service supports are provided;

o any equipment and materials required; and

o techniques that are consistent with the person’s communication mode and learning style;

· the measurable and observable criteria for identifying when the desired outcome had been achieved and how data would be collected;

· the projected starting date for implementing the supports and methods and the date by which progress towards accomplishing the outcomes would be reviewed and evaluated; and

· the names of the staff or position responsible for implementing the supports and methods.

Corrective Action Ordered: Within 30 days of receiving this order,

· you must develop a service plan that documents the service outcomes, and supports and methods listed above for P1;

· submit to and obtain signatures from P1 and P1’s case manager to document completion and approval of the assessment and support plan addendum.

· complete an audit of all persons served records to ensure the above has been developed, implemented, and documented; and

· submit evidence of the above and the results of the audit to your licensor.

On an ongoing basis, you must maintain compliance as required in this subdivision.

6.   Citation: Minnesota Statutes, section 245D.071, subdivision 5.

Violation: For one person whose record was reviewed (P1), the license holder did not meet requirements for service plan review and evaluation as required.

The license holder failed to meet, in coordination with P1’s support team, with P1, P1’s case manager and other people as identified by P1 to participate in progress review meetings at least once per year.

Corrective Action Ordered: Within 30 days of receiving this order, you must:

· provide the person, their case manager, and other people as identified by the person, an opportunity to participate in an annual meeting; and

· submit evidence of this meeting to your licensor, including signatures from P1, P1’s case manager, and other members of P1’s support team.

On an ongoing basis, you must maintain compliance as required in this subdivision.

7.  Citation: Minnesota Statutes, section 245D.10, subdivision 4.

Violation: For two persons whose record was reviewed (P1 and P2), the license holder did not inform and provide copies of the policies and procedures affecting a person’s rights as required.

a. P1’s services were initiated December 15, 2021. The license holder failed to inform P1’s case manager of the following policies and procedures affecting a person’s rights and provide copies of those policies and procedures within five working days of P1’s service initiation:

· grievance policy;

· service suspension policy;

· service termination policy;

· emergency use of manual restraints policy; and

· data privacy.

b. P2’s services were initiated September 6, 2022. The license holder failed to inform P2’s case manager of the following policies and procedures affecting a person’s rights and provide copies of those policies and procedures within five working days of P2’s service initiation:

· grievance policy;

· service suspension policy;

· service termination policy; and

· emergency use of manual restraints policy

Corrective Action Ordered: Within 30 days of receiving this order, you must:

· audit all persons served records to ensure each person’s case manager has been informed of the policies and procedures that affect a person’s rights and were provided copies of those policies and procedures;

· for case managers not informed of the policies and procedures that affect a person’s rights, you must inform the persons served case manager of these policies and provide copies; and

· maintain documentation of the audit results.

On an ongoing basis, you must maintain compliance as required in this subdivision.

8.   Citation: Minnesota Rules, part 9544.0030, subpart 1.

Violation: For two persons whose records were reviewed (P1 and P2), the license holder did not evaluate positive support strategies as required.

  The license holder failed to evaluate with P1 and P2 the identified positive support strategies at least every six months.

Corrective Action Ordered: Within 30 days of receiving this order, you must:

· evaluate with the P1 and P2 whether the identified positive support strategies currently meet the standards in Minnesota Rules, part 9544.0030, subpart 2. Based upon the results of the evaluation, you must determine whether changes are needed in the positive support strategies, and if so, make appropriate changes; and

· maintain documentation of compliance with these requirements as require in Minnesota Rules, part 9544.0100.

· audit all persons served records to ensure the above has been completed; and

· maintain documentation of the results of this audit.

On an ongoing basis, you must maintain complains as required in this subpart.

9.  Citation: Minnesota Statutes, section 245D.09, subdivision 5.

Violation: For one of one staff person whose record was reviewed (SP1), the license holder did not provide annual training as required.

245A.02, subdivision 2b defines “annual” or “annually” to mean prior to within the same month of the subsequent calendar year.

The license holder failed to provide SP1 annual training on the following topics:

· 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 practice;

· 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 and 626.557 and chapter 260E 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 the above training;

· maintain documentation of this training in SP1’s personnel records;

· submit evidence that this training has been provided to SP1.

On an ongoing basis, you must maintain compliance as required in this subdivision.

10.  Citation: Minnesota Statutes, section 245D.095.

Violation: For one staff person whose record was reviewed (SP1), the license holder did not maintain a personnel record as required.

The license holder failed to document the following information in SP1’s personnel record:

· the employee’s date of hire;

· documentation or staff qualifications and orientation;

· staff training including:

o the date the training was completed;

o the number of hours per subject area; and

o the name of the trainer or instructor; and

· documentation in SP1’s personnel record, or elsewhere, sufficient to determine the dates of SP1’s first supervised and unsupervised direct contact with a person served by the program.

Corrective Action Ordered: On an ongoing basis, you must maintain personnel records for all staff 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 nicole.m.riley@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: Nicole Riley

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

ATTN: Legal Unit

Licensing Division

PO Box 64242

St. Paul, MN 55164-0242

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 Nicole Riley at 651-431-3657 as soon as possible.

Christala Culhane, Senior Human Services Licensor

Licensing Division

Office of Inspector General

PO Box 64242 • Saint Paul, Minnesota • 55164-0242 • An Equal Opportunity and Veteran Friendly Employer
https://mn.gov/dhs/general-public/licensing/