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September 8, 2023 Vanessa Peterson 5396 Loon Lane NS Rochester, MN 55901 RE: Report No. 202302931 Vanessa Mae Peterson Adult Foster Care License No. 1089962 Dear Vanessa Peterson: CORRECTION ORDER An investigation of Vanessa Mae Peterson Adult Foster Care was completed regarding report number 202302931 which alleged violation of Minnesota Statutes, section 626.557, and Minnesota Rules, parts 9555.6205 and 9555.6225. This maltreatment allegation concerned neglect and verbal abuse. The disposition of the investigation report is inconclusive. Three violations were noted. A. Reason for Correction Order The following violations of state and (or) federal laws and rules were observed. Corrective action for each violation is required by Minnesota Statutes, section 245A.06, and is hereby ordered by the Commissioner of Human Services. Failure to correct the violations within the prescribed amount of time may result in fines and/or action against your license, as provided for in Minnesota Statutes, sections 245A.06 and 245A.07. 1. Citation: Minnesota Rules, part 9555.6205, subpart 4, item B, subitems (1) and (2). Violation: The license holder did not ensure that each resident shall be provided with the following furnishings: a separate, adult size single bed or larger with a clean mattress in good repair; and clean bedding appropriate for the season for each resident. On May 3, 2023, C1’s bedsheets were stained urine color and a chux pad was on his/her bed with a brown substance. Correct Action Ordered: On an ongoing basis, you must maintain compliance as required in this item. 2. Citation: Minnesota Rules, part 9555.6225, subpart 1. Violation: The license holder did not ensure that the residence must be clean, as specified in part 4625.0100, subpart 2, and free from accumulation of dirt, rubbish, peeling paint, vermin, or insects. On May 3, 2023, C1’s bedroom had a clear garbage bag next to the bed with multiple soiled chux pads and adult disposable undergarments; and had feces that was visible on the lining of the garbage bag. At the time of the site visit (late morning) a urinal was hooked to a shower chair in C1’s bedroom. The urinal held approximately 32 ounces and was half full of dark tan urine and also appeared to have sediment at the bottom. Correct Action Ordered: On an ongoing basis, you must maintain compliance as required in this item. 3. Citation: Minnesota Statues, sections 245A.04m subd 5, and 245H.04. Violation: Applicants, license holders, and certification holders must provide access to the physical plant and grounds, documents and records, (including records maintained in electronic format), persons served by the program, and staff. The licenser holder did not provide the care plan for C2 that was requested by phone and email on July 10, 19, 21, and 25, 2023. Correct Action Ordered: On an ongoing basis, you must maintain compliance as required in this item. If you believe any of the citations are in error, you may ask the Commissioner of Human Services to reconsider the parts of the correction order that you believe to be in error. If you choose to exercise this right, your request for reconsideration must be in writing and received by the Commissioner within 20 calendar days after receipt of this letter. Your request for reconsideration must be sent to: Commissioner Minnesota Department of Human Services c/o Licensing Division PO Box 64242 St. Paul, MN 55164-0242 You must include any and all information, documentation, or other evidence you have to support your request for reconsideration. Please note that a request for reconsideration does not stay any provisions of the correction order. If you have any questions regarding the investigation, contact me immediately. If you have any questions regarding compliance with this Correction Order or applicable rules, contact your licensor, Ellen Turner at 507-328-6375 Sincerely,
Thomas Nixon, Investigator Office of Inspector General Licensing Division thomas.c.nixon@state.mn.us 651-431-2155 Enclosure
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