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September 20, 2023
David Baker, Authorized Agent Renaissance Adult Day Care Inc 14226 Opal Street Northeast Ham Lake, MN 55304-2879 License Number: 1112709 (Rule 223) CORRECTION ORDER Dear David Baker: On August 31, 2023, a licensing review of Renaissance Adult Day Care Inc, located at 3045 Coon Rapids Blvd Northwest, Minneapolis, 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 Statutes, section 245A.14, subdivision 14, paragraph (c). Violation: The license holder did not meet the requirements for attendance record documentation. The license holder failed to maintain documentation of actual attendance for each adult day service recipient for which the license holder was reimbursed by a governmental program that included: · the time of day that the recipient was dropped off; and · the time of day that the recipient was picked up. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b). Violation: For two of three participants whose records were reviewed (P2 and P3), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). The license holder failed to review P2 and P3’s IAPPs quarterly as part of the review of the program plan or service plan. Corrective Action Ordered: Within 30 days of receiving this order, you must review P2 and P3’s IAPPs with the person and their interdisciplinary team and document the review. On an ongoing basis, you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Rules, part 9555.9660, subpart 1.
Violation: For one participant whose record was reviewed (P2), the license holder did not include information in the participant’s written record as required.
The license holder failed to maintain a medical record in P2’s record dated within the 3 months prior to or 30 calendar days after P2’s admission to the center signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician. P2 was admitted on February 6, 2023 and the license holder maintained a report for P2 on September 23, 2022. Additionally, the license holder failed to maintain a medical report that included: · indication of dietary restrictions and medication regimen, including the need for medication assistance, that applied to P2; · a release signed by the physician indicating whether P2 may engage in a structured exercise program; and · documentation that P2 was free of communicable disease or infestations, as specified in parts 4605.700 to 4605.7090, and would endanger the health of other participants. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain a medical report in P2’s record that includes the information detailed above. On an ongoing basis, you must maintain compliance as required in this subpart. 4. Citation: Minnesota Rules, part 9555.9690, subpart 3.
Violation: For one of two staff persons whose record was reviewed (SP1), the license holder did not provide orientation to the center as required. The license holder failed to provide SP1 with 20 hours of orientation to the center within SP1’s first 40 hours of employment at the center. The license holder maintained documentation that SP1 was provided 15 hours of orientation to the center. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subpart. 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 had food prepared off-site by a food service provider; however, the license holder failed to maintain a contract with a food service provider. b. The license holder failed to ensure a physical therapist provided consultation and review of the exercise program at least quarterly. Corrective Action Ordered: Within 30 days of receiving this order, you must: · maintain a contract with a food service provider; and · ensure your physical therapist provides consultation and review of the exercise program. On an ongoing basis, you must maintain compliance as required in these subparts.
6. Citation: Minnesota Rules, part 9555.9720, subpart 5.
Violation: The license holder did not ensure safety as required.
The license holder failed to store chemicals that were poisonous when swallowed or inhaled or that were damaging to eyes or skin in an area not accessible to the participants. A bucket of bleach water was stored accessible to participants in the kitchen. Corrective Action Ordered: Immediately, you must store chemicals that are poisonous when swallowed or inhaled or that are damaging to eyes or skin in an area not accessible to the participants. On an ongoing basis, you must maintain compliance as required in this subpart. 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, HCBS Unit Supervisor Licensing Division Office of Inspector General
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