Minnesota

September 21, 2023

Terence Mukong, Authorized Agent

Dynamik Services Inc

4124 Quebec Avenue North, Suite 108

New Hope, Minnesota 55427

License Number: 1109127 (245D – HCBS)

CORRECTION ORDER

Dear Terence Mukong:

On August 16, 2023, a licensing review of Dynamik Services Inc, located at 4124 Quebec Avenue North, Suite 108, New Hope, 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 1.

Violation: For one of two persons whose records were reviewed (P1), the license holder did not provide orientation to the internal and external reporting procedures of alleged or suspected maltreatment of vulnerable adults as required.

P1’s services were initiated on July 2, 2022. The license holder failed to provide P1 with an orientation to the internal and external reporting procedures of alleged or suspected maltreatment of vulnerable adults within 24 hours of admission. The license holder provided this orientation on January 2, 2023.

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.

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

a. The license holder failed to develop an IAPP as part of P1’s initial individual program plan or service plan prior to or upon service initiation. P1’s services were initiated on July 2, 2022. The license holder developed P1’s IAPP on January 2, 2023.

b. The license holder failed to include an individualized assessment of P1’s susceptibility to abuse by others, P1’s risk of abusing other adults, and provide statements of the specific measures to be taken to minimize the risk of abuse to P1 and other vulnerable adults. P1’s IAPP documented that P1 was not susceptible to abuse or at risk of abusing other vulnerable adults, however, this assessment was not consistent with information reviewed elsewhere in P1’s record. The coordinated services and supports plan (CSSP) completed by P1’s case manager indicated that P1 was susceptible to self-abuse and financial exploitation.

Corrective Action Ordered: Within 60 days of receiving this order, you must:

· revise the IAPP’s for P1 to include individualized assessments of susceptibility to abuse and provide statements of the specific measures that would be taken to minimize the risk of abuse for each assessed area;

· review P1’s IAPP with P1, P1’s case managers, and other members of the support team;

· audit the records of all persons served to ensure an IAPP has been developed that includes individualized assessments of susceptibility to abuse and includes statements of the specific measures that would be taken to minimize the risk of abuse for each assessed area;

· based on the results of the audit, develop, or revise the IAPP’s for all services recipients to ensure they include the above-mentioned requirements.; and

· submit copies of P1’s IAPP’s to your licensor.

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

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

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

The license holder failed to provide P1 with a written notice that identified the service recipient’s rights in subdivisions 2 and 3 and explanation of those rights annually. The service recipient rights were last reviewed with P1 on July 2, 2022.

Corrective Action Ordered: Within 60 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 service recipient rights; and

· audit the records of all persons receiving services to ensure they receive service recipient rights and an explanation of those rights annually; and

· based on the results of the audit, provide a copy and explanation of the service recipient rights to service recipients who have not received this annually.

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

4. Citation: Minnesota Statutes, section 245D.071, subdivision 3.

Violation: For two persons whose records were reviewed (P1 and P2), the license holder did not meet initial service planning and delivery requirements for intensive services as required.

a. Regarding P1, the license holder failed to:

· complete assessments for P1 that described P1’s overall strengths, functional skills and abilities, and behaviors or symptoms in the following areas:

o 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 of medication or treatment orders, preventative screening, and medical and dental appointments;

o 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; and

o 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.

· 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 complete assessments in the following areas:

o the scope of the services to be provided to support the person's daily needs and activities;

o the person's desired outcomes and the supports necessary to accomplish the person's desired outcomes;

o P1'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;

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

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

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

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

o 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 P1.

· have a discussion of how technology might be used to meet P1's desired outcomes. The coordinated service and 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.

b. Regarding P2, the license holder failed to:

· complete assessments for P2 that described P2’s overall strengths, functional skills and abilities, and behaviors or symptoms in the following areas:

· meet with P2, P2’s legal representative, P2’s case manager, and other members of the support team or expanded support team within 45 days of service initiation to complete assessments in the following areas:

o P2'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;

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

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

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

· have a discussion of how technology might be used to meet P2's desired outcomes. The coordinated service and 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 60 days of receiving this order, you must:

· complete the above-mentioned assessments for P1 and P2;

· meet with P1 and P2, P1 and P2’s case managers, P2’s legal guardian and any other members of the support team to review the results of the assessments;

· have a discussion of how technology might be used to meet P1 and P2's desired outcomes. P1 and P2’s support plans must include a summary of this discussion;

· audit the records of all persons served to ensure the above mentioned initial service planning and delivery requirements for intensive services have been completed;

· based on the results of the audit, complete the initial service planning and delivery requirements for intensive services for service recipients that did not have it completed upon initiation;

· submit copies of P1 and P2’s assessments to this licensor; and

· submit copies of P1 and P2’s support plans that include a summary of how technology may be used to meet P1 and P2’s desired outcomes.

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

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

Violation: For two persons whose records were reviewed (P1 and P2), the license holder did not develop a service plan that documents the service outcomes and supports as required.

The license holder failed to develop a service plan that documented the service outcomes and supports based on the assessments and person-centered planning for P1 and P2 that documented the following:

· methods of actions that will be used to support the person and to accomplish the service outcomes;

· the measurable and observable criteria for identifying when the desired outcomes had been achieved;

· the projected starting date for implementing the supports and methods; and

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

Corrective Action Ordered: Within 60 days of receiving this order, you must:

· develop a service plan for P1 and P2 that documents the service outcomes and supports that includes the following:

o the methods or actions that will be used to support P3 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;

o the measurable and observable criteria for identifying when the desired outcome has been achieved and how data will be collected;

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

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

· audit the records of all persons receiving intensive services to ensure a service plan that documents the service outcomes and supports has been developed;

· based on the results of the audit, development a service plan that documents the service outcomes and supports as required; and

· submit a copy of the service outcomes for P1 and P2 to your licensor.

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

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

Violation: For two persons whose record were reviewed (P1 and P2), the license holder did not provide written or electronic copies of policies and procedures as required.

a. P1’s services were initiated on July 2, 2022. The license holder failed to inform P1 and P1’s case manager of the policies and procedures affecting P1’s rights under section 245D.04, and provide copies of the following policies and procedures, within 5 working days of service initiation. P1 received this on January 2, 2023.

· grievance policy;

· temporary service suspension policy;

· service termination policy;

· emergency use of manual restraints policy; and

· data privacy policy.

b. P2’s services were initiated on September 1, 2022. The license holder failed to inform P2’s case manager of the policies and procedures affecting P2’s rights under section 245D.04, and provide copies of the following policies and procedures, within 5 working days of service initiation:

· grievance policy;

· temporary service suspension policy;

· service termination policy;

· emergency use of manual restraints policy; and

· data privacy policy.

Corrective Action Ordered: Within 60 days of receiving this, you must inform and provide copies of the above-mentioned policies and procedures to P1 and P2’s case manager. On an ongoing basis, you must maintain compliance as required in this subdivision.

7. Citation: Minnesota Rule, 9544.0030, subpart 1.

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

The license holder failed to evaluate the identified positive support strategies with P1 and P2 every 6 months.

Corrective Action Ordered: Within 60 days of receiving this order, you must evaluate the identified positive support strategies with P1 and P2. Additionally, you must evaluate the identified positive support strategies for P1 and P2 every 6 months. On an ongoing basis, you must maintain compliance as required in this subdivision.

8. Citation: Minnesota Statutes, subdivision 245D.09, subdivision 4.

Violation: For two staff persons whose records were reviewed (SP1 and SP2), the license holder did not provide orientation training as required.

SP1 was hired on March 23, 2022. SP2 was hired on November 15, 2022. The license holder failed to provide SP1 and SP2 with the following orientation training within 60 days of hire:

· a job description and how to complete specific job functions including:

o responding to and reporting incidents as required in Minnesota statutes, section 245d.06, subdivision 1; and

o following safety practices established by the license holder and as required in section 245d.06, subdivision 2;

· the license holder’s current policies and procedures required under this chapter, including their location and access, and staff responsibilities related to implementation of those policies and procedures including:

o use of universal precautions and sanitary practices;

o safe medication assistance and administration;

o safe transportation;

o service admission;

o emergency response, reporting, and reviewing; and

o incident response, reporting, and reviewing;

· basic first aid; and

· strategies to minimize the risk of sexual violence, including concepts of health relationships, consent, and bodily autonomy of people with disabilities.

Corrective Action Ordered: Within 60 days of receiving this order, you must:

· provide SP1 and SP2 with the above mentioned trainings;

· complete an audit of all staff person’s records to ensure all staff have received orientation training on all required subject areas;

· based on the results of the audit, provided orientation training to all staff who have not received training on the required orientation training topics; and

· submit copies of the above mentioned orientation trainings for SP1 and SP2 to this licensor.

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

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

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

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

The license holder failed to provide SP1 with the following annual trainings in 2023:

· data privacy requirements according to Minnesota Statutes, 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 practices;

· the service recipient rights and staff responsibilities related to ensuring the exercise and protection of those rights according to the requirements in Minnesota Statutes, 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 Minnesota Statutes, section 245D.07, subdivision 1a, and how they applied 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 and what constitutes the use of restraints, time out, and seclusion, including chemical restraint; and

· staff responsibilities related to prohibited procedures under section 245D.06, subdivision 5, why such procedures are not effective for reducing or eliminating symptoms or undesired behavior, and why such procedures are not safe.

Corrective Action Ordered: Within 60 days of receiving this order, you must:

· provide SP1 with the above-mentioned annual training topics;

· audit the personnel records for staff to ensure all staff have received annual training on all required topics;

· based on the results of the audit, provide annual training to all staff who have not received training on any of required annual training topics; and

· submit copies of documentation of SP1’s annual trainings.

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

10. Citation: Minnesota Statutes, subdivision 245D.095, subdivision 5.

Violation: For two staff persons whose records were reviewed (SP1 and SP2), the license holder did not maintain personnel records as required.

The license holder failed to maintain the number of subject hours per subject area and the name of the trainer or instructor in SP1 and SP2’s personnel record for each required training subject area.

Corrective Action Ordered: Within 60 days of receiving this order, you must maintain personnel records for SP1 and SP2 that includes the number of subject hours per subject area and the name of the trainer or instructor. On an ongoing basis, you must maintain compliance 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 amber.n.nielsen@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: Amber Nielsen

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

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 Amber Nielsen at amber.n.nielsen@state.mn.us or 651-431-3661 as soon as possible.

Christala Culhane, HCBS Licensing Supervisor

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/