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October 2, 2023 Yusuf Hassan, Authorized Agent Hiawatha Senior Center Inc 1433 E Franklin Avenue Minneapolis, Minnesota 55404 License Number: 1110405 (Rule 223) NOTICE OF NON-COMPLIANCE AND CORRECTION ORDER Dear Yusuf Hassan: On June 13, 2023, as a result of a licensing review, a Correction Order was issued to Hiawatha Senior Center Inc, located at 1433 E Franklin Avenue, Minneapolis, Minnesota. You were ordered to take corrective action for violations determined under citations 1 through 9. On September 26, 2023, a follow-up licensing review was conducted to determine that corrective action was achieved. For citations 4, 5, and 6 it was determined that corrective action has not been achieved. As a result, this Notice of Noncompliance and 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. 4. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For five participants whose records were reviewed (P1, P2, P3, P4 and P6), 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’s record: · an application form that included the name and telephone number of P1’s physician or medical provider; · a medical report, dated within the three months prior to or 30 days after P1’s admission to the center signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on a physical examination, updated annually; o a medical history of P1; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P1; o a release signed by the physician indicating whether P1 may engage in a structured exercise program; and o documentation that P1 was free of communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants; · participation reports and progress notes that are recorded at least monthly; · notes on special problems, medication changes, and need for medication assistance. b. The license holder failed to include the following information in P2’s record: · a medical report, dated within the three months prior to or 30 days after P2’s admission to the center that included a report on a physical examination. P2 was admitted to the center on May 16, 2022 and the license holder maintain a medical report for P2 on November 7, 2022; · participation reports and progress notes that are recorded at least monthly; and · notes on special problems, medication changes, and need for medication assistance. c. The license holder failed to include the following information in P3’s record: · an application form that included the name and telephone number of P3's physician or medical provider; · a medical report that included a physical examination, updated annually. The most recent report on a physical examination that the license holder maintained for P3 was dated April 26, 2022; · participation reports and progress notes that are recorded at least monthly; and · notes on special problems, medication changes, and need for medication assistance. d. The license holder failed to include the following information in P4 and P6’s record: · a medical report, dated within the three months prior to or 30 days after the participant’s admission to the center signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on a physical examination, updated annually; o a medical history of the participant; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to the participant; 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; · participation reports and progress notes that are recorded at least monthly. Corrective Action Ordered: Within 30 days of receiving this order, you must: · maintain all information detailed above in P1, P2, P3, P4, and P6’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. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this part. License Holder Response: The license holder maintained the following in P1’s record: · an application form that included the name and telephone number of P1’s physician or medical provider; · a medical report signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on a physical examination, updated annually; o a medical history of P1; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P1; o a release signed by the physician indicating whether P1 may engage in a structured exercise program; and o documentation that P1 was free of communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants; · participation reports and progress notes that are recorded at least monthly; and · notes on special problems, medication changes, and need for medication assistance. The license holder maintained notes on special problems, medication changes, and need for medication assistance in P2’s record. The license holder maintained the following information in P3’s record: · an application form that included the name and telephone number of P3's physician or medical provider; · a medical report that included a physical examination, updated annually; · participation reports and progress notes that are recorded at least monthly; and · notes on special problems, medication changes, and need for medication assistance. The license holder failed maintained the following information in P4 and P6’s record: · a medical report signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on a physical examination, updated annually; o a medical history of the participant; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to the participant; 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. · participation reports and progress notes that are recorded at least monthly. DHS Response: The license holder failed to include a medical report in P2’s record that included a report on a physical examination, updated annually. Corrective Action Ordered: Within 15 days of receiving this order, you must maintain a medical report in P2’s record that includes a report on a physical examination. On an ongoing basis, you must maintain compliance as required in this part.
5. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For three participants whose records were reviewed (P1, P2, and P3), the license holder did not complete initial service planning as required. a. The license holder failed to: · conduct a needs assessment for P1 that included P1’s physical status, determined by observation, from the intake screening interview, and from the medical report received from P1’s physician; and · develop a preliminary service plan for P1 that included: o scheduled days of the participant’s attendance at the center; o the role of the participant’s caregiver or caregivers in carrying out the service plan; and o services and activities in which the participant would take part immediately upon admission. b. P2’s admission date was May 15, 2022. The license holder failed to: · conduct a needs assessment for P2 that addressed P2’s physical status determined from the medical report received from P2’s physician. The license holder conducted a needs assessment for P2 on May 15, 2022 but did not maintain a medical report from P2’s physician until November 7, 2022; and · develop a preliminary service plan for P2 that included: o scheduled days of the participant’s attendance at the center; o transportation arrangements for getting the participant to and from the center; and o the participant’s nutritional needs and, where applicable, dietary restrictions. c. The license holder failed to develop a preliminary service plan for P3 that included: · §scheduled days of the participant’s attendance at the center; and · services and activities in which the participant would take part immediately upon admission. §Corrective Action Ordered: Within 30 days of receiving this order, you must: · conduct needs assessments for P1 and P2 as detailed above; · develop preliminary service plans for P1, P2, and 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. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. License Holder Response: The license holder updated P1, P2, and P3’s preliminary service plan as ordered. DHS Response: The license holder failed to conduct a needs assessment for P1 and P2 that included P1 and P2’s physical status, determined by observation, from the intake screening interview and from the medical report received from P1 and P2’s physicians. Corrective Action Ordered: Within 15 days of receiving this order, you must update P1 and P2’s needs assessment to include an assessment of P1 and P2’s physical status. On an ongoing basis, you must maintain compliance as required in this subpart. 6. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For three participants whose records were reviewed (P2, P3 and P5), the license holder did not develop a written plan of care as required. a. The license holder failed to develop written plans of care for P2 and P3 that included§ short and long term objectives for the participant stated in concrete, measurable and time specific outcomes. b. The license holder failed to develop a written plan of care for P5 that included provisions for quarterly review and quarterly revision of the individual plan of care. §Corrective Action Ordered: Within 30 days of receiving this order, you must: · develop written plans of care for P2, P3, and P5 that include the information listed above; · 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. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. License Holder Response: The license holder developed written plans of care for P2 and P5 as ordered.
DHS Response: The license holder failed to develop a written plan of care for P3 that included short and long term objectives for P3 stated in concrete, measurable and time specific outcomes. Corrective Action Ordered: Within 15 days of receiving this order, you must update P3’s written plan of care to include short and long term objectives for P3 stated in concrete, measurable and time specific outcomes. On an ongoing basis, you must maintain compliance as required in this subpart. 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, please contact your licensor, Desiree Tiller, at 651-431-4622. Brittany Raddatz, Supervisor Licensing Division Office of Inspector General
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