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October 4, 2023 CERTIFIED MAIL Rajesh Mehta, Authorized Agent MN Adult Day Care 220 Robert Street Suite 101 & 102 Saint Paul, MN 55107 License Number: 1094266 (Rule 223: Adult Day Center) ORDER OF LICENSE REVOCATION Dear Rajesh Mehta: The Department of Human Services (DHS) is revoking your license to provide adult day center services for MN Adult Day Care, located at 220 Robert Street, Suite 101 and 102, Saint Paul, Minnesota. This revocation is based on your failure to comply with adult day center and background study laws and rules and the Commissioner’s evaluation of your program. Details of our findings are provided below. Our next steps and your options are also detailed. The revocation goes into effect on October 18 at 5:00 p.m. to allow time for delivery of this order and ten days for you to inform the Commissioner whether you intend to appeal the license revocation explained below. REASON FOR LICENSE REVOCATION 1. Failure to comply with licensing laws and rules DHS determined that your program failed to fully comply with the laws and rules that apply to licensed adult day centers. DHS has also considered the nature, chronicity, or severity of the violations that led to the revocation of your license. · Nature: Many of the violations cited in this Order of License Revocation are violations of law or rule affecting the health, safety, or rights of individuals served by the program. The licensing violations include: o Failure to develop and review individual abuse prevention plans; o Failure to distribute policies and program information; o Failure to maintain participant records including attendance records; o Failure to complete initial service planning and develop written plans of care; o Failure to maintain personnel records; o Failure to provide staff orientation to the center; o Failure to ensure policies and procedures were developed to maintain compliance with licensing requirements under Minnesota Statutes and Minnesota Rules; o Failure to provide food service and nutrition, health, structured exercise program, diversified daily program activities, and social services as required; o Failure to ensure safety requirements; and o Failure to post a copy of the internal and external reporting policies and procedures and program abuse prevention plan. · Chronicity: Your program received its license on August 13, 2021. Since that time, your program has demonstrated a history of noncompliance with licensing rules and statutes. The information below summarizes this history: o August 13, 2021 License Issued o June 29, 2022 License holder reported to not be serving participants o August 8, 2023 Temporary Immediate Suspension: Imminent risk of harm to persons served o October 4, 2023 Revocation (this order): 10 violations · Severity: Many of the violations that led to the revocation of your license relate to the health and safety of persons served. Due to the serious and chronic nature of these violations, and the conditions in the program, which impact the health and safety of persons served in your care, your license to provide adult day services is being revoked. Legal Authority: Minnesota Statutes, section 245A.07, subdivision 3(a)(1). 2. Commissioner’s evaluation of program In determining whether a licensing action is warranted, DHS evaluated the facts, conditions, and circumstances concerning your program’s operation. This includes consideration of the well-being of persons served by your program, and information about the qualifications of staff persons that are working in your program. DHS has determined that revocation of your license is appropriate based on the violations identified below and the program evaluation. Legal Authority: Minnesota Statutes, section 245A.04, subdivision 6. Due to the serious and chronic nature of these violations and the conditions in the program, which impact the health and safety of persons served in your care, your license to provide adult day services is revoked. LICENSING VIOLATIONS DETERMINED ON AUGUST 2, 2023. DHS determined that your program failed to follow licensing rules and statutes, as described below. PARTICIPANT RECORD VIOLATIONS 1. Violation: For two of two participants whose records were reviewed (P1 and P2), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). The license holder failed to review P1 and P2’s IAPPs quarterly as part of the review of the program plan or service plan. Statute Violated: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b). 2. Violation: For two participants whose records were reviewed (P1 and P2), 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: o P1’s source of referral; and o the name and telephone number of P1’s physician or medical provider; and · 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 physician examination; 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 is free from communicable disease or infestations, as specified in parts 4605.700 to 4605.7090, that would endanger the health of other participants; · participation reports and progress notes that are recorded at least monthly. b. The license holder failed to include the following information in P2’s record: · an application form that included the secondary name and number of the person to call in case of emergency involving P2; and · a medical report dated within the three months prior to or 30 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, that included: o a report on a physician examination; o a medical history of P2; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P2; o a release signed by the physician indicating whether P2 may engage in a structured exercise program; and o documentation that P2 is free from communicable disease or infestations, as specified in parts 4605.700 to 4605.7090, that would endanger the health of other participants; · P2's service agreement with the center that specified the responsibilities of P2 and the center with respect to payment for and provision of services and was signed by P2 or P2's caregiver and the center director; and · participation reports and progress notes that are recorded at least monthly. Rule Violated: Minnesota Rules, part 9555.9660, subpart 1. 3. Violation: For two of two participants whose records were reviewed (P1 and P2), 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 the following: · P1's psychosocial status (for example, awareness level, personal care needs, need for privacy or socialization);§ · P1's functional status (for example, endurance and capability for ambulation, transfer, and managing activities of daily living); · P1's physical status, determined by observation, from the intake screening interview, and from the medical report received from the participant's physician; and · develop a preliminary service plan for P1 that included: o scheduled days of P1’s attendance at the center; o transportation arrangements for getting P1 to and from the center; o P1’s nutritional needs and, where applicable, dietary restrictions; o the role of P1’s caregiver or caregivers in carrying out the service plan; and o services and activities in which P1 would take part immediately upon admission. b. The license holder failed to conduct a needs assessment for P2 that included the following: · P2's psychosocial status (for example, awareness level, personal care needs, need for privacy or socialization);§ and · P2's physical status, determined by observation, from the intake screening interview, and from the medical report received from the participant's physician. Rule Violated: Minnesota Rules, part 9555.9700, subpart 2. 4. Violation: For two participants whose records were reviewed (P1 and P2), the license holder did not develop a written plan of care as required. The license holder failed to develop written plans of care for P1 and P2, that included§: · an update of the preliminary service plan and additional services required by the participant; · short and long term objectives for the participant stated in concrete, measurable and time specific outcomes; · the staff members responsible for implementing the individual plan of care; · the anticipated duration of the individual plan of care as written; and · provisions for quarterly review and quarterly revisions of the individual plan of care. Rule Violated: Minnesota Rules, part 9555.9700, subpart 3. PERSONNEL RECORD VIOLATIONS 5. Violation: For one of one staff person whose record was reviewed (SP1), the license holder did not maintain a personnel record as required. The license holder failed to maintain the following in SP1’s personnel record: · SP1’s job description; · an employment application or resume; and · documentation of an annual performance evaluation. Rule Violated: Minnesota Rules, part 9555.9650, item A. 6. Violation: For three consultants whose records were reviewed, the license holder maintain personnel records for the physical therapist, registered nurse, and dietician. Personnel records for the physical therapist, registered nurse, and dietician must contain a copy of a signed contract or letter of appointment specifying conditions and terms of employment; and documentation that the consultant met any licensure, registration, or certification requirements required to perform services. The license holder had no personnel records and did not have any of the required information. Rule Violated: Minnesota Rules, part 9555.9650, item B. 7. Violation: For one staff person whose record was reviewed (SP1), the license holder did not provide orientation to a mandated reporter as required. The license holder failed to provide SP1 orientation to the reporting requirements and definitions in sections 626.557 and 626.5572, the requirements of this section, the license holder's program abuse prevention plan, and all internal policies and procedures related to the prevention and reporting of maltreatment of individuals receiving services within 72 hours of first providing direct contact. Statute Violated: Minnesota Statutes, section 245A.65, subdivision 3. 8. Violation: For one staff person whose record was reviewed (SP1), the license holder did not provide orientation to the center as required. The license holder failed to provide SP1 20 hours of orientation to the center within the employee’s first 40 hours of employment at the center, including: · at least 4 hours of supervised orientation before the employee worked directly with persons at the center; · training related to the kinds of functional impairments of persons currently at the center; and · safety requirements and procedures in part 9555.9720. Rule Violated: Minnesota Rules, part 9555.9690, subpart 3. SERVICE AND PROGRAM VIOLATIONS 9. Violation: The license holder did not offer services as required. a. The license holder failed to ensure menus for all meals and snacks were approved by a registered dietitian and met all applicable state rules and laws and United States Department of Agriculture regulations. b. The license holder failed to maintain a record indicating the menu for all meals served for at least six months. c. The license holder failed to ensure a registered physical therapist provided consultation and review of the exercise program. d. The license holder failed to ensure a registered nurse provided consultation and review of the health services at least monthly. Additionally, the license holder failed to ensure health services included: · monitoring a person’s health status and reporting changes to the person’s caregiver, physician, and center director; · educating and counseling persons on good health practices; · maintaining a listing of professional health resources available for referrals as needed by people; · developing policies and monitoring procedures for participant self-administration of medications for training unlicensed personnel who provide medication assistance; and · supervising staff distribution of medication and assistance with a person’s self-administration of medication and ensuring compliance with 9555.9680, subpart 2, item C. e. The license holder failed to maintain family and social histories in P1 and P2’s records. Rule Violated: Minnesota Rules, part 9555.9710, subparts 1, 3, 4, and 7. 10. Violation: The license holder did not post a copy of the internal and external reporting policies and procedures and the program abuse prevention plan (PAPP) as required. The license holder failed to post a copy of the internal and external reporting policies and procedures and the program abuse prevention plan in a prominent location in the center. Statute Violated: Minnesota Statutes, section 245A.65, subdivision 1, paragraph (d) and subdivision 2, paragraph (a). YOUR RIGHT TO APPEAL You have the right to appeal the revocation. Your request must be in writing and clearly state that you are requesting a contested case hearing for this matter. Your request must be made before the deadlines provided below. If you do not meet this deadline, you lose your right to an administrative appeal. The timeline to appeal began when you received this order. If you are mailing your request, it must be sent by certified mail and postmarked within 10 calendar days from when you received this order. Please send it 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 If your request is being personally delivered, it must be received by DHS within 10 calendar days from when you received this order. Please bring it to: Commissioner, Department of Human Services Office of Inspector General Legal Counsel’s Office Attention: Licensing Legal Unit 444 Lafayette Road North St. Paul, MN 55155 Upon DHS’ receipt of your timely appeal, your case would be scheduled for a contested case hearing in front of an Administrative Law Judge. Following this hearing, the Commissioner of DHS will issue a final order. If you do not appeal or if the order is affirmed by the Commissioner following a hearing, DHS is prohibited from issuing you and the controlling individuals a license for five years. In addition, any additional licenses held by you or the controlling individuals shall also be revoked. Legal representation at the contested case hearing: You do not need a lawyer to appeal. However, a lawyer can help you with your appeal. The state or county will not get you a lawyer and will not pay for a lawyer. If you cannot afford a lawyer, you may be able to get free legal advice or help with your appeal. To find out if free help is available, contact: Volunteer Lawyers Network at 612-752-6677; Central Minnesota Legal Services at 612-332-8151; Southern Minnesota Legal Services at 651-222-4731; or go to www.lawhelpmn.org to find a local legal services program that may be able to help you. You can also find information on contested cases from the Office of Administrative Hearings website at https://mn.gov/oah/self-help. Click on Administrative Law Overview, then click on Administrative Law Contested Case Hearing Guide for a list of frequently asked questions. Pending the outcome of the appeal: You may file an appeal within the timeframes described above. DHS issued an Order of Temporary Immediate Suspension of the license on August 8, 2023, and you did not appeal that decision. Because the immediate suspension of the license remains in effect, if you appeal the revocation, you may not operate pending the outcome of your appeal. Legal Authority: Minnesota Statutes, section 245A.07, subdivision 2a, paragraph (c). Legal authority for this licensing action · This action is taken under Minnesota Statutes, section 245A.07, subdivision 3, which describes under which conditions DHS may revoke a license. · The timeline to appeal a revocation order is provided in Minnesota Statutes, section 245A.07, subdivision 3(b). · “Controlling individual” is defined under Minnesota Statutes, section 245A.02, subdivision 5a. · Minnesota Statutes, section 245.095 defines which programs administered by DHS are included in the exclusion provision, and further defines “excluded,” “individual,” and “provider.” · License holders have a right to appeal licensing actions and request a contested case hearing, under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. · A license holder who files a timely appeal of a revocation order but was under a temporary immediate suspension at the time of the revocation order, may not operate the program pending a final order of the appeal under Minnesota Statutes, section 245A.07, subdivision 2a(c). · Under Minnesota Statutes, section 245A.04, subdivision 7, paragraph (d), clause (3), the commissioner shall not issue or reissue a license if the applicant, license holder, or controlling individual has had a license issued under this chapter revoked within the past five years. · Under Minnesota Statutes, section 245A.04, subdivision 7, paragraph (d), clause (5), when a license issued under this chapter is revoked under clause (1) or (3), the license holder and controlling individual may not hold any license under chapter 245A for five years following the revocation, and other licenses held by the applicant, license holder, or controlling individual shall also be revoked. Questions If you have any further questions regarding this matter, you may contact Brittany Raddatz, HCBS Unit Supervisor, at 651-431-6591. Sincerely,
Jill Slaikeu, HCBS Unit Manager Licensing Division Office of Inspector General
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