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October 17, 2023 Edao Bukula, Authorized Agent Eddie Home Care Services 15011 Aberdeen Street Northeast Andover, Minnesota 55304 License Number: 1095405 (245D – Home and Community-Based Services) CORRECTION ORDER Dear Edao Bukula: On September 27, 2023, a licensing review of Eddie Home Service, located at 15011 Aberdeen Street Northeast, Andover, 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 245D.09, subdivision 4. Violation: For one of two staff person whose record was reviewed (SP1), the license holder did not provide orientation as required. The license holder failed to provide basic first aid training to SP1 within 60 days of hire. SP1’s hire date was April 4, 2022; however, this training was not completed until July 31, 2023. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section 245D.095, subdivision 5. Violation: For one staff person whose record was reviewed (SP1), the license holder did not document the date of all orientation trainings. The license holder failed to document SP1’s orientation to the license holder’s program abuse prevention plan within 72 hours of first providing direct contact. SP1’s date of first direct contact was April 4, 2023. SP1’s orientation training record documented that SP1 received this training on May 3, 2023. The license holder stated they provided this training within 72 hours of providing direct contact but failed to document that training. Corrective Action Ordered: 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. 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 ATTN: Legal Unit Licensing Division PO Box 64953 St. Paul, MN 55164-0242 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 me as soon as possible. Diana Arnzen, Senior Human Services Licensor Licensing Division Office of Inspector General 651-431-6638
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