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October 18, 2023 Simon Nyamari, Authorized Agent Amani Health Care Services LLC 1705 Southcross Drive West 105 Burnsville, Minnesota 55306 License Number: 1091055 (245D – Home and Community-Based Services) CORRECTION ORDER Dear Simon: On September 28, 2023, a licensing review of Amani Health Care Services LLC, located at 1705 Southcross Drive West 105, Burnsville, 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 2. Violation: For two of four person whose record was reviewed (P1 and P4), the license holder did not develop individual abuse prevention plans as required. a. The license holder developed an individual abuse prevention plan for P1 that documented P1 did not have any vulnerabilities that made them at risk for abuse. P1’s support plan and the license holder identified vulnerabilities that made P1 susceptible to abuse. The license holder failed to assess P1’s vulnerabilities for abuse. b. The license holder developed an individual abuse prevention plan for P4 that documented P4 was susceptible to physical abuse; however, the license holder failed to include specified actions the program would take to minimize the risk within the scope of the licensed services. Corrective Action Ordered: Within 30 days of receipt of this order, you must review and update P1 and P4’s individual abuse prevention plans to include the above-mentioned information. On an ongoing basis, you must develop individual abuse prevention plans as required. Repeat Violation: The license holder was cited for a similar violation in an order of conditional license dated February 23, 2022, and correction orders dated March 1, 2019, June 16, 2022, and February 28, 2023. 2. Citation: Minnesota Statutes, section 245D.07, subdivision 1a. Violation: For one person whose record was reviewed (P1), the license holder did not provide services in response to the person’s identified needs, interests and preferences as required for each service. The license holder provided multiple services to P1. The license holder failed to ensure that P1’s support plan addendum identified how services were to be provided for each service, including how, when and by whom, and the person’s responsible for overseeing the delivery of coordination of the services. Corrective Action Ordered: Within 30 days of receiving this order, you must review and update P1’s support plan addendum to include the above-mentioned information. On an ongoing basis, you must maintain compliance as required. Repeat Violation: The license holder was cited for a similar violation in an order of conditional license dated February 23, 2022, and correction orders dated June 16, 2022, and February 28, 2023. 3. Citation: Minnesota Statutes, section 245D.07, subdivision 2, paragraph (c). Violation: For one person whose record was reviewed (P2) the license holder did not meet service planning and delivery requirements for a basic service. The license holder failed to review and revise, as needed P1’s preliminary support plan to document the services that would be provided including how, when and by whom services would be provided and the person responsible for overseeing the delivery and coordination of services. Corrective Action Ordered: Within 30 days of receipt of this order, you must review and revise P2’s preliminary support plan for the above-mentioned information. On ongoing basis, you must maintain compliance as required. Repeat Violation: The license holder was cited for a similar violation in an order of conditional license dated February 23, 2022, and correction orders dated March 1, 2019, and June 16, 2022. 4. Citation: Minnesota Statute, section 245D.071, subdivision 3. Violation: For one person whose record was reviewed (P1), the license holder did not meet service planning and delivery requirements for an intensive service as required. The license holder failed to complete assessments in the following areas for P1: · P1’s ability to self-manager 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; · P1’s ability to self-manger 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; · P1’s ability to self-manager symptoms or behaviors that may other result in an incident as defined in section 245D.02, subdivision 11 clauses (4) to (7), suspension or termination of services by the licenses, or other symptoms or behaviors that my jeopardized the health and safety of the person or others. Corrective Action Ordered: Within 30 days of receipt of this order you must complete the above-mentioned assessments for P1. On an ongoing basis, you must maintain compliance as required with this subdivision. 5. Citation: Minnesota Statutes, section 245D.071, subdivision 4. Violation: For one person whose record was reviewed (P1) the license holder did not develop supports and outcomes as required. The license holder failed to maintain the following documentation for P1’s outcomes: · the methods or actions that will be used to support the person 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 were provided; o any equipment and materials required; o techniques that were consistent with the person’s communication mode and learning style; · how data would be collected; · the projected starting date for implementing the supports and methods and the date by which progress would be reviewed and evaluated; · the names of the staff or position responsible for implementing the supports and methods. Corrective Action Ordered: Within 30 days of receipt of this order, you must document the above-mentioned information for P1’s outcome. On an ongoing basis, you must maintain compliance as required with this subdivision. Repeat Violation: The license holder was cited for a similar violation in an order of conditional license dated February 23, 2022. 6. Citation: Minnesota Statutes, section 245D.10, subdivision 2. Violation: The license holder did not establish policies and procedures that promoted service recipient rights by providing a simple complaint process for person served as required. The license holder failed to include the name of the highest level of authority of the program in their grievance policy. Corrective Action Ordered: Within 30 days of receipt of this order, you must review and revise your grievance policy to include the above-mentioned information. On an ongoing basis, you must maintain compliance as required with this subdivision. 7. Citation: Minnesota Statutes, sections 245D.10, subdivision 4. Violation: For one person whose record was reviewed (P2), the license holder did not provide policies and procedures as required. The license holder failed to inform and provide copies of the policies and procedures affecting a person‘s rights under section 245D.04 to P2’s case manager within five working days of service initiation. P2’s service initiation date was June 27, 2023; however, these policies were not provided until July 14, 2023. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required with 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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