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November 20, 2023 Fahima Mohamed Abdi, Authorized Agent Providence Home Care 3423 26th Avenue South Minneapolis, Minnesota 55406 License Number: 1104429 (245D – HCBS) CORRECTION ORDER Dear Fahima Mohamed Abdi: On August 16, 2023, a licensing review of Providence Home Care, located at 11979 County Road 11 Suite 260, 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 1. Violation: For one of two persons whose record was reviewed (P1), the license holder did not provide an orientation to the internal and external reporting procedures related to suspected or alleged maltreatment as required. P1 was admitted to the program on February 1, 2023. The license holder failed to provide P1 with an orientation to the internal and external reporting procedures related to suspected or alleged maltreatment within 24 hours of admission. The license holder provided this orientation to P1 on February 9, 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, paragraph (a). Violation: For one person whose record was reviewed (P2), the license holder did not establish, enforce, and provide orientation to a written program abuse prevention plan (PAPP) as required. The license holder provided Integrated Community Supports to P2, which required the license holder to establish and enforce a PAPP. The license holder failed to establish, enforce and provide orientation to the ongoing written PAPP to P2. Corrective Action Ordered: Within 15 days of receiving this order, you must establish and enforce a written PAPP for all service types you provide under this license in which a PAPP is required. Additionally, within 30 days of receiving this order, you must provide all service recipients with an orientation to this plan, if applicable, and maintain documentation of this orientation in the service recipient’s record. On an ongoing basis, you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b). Violation: For two persons whose records were reviewed (P1 and P2), the license holder did not develop an individual abuse prevention plan (IAPP) as required. a. P1’s services were initiated on February 1, 2023. The license holder failed to develop an IAPP for P1 as part of the initial program or service plan. The license holder developed an IAPP for P1 on February 9, 2023. Additionally, the license holder failed to develop an IAPP for P1 that included an individualized assessment of P1’s susceptibility of abuse according to Minnesota Statutes, section 626.557, subdivision 14, and statements of measures include measures with specific action the program will take to minimize the risk of abuse within the scope of the licensed services. P1’s IAPP indicated that P1 was not susceptible to abuse; however, this assessment was not consistent with other information in P1’s record. b. The license holder failed to develop an IAPP for P2 that included an individualized assessment of P2’s susceptibility of abuse according to Minnesota Statutes, section 626.557, subdivision 14, and include statements of measures with specific action the program will take to minimize the risk of abuse within the scope of the licensed services. P2’s IAPP indicated that P2 was not susceptible to abuse; however, this assessment was not consistent with other information in P2’s record. Corrective Action Ordered: Within 30 days of receiving this order, you must: · review and revise P1 and P2’s IAPP to include: o an assessment of the person's susceptibility to abuse by other individuals, including other vulnerable adults and the person's risk of abusing other vulnerable adults; and o statements of measures, with specific actions your program will take to minimize the risk of abuse within the scope of the licensed service(s); · review P1 and P2’s revised IAPP with the person and their case manager; and · maintain documentation of this review in P1 and P2’s record. On an ongoing basis, you must maintain compliance as required in this subdivision. 4. Citation: Minnesota Statutes, section 245D.04, subdivision 1. Violation: For one person whose record was reviewed (P1), the license holder did not provide a written notice that identified the service recipient’s 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 an explanation of those rights within 5 working days of service initiation. The license holder provided this to P1 on February 9, 2023. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 5. Citation: Minnesota Statutes, section 245D.07, subdivision 2, paragraph (c). Violation: For one person whose record was reviewed (P1), the license holder did not meet service planning requirements for basic support services. While the license holder did complete a review of P1’s preliminary support plan addendum within 60 calendar days of service initiation, the license holder failed to document by whom service would be provided. Corrective Action Ordered: Within 30 days of receiving this order, you must review and revise P1’s support plan addendum to include by whom services will be provided and maintain this documentation in P1’s record. On an ongoing basis, you must maintain compliance as required in this subdivision. 6. Citation: Minnesota Statutes, section 245D.071, subdivision 4. Violation: For one person whose record was reviewed (P2), the license holder did not develop service outcomes and supports as required. P2’s 45-day planning meeting was held on September 22, 2022. The license holder failed to develop a service plan for P2 within 10 working days of the 45-day planning meeting that documented the following supports and methods to be implemented to support P2 and accomplish outcomes related to acquiring, retaining, or improving skills and physical, mental, and emotional health and well-being: · 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 are provided; o any equipment and materials required; and o techniques that were consistent with the person’s communication mode and learning style; · the measurable and observable criteria for identifying when the desired outcome has been achieved; · how data would be collected; · the projected starting date for implementing the supports and methods; · the date by which progress towards accomplishing the outcomes would be reviewed and evaluated; and · the names of the staff or position responsible for implementing the supports and methods. Corrective Action Ordered: Within 30 days of receiving this order, you must develop and implement a service plan for P2 that documents the requirements identified above. Within 20 working days of the development of this plan, you must submit to and obtain dated signatures from P2 and P2’s case manager to document completion and approval of the support plan addendum. Additionally, you must maintain this documentation in P2’s record. On an ongoing basis, you must maintain compliance as required in this subdivision. 7. Citation: Minnesota Statutes, section 245D.095, subdivision 3, paragraph (b). Violation: For one person whose record was reviewed (P1), the license holder did not maintain a service recipient record as required. The license holder failed to maintain progress or daily notes in P1’s service recipient record. Corrective Action Ordered: Immediately, you must begin recording progress or daily notes and maintain them in P1’s service recipient record. On an ongoing basis, you must maintain compliance as required in this subdivision. 8. Citation: Minnesota Statutes, section 245D.10, subdivision 4, paragraph (b). Violation: For two persons whose records were reviewed (P1 and P2), the license holder did not inform and provide the policies and procedures affecting a person’s rights under section 245D.04, as required. a. P1’s services were initiated on February 1, 2023. The license holder failed to inform and provide copies of the following policies and procedures affecting a person’s rights to P1 and P1’s case manager within 5 working days of service initiation: · grievance policy and procedure; · service suspension policy and procedure; · service termination policy and procedure; and · emergency use of manual restraints policy and procedure. The license holder provided these policies to P1 on February 9, 2023. As of the date of the licensing review, the license holder had not provided these policies to P1’s case manager. b. P2’s services were initiated on August 12, 2022. The license holder failed to inform and provide copies of the following policies and procedures affecting a person’s rights to P2’s case manager within 5 working days of service initiation: · grievance policy and procedure; · service suspension policy and procedure; · service termination policy and procedure; · emergency use of manual restraints policy and procedure; and · data privacy policy and procedure. The license holder provided these policies to P2’s case manager on August 8, 2023. Corrective Action Ordered: Within 30 days of receiving this order, you must provide P1’s case manager with the policies and procedures identified in paragraph “a” of this violation. On an ongoing basis, you must maintain compliance as required in this subdivision. 9. Citation: Minnesota Statutes, section 245A.65, subdivision 3. Violation: For one of four staff persons whose record was reviewed (SP2), the license holder did not provide an orientation to the program abuse prevention plan (PAPP) as required. The license holder failed to provide SP2 with an orientation to the PAPP within 72 hours of first providing direct contact services as required. Corrective Action Ordered: Within 30 days of receiving this order, you must provide SP2 with an orientation to the PAPP. Additionally, you must maintain documentation of this training in SP2’s personnel record. On an ongoing basis, you must maintain compliance as required in this subdivision. 10. Citation: Minnesota Statutes, section 245D.095, subdivision 5, paragraph (a). 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 a personnel record for SP1 and SP2 that documented orientation and training that included: · the date the training was completed; · the number of hours per subject area; and · the name of the trainer or instructor. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subject area. 11. Citation: Minnesota Statutes, section 245D.061, subdivision 9. Violation: The license holder did not develop, document, and implement policies and procedures related to the emergency use of manual restraint as required. While the license holder did develop a policy titled “Emergency Use of Manual Restraints Policy”, the license holder’s policy failed to include the following: · a description of the types of manual restraints the license holder allows staff to use on an emergency basis; · instructions for safe and correct implementation of the allowed manual restraint procedures; and · the person or position responsible for completing the internal reviews and for ensuring that corrective action is taken or the person’s support plan addendum is revised, when determined necessary. Corrective Action Ordered: With 15 days of receiving this order, you must develop, document, and implement a policy and procedures related to the emergency use of manual restraints that includes the requirements identified above. Within 30 days of receiving this order, you must: · provide all staff persons with an orientation to this policy and maintain documentation of this orientation in the staff person’s personnel record; · provide all persons receiving services under this license, and their legal representative, if applicable, with a copy of and orientation to this policy; and · maintain written acknowledgement from the person, or the person’s legal representative, that the person receiving services has been notified as required under Minnesota Rules, part 9544.0080. On an ongoing basis, you must maintain this policy 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 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 me as soon as possible. Krista Hastings, Senior Human Services Licensor Licensing Division Office of Inspector General 651-431-4825
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