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February 15, 2024 Paul Thao, Authorized Agent 5 Star Adult Day Center Inc 2966 White Bear Avenue North Maplewood, Minnesota 55109 License Number: 1103165 (Rule 223) CORRECTION ORDER Dear Paul Thao: On January 31, 2024, a licensing review of 5 Star Adult Day Center Inc, located at 2966 White Bear Avenue North, Maplewood, Minnesota, was conducted to determine compliance with Minnesota Statutes and Rules governing adult day care services under Minnesota Rules, parts 9555.9600 through 9555.9730 (Rule 223). 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, paragraph (b). Violation: For two of four participants whose records were reviewed (P3 and P4), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). The license holder failed to review P3 and P4’s IAPP annually with the participant and the participant’s interdisciplinary team and document the review. Repeat Violation: The license holder was cited for a similar violation in an Order of Conditional License dated October 27, 2023. Corrective Action Ordered: Within 30 days of receiving this order, you must: · review P3 and P4’s IAPP with P3 and P4 and P3 and P4’s interdisciplinary team and document the review; · complete an audit of all participants’ IAPPs to ensure the requirements in Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b) are maintained; and · for participants whose IAPPs are not developed and reviewed as required, you must develop a plan detailing how your program will maintain IAPPs as required within 60 calendar days of receiving this order. On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For two participants whose records were reviewed (P3 and P4), the license holder did not include information in the participant’s written record as required.
The license holder failed to include the following information in P3 and P4’s records: · 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 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; o a release signed by the physician indicating whether the participant may engage in a structured exercise program; and o documentation that the participant was free from communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would otherwise endanger the health of other participants; and · notes on special problems or on changes needed in medication and on the need for medication assistance. Repeat Violation: The license holder was cited for a similar violation in an Order of Conditional License dated October 27, 2023. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain all information detailed above in P3 and P4’s participant record. On an ongoing basis, you must maintain compliance as required in this subpart. 3. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For two participants whose records were reviewed (P3 and P4), the license holder did not complete initial service planning as required. The license holder failed to conduct needs assessments for P3 and P4 that included the participant’s physical status, determined by observation, from the intake screening interview, and from the medical report received from the participant’s physician. Repeat Violation: The license holder was cited for a similar violation in an Order of Conditional License dated October 27, 2023. Corrective Action Ordered: Within 30 days of receiving this order, you must update P3 and P4’s needs assessments to include information from the medical report received from P3 and P4’s physician. 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 regarding this Correction Order, please contact me as soon as possible. Desiree Tiller, Senior Human Services Licensor Licensing Division Office of Inspector General 651-431-4622
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