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February 15, 2024 Rita Wiersma, Authorized Agent Accord 1515 Energy Park Drive Saint Paul, Minnesota 55108 License Number 1069788 (Home and Community Based Services) CORRECTION ORDER Dear Rita Wiersma: On November 14—November 16, 2023, Department of Human Services (DHS) licensors conducted a licensing review at your facility located at 1515 Energy Park Road, Saint Paul Minnesota. As a result of this visit, DHS determined that you are in violation of 18 of the 245D rules and statutes. As a result, DHS is issuing this order which requires you to take the correction action as described under each violation. Details of our findings are provided below. Our next steps and your options are also detailed. LICENSING VIOLATIONS DHS determined that your program failed to follow licensing rules and statutes, as described below. PROGRAM COORDINATION, EVALUATION, AND OVERSIGHT 1. Violation: The license holder did not ensure the designated coordinators and the designated managers provided program coordination and evaluation as required. The designated coordinators identified by the license holder failed to provide supervision, support, and evaluation of the activities that include: · oversight of the license holder’s responsibilities as assigned in the person’s coordinated service support plan and the coordinated service support plan addendum; · taking the action necessary to facilitate the accomplishment of the outcomes according to the requirements in section 245D.07; · instruction and assistance to direct support staff implementing the coordinated service support plan and service outcomes, including direct observation of service delivery sufficient to assess staff competency; and · evaluation of the effectiveness of service delivery, methodologies, and progress on the person’s outcomes based on the measurable and observable criteria for identifying when the desired outcome had been achieved according to the requirements in section 245D.07. See citations 2-18 as evidence of the failures of the designated coordinators identified by the license holder. The designated managers identified by the license holder failed to provide program management and oversight of the services provided by the license holder that include: · maintain a current understanding of the licensing requirements sufficient to ensure compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph (e), and when applicable, as identified in section 256B.04, subdivision 21, paragraph (b); · ensure the duties of the designated coordinator are fulfilled according to the requirements in subdivision 2; · evaluation of satisfaction of persons served by the program, the person's legal representative, if any, and the case manager, with the service delivery and progress towards accomplishing outcomes identified in sections 245D.07 and 245D.071 and ensuring and protecting each person's rights as identified in section 245D.04; · ensuring staff competency requirements are met according to the requirements in section 245D.09, subdivision 3, and ensuring staff orientation and training is provided according to the requirements in section 245D.09, subdivisions 4, 4a, and 5; · ensuring corrective action is taken when ordered by the commissioner and that the terms and conditions of the license and any variances are met; and · evaluating the information identified in clauses (1) to (6) to develop, document, and implement ongoing program improvements. See citations 2-18 as evidence of the failures of the designated managers identified by the license holder. Statute Violated: section 245D.081, subdivision 1. Corrective Action Ordered: Within 30 days of receiving the order, you must submit documentation to your licensor that the designated coordinator has acknowledged their responsibilities as required in Minnesota Statutes, section 245D.081, subdivisions 2 and the designated manager has acknowledged their responsibilities as required in Minnesota Statutes, section 245D.081, subdivision 3. On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. SERVICE RECIPIENT 2. Violation: For one of thirteen persons whose records were reviewed (P3), the license holder did not provide orientation to the internal and external reporting procedures of alleged or suspected maltreatment of vulnerable adults as required. The license holder failed to provide P3 and P3’s legal representative with an orientation to the internal and external reporting procedures of alleged or suspected maltreatment of vulnerable adults within 24 hours of admission. Statute Violated: section 245A.65, subdivision 1. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. Compliance will be monitored during onsite reviews. 3. Violation: For seven persons whose records were reviewed (P1, P2, P3, P5, P8, P9, and P10), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP) as required.
The license holder failed review and revise as needed, an IAPP annually for P1, P2, P3, P5, P8 P9 and P10. Statute Violated: section 245A.65, subdivision 2, paragraph (b). Repeat Violation: In a Correction Order that DHS issued on August 29, 2016, you were previously found in violation of this same statute. Corrective Action Ordered: Within 60 days of receiving this order, you must audit all service recipient Individual Abuse Prevention Plans currently receiving services, to ensure compliance under this subdivision. You must allow the person and their legal representative opportunity to participate in the development of this plan and document the teams review if changes are made. On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. Compliance will be monitored during onsite reviews. 4. Violation: For seven persons whose records were reviewed (P1, P2, P3, P5, P7, P8 and P9), the license holder did not provide a written notice that identified the service recipient rights as required. a. The license holder failed to provide, P3, P3’s legal representative and P9 and P9’s legal representative with a written notice that identifies the service recipient rights and an explanation of those rights within five working days of service initiation. b. The license holder failed to provide P1, P2, P3, P5, P7, P8 and P9’s legal representative with a notice and explanation of the service recipient rights annually. Statute Violated: section 245D.04, subdivision 1. Repeat Violation: In a Correction Order that DHS issued on August 29, 2016, you were previously found in violation of this same statute. Corrective Action Ordered: Within 60 days of receiving this order, you must audit all service recipient records currently receiving services, to ensure rights have been provided as required and provide copies to all service recipients and their legal representatives (if applicable) where rights have not been provided as required. On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. Compliance will be monitored during onsite reviews. 5. Violation: For one person whose record was reviewed (P2), the license holder did not maintain documentation of how the person’s health needs would be met as required. The license holder was assigned responsibility for health service needs of P2’s medication management, including medication assistance. The license holder failed to maintain documentation on how P2’s health needs would be met, including a description of the procedures the license holder will follow in order to provide medication assistance. Statute Violated: section 245D.05, subdivision 1, paragraph (b). Corrective Action Ordered: Within 30 days of receiving this order, you must document the above-mentioned information for P2. Within 60 calendar days of receiving this order, you must audit all service recipient records who are currently receiving services, where Accord is responsible for health service needs, and ensure health needs are documented as required. On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. Compliance will be monitored during onsite reviews. 6. Violation: For one person whose records were reviewed (P2), the license holder did not provide services in response the person’s identified needs, interests, preferences, and desired outcomes as specified in the support plan and support plan addendum as required. The license holder identified P2’s outcome as, “as [P2’s] employment specialist, my outcome for [P2] is to gain successful employment in a safe environment while learning new skills that [P2] can apply to employment now and in the future and earn competitive pay.”
P2’s support plan identified P2’s desired goals as: · attend a class to “learn more English”; and · move into their own apartment. The license holder failed to use information consistent with the principals of person-centered service planning and delivery, that uses information to identify outcomes P2 desired. Statute Violated: section 245D.07, subdivision 1a. Corrective Action Ordered: Within 30 days of receiving this order, you must use person-centered planning tools to develop a service plan for P2 that includes a person-centered outcome. On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. Compliance will be monitored during onsite reviews. 7. Violation: For three persons whose records were reviewed (P1, P3 and P5), the license holder did not meet service planning requirements for basic support services. a. For P1 and P5, the license holder failed to participate in meetings and provide reports as requested by P1 and P5’s expanded support team. b. The license holder failed to complete a preliminary support plan for P3 within 15 calendar days of service initiation. Statute Violated: section 245D.07, subdivision 2. Corrective Action Ordered: On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. 8. Violation: For three persons whose record was reviewed (P2, P8 and P9), the license holder did not complete assessments and initial service planning as required. a. The license holder failed to ensure that P2’s completed assessments produced information about the person’s overall strengths, functional skills, and abilities. b. For P8, the license holder failed to: · include in the 45-day planning meeting, a discussion with P8 and their team on how technology might be used to meet P8’s desired outcomes and include a summary of the discussion; and · complete assessments annually as required. c. The license holder did not complete assessments for P9 annually as required. Statute Violated: section 245D.071, subdivision 3. Corrective Action Ordered: Within 60 days of receiving this order, you must ensure the above-mentioned items are documented in P2’s record on an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. Compliance will be monitored during onsite reviews. 9. Violation: For three persons whose records were reviewed (P2, P8 and P9), the license holder did not develop a service plan that documented service outcomes and supports as required. a. For P2 and P8, the license holder failed to document the following supports and methods to accomplish the outcome that included: · 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 are consistent with the person’s communication mode and learning style; · the measurable and observable criteria for identifying when the desired outcome had been achieved and how data would be collected; · the projected starting date for implementing the supports and methods and 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. b. For P9’s employment services outcome, the license holder failed to: · document the measurable and observable criteria for identifying when the desired outcome has been achieved; and · how data will be collected. Additionally, in a progress report dated in a progress report dated January 6, 2023, the license holder failed to collect data on P9’s outcomes from June 1, 2022, through January 6, 2023. Statute Violated: section 245D.071, subdivision 4. Corrective Action Ordered: Within 30 days of receiving this order, you must review and revise P2, P8 and P9’s outcome to include the above-mentioned information. On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. Compliance will be monitored during onsite reviews. 10. Violation: For two persons whose records were reviewed (P9 and P10), the license holder did not meet the requirements for service plan review and evaluation as required. a. For P9 the license holder failed to: · provide progress reports on a semi-annual basis as required in the support plan; and · meet with the person, the person’s legal representative, case manager and other members of the support team on an annual basis as required in the support plan. b. For P10, the license holder failed to meet with the person, the person’s legal representative, case manager and other members of the support team on an annual basis as required in the support plan. Statute Violated: section 245D.071, subdivision 5. Corrective Action Ordered: On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. 11. Violation: For two persons whose records were reviewed (P4 and P12), the license holder did not enforce written policies and procedures when initiating service suspension as required. a. The license holder gave notice of temporary service suspension to P4 on March 23, 2023. The license holder failed to limit the temporary service suspension to situations in which: · the person's conduct poses an imminent risk of physical harm to self or others and either positive support strategies have been implemented to resolve the issues leading to the temporary service suspension but have not been effective and additional positive support strategies would not achieve and maintain safety, or less restrictive measures would not resolve the issues leading to the suspension; · the person has emergent medical issues that exceed the license holder's ability to meet the person's needs; or · the program has not been paid for services. Additionally, prior to giving notice of temporary service suspension, the license holder failed to: · document actions taken to minimize or eliminate the need for service suspension prior to giving notice of temporary service suspension including at a minimum: o consultation with P4’s support team or expanded support team to identify and resolve issues leading to issuance of the notice; and o a request to the case manager for intervention services identified in section 245D.03, subdivision 1, paragraph (c), clause (1), or other professional consultation or intervention services to support the person in the program. b. The license holder gave notice of temporary service suspension to P12 on May 5, 2023. The license holder failed to limit the temporary service suspension to situations in which: · the person's conduct poses an imminent risk of physical harm to self or others and either positive support strategies have been implemented to resolve the issues leading to the temporary service suspension but have not been effective and additional positive support strategies would not achieve and maintain safety, or less restrictive measures would not resolve the issues leading to the suspension; · the person has emergent medical issues that exceed the license holder's ability to meet the person's needs; or · the program has not been paid for services. Additionally, prior to giving notice of temporary service suspension, the license holder failed to: · document actions taken to minimize or eliminate the need for service suspension prior to giving notice of temporary service suspension including at a minimum: o consultation with P12’s support team or expanded support team to identify and resolve issues leading to issuance of the notice; and o a request to the case manager for intervention services identified in section 245D.03, subdivision 1, paragraph (c), clause (1), or other professional consultation or intervention services to support the person in the program. Statute Violated: section 245D.10, subdivision 3. Corrective Action Ordered: On an ongoing basis, you must enforce written policies and procedures as required in this subdivision. 12. Violation: For four persons whose records were reviewed (P2, P3, P9, and P10) the license holder did not provide written or electronic copies of policies and procedures as required. a. The license holder failed to inform P2, P2’s legal representative, and P2’s case manager of the following policies and procedures and provide copies within five working days of service initiation: · emergency use of manual restraints policy; and · data privacy policy. b. The license holder failed to inform P3, P3’s legal representative, and P3’s case manager of the following policies and procedures and provide copies within five working days of service initiation: · grievance policy; · temporary service suspension policy; · service termination policy; and · emergency use of manual restraints policy. c. The license holder failed to inform P9 and P9’s case manager of the following policies and procedures and provide copies within five working days of service initiation: · grievance policy; · temporary service suspension policy; · service termination policy; · emergency use of manual restraints policy; and · data privacy policy. d. P10's employment services were initiation on May 1, 2021. The license holder failed to inform P10's case manager of the following policies and procedures and provide copies within five working days of service initiation: · grievance policy; · temporary service suspension policy; · service termination policy; · emergency use of manual restraints policy; and · data privacy policy. Statute Violated: section 245D.10, subdivision 4. Corrective Action Ordered: On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. 13. Violation: For nine persons whose records were reviewed (P1, P2, P3, P4, P5, P7, P8, P9, and P10), the license holder did not incorporate and evaluate positive support strategies as required. For P1, P2, P3, P4, P5, P7, P8, P9 and P10, the license holder failed to evaluate the identified positive support strategies with the person at least every six months. Rule Violated: part 9544.0030, subpart 1. Corrective Action Ordered: Within 60 days of receiving this order, you must audit all current service recipient records to ensure positive support strategies are incorporated in writing to an existing support plan, the positive support strategies have been reviewed as required and make changes to the positive support strategies as needed. On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. Compliance will be monitored during onsite reviews. STAFFING STANDARDS VIOLATIONS 14. Violation: For four staff persons whose records were reviewed (SP2, SP7, and SP8, and SP9), the license holder did not provide orientation to individual service recipient as required. The license holder failed to provide SP2, SP7, SP8, and SP9 orientation to individual service recipient needs training. At the time of the review DHS licensors could not determine if training was provided as required. Statute Violated: section 245D.09, subdivision 4a. Corrective Action Ordered: Within 30 days of receiving this order, you must ensure SP2, SP7, SP8 and SP9 have received the above-mentioned training. On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. Compliance will be monitored during onsite reviews.
15. Violation: For six staff whose records were reviewed (SP2, SP3, SP4, SP5, SP6, and SP9), the license holder did not provide annual training as required. The license holder failed to provide SP2, SP3, SP4, SP5, SP6, and SP9 with the following training on an annual basis: · data privacy requirements according to sections 13.01 to 13.10 and 13.46, the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff responsibilities related to complying with data privacy practices; · the service recipient rights and staff responsibilities related to ensuring the exercise and protection of those rights according to the requirements in Minnesota Statutes, section 245D.04. · the principles of person-centered service planning and delivery as identified in section 245D.07, subdivision 1a, and how they apply to direct support service provided by the staff person; · the safe and correct use of manual restraint on an emergency basis according to the requirements in section 245D.061 and what constitutes the use of restraints, time out, and seclusion, including chemical restraint; · staff responsibilities related to prohibited procedures under section 245D.06, subdivision 5, why such procedures are not effective for reducing or eliminating symptoms or undesired behavior, and why such procedures are not safe; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities. Statute Violated: section 245D.09, subdivision 5. Repeat Violation: In a Correction Order that DHS issued on August 29, 2016, you were previously found in violation of this same Statute. Corrective Action Ordered: Within 30 days of receiving this order, you must ensure SP2, SP3, SP4, SP5, SP6 and SP9 have received the above-mentioned training. On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. Compliance will be monitored during onsite reviews. RECORD REQUIREMENTS VIOLATIONS 16. Violation: The license holder did not ensure that the license holder’s use of electronic record keeping met the requirements of this subdivision. The license holder maintained most records electronically and used multiple electronic systems to store records. Throughout the licensing review, DHS licensors were unable to access all person served and staff records requested. The license holder stated that they were unsure where certain records were stored due to the use of a new electronic database. Requested records were unable to be found due to them being stored in databases that the program previously used and were not accessible at the time of the review. Statute Violated: section 245A.041, subdivision 3. Corrective Action Ordered: Within 60 days of receiving this order, you must submit to your licensor a written plan detailing how your program will come into compliance and allow for review of records as required under this chapter. On an ongoing basis, you must maintain compliance throughout your program as required in this subdivision. 17. Violation: For five persons whose records were reviewed (P3, P4, P5, P7, and P10), the license holder failed to maintain service recipient records as required. a. The license holder failed to maintain progress or daily log notes in P3, P4, P5, P7 and P10’s service recipient record. b. The license holder failed to maintain documentation in P3’s record to show a signed statement authorizing the license holder to act in a medical emergency when P3’s legal representative, if and, cannot be reached or is delayed in arriving. Statute Violated: section 245D.095, subdivision 3. Corrective Action Ordered: Within 30 days of receiving this order, you must: · begin maintaining progress or daily log notes for each person served by your program. You must maintain the progress or daily log notes in the person’s service recipient record; and · maintain documentation in P3’s record to show signed statement authorizing the license holder to act in a medical emergency. On an ongoing basis, you must maintain compliance as required. Compliance will be monitored during onsite reviews. 18. Violation: For eleven staff persons whose records were reviewed (SP3, SP6, SP7, and SP8, SP11—SP17), the license holder did not maintain documentation in the personnel record as required. a. For SP3, SP7, and SP8, the license holder failed to maintain documentation in the staff person’s personnel record or elsewhere, sufficient to determine the date of the staff person’s first date of supervised direct contact a with a person served by the program. b. For SP3, the license holder failed to maintain a completed application and an acknowledgment signed by SP3 that job duties were reviewed with the staff person, and they understood those duties. c. For SP6, SP11—SP17, the license holder failed to maintain documentation in the staff person’s personnel record or elsewhere, sufficient to determine the date of the staff persons first supervised direct contact with a person served by the program, and the date of first unsupervised direct contact with a person served by the program. Statute Violated: section 245D.095, subdivision 5. Corrective Action Ordered: Within 60 days of receiving this order, you must audit all staff currently providing direct support, who was hired after January 1, 2014, to ensure the following information is documented in the personnel record: · date of employee’s first supervised direct contact with person served by the program; and · the date of first unsupervised direct contact with persons served by the program. On an ongoing basis, you must maintain compliance as required. Compliance will be monitored during onsite reviews. YOUR RIGHT TO REQUEST RECONSIDERATION You have the right to request reconsideration of this order and the cited violations. Your request must: · Be in writing. · List each violation you are challenging and identify what is inaccurate or incomplete about the information in the order. · Supply information that is accurate or more complete · Be made before the deadlines provided below. If you are mailing your request, it must be received by DHS within 20 calendar days from when you received this order. If you do not meet this deadline, you lose your right to request reconsideration. The timeline to appeal began when you received this order. Please send it to: Commissioner, Department of Human Services Office of Inspector General Legal Counsel’s Office Attn: 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 20 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 Attn: Licensing Legal Unit 444 Lafayette Road North St. Paul, MN 55155 Legal authority for this licensing action · This action is taken under Minnesota Statutes, section 245A.06, subdivision 1. · The timeline to request reconsideration of the order is provided in Minnesota Statutes, section 245A.06, subdivision 2. Questions If you have any further questions regarding this matter, you may contact me, at 651-431-6646. Sincerely, Nichole Dawson, Senior Licensor Licensing Division Office of Inspector General
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