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March 6, 2024 Debra Shriver, Authorized Agent 328 5th St SW Suite 5 Willmar, MN 56201 RE: Report No. 202310467 Divine House Inc License No. 1069140 Dear Debra Shriver: CORRECTION ORDER An investigation of Divine House Inc. was completed regarding report number 202310467 which alleged violation of Minnesota Statutes, section 626.557, and Minnesota Statutes, Chapter 245D. This maltreatment allegation concerned neglect of supervision. The disposition of the investigation report is inconclusive. One violation was noted. VIOLATIONS AND CORRECTION ORDERS The following violation of state and (or) federal laws and rules were observed. Corrective action for each violation is required by Minnesota Statutes, section 245A.06, and is hereby ordered by the Commissioner of Human Services. Failure to correct the violation within the prescribed amount of time may result in fines and/or action against your license, as provided for in Minnesota Statutes, sections 245A.06 and 245A.07. Citation: Minnesota Statutes, section 245.07, subdivision 1a, paragraph (a). Violation: The license holder failed to ensure that services were provided in response to a consumer’s identified needs, as specified in the consumer’s support plan and individual abuse prevention plan. On December 10, 2023, a consumer (C1) went to another consumers (C2’s) facility that was operated by the same license holder. C1 required 1:1 staffing and C2 required 2:1 staffing with the exception of while in the facility garage and C2’s bedroom. · The staff person (P4) assigned to supervise C1 while at C2’s was not within visual and/or audible range of C1 while at the facility. · Four staff persons (P1-P4) were not aware that C1 and C2 went into C2’s bedroom for 14 minutes. Corrective Action Ordered: Immediately, and on an ongoing basis, you must maintain compliance as required in this subdivision. If you believe any of the citations are in error, you may ask the Commissioner of Human Services to reconsider the parts of the correction order that you believe to be in error. If you choose to exercise this right, your request for reconsideration must be in writing and received by the Commissioner within 20 calendar days after receipt of this letter. Your request for reconsideration must be sent to: Commissioner Minnesota Department of Human Services c/o Licensing Division PO Box 64242 St. Paul, MN 55164-0242 You must include any and all information, documentation, or other evidence you have to support your request for reconsideration. Please note that a request for reconsideration does not stay any provisions of the correction order. If you have any questions regarding the investigation, contact me immediately. If you have any questions regarding compliance with this Correction Order or applicable rules, contact your licensor, . Sincerely,
Scout Peterson, Investigator Office of Inspector General Licensing Division scout.peterson@state.mn.us 651-431-6578 Enclosure
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