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March 11, 2024
Pafoua Vang Xiong, Authorized Agent Asian Adult Day Care 1410 Energy Park Drive Suite 1 Saint Paul, Minnesota 55108 License Number: 1055524 (Rule 223) CORRECTION ORDER Dear Pafoua Vang Xiong: On February 20, 2024, a licensing review of Asian Adult Day Care, located at 1410 Energy Park Drive, Saint Paul, 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) and Minnesota Rules, part 9555.9700, subpart 3. Violation: For one of three participants whose record was reviewed (P3), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). The license holder failed to review P3’s IAPP quarterly as part of the review of the program plan or service plan. Corrective Action Ordered: Within 30 days of receiving this order, you must review P3’s IAPP and revise the IAPP to reflect the results of this review. On an ongoing basis, you must maintain compliance as required in this subdivision and subpart. 2. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For one participant whose record was reviewed (P2), the license holder did not maintain a written record as required. The license holder failed to include a medical report in P2’s record, signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included documentation that P2 was free from communicable disease or infestations, as specified in parts 4605.700 to 4605.7090, that would endanger the health of other participants. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain a medical report in P2’s record that includes the information detailed above. On an ongoing basis, you must maintain compliance as required in this subpart. 3. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For one participant whose record was reviewed (P2), the license holder did not develop a written plan of care as required. The license holder failed to develop a written plan of care for P2 that included provisions for quarterly review and quarterly revisions of the individual plan of care. Corrective Action Ordered: Within 30 days of receiving this order, you must review P2’s individual plan of care and revise the plan based on the results of the review. On an ongoing basis, you must maintain compliance as required in this subpart. 4. Citation: Minnesota Rules, part 9555.9710, subparts 1 and 4. Violation: The license holder did not offer services as required. a. The license holder failed to offer a midmorning snack. b. The license holder failed to ensure a physical therapist provided consultation and review of the exercise program at least quarterly in 2023. Corrective Action Ordered: Immediately, you must offer a midmorning snack. Within 30 days of receiving this order, you must have your physical therapist provide consultation and review of your exercise program. On an ongoing basis, you must maintain compliance as required in these subparts. 5. Citation: Minnesota Rules, part 9555.9730, subpart 3. Violation: The license holder did not ensure physical plant and space requirements.
Corrective Action Ordered: Immediately, you must ensure all restrooms used by participants are equipped with a mechanism that participants can use to signal staff members. On an ongoing basis, you must maintain compliance as required in this subpart. 6. Citation: Minnesota Statutes, section 245A.04, subdivision 7a. Violation: The license holder did not notify the commissioner and obtain the commissioner’s approval before making any changes that would alter the license information, including the hours of operation, as required.
Corrective Action Ordered: Immediately, you must comply with the special conditions stated on your license, including the hours of operation. On an ongoing basis, you must maintain compliance as required in this subdivision. 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 your licensor, Katie Johnson, at 651-431-4113. Brittany Raddatz, HCBS Unit Supervisor Licensing Division Office of Inspector General
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