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March 11, 2024 Michael Rudolph, Authorized Agent Rudolph Community & Care 12400 Princeton Avenue Suite B Savage, MN, 55378 License Number: 1069732 (245D – HCBS) License Number: 1086414 Investigation Report Number: 202302837 Dear Mr. Rudolph: The Minnesota Department of Human Services (DHS), Division of Licensing, received your request for reconsideration of the citation in a Correction Order (Attachment A) issued to you by the Department of Human Services on June 9, 2023. After an independent review of the record, the Commissioner has determined that there is sufficient evidence to support the challenged citation. Reconsideration Determination Citation 1. Citation 1 was issued because for one person whose record was reviewed (P1), the license holder did not enforce policies and procedures related to service termination as required. The license holder issued a service termination to P1 on March 28, 2023, however the license holder failed to document the following actions prior to giving notice of the service termination: · consultation with P1’s support team or expanded support team to identify and resolve issues leading to the issuance of the termination notice; and · 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. Applicable Law. The license holder must establish policies and procedures for service termination that promote continuity of care and service coordination with the person and the case manager and with other licensed caregivers, if any, who also provide support to the person. Prior to giving notice of service termination, the license holder must document actions taken to minimize or eliminate the need for termination. Action taken by the license holder must include, at a minimum: - consultation with the person’s support team or expanded support team to identify and resolve issues leading to the issuance of termination of service; and - a request to the case manager for intervention services identified in section 245D.03 or other professional consultation or intervention services to support the person in the program. If based on the best interests of the person, the circumstances at the time of the notice were such that the license holder was unable to take the action specified in clauses 1 and 2, the license holder must document the specific circumstances and the reason for being unable to do so. Minnesota Statutes, section 245D.10, subdivision 3a(a)(c) Your Response. You contend that the Correction Order is premature due to P1’s pending fair hearing appeal and possibly moot because the person has been or will be transferred to a new facility. You argue you were not required to request intervention services from the case manager because P1 had been hospitalized so s/he could not benefit from additional behavior expertise. You also contend DHS denied your rate exception request for 1:1 staffing, which would have allowed additional services for P1. You state you did not have time to consult with P1’s team and to request intervention services because P1 was in the hospital and did not return to the facility. You indicate you notified P1’s support team of their condition in an annual meeting on November 9, 2022, and license holder kept the care team informed of their condition while services were provided. You state you consulted with P1’s Guardian on March 29, 2023, and that DHS should look beyond the four corners of the Notice to determine whether you consulted with P1’as team. Reconsideration Determination. Prior to giving Notice of Service Termination (“the Notice”), you did not consult with P1’s support team to identify and resolve issues leading to the issuance of the termination. Prior to service termination you were required not only to complete the actions in paragraphs 1 and 2, but to “document actions taken.” Minnesota Statutes 245D.10, subdivision 3. Therefore, the documentation of the actions taken must occur prior to the Notice. License holders are also required to maintain service termination records and related documentation. Minnesota Statutes, section 245D.091, subdivision 3(b)(12). On the Notice you marked an “x” indicating you consulted with P1’s support team to identify and resolve issues related to the issuance of the Notice. However, in the section of the Notice that required you to indicate the actions you took, you did not state that you consulted with P1’s support team. The Notice and documentation you provided to the licensor during the licensing investigation did not show you consulted with P1’s team to identify and resolve issues leading to termination. In addition, P1’s Case Manager stated you did not consult with the team to identify and resolve issues that lead to the termination. On reconsideration you stated that on March 29, 2023, you spoke with P1’s Guardian to inform him/her that “things” are progressing for P1. However, informing P1’s guardian of his/her condition is not identifying and resolving the issues that lead to termination; this conversation was not included in the Notice; and it took place after the Notice was issued, not prior to, as required. On reconsideration you also state the November 9, 2022, annual meeting should be considered the required consultation. You did document this meeting in the Notice or accompanying documentation. Because this meeting was not documented at the time of the investigation, the licensor could not determine whether it met compliance. In the alternative, you contend, you did not have time to consult with P1’s team because P1’s condition deteriorated so quickly. However, you failed to document the specific circumstances and the reasons you were unable to consult, as required by section 245D.10, subdivision 3a(c). Therefore, you failed document how you consulted with P1’s team to resolve the issues that lead to termination prior to issuing the Notice. You did not request intervention services or other professional consultation to support P1 from P1’s case manager. On the Notice, you left the space blank where you were to indicate that you requested intervention or other professional services. Further, during the investigation the case manager specifically stated you did not request intervention services. On reconsideration you state you requested a rate exception for 1:1 care as an intervention service. You did not document this in the Notice or in any documentation accompanying the Notice. In the alternative, you contend you were not required to request intervention services from P1’s case manager because P1 was hospitalized and would not have benefited from behavioral intervention. However, you did not document the specific circumstances and the reasons for being unable request intervention services, as required by section 245D.10, subdivision 3a(c). You did not document that you requested intervention or other professional services to minimize or eliminate the need for termination.
Disposition The Commissioner has reviewed the relevant laws and all of the information you submitted in response to the Correction Order. The record supports the citation, and it is affirmed. This is a final agency decision. Sincerely, Kofi Montzka, Attorney Legal Counsel’s Office Office of Inspector General cc: Samuel D. Orbovich, Esq. Fredrickson & Byron P.A. 60 South Sixth Street Suite 1500 Minneapolis, MN 55402-4400
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