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April 3, 2024 CERTIFIED MAIL Curt Bossert, Authorized Agent REM Heartland Inc 6600 France Ave South Suite 350 Edina MN 55435-1810 License Number 1071456-HCBS (Home and Community-Based Services) License Number 1115738-H_CRS (Home and Community-Based Services-Community Residential Setting) Report Numbers 202308803/202309237 DETERMINATION OF MALTREATMENT AND ORDER TO PAY A FINE Dear Curt Bossert: The Department of Human Services (DHS) determined that REM Heartland located at 106 Bluestem Drive, Blue Earth, Minnesota is responsible for maltreatment by abuse as to the use of aversive/deprivation procedures. Based on this determination, DHS is ordering you to pay a fine of $1000. Details of our findings are provided below and in the enclosed Investigation Memorandum for reports 202308803/202309237. Our next steps and your options are also detailed. I. Determination of Maltreatment Allegation One: It was reported that a staff person (SP) struck a vulnerable adult (VA) with a fly swatter more than once leaving marks on the VA’s face. DHS investigated the report as alleged maltreatment by physical abuse and determined that a staff person was responsible for maltreatment. Allegation Two: It was reported that more than once, staff declined to assist the VA out of bed, which left him/her in bed longer than s/he wanted. DHS investigated the report as alleged maltreatment by neglect and determined it was inconclusive as to maltreatment. Allegation Three: It was reported that throughout the day, staff put the VA in his/her bedroom as punishment for behaviors. DHS investigated the report as alleged maltreatment by abuse as to the use of aversive/deprivation procedures and determined that the facility (REM Heartland) was responsible for maltreatment. Allegation Four: It was reported that the VA had a pressure sore on his/her buttock that was infected. DHS investigated the report as alleged maltreatment by neglect and determined it was false as to neglect. Based on the maltreatment investigation, DHS determined that REM Heartland was responsible for abuse as to the use of aversive/deprivation procedures to a vulnerable adult. See Allegation Three in the enclosed Investigation Memorandum for more information. Legal Authority: Minnesota Statutes, section 626.557, subdivision 9c. Fine: $1,000 Citation Related to the Maltreatment Determination Citation: Minnesota Statutes section 245D.06, subdivision 5 Violation: The license holder did not ensure the prohibition of staff using a time out or seclusion to reduce or eliminate behavior, as punishment, or for staff convenience. · Consistent information, including progress notes, stated that more than once between October 1 and 31, 2023, staff brought a client (C) to his/her bedroom as a consequence for yelling. The staff then left the C alone in the bedroom for 15 minutes or longer or until the C “calmed down” at which point the staff brought him/her out of his/her bedroom. · A progress note stated that on October 4, 2023, at some point prior to 1 p.m., staff transferred the C into his/her bed to await a nursing visit. “[The C] was screaming and yelling for staff to come and let [him/her] out.” Staff “explained” to the C that the nurse wanted the C “left in bed as it’s earier [sic] and quicker for [the nurse] to do the procedure.” The nurse arrived at 1:57 p.m. to start the procedure. Corrective Action Ordered: The license holder completed an internal review and determined that policies and procedures were adequate but not followed. The license holder reported, “All staff were retrained on prohibited procedures. [C’s] support plans will be updated, specifically [his/her] Behavior Support Plan. All staff will be trained on any revisions. Corrective action will be completed with the staff involved.” The license holder must ensure that the staff training and updated support plans have been completed within 10 days of receiving this order. On an ongoing basis, the license holder must maintain compliance with this licensing requirement on a continuing basis. Recommendation: Legal Authority: Minnesota Statutes, section 245D.07, subdivision 1a DHS recommends that the license holder review the C’s support plan in context with the requirements of this subdivision. Separate from the maltreatment investigation, there were concerns that services and supports failed to be provided in response to C’s identified needs, interests, preferences, and desired outcomes. Specifically, C was unable to self-manage their activities of daily living and required significant staff support; however, when in their bedroom the C had no other means to communicate their needs except to yell for assistance. II. Order to Pay a Fine Because DHS determined that REM Heartland is responsible for maltreatment, you must pay a $1000 fine. Legal Authority: Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), subparagraph (4). III. Billing and Payment of the Fine DHS will send you an invoice for the $1000 fine. Payment must be made as directed on the invoice. If you request a contested case hearing, as described below, do not pay the fine at this time. After the contested case hearing, the Commissioner of DHS will issue a final order. Please note, you may not avoid payment of this fine by closing, selling, or otherwise transferring the license to a third party. If this occurs, each controlling individual is personally and jointly responsible for payment. If you do not pay the fine on or before the date specified on the invoice and you did not request a contested case hearing, as described below, the Commissioner may issue a second fine, may not issue or reissue a license, or may suspend the license until the license holder pays the fine. IV. YOUR RIGHT TO APPEAL You have right to appeal the maltreatment determination and/or fine. Please see options below. Should you exercise your rights to appeal send: 1.
Right to appeal the fine and maltreatment determination You have the right to appeal the fine and maltreatment determination. Your request must be in writing and clearly state that you are requesting a contested case hearing for this matter. Your request must be made before the deadlines provided below. If you do not meet this deadline, you lose your right to an administrative appeal. The timeline to appeal began when you received this order. If you are mailing your request, it must be sent by certified mail and postmarked within 15 calendar days from when you received this order. See address, section IV. If your request is being personally delivered, it must be received by DHS within 15 calendar days from when you received this order. See address, section IV. Upon DHS’ receipt of your timely appeal, your case would be scheduled for a contested case hearing in front of an Administrative Law Judge. After this hearing, the Commissioner of DHS will issue a final order. 2. Request for reconsideration of the maltreatment determination only If you do not appeal the fine, you may still request reconsideration of the maltreatment determination. Your request must be made before the deadlines provided below. If you do not meet this deadline, you lose your right to request reconsideration. The timeline to request reconsideration began when you received this order. Your request must: · Be in writing · Clearly state that you are requesting reconsideration of the maltreatment determination · Identify what is inaccurate or incomplete about the information in the Investigation Memorandum · Supply information that is accurate or more complete · State why you believe the finding of maltreatment should be changed · Be made before the deadlines provided below. Your request must be postmarked within 15 calendar days from when you received this order. See address, section IV. A response to your reconsideration request will be mailed within 15 working days after DHS receives your request. You have the right to request a fair hearing if a response is not mailed within 15 working days. 3. Right to appeal the order to pay a fine only You have the right to only appeal the fine. Your request must be in writing and clearly state that you are requesting a contested case hearing for this matter. Your request must be made before the deadlines provided below. If you do not meet this deadline, you lose your right to an administrative appeal. The timeline to appeal began when you received this order. If you are mailing your request, it must be sent by certified mail and postmarked within 10 calendar days from when you received this order. See address, section IV. If your request is being personally delivered, it must be received by DHS within 10 calendar days from when you received this order. See address, section IV. Upon DHS’ receipt of your timely appeal, your case would be scheduled for a contested case hearing in front of an Administrative Law Judge. After this hearing, the Commissioner of DHS will issue a final order. 4. Legal representation at the contested case hearing You do not need a lawyer to appeal. However, a lawyer can help you with your appeal. The state or county will not get you a lawyer and will not pay for a lawyer. If you cannot afford a lawyer, you may be able to get free legal advice or help with your appeal. To find out if free help is available, contact: Volunteer Lawyers Network at 612-752-6677; Central Minnesota Legal Services at 612-332-8151; Southern Minnesota Legal Services at 651-222-4731; or go to www.justice4mn.org to find a local legal services program that may be able to help you. You can also find information on contested cases from the Office of Administrative Hearings website at https://mn.gov/oah/self-help. Click on Administrative Law Overview, then click on Administrative Law Contested Case Hearing Guide for a list of frequently asked questions. Legal authority for this licensing action · This action is taken under Minnesota Statutes, section 245A.07, subdivision 1, paragraph (a), which describes under which conditions DHS may impose a fine against a license. · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (4), item (i) provides that DHS may impose a $1000 fine for each determination of maltreatment of a vulnerable adult under section 626.557 for which the license holder is determined responsible. · In determining whether the facility, an individual, or both are responsible for substantiated maltreatment, DHS must consider the mitigating factors provided in Minnesota Statutes, section 626.557, subdivision 9c, paragraph (c). · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (5) states that license holders may not avoid payment of a fine by closing, selling, or transferring a license. · License holders have a right to appeal licensing actions and request a contested case hearing, under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. · License holders have a right to request reconsideration of a maltreatment determination, under Minnesota Statutes, section 626.557, subdivision 9d. · Minnesota Statutes, section 245A.04, subdivision 7, paragraph (d), clause (4), states that DHS shall not issue or reissue a license if the applicant, license holder, or controlling individual has an outstanding debt related to a license fee, licensing fine, or settlement agreement for which payment is delinquent. · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (2), states that that the license holder shall pay the fine assessed on or before the payment date specified, and if the license holder does not do so the commissioner may issue a second fine or suspend the license until the license holder complies. Questions If you have any further questions regarding this matter, you may contact Melanie Daniel, Supervisor, at 651-431-6559. Sincerely,
Maggie Hanson, Intake and Investigations Unit Manager Licensing Division Office of Inspector General Enclosure
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