|
May 3, 2024 CERTIFIED MAIL Kiara Clark, Authorized Agent Your Home Care Services Inc 577 Kayla Lane Hanover, MN 55341-4504 License Number 1098882 (HCBS) License Number 1110084 (CFRS) License Number 1115234 (CFRS) License Complaint Report Number 202307636 License Complaint Report Number 202310589 License Complaint Report Number 202400440 Maltreatment Report Number 202310537 ORDER OF LICENSE REVOCATION Dear Kiara Clark: The Department of Human Services (DHS) is revoking your license to provide Home and Community Based Services for Your Home Care Services Inc., located at 5611 Chicago Avenue, Minneapolis, Minnesota. DHS is also revoking your Child Foster Residential Setting licenses located at 5141 28th Avenue South, Minneapolis, Minnesota and 1663 196th Lane Northwest, Oak Grove, Minnesota. This revocation order is based on the Commissioner’s evaluation of the program and your noncompliance with Home and Community-Based Services (HCBS) and Child Foster Residence Setting (CFRS) licensing requirements. Details of our findings are provided below. Our next steps and your options are also detailed. The revocation goes into effect on May 17, 2024 at 4:00 pm. to allow time for delivery of this order and ten days for you to inform the Commissioner whether you intend to appeal the license revocation explained below. REASON FOR LICENSE REVOCATION 1. Commissioners Access The license holder failed to provide access to the physical plant, grounds, documents, and records, persons served by the program, staff and personnel records. Failure or refusal of a license holder to fully comply with this subdivision is reasonable cause for the commissioner to immediately revoke the license. a. While conducting a licensing review on December 13, 2023, DHS licensors attempted to contact service recipients at a service site. During this time, DHS licensors overheard the license holder telling staff to physically evade DHS licensors. The license holder failed to provide access to persons served by the program. b. While conducting the maltreatment investigation, report number 202310537, the DHS investigator made several attempts to contact the license holder to schedule an interview with and review records, including service recipient support plans and support plan addendums, staff person records, and facility police and procedures. The license holder did not provide the requested documents and failed to engage in an interview. The license holder failed to provide the commissioner necessary access when investigating alleged maltreatment. Legal Authority: Minnesota Statutes, section 245A.04, subdivision 5. 2. Failure to comply with licensing laws and rules DHS determined that your program failed to fully comply with the laws and rules that apply to licensed home and community-based services. DHS considered the nature, chronicity, or severity of the violations that led to the revocation of your license. · Nature: Many of the violations cited in this Order of License Revocation are violations of law or rule affecting the health, safety, or rights of persons served by the program. Licensing violations include: o Failure to provide services in compliance with the requirements of this chapter; o Failure to maintain service recipient records; o Failure to meet service planning requirements; o Failure to meet health service needs consistent with the person’s health needs; o Failure to designate a qualified and competent staff person(s) to fulfill the responsibilities for coordination and evaluation of individual service delivery requirements and program management and oversight; o Failure to provide required orientation and annual training to staff persons. · Chronicity: Your program received its HCBS license on April 4, 2019. Since that time, your program has demonstrated a history of noncompliance with HCBS licensing rules and statutes. The information is summarized below. o May 3, 2024 Revocation Order (this order): 24 violations (4 repeat) o December 21, 2023, Temporary Immediate Suspension: Imminent risk of harm to persons served. o October 7, 2022, Correction Order: 2 violations (2 repeat) o June 4, 2021, Correction Order: 11 violations You also hold two child residential foster setting licenses, numbers 1110084 (Hennepin County) and 1115234 (Ramsey County) and both programs have a history of noncompliance as summarized below: o September 15, 2023, Correction Order: 1 violation (License No.:1110084) o August 30, 2023, Correction Order: 3 violations (License No.: 1115234) o August 1, 2023, Correction Order: 1 violation (License No.: 1110084) · Severity: Many of the violations that led to the revocation of your license relate to the health and safety of the persons served within your program. Legal Authority: Minnesota Statutes, section 245A.07, subdivision 3(a)(1). 3. Commissioner’s evaluation of program In determining whether a licensing action is warranted, DHS evaluated the facts, conditions, and circumstances concerning your program’s operation. This includes consideration of the well-being of persons served by your program, and information about the qualifications of caregivers and staff persons that are working in your program. DHS has determined that revocation of your license is appropriate based on the violations described in this order and the program evaluation. Legal Authority: Minnesota Statutes, section 245A.04, subdivision 6. Due to the serious and chronic nature of these violations and the conditions in the program, which impact the health and safety of persons served in your care, your license to provide home and community-based services is revoked. LICENSING VIOLATIONS DETERMINED ON DECEMBER 13-15, 2023. DHS determined that your program failed to follow licensing rules and statutes, as described below. Program Coordination, Evaluation, and Oversight Violations 1. Violation: The license holder did not meet the requirements of program coordination, evaluation, and oversight. a. The license holder failed to ensure that the designated coordinator (SP6), provided supervision, support, and evaluation of activities that include: · oversight of the license holders’ responsibilities in the persons support plan and 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 CSSP and the service outcomes, including direct observation of service delivery sufficient to assess staff competency; and · evaluation of the effectiveness of services delivery, methodologies, and progress on the person’s outcomes based on the measurable and observable criteria for identifying when the desired outcomes based on the measurable and observable criteria for identifying when the desired outcome has been achieved according to the requirements in section 245D.07. b. The license holder failed to ensure that the designated manager (SP7) provided program management and oversight of the services provided by the license holder that include: · maintaining 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 (g); · ensuring 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, subdivision3, and ensuring staff orientation and training is provided according to the requirements in section 245D.09, subdivision 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 through 24 for the designated coordinator and designated manager’s failure to provide the above state requirements. Statute Violated: Minnesota Statutes, section 245D.081. Repeat Violation: In a Correction Order that DHS issued on June 4, 2021, you were previously found in violation of this same statute. Protection Standards 2. Violation: For six persons whose records were reviewed (P1, P8, P9, P10, P11 and P12), the license holder did not meet the requirements for incident response and reporting as required. For the incidents below, the license holder failed to maintain information about the incidents and to report the incidents to the person’s legal representative or designated emergency contact and case manager within 24 hours of the incident occurring. a. T-Log entries document incidents regarding P1 that included: · November 29, 2023; regarding a hospitalization; · November 30, 2023; regarding a medical emergency that required the program to call 911; b. T-Log entries for P8 documented an incident that occurred on October 15, 2023, that involved P8 regarding a medical emergency that required the program to call 911. c. T-Log entries for P9 documented an incident that occurred on October 11, 2023, that involved P9 regarding a medical emergency that required the program to call 911. d. T-log entries documented incidents regarding P10 that included: · July 27, 2023; regarding conduct by P10 against a person receiving services; · October 24, 2023; regarding an elopement; · October 26, 2023; regarding an elopement; · November 8, 2023; regarding an elopement; · November 20, 2023; regarding an elopement; · November 21, 2023; regarding an elopement; and · November 26, 2023, regarding two separate elopements e. Documentation found at the CFRS site on December 15, 2023, maintained information related to incidents regarding P11, that included: · May 8, 2023; regarding a situation that required the program to call 911; · July 29, 2023; regarding an elopement and 911 call; · August 2, 2023; regarding a situation that required the program to call 911; · August 8, 2023; regarding a situation that required the program to call 911; · August 12, 2023; regarding an elopement and 911 call; · August 13, 2023; regarding an elopement and 911 call; · August 14, 2023; regarding a situation that required the program to call 911; f. Documentation found at the CFRS site on December 15, 2023, included information related to an incident on May 30, 2023, involving P12 regarding an elopement and 911 call. Statute Violated: Minnesota Statutes, section 245D.06 3. Violation: For one person whose record was reviewed (P12), the license holder did not meet requirements for safeguarding and handling funds and property. During a site visit at the CFRS site on December 15, 2023, staff informed DHS licensors that the license holder was not responsible for safeguarding and handling P12’s funds and property. However, documentation in a T-Log for P12 stated P12’s legal representative gave the staff $30 to safekeep for three weeks before giving it to P12. The license holder failed to obtain written authorization from P12 or P12’s legal representative and P12’s case manager within five working days of service initiation to safeguard and handle P12’s funds and property. Statute Violated: Minnesota Statutes, section 245D.06, subdivision 4. Service Recipient Violations 4. Violation: For two persons whose records were reviewed (P2 and P4), the license holder did not provide services as assigned in the person’s support plans and in compliance with the requirements of this chapter and the federal waiver plans. a. P2 required 2:1 awake staffing 24 hours a day from the license holder according to information provided by P2’s case manager. The license holder failed to provide services as assigned in P2’s support plan when P2 was left unsupervised without any staff on multiple occasions. b. P4 required 1:1 staffing from the license holder according to documentation maintained in P4’s record. The license holder failed to provide services as assigned in P4’s support plan when P4 was left unsupervised without staff on multiple occasions. c. During a site visit to CFRS 1110084, DHS licensors were informed residential child foster care services were being provided next-door at times in an unlicensed setting. The license holder failed to comply with the federal waiver plan. Statute Violated: Minnesota Statutes, section 245D.07, subdivision 1. 5. Violation: For four persons whose records were reviewed (P8, P9, P11 and P12), the license holder did not meet requirements for initial service planning and review. a. The license holder failed to develop a service plan for P8, P9 and P11, that documented the following supports and methods to be implemented to support the person and accomplish outcomes related to acquiring, retaining, or improving skills and physical, mental, and emotional health and wellbeing, within ten working days of the 45-day planning meeting: · the methods or actions that will be used to support the person and to accomplish the service outcomes, including information about: · any changes or modifications to the physical and social environments necessary when the service supports are provided; and · any equipment and materials required; and · techniques that were consistent with the person’s communication mode and learning style; · the measurable and observable criteria for identifying when the desired outcome has been achieved; · how data will 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. Additionally, while on site at the CFRS’s, DHS licensors asked staff what P8, P9 and P11’s outcomes were and where the daily documentation related to P8, P9 and P11’s outcomes would be located. Program staff stated P8, P9 and P11 do not have outcomes they actively work on and there was no documentation related to their outcomes at the CFRS’s. The license holder failed to maintain data that recorded the progress or lack of progress towards each outcome or goal for P8, P9 and P11. b. The license holder failed to develop a service plan for P12 that documented the following supports and methods to be implemented to support the person and accomplish outcomes related to acquiring, retaining, or improving skills and physical, mental, and emotional health and wellbeing, within ten working days of the 45-day planning meeting: · 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; and o any equipment and materials required. · the measurable and observable criteria for identifying when the desired outcome has been achieved; · how data will 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. Additionally, the license holder failed to maintain appropriate data that recorded the progress or lack of progress towards each outcome or goal for P12. Statute Violated: Minnesota Statutes, section 245D.071, subdivision 4. 6. Violation: For ten persons whose records were reviewed (P1, P2, P3, P4, P5, P6, P8, P9, P10, and P11) the license holder did not maintain service recipient records as required. a. The license holder failed to keep a written or electronic register, listing in chronological order the dates and names of all persons served by the program who have been admitted, discharged, or transferred, including service terminations initiated by the license holder. b. The license holder failed to maintain a record of current services provided to P1, P2, P3, P4, P5, P6, P8, P9, P10 and P11 on the premises where the services are provided and coordinated. c. For P1, P2, P4, P5, P6, P8 ,P9, P10 and P11 the license holder failed to maintain the following information for each person: · identifying information, including the person’s date of birth (P8’s admission form included P8’s birthday); · the name, address, and telephone number of the person’s legal representative, if any, and a primary emergency contact, the case manager, and family members or others as identified by the person or case manager (P8’s admission form had a family member’s name and phone number); · health information, including medical history, special dietary needs, and allergies, and when health service needs according to section 245D.05; · medication administration procedures; · current support plan or the portion of the plan assigned to the license holder; Statute Violated: Minnesota Statutes, section 245D.095, subdivision 2 and 3. 7. Violation: For thirteen persons whose records were reviewed (P1-P13), the license holder did not ensure access to service recipient records. For P1 – P13, the license holder failed to ensure staff providing services had access to the information in subdivision 1 relevant to carrying out the support plan or support plan addendum. Statute Violated: Minnesota Statutes, section 245D.095, subdivision 4. Health Needs Violations 8. Violation: For ten persons whose records were reviewed (P1, P2, P3, P4, P5, P7, P8, P10, P11, and P12), the license holder did not meet health service needs as required. a. Regarding P1, during the licensing review conducted on December 13-15, 2023, DHS licensors determined the license holder was responsible for P1’s health needs. The license holder was responsible for monitoring P1’s diabetes, including managing P1’s diabetes and food planning to ensure P1 has access to balanced meals and stays within recommended dietary needs. The license holder failed to maintain documentation on how P1’s health needs will be met, including a description of the procedures the license holder will follow in order to monitor health conditions according to written instructions from a licensed health professional. In P1’s record, the license holder maintained a diabetes protocol, however, it was from a previous provider. Additionally, during the licensing review, DHS licensors observed many unhealthy food options in P1’s refrigerator and freezer. The license holder failed to meet P1’s health needs. b. During the licensing review conducted on December 13-15, 2023, DHS licensors determined the license holder was responsible for health needs for P2, P3, P4, P5, P7, P8, P10, and P11. The license holder failed to maintain documentation on how P2, P3, P4, P5, P7, P8, P10, and P11’s health needs will be met, including a description of the procedures the license holder will following in order to: · provide medication setup, assistance, or administration; · monitor health conditions according to written instructions from a licensed health professional; and · assist with or coordinate medical, dental, and other health service appointments. c. During the licensing review conducted on December 13-15, 2023, DHS licensors determined the license holder was responsible for meeting P5’s health needs. P5 was prescribed Hydroxyzine HCL 24mg tab to be taken daily. 5’s record contained a note from the pharmacy, dated November 29, 2023, that stated that P5’s prescriber would not refill the prescription due to P5 not attending appointment. The pharmacy provided 12 doses of the medication and indicated in the note that the P5 must be seen before any further refills could occur. DHS licensors were unable to determine if the license holder set up an appointment for P5 to see the prescriber or if P5’s medication had been refilled. The license holder failed to meet P5’s health needs. d. Regarding P12, during the licensing review conducted on December 13-15, 2023, DHS licensors determined the license holder was responsible for P12’s health needs. The license holder was responsible for monitoring P12’s diabetes, including managing P12’s diabetes, monitoring blood sugars and to ensure P12 has access to low carb snacks. Additionally, the license holder was responsible for ensuring P12’s Dexcom was changed every three months. The license holder failed to maintain documentation on how P1’s health needs will be met, including a description of the procedures the license holder will follow in order to: · monitor health conditions according to written instructions from a licensed health professional; and · use medical equipment, devices, or adaptive aides or technology safely and correctly according to written instructions form a licensed health professional. Repeat Violation: In a Correction Order that DHS issued on June 4, 2021, you were previously found in violation of this same statute. Statute Violated: Minnesota Statutes, section 245D.05, subdivision 1, paragraph (b). 9. Violation: For nine persons whose records were reviewed (P1, P2, P3, P4, P7, P8, P10, P11 and P12), the license holder did not ensure persons served received medication as prescribed when assigned responsibility of medication administration. The license holder failed to implement medication procedures to ensure P1, P2, P3, P4, P7, P8, P10, P11 and P12 took medications and treatments as prescribed. a. During the licensing review, DHS licensors found two single bubble packs on the floor for P1, dated for November 1, 2023, and November 30, 2023. Both bubble packs still contained the medications for both dates. The license holder failed to implement medication procedures to ensure P1 took medications as prescribed. b. During the licensing review DHS licensors observed a bubble pack, dated December 8, 2023, for P2 that was for P2’s medications. The blister for P2’s three morning medications for December 11, 2023, was still present at the time of the licensing review and had not been administered to P2. P2 was prescribed several medications. The license holder maintained a MAR for December 2023 that included missing signatures for all P2’s medications for December 6 -13, 2023. DHS licensors could not determine if these medications were administered to P2. The license holder failed to implement medication procedures to ensure P2 took medications and treatments as prescribed. c. P3’s record included a MAR for the month of October 2023P3’s record included a MAR for the month of November 2023, that included P3’s prescribed medications, including risperidone 1mg and Risperidone .25mg, and P3 was to take one tablet of each milligram, two times a day totaling 1.25mg. However, documentation maintained on the MAR, has both the 1mg and .25mg medications transcribed as only to be administered one time a day. On the MAR staff documented P3 did not receive risperidone 1mg and risperidone 25mg on November 4, 5 and 6, however, P3 did not receive the prescribed PM doses for November 1-7, 2023. The license holder failed to implement medication procedures to ensure P3 took medications and treatments as prescribed. d. P4’s record included a MAR for the month of November 2023. On this MAR staff documented P4 was not present at the service site and P4 did not take medications as prescribed on November 11-14, 18-19, 23, 25 and 26. Additionally, on November 24, 2023, staff documented P4’s medications were left in the room for P4 but was unsure if P4 took the medications as prescribed. The license holder failed to implement medication procedures to ensure P4 took medications and treatments as prescribed. e. P7 was prescribed Bydureon Bcise 2mg to be administered every seven days as a subcutaneous injection. P7’s MARs from October-December 2023 show several instances where P7 received the injection at intervals either shorter or longer than every seven days. The license holder failed to implement medication administration procedures to ensure P7 took medications and treatments as prescribed. f. P8 was prescribed several medications. Documentation maintained on P8’s MAR for October 2023 has no notations of for the daily prescribed medications for October 1, 21-31. Documentation maintained on P8’s MAR for November 2023 indicates P8 did not take any prescribed medications from November 7-18. On November 19th P8 began taking one prescribed medication, however, documentation shows P8 did not take the remaining prescribed medications through November 30, 2023. Additionally, a T-Log note maintained in P8’s record states P8 informed staff at 10:00 am on October 15, 2023, that P8 ran out of medications; however, it was later determined P8 ran out of medications due to P8 taking 6 prescribed medications at once. P8 was prescribed an antibiotic on November 21, 2023, that was to be given two times a day for seven days. There was no documentation for the second dose of the antibiotic on November 21, 22, 24, 25, 26 and 27. P8’s December 2023 MAR included three prescribed daily medications and two medications to be taken as needed. P8’s December 2023 MAR had no notations for the daily prescribed medications from December 1-8 and 10-12. During the licensing review DHS licensors observed a bubble pack for P8 that was for Bupropion HCL take 1 tablet every morning. The medication had a date of December 5, 2023, and was not transcribed on P8’s December 2023 MAR. There were six pills missing from the bubble pack, however, DHS licensors could not determine if P8 received the pills as prescribed or who had administered the medication. g. P10 was prescribed several medications. The license holder maintained a MAR for October 2023 that included missing signatures for all P10’s medications for October 18-20 and 21-24, 2023. Additional documentation maintained on the October MAR shows P10 was hospitalized on October 24, 2023. During the site visit, the staff present at the program were asked for an explanation; however, both staff stated they did not know what occurred or where to find that information. DHS licensors were not able to determine if the medications were given during that time period. h. Regarding P11, on [December 1, 2023] the program nurse, entered a T-log note stating P11’s medication was to be increased to three tabs daily, however, the increase of medication did not occur, the medication bubble packs maintained onsite still contained the medications. Additionally, the December 2023 MAR maintained documentation showing the medication increase was not given at all. P11 was prescribed Gabapentin, Loratadine, Melatonin and Mirtazapine. According to the documentation maintained on P11’s December 2023 MAR there is no documentation for one or more of the medications prescribed on the following days: December 1-10 and 14. i. Regarding P12, during a site visit on December 15, 2023, DHS licensors observed daily bubble packs for June 30, 2023, November 20-21, 2023, November 30, 2023, and December 4, 2023, that had prescribed medications still present. Documented maintained in P12’s record on a T-log dated, July 26, 2023, stated staff gave P8 their morning meds, however, around 1:00pm P8 reported to staff they forgot to take their morning medications. DHS licensors could not determine if P8 took their morning medications that day. Statute Violated: Minnesota Statutes, section 245D.05, subdivision 2, paragraph (b). 10. Violation: For ten persons whose records were reviewed (P1, P2, P3, P4, P5, P7, P8, P10, P11 and P12), the license holder did not implement medication administration procedures as required and document information on any risks or side effects as required. a. P1, P2, P3, P4, P5 and P7 medication administration records (MARs) were located in the same binder onsite. The binder and MARs did not include any risks or side effects for P1, P2, P3, P4, P5 and P7. Additionally, P1, P2, P3, P4, P5 and P7’s MARs were kept in a separate locked room, that staff did not have a key to access at any time needed. The license holder failed to document information on any risks or side effects and have the information readily available to all staff administering medications. b. P8 and P10’s MARs were located in the same binder onsite at the CFRS. The binder and MARs did not include risks or side effects for P8 and P10. The license holder failed to document information on any risks or side effects and have the information readily available to all staff administering medications. c. P11 and P12 MARs did not include risks or side effects, additionally, risks or side were not maintained onsite at the CFRS. The license holder failed to document information on any risks or side effects and have the information readily available to all staff administering medications. Statute Violated: Minnesota Statutes, section 245D.05, subdivision 2, paragraph (c), clause 2. 11. Violation: For two persons whose records were reviewed (P8 and P11), the license holder did not implement medication administration procedures as required. During a site visit on December 13, 2023, DHS licensors observed P8 and P11’s medications were in the same medication box. P8 informed DHS licensors that their medications are mixed up frequently. Statute Violated: Minnesota Statutes, section 245D.05, subdivision 2, paragraph (c), clause 4 and 5. 12. Violation: For three person whose record was reviewed (P5, P8 and P11), the license holder did not implement medication administration procedures to ensure when a medication or treatment is started, administered, changed, or discontinued. a. P5 was prescribed aripiprazole 2mg tablets on December 5, 2023; however, according to the documentation maintained on P5’s MAR, the new medication was not added to P5’s MAR until December 12, 2023. The license holder failed to implement medication administration procedures when the medication started. b. P8 was prescribed Desvenlafaxine ER 100mg tab, Desvenlafaxine 50mg ER tab and Protonix 20mg tab, and were to take 1 tablet of every morning for ten days. The 100mg ER tab was not signed off by staff for the entire month of October. The 50mg ER tablet and 20mg tablet started being signed off on by staff October 2, 2023, however, no other medications were signed for October 1, 2023, so DHS licensors were unable to determine when the medications started. Additionally, the medications were signed off as administered through October 20, 2023, which is 9 days over the prescription. DHS licensors were unable to determine were unable to determine when the medications should have been discontinued or how many additional days were administered. P8 was prescribed Bupropion HCL take 1 tablet every morning around December 5, 2023; however, according to the documentation maintained on P8’s MAR for December, the new medication was not added to P8’s MAR. There were six doses of the medication missing from the bubble pack. The license holder failed to implement medication administration procedures when the medication for P8 was started. c. Documentation maintained on P11’s October 2023 MAR, P11 was prescribed 1 tablet by mouth at bedtime of Lamotrigine 25mg for two weeks and then increase to two tablets. There was no notation of when this prescription started or when the increase to two tablets started. Statute Violated: Minnesota Statues, section 245D.05, subdivision 2, paragraph (c), clause 6. 13. Violation: For eight persons whose records were reviewed (P1, P3, P4, P7, P8, P10, P11 and P12), the license holder did not review medication administration records as required. For P1, P3, P4, and P7, the license holder maintained a document titled “Medication Administration Record Review” that documented the review of P1, P3, P4, and P7’s medication administration record (MAR) for the month of November. Additionally, the license holder also maintained a document with the same title for P3, P7, P8 and P10 for the month of October. a. Regarding P1, during a site visit, DHS licensors found two medication daily bubble packs for P1 on the floor, that included the pills to be administered, the medication names and the date the medication was supposed to be administered, the two errors were not included on MAR review. The MAR review completed by the license holder failed to include all medication administration errors. b. Regarding P3, program staff initialed on the MAR for a medication named Risperidone for the dates of November 1-7th; however, on the back of the MAR staff documented that on November 4, 5 and 6 Risperidone 1mg and Risperidone .25mg the medications were not given but were initialed by mistake. The license holder failed to include all medication errors on the MAR review. c. Regarding P4, program staff initialed on the MAR for November 24, 2023, indicating the medications were administered to P4. The notes on the back of the MAR stated medications were let in P4’s room on November 24, 2023, because program staff was not sure if P4 was present on-site. The license holder failed to include this medication error in P4’s MAR review. d. Regarding P7, they were prescribed an injection to be administered every seven days. Program staff documented on P7’s MARs for October and November 2023 that they administered P7 injections on several occasions at intervals either shorter or longer than every seven days. The license holder failed to include these errors on the MAR reviews conducted for October and November 2023. e. Regarding P8, they were prescribed three medications for 10 days in October 2023, see citation 12 for additional evidence. The license holder failed to include the medication errors on the MAR review for October 2023. f. For P10, they were prescribed seven medications for the month of October 2023. Documentation maintained on the October 2023 MAR include errors every day for multiple medications; however, those errors were not reflected on the MAR review completed by the license holder on November 13, 2023. g. For P11, the license holder completed a MAR review for the month of October 2023 on November 13, 2023. The MAR review included an error for October 3, 2023; however, the MAR review did not include all medications missed that day. h. Regarding P12, they were prescribed several medications. During a site visit DHS licensor observed several dates that were not administered and still present in the bubble packs, see citation 9, letter i for further evidence. The license holder failed to include these errors on the MAR review conducted for November 2023. For P1, P3 P4, P11, and P12, based up on their MAR reviews, the license holder failed to develop and implement a plan to correct patterns of medication administration errors when identified. Statute Violated: Minnesota Statutes, section 245D.05, subdivision 4. 14. Violation: For one person whose record was reviewed (P7), the license holder did not ensure the requirements to administer injections were met prior to administering injections. P7 was prescribed a subcutaneous injection to be administered every seven days. Program staff documented on the MARs for P7 that they administered this injection. The license holder may administer injections according to a prescriber’s order and written instructions when one of the following conditions had been met. The license holder failed to ensure one of the following conditions was met prior to administering the injection to P7: · a supervising registered nurse with a physician’s orders delegated the administration of injectable medication to an unlicensed staff member and has provided the necessary training; or · an agreement was signed by the license holder, the prescriber, and the person specifying what injections may be given, when, how, and that the prescriber must retain responsibility for the license holder’s giving the injection. A copy of the agreement must be placed in the person’s service recipient record. Statute Violated: Minnesota Statutes, section 245D.05, subdivision 5. 15. Violation: For nine persons whose records were reviewed (P1, P2, P3, P4, P5, P7, P8, P11 and P12), the license holder did not meet the requirements for psychotropic medication use and monitoring as required. P1, P2, P3, P4 P5, P7, P8, P11 and P12 were prescribed multiple psychotropic medications. The license holder failed to develop, implement, and maintain documentation that included a description of the target symptoms that each psychotropic medication is used to alleviate. Statute Violated: Minnesota Statutes, section 245D.051, subdivision 1. Policy and Procedure Violations 16. Violation: The license holder failed to enforce the program’s policy and procedures on data privacy according to the requirements in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as required. The program used a group messaging application named, “GroupMe.” The license holder used GroupMe to communicate information regarding service recipients. The license holder failed to enforce the program’s policy on data privacy when the license holder used GroupMe to communicate health related information of a person they provide services to. GroupMe messages were not encrypted, and GroupMe was not a HIPAA compliant application. Statute Violated: Minnesota Statutes, section 245D.11, subdivision 3. Staff Standards Violations 17. Violation: For three of seven staff persons whose records were reviewed (SP3-SP5), the license holder did not provide orientation training as required. SP3 was hired on October 5, 2023. SP4 was hired on October 3, 2021. SP5 was hired on February 1, 2022. The license holder failed to, within 60 days of hire, provide SP3, SP4 and SP5 with training on basic first aid. Statute Violated: Minnesota Statutes, section 245D.09, subdivision 4. Repeat Violation: In a Correction Order that DHS issued on June 4, 2021, you were previously found in violation of this same statute. 18. Violation: For five staff persons whose records were reviewed (SP1-SP5), the license holder did not provide orientation to individual service recipient needs as required. a. The license holder failed to provide SP1-SP5 the following training before having unsupervised contact with persons served by the program: · orientation to the individual service recipient needs; · the persons support plan or support plan addendum as it relates to the responsibilities assigned to the license holder; and · the persons individual abuse prevention plan, to achieve and demonstrate an understanding of the person as a unique individual, and how to implement those plans. b. Additionally, during a site visit to CFRS # 1110084 on December 13, 2023, the staff on shift were not able to provide any information or service plans specific to P9. Statute Violated: Minnesota Statutes, section 245D.09, subdivision 4a, paragraph (c). Repeat Violation: In a Correction Order that DHS issued on June 4, 2021, you were previously found in violation of this same statute. 19. Violation: For five staff persons whose records were reviewed (SP1-SP5), the license holder did not provide medication orientation and training as required. a. The license holder failed to provide SP1-SP5 medication orientation and training from a training curriculum developed by a registered nurse or appropriate health professional that incorporated an observed skill assessment conducted by the trainer to ensure unlicensed staff demonstrated the ability to safely and correctly follow medication procedures. b. The license holder failed to ensure SP1-SP5 only administered medications only after successful completion of a medication administration training. Statute Violated: Minnesota Statutes, section 245D.09, subdivision 4a, paragraph (d). 20. Violation: For four staff persons whose records were reviewed (SP1, SP2, SP4 and SP5), the license holder did not provide annual training as required. Minnesota Statutes, section 245A.02, subdivision 2b defines “annual” or “annually” to mean prior to or within the same month of the subsequent calendar year. a. The license holder failed to provide SP1 with the following required annual training in 2023: · the safe and correct use of manual restraint on an emergency basis according to the requirements in section 245D.061 or successor provisions, and what constitutes the use of restraints, time out, and seclusion, including chemical restraint; and · staff responsibilities related to prohibited procedures under section 245D.06, subdivision 5, or successor provisions, why such procedures are not effective for reducing or eliminating symptoms or undesired behavior, and why such procedures are not safe. b. The license holder failed to provide the following required annual trainings for SP2 in 2022 and 2023, and SP4 and SP5 in 2023: · 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 section 245D.04; · sections 245A.65, 245A.66, 626.556 and 626.557, governing maltreatment reporting and service planning for vulnerable adults, and staff responsibilities related to protecting persons from maltreatment and reporting maltreatment. This orientation must be provided within 72 hours of first providing direct contact services and annually thereafter according to section 245A.65, subdivision 3; · 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 or successor provisions, 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, or successor provisions, why such procedures are not effective for reducing or eliminating symptoms or undesired behavior, and why such procedures are not safe; · basic first aid; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities. Statute Violated: Minnesota Statutes, section 245D.09, subdivision 5. 21. Violation: For five staff persons whose records were reviewed (SP1-SP5), the license holder did not maintain personnel record as required. The license holder failed to maintain documentation in SP1-SP5’s personnel record of an acknowledgement signed by SP1-SP5 that job duties were reviewed with the SP1-SP5 and SP1-SP5 understands the duties, and documentation that SP1-SP5 meet the position requirements as determined by the license holder. Statute Violated: Minnesota Statutes, section 245D.095, subdivision 5. Background Study Requirements 22. Violation: As a result of a licensing review, a DHS licensor determined that the license holder did not initiate background studies for two staff persons before they began in positions allowing direct contact with persons served by the program. a. SP11 began working in a position allowing direct contact with persons served by the program on an unknown date. Documentation maintained in persons served records indicated SP11 had direct contact on October 14, 2023. The license holder had not initiated a background study on SP11 in NETStudy 2.0 under the HCBS license 1098882 or the CFRS license 1110084 at the time of the licensing review. b. SP14 began working in a position allowing direct contact with persons served by the program on an unknown date. Documentation maintained by the license holder indicated SP14 had direct contact on June 21, 2023. The license holder had not initiated a background study on SP14 in NETStudy 2.0 under the HCBS license 1098882 or the CFRS licenses 1110084 and1115234 at the time of the licensing review. Statute Violated: Minnesota Statutes, section 245C.04, subdivision 1, paragraph (g). 23. Violation: As a result of a licensing review, a DHS licensor determined you did not comply with the background sensitive information person (SIP) requirements. The license holder has multiple programs. The license holder failed to designate one individual with one address and telephone number as the person to review sensitive background study information for the multiple licensed programs or services that depend on the same background study. · SP1 began working in a position allowing direct contact with persons served by the program on October 16, 2022. However, the license holder had not initiated a background study on SP1 in NETStudy under the 245D license 1098882 at the time of the licensing review. · SP2 began working in a position allowing direct contact with persons served by the program on January 25, 2022. The license holder had not initiated a background study on SP2 in NETStudy under the HCBS license 1098882 at the time of the licensing review. · SP3 began working in a position allowing direct contact with persons served by the program on October 24, 2023. The license holder had not initiated a background study on SP3 in NETStudy under the 245D license 1098882 at the time of the licensing review. · SP4 began working in a position allowing direct contact with persons served by the program on October 4, 2021. The license holder had not initiated a background study on SP4 in NETStudy under the CFRS licenses 1110084 and 1115234 at the time of the licensing review. Documentation maintained by the license holder showed SP4 had unsupervised direct contact on September 22, 2023, at CFRS 1110084 and unsupervised direct contact on May 8, 2023, at CFRS 1115234. · SP8 began working in a position allowing direct contact with persons served by the program on an unknown date. Documentation maintained by the license holder stated SP8 had direct contact on September 19, 2023. The license holder had not initiated a background study on SP8 in NETStudy under the 245D license 1098882 at the time of the licensing review. · SP9 began working in a position allowing direct contact with persons served by the program on an unknown date. Documentation maintained by the license holder showed SP9 had unsupervised direct contact on October 7, 2023, at CFRS number 1110084. The license holder had not initiated a background study on SP9 in NETStudy under the CFRS license 1110084 at the time of the licensing review. · SP10 began working in a position allowing direct contact with persons served by the program on an unknown date. Documentation maintained by the license holder showed SP10 had unsupervised direct contact on October 9, 2023, at CFRS 1110084. The license holder had not initiated a background study on SP10 in NETStudy 2.0 under the HCBS license 1098882 or the CFRS licenses 1110084 at the time of the licensing review. · SP12 began working in a position allowing direct contact with persons served by the program on an unknown date. Documentation maintained by the license holder showed SP12 had unsupervised direct contact on November 24, 2023, at CFRS number 1110084. The license holder had not initiated a background study on SP12 in NETStudy under the CFRS license 1110084 at the time of the licensing review. · SP13 began working in a position allowing direct contact with persons served by the program on an unknown date. Documentation maintained by the license holder showed SP13 had unsupervised direct contact on October 9, 2023, at CFRS number 1115234. The license holder had not initiated a background study on SP13 in NETStudy under the CFRS license 1115234 at the time of the licensing review. · SP15 began working in a position allowing direct contact with persons served by the program on an unknown date. Documentation maintained by the license holder showed SP15 had unsupervised direct contact on July 5, 2023, at CFRS number 1115234. The license holder had not initiated a background study on SP15 in NETStudy under the CFRS license 1115234 at the time of the licensing review. Statute Violated: Minnesota Statutes, section 245C.07, subdivision 1, paragraph (a). License holders determined to have a background study violation are required to pay a $200 fine for each violation. Because license revocation is a more severe sanction against your license, DHS is not imposing this fine. If the revocation is rescinded, DHS may impose the fine at that time. LICENSING VIOLATIONS DETERMINED DURING MALTREATMENT INVESTIGATION, REPORT NUMBER 202310537. 24. Violation: The facility did not complete an internal review regarding report number 202310537 when the facility had reason to know that an internal or external report of alleged or suspected maltreatment was made. Statute Violated: Minnesota Statutes, sections 245A.65, subdivision 1 (b). On January 10, 2024, you notified DHS of your request to close your HCBS license effective January 21, 2024. Please note that closure of a license by the license holder before an investigation is complete does not preclude DHS from issuing a licensing action at the conclusion of the investigation. See Minnesota Statutes, section 245A.07, subdivision 1, paragraph (d). YOUR RIGHT TO APPEAL You have the right to appeal the revocation. 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. Please send it 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 If your request is being personally delivered, it must be received by DHS within 10 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 Attention: Licensing Legal Unit 444 Lafayette Road North St. Paul, MN 55155 Upon DHS’ receipt of your timely appeal, your case would be scheduled for a contested case hearing in front of an Administrative Law Judge. Following this hearing, the Commissioner of DHS will issue a final order. If you do not appeal or if the order is affirmed by the Commissioner following a hearing, DHS is prohibited from issuing you and the controlling individuals a license for five years. In addition, any additional licenses held by you or the controlling individuals shall also be revoked. 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.lawhelpmn.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 3, which describes under which conditions DHS may revoke a license. · The timeline to appeal a revocation order is provided in Minnesota Statutes, section 245A.07, subdivision 3(b). · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (4)(iv) states that license holders shall pay a $200 for each background study violation. · 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. · Under Minnesota Statutes, section 245A.04, subdivision 7, paragraph (d), clause (3), the commissioner shall not issue or reissue a license if the applicant, license holder, or controlling individual has had a license issued under this chapter revoked within the past five years. · Under Minnesota Statutes, section 245A.04, subdivision 7, paragraph (d), clause (5), when a license issued under this chapter is revoked under clause (1) or (3), the license holder and controlling individual may not hold any license under chapter 245A for five years following the revocation, and other licenses held by the applicant, license holder, or controlling individual shall also be revoked. Questions If you have any further questions regarding this matter, you may contact Christala Culhane, HCBS Unit Supervisor, at 651-431-6541. Sincerely,
Jill Slaikeu, HCBS Unit Manager Licensing Division Office of Inspector General
|
