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May 22, 2024 CERTIFIED MAIL Tamara and Brian Olson 270 Milkyway Ave W. Lake Lillian, MN 56253 License Number 1112662 AFC 1110595 HCBS ORDER OF LICENSE REVOCATION Dear Mr. and Ms. Olson: Based on the recommendation of Kandiyohi County Family Services Department, the Department of Human Services (DHS) is revoking your licenses to provide family adult foster care (AFC) and home and community-based services (HCBS) at 270 Milkyway Ave. W, Lake Lillian, MN. This revocation is based on the Commissioner’s evaluation, false and misleading information, and failure to comply with licensing laws and rules. Details of our findings are provided below. Our next steps and your options are also detailed. REASON FOR LICENSE REVOCATION 1. Commissioner’s evaluation of the 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 in your program, available evaluations from consumers of your program, and information about the qualifications of staff persons working in your program. DHS has determined that revocation of your license is appropriate based on the violations identified below and the program evaluation. You have been licensed as a family AFC provider since May 19, 2022. Additionally, you are licensed to provide HCBS family residential services at your family AFC program. In June 2023, Kandiyohi County received and investigated a report you were not meeting licensing standards. As a result of the investigation, Kandiyohi County determined the following: · Your family adult foster home does not meet the definition of a family adult foster home. · You failed to report a change in the health status of Ms. Olson. · You knowingly withheld relevant information. On February 9, 2024, HCBS issued a correction order from a licensing review on November 21, 2023. Details are outlined below. Legal Authority: Minnesota Statutes, section 245A.04, subdivision 6. 2. False and misleading information or knowingly withheld relevant information Kandiyohi County determined that you knowingly withheld relevant information or provided false or misleading information to the Commissioner during an investigation and your compliance with licensing rules and laws. Kandiyohi County determined you knowingly withheld relevant information when you failed to notify them of a medical procedure Ms. Olson underwent and did not provide discharge documentation or sign a release of information when requested. Additionally, it was determined you gave false information when there was contradictory information on who was working in the programs. Specifically, employment time sheets showed that Ms. Olson worked in the program when she reports she was in the hospital for her medical procedure. Legal Authority: Minnesota Statutes, section 245A.07, subdivision 3, paragraph (a), subparagraph (3). 3. Failure to comply with licensing laws and rules Kandiyohi County determined that you failed to fully comply with the laws and rules that apply to licensed adult foster care. DHS has considered the nature, chronicity, or severity of the violations that led to the revocation of your license. Legal Authority: Minnesota Statutes, section 245A.07, subdivision 3, paragraph (a), subparagraph (1). Nature, history and severity of violations New violations determined Kandiyohi County conducted a licensing investigation at your licensed program. The following are new violations that have not been the subject of a previous correction order. If you appeal this order, the following violations will be reviewed as a part of the appeal. DHS considered these violations, as a factor when it determined that revocation of your license is appropriate. 1. Kandiyohi County determined that you are not the primary providers of care to the person served by your program when staffing patterns show that you have two to five staff providing care to the persons served in your program daily. Statute Violated: Minnesota Statutes, section 245A.02, subdivision 6f. 2. Kandiyohi County determined you failed to report a change in the health status of a caregiver when Ms. Olson had a medical procedure, and you did not notify Kandiyohi County. Rule Violated: Minnesota Rules, part 9555.6175, subpart 3, item D. Previous licensing actions The following violations summarize the nature of your previous licensing violations. Because these violations are now conclusive, the individual violations are not within the scope of your appeal rights. Please refer to the previously issued correction orders for further details on these violations. If you do not have copies of these orders, contact your HCBS licensor for assistance. DHS also considered this history as a factor when it determined that revocation of your license is appropriate. · February 9, 2024, Correction Order o The Correction Order included three violations for failing to meet the requirements for service planning and delivery, under Minnesota Statues, section 245D.071. o The Correction Order included one violation for failing to maintain documentation on target symptoms for psychotropic medication use and monitoring, under Minnesota Statues, section 245D.051, subdivision 1. o The Correction Order included one violation for failing to maintain personnel records, under Minnesota Statues, section 245D.095, subdivision 5. Severity of violations DHS also considered the severity of these violations when it determined that revocation of your license is appropriate. Because your foster home does not meet the definition of a family adult foster home, because you knowingly withheld relevant information from or gave false or misleading information to the commissioner, and due to the serious and chronic nature of the licensing violations and the conditions in the program, which impact the health and safety of persons served in your care, your license to provide adult foster care and home and community-based services are revoked. 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 a license for five years. In addition, any additional licenses held by you 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. Operating the program pending the outcome of the appeal: If you file an appeal within the timeframes described above, you may continue to operate pending the outcome of your appeal. If you continue to operate, you must do so in full compliance with all licensing laws and rules. Failure to follow a law or rule that may impact the health or safety of people served by your program could result in the immediate suspension of your license. 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. · 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 Cory Jelinek, Supervisor, at 651-431-3512. Sincerely,
Jill Slaikeu, Unit Manager Licensing Division Office of Inspector General cc: Melissa Helgeson, Kandiyohi County Family Services Department
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