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May 31, 2024 Michael Kashevatsky, Authorized Agent Golden Time Adult Day Care Inc 14233 O’Connell Court, Suite 100 Savage, Minnesota 55378 License Number: 1035837 (Rule 223) CORRECTION ORDER Dear Michael Kashevatsky: On May 22, 2024, a licensing review of Golden Time Adult Day Care Inc located at 14233 O’Connell Court, Savage, 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 three of three participants whose records were reviewed (P1, P2, and P3), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). a. The license holder failed to review P1, P2, and P3’s IAPPs quarterly as part of the review of the program plan or service plan. b. The license holder failed to review P1 and P2’s IAPP with P1 and P2’s interdisciplinary team at least annually. Corrective Action Ordered: Within 30 days of receiving this order, you must: · review P1, P2, and P3’s IAPPs with the person’s interdisciplinary team and document the review; · complete an audit of all participants’ IAPPs to ensure the requirements in Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b) and Minnesota Rules, part 9555.9700, subpart 3 are maintained; and · for participants whose IAPPs are not developed and reviewed as required, you must develop a plan detailing how your program will maintain IAPPs as required within 60 calendar days of receiving this order. On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For two participants whose records were reviewed (P1 and P3), the license holder did not include information in the participant’s written record as required. a. The license holder failed to include a medical report in P1’s record that included a report on a physical examination updated annually in 2024. The most recent report on a physical examination that the license holder maintained for P1 was dated February 28, 2023. b. The license holder failed to maintain an application form for P3 that included the name and telephone number of a secondary person to call in case of an emergency involving P3. Corrective Action Ordered: Within 30 days of receiving this order, you must: · maintain a report on P1’s physical examination in P1’s record; and · update P3’s application form to include the telephone number of a secondary person to call in case of an emergency involving P3. On an ongoing basis, you must maintain compliance as required in this subpart. 3. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For one participant whose record was reviewed (P2), the license holder did not complete initial service planning as required. The license holder failed to develop a preliminary service plan for P2 that included P2’s nutritional needs and, where applicable, dietary restrictions. Corrective Action Ordered: Within 30 days of receiving this order, you must update P2’s preliminary service plan to include P2’s nutritional needs and, where application, dietary restrictions. On an ongoing basis, you must maintain compliance as required in this subpart. 4. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For three participants whose records were reviewed (P1, P2, and P3), the license holder did not develop a written plan of care as required. The license holder failed to develop written plans of care for P1, P2 and P3 that included: · the anticipated duration of the plan of care as written; and · 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: · develop written plans of care for P1, P2, and P3 that include the information listed above; · complete an audit of all participants’ written plans of care to ensure the requirements in Minnesota Rules, part 9555.9700, subpart 3 are maintained; and · for participants who do not have a written plan of care that includes all required information, you must develop a plan detailing how your program will maintain a complete written plan of care within 60 days of receiving this order. On an ongoing basis, you must maintain compliance as required in this subpart. 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 me as soon as possible. Desiree Tiller, HCBS Licensor Licensing Division Office of Inspector General 651-431-4622
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