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August 28, 2024 Mohamed Ali, Authorized Agent Shifo Adult Center Inc 373 Pederson Street Suite 101B Saint Paul, Minnesota 55119-4408 License Number: 1091375 (Rule 223) CORRECTION ORDER Dear Mohamed Ali: On August 19, 2024, a licensing review of Shifo Adult Center Inc located at 373 Pederson Street, Saint Paul, 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 Rules, part 9555.9650, item A. Violation: For two of three staff persons whose records were reviewed, the license holder did not maintain a personnel record as required. The license holder failed to maintain a job description in SP2 and SP3’s personnel records. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain a copy of SP2 and SP3’s job descriptions in their personnel records. On an ongoing basis, you must maintain compliance as required in this item. 2. Citation: Minnesota Rules, part 9555.9720, subparts 7 and 8. Violation: The license holder did not ensure safety as required. a. The license holder failed to ensure equipment and furniture was in good repair, including: · a ceiling tile in the women’s restroom with water damage; · a ceiling tile in the men’s restroom that is cracked and buckling; and · stained carpet throughout the center. b. The license holder failed to ensure the areas used by participants were free from loose plaster and peeling paint. Corrective Action Ordered: Immediately, you must ensure: · equipment and furniture is in good repair; and · areas used by participants are free from loose plaster and peeling paint. On an ongoing basis, you must maintain compliance as required in these subparts. If you fail to correct the violations specified in the Correction Order within the prescribed time lines the Commissioner may issue an Order of Conditional License or may impose a fine and order other licensing sanctions pursuant to Minnesota Statutes, sections 245A.06 and 245A.07. 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 P.O. Box 64953 Saint 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. Alexandra Devick, HCBS Human Services Licensor Licensing Division Office of Inspector General
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