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September 20, 2024 Kevin Guillory, Authorized Agent 355 15TH Avenue N South St Paul, MN 55075 RE: Report No. 202307723 Everyday Living Central MN Evergreen Acres License No. 1075536/1067112 Dear Kevin Guillory: CORRECTION ORDER An investigation of Everyday Living Central MN Evergreen Acres was completed regarding report number 202307723 which alleged violation of Minnesota Statutes, section 626.557, and Minnesota Statutes, Chapter 245D. This maltreatment allegation concerned financial exploitation. The disposition of the investigation report is substantiated. Two violations were noted. VIOLATIONS AND CORRECTION ORDERS The following violations of state and (or) federal laws and rules was observed. Corrective action for the violations is required by Minnesota Statutes, section 245A.06, and is hereby ordered by the Commissioner of Human Services. Failure to correct the violations within the prescribed amount of time may result in fines and/or action against your license, as provided for in Minnesota Statutes, sections 245A.06 and 245A.07. 1. Citation: Minnesota Statutes, section 245D.095, subdivision 5. Violation: For one staff person whose record was reviewed (SP1), the license holder did not maintain personnel records as required. As a part of this investigation of alleged maltreatment, a DHS investigator requested copies of SP1’s personnel record that included documentation of: · SP1’s orientation and training on a consumer’s (C) individual service recipient needs, including: o the C’s support plan or support plan addendum as it relates to the responsibilities assigned to the license holder; o the C's individual abuse prevention plan, to achieve and demonstrate an understanding of the person as a unique individual, and how to implement those plans; and · SP1’s orientation and training on sections 245A.65 and 626.557, governing maltreatment reporting and service planning for vulnerable adults, and staff responsibilities related to protecting persons from maltreatment and reporting maltreatment. The license holder was unable to provide this information to the DHS investigator. SP1 is no longer employed by the program. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section 245D.071, subdivision 2. Violation: For the C’s Individual Abuse Prevention Plan (IAPP), the license holder did not maintain records as required. As a part of this investigation of alleged maltreatment, a DHS investigator requested a copy of the C’s IAPP that was in place at the time of the incident. The license holder was unable to provide this information to the DHS investigator. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. If you believe any of the citations are in error, you may ask the Commissioner of Human Services to reconsider the parts of the correction order that you believe to be in error. If you choose to exercise this right, your request for reconsideration must be in writing and received by the Commissioner within 20 calendar days after receipt of this letter. Your request for reconsideration must be sent to: Commissioner Minnesota Department of Human Services c/o Licensing Division PO Box 64242 St. Paul, MN 55164-0242 You must include any and all information, documentation, or other evidence you have to support your request for reconsideration. Please note that a request for reconsideration does not stay any provisions of the correction order. If you have any questions regarding the investigation, contact me immediately. If you have any questions regarding compliance with this Correction Order or applicable rules, contact your HCBS licensor, Krista Hastings. Sincerely,
Christine Cavanaugh, Investigator Office of Inspector General Licensing Division christine.cavanaugh@state.mn.us 651-431-3444 Enclosure
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