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October 16, 2024
Abdinasir Kahin, Authorized Agent Loving Arms Adult Care LLC 625 Cedar Avenue South Minneapolis, Minnesota 55454 License Number: 1079422 (Rule 223) CORRECTION ORDER Dear Abdinasir Kahin: On August 28, 2024, a licensing review of Loving Arms Adult Care Inc, located at 625 Cedar Avenue South, Minneapolis, 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 four 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. · The license holder most recently reviewed P1 and P3’s IAPPs in March 2024. · The license holder most recently reviewed P2’s IAPP in April 2024. b. The license holder failed to review P1, P2, and P3’s IAPPs with their interdisciplinary teams, at least annually in 2023, using the individual assessment and any reports of abuse relating to the person. Corrective Action Ordered: Within 30 days of receiving this order, you must review P1, P2, and P3’s IAPPs with the person and their interdisciplinary team. Additionally, you must document the review of P1, P2, and P3’s IAPPs in the person’s record. 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 (P3 and P4), the license holder did not include information in the participant’s written records as required. a. The license holder failed to include an application form in P3’s participant record that included P3’s source of referral. b. The license holder failed to include an application form in P4’s participant record that included P4’s date of birth, living arrangement, and source of referral. Corrective Action Ordered: Within 30 days of receiving this order, you must: · update P3’s application form to include P3’s source of referral; and · update P4’s application form to include P4’s date of birth, living arrangement, and source of referral. 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 person whose record was reviewed (P3), the license holder did not complete initial service planning as required. The license holder failed to develop a preliminary service plan for P3 that included the role of P3’s care giver or caregivers in carrying out the service plan. Corrective Action Ordered: Within 30 days of receiving this order, you must update P3’s preliminary service plan to include the role of the P3’s caregiver in carrying out the service plan. On an ongoing basis, you must maintain compliance as required in this subpart. 4. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For four participants whose records were reviewed (P1, P2, P3, and P4), the license holder did not develop a written plan of care as required. a. The license holder failed to: · develop written plans of care for P1, P2, and P3 that included the staff members responsible for implementing the individual plan of care; and · review P1, P2, and P3’s individual plan of care quarterly. The license holder most recently reviewed P1 and P3’s individual plans of care in March 2024. The license holder most recently reviewed P2’s individual plan of care in April 2024. b. The license holder failed to develop a written plan of care for P4 that included: · short and long term objectives for P4 stated in concrete, measurable, and time specific outcomes; and · the staff members responsible for implementing 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 staff members responsible for implementing the individual plan of care; · review P1, P2, and P3’s individual plans of cares; and · develop a written plan of care for P4 that includes short and long term objectives for P4 and the staff members responsible for implementing the individual plan of care. On an ongoing basis, you must maintain compliance as required in this subpart. 5. Citation: Minnesota Rules, part 9555.9650, items A and B. Violation: For two of two staff persons (SP1 and SP2) and one consultant whose records were reviewed, the license holder did not include all required information in the personnel record. a. The license holder failed to maintain employee job descriptions in SP1 and SP2’s personnel file. b. The license holder failed to maintain a personnel file for the physical therapist that included: · a copy of a signed contract or letter of appointment specifying conditions and terms or employment; and · documentation that the person under contract met any licensure, registration, or certification requirements required to perform the services specified in the contract. Corrective Action Ordered: Within 30 days of receiving this order, you must: · maintain employee job descriptions in SP1 and SP2’s personnel records; and · maintain a personnel file for the physical therapist that includes a copy of a signed contract or letter or appointment specifying conditions and terms of employment and documentation that the person under contract meets any licensure, registration, or certification requirements required to perform the services specified in the contract. On an ongoing basis, you must maintain compliance as required in these items. 6. Citation: Minnesota Rules, part 9555.9710, subparts 1, 4, and 7. Violation: The license holder did not offer services as required. a. The license holder failed to ensure the menus for all meals and snacks were approved by a registered dietician and met all applicable state rules and laws and United States Department of Agriculture regulation. b. The license holder failed to offer a midafternoon snack. c. The license holder failed to ensure a physical therapist provided consultation and review of the exercise program, at least quarterly. The license holder maintained documentation that the most recent review of the exercise program was completed in July 2023. d. The license holder failed to maintain a family and social history in P1’s record that was updated annually in 2023 and 2024. Corrective Action Ordered: Immediately, you must offer a midafternoon snack. Within 30 days of receiving this order, you must: · ensure your menus for all meals and snacks are approved by a registered dietician; · ensure your physical therapist provides consultation and review of your exercise program; and · maintain and update P1’s family and social history, as applicable. On an ongoing basis, you must maintain compliance as required in these subparts. 7. Citation: Minnesota Rules, part 9555.9720, subpart 9. Violation: The license holder did not ensure safety as required. The license holder failed to post the plans for emergencies caused by fire, blizzard, and tornadoes in a visible place in the center. Corrective Action Ordered: Immediately you must post the plan for emergencies caused by fire, blizzard, and tornadoes in a visible place in the center. On an ongoing basis, you must maintain compliance as required in this subpart. 8. Citation: Minnesota Rules, part 9555.9730, subpart 9. Violation: The license holder did not ensure physical plant and space requirements. The license holder failed to ensure restrooms used by participants were equipped with a mechanism that participants can use to signal staff members by light or by sound if participants need assistance. Corrective Action Ordered: Immediately you must equip restrooms used by participants with a mechanism that participants can use to signal staff members by light or by sound if participants need assistance. On an ongoing basis, you must maintain compliance as required in this subpart. 9. Citation: Minnesota Statutes, section 245A.65, subdivisions 1 and 2. Violation: The license holder did not post the internal and external reporting policies and procedures and the program abuse prevention plan (PAPP) in a prominent location in the program as required. a. The license holder failed to post the internal and external reporting policies and procedures in a prominent location in the program. b. The license holder failed to post the PAPP in a prominent location in the program. Corrective Action Ordered: Immediately, you must: · post the internal and external reporting policies and procedures in a prominent location in the program; and · post the PAPP in a prominent location in the program. On an ongoing basis, you must maintain compliance as required in these subdivisions. 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. Katie Johnson, HCBS Human Services Licensor Licensing Division Office of Inspector General 651-431-4113
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