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Date Issued: July 08, 2024 Date Reissued: October 21, 2024 Kayla Kovar, Authorized Agent New Dimensions Home Health Care Inc. 312 North Tower Road Fergus Falls, Minnesota 56537 License Number: 1103465 (245D – HCBS) Notice: This Amended Correction order supersedes the original Correction order dated July 8, 2024. This document is amended to correct the person (P3) referenced in citation 7. The original Correction Order dated July 8, 2024, must be destroyed. AMENDED CORRECTION ORDER Dear Kayla Kovar: On May 29, 2024, a licensing review of New Dimensions Home Health Care, located at 312 North Tower Road, Fergus Falls, Minnesota, was conducted to determine compliance with state and federal laws and rules governing the provision of home and community-based services to persons with disabilities and age 65 and older under Minnesota Statutes, Chapter 245D. 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 Statues, section 245A.65, subdivision 2, paragraph (b). Violation: For one of two persons whose records were reviewed (P3), the license holder did not develop an individual abuse prevention plan (IAPP) as required. P3’s services were initiated on February 5, 2024. The license holder failed to develop an IAPP for P3 prior to or upon service initiation. Corrective Action Ordered: Within 30 days of receiving this order, you must develop an IAPP for P3 with individualized assessment of: · P3’s susceptibility to abuse by other individuals, including other vulnerable adults; · P3’s risk of abusing other vulnerable adults; and · statements of the specific measure to be taken to minimize the risk of abuse to P3’s and other vulnerable adults. The IAPP must include a statement of measures that would be taken to minimize the risk of abuse within the scope of the licensed services and identified referrals made when the vulnerable adult was susceptible to abuse outside of the scope or control of the licensed services. Within 60 days of receiving this order, you must submit P3’s completed IAPP to your licensor. On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statues, section 245D.071, subdivision 3, paragraph (a). 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 complete a preliminary support plan addendum for P3 based on P3’s support plan within 15 days of service initiation. Corrective Action Required: On an ongoing basis, you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Statues, section 245D.071, subdivision 3, paragraph (b). Violation: For two persons whose records were reviewed (P2 and P3), the license holder did not complete the assessment and service planning for intensive support service as required. The license holder failed to complete assessments for P2 and P3 in the following areas before the 60-day planning meeting: · P2 and P3’s ability to self-manage health and medical needs to maintain or improve physical, mental and emotional well-being, including, when applicable, allergies, seizures, choking, special dietary needs, chronic medical conditions, self-administration of medication or treatment orders, preventative screening, and medical and dental appointments; · P2 and P3’s ability to self-manage personal safety to avoid injury or accident in the service setting, including, when applicable, risk of falling, mobility, regulating water temperature, community survival skills, water safety skills, and sensory disabilities; and · P2 and P3’s ability to self-manage symptoms or behavior that may otherwise result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to (7), suspension or termination of services by the license holder, or other symptoms or behaviors that may jeopardize the health and welfare of the person or others. Corrective Action Ordered: Within 30 days of receiving this order, you must: · complete the assessments listed above for P2 and P3; · review the results with P2 and P3 and their support teams or expanded support teams; and · document the review with P2 and P3’s support team in P2 and P3’s record. Additionally, you must conduct these assessments annually at a minimum or within 30 days of written request from the person or the person’s case manager. Within 60 days of receiving this order, you must submit completed assessments for P2 and P3 to your licensor. On an ongoing basis, you must maintain compliance as required in this subdivision. 4. Citation: Minnesota Statues, section 245D.071, subdivision 3, paragraph (c). Violation: For one person whose record was reviewed (P3), the license holder did not meet the requirements of service planning and delivery for intensive support services. The license holder failed to meet with P3, P3’s legal representative, P3’s case manager, and other members of the support team before providing 60 days of service to determine the following requirements: · the scope of services to be provided to support P3’s daily needs and activities; · P3’s desired outcomes and the supports necessary to accomplish the desired outcomes; · P3’s preferences for how services and supports are provided, including how the provider will support P3 to have control of P3’s schedule; · whether the current service setting is the most integrated setting available and appropriate for P3; · opportunities to develop and strengthen personal relationships with other persons of P3’s choice in the community; · opportunities for community access, participation, and inclusion in preferred community activities; · opportunities to seek competitive employment and work at competitively paying jobs in the community; and · how services must be coordinated across other providers licensed under this chapter serving P3 and members of the support team or expanded support team to ensure continuity of care and coordination of services for P3. Corrective Action Ordered: Within 30 days of receiving this order, you must meet with P3, P3’s legal representative, P3’s case manager, and other members of the support team to meet the service planning and delivery requirements for intensive services as detailed above. Within 60 days of receiving this order, you must submit documentation of the above requirements to your licensor. On an ongoing basis, you must maintain compliance as required in this subdivision. 5. Citation: Minnesota Statues, section 245D.071, subdivision 3, paragraph (d). Violation: For two persons whose records were reviewed (P2 and P3), the license holder did not meet the requirements of service planning and delivery for intensive support services. The license holder failed to discuss how technology might be used to meet P2 and P3’s desired outcomes within 60 days of service initiation and maintain a summary of the above discussion in P2 and P3’s support plan addendum that included a statement in the summary regarding any decision that is made regarding the use of technology and a description of any further research that needs to be completed before a decision regarding the use of technology can be made. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 6. Citation: Minnesota Statues, section 245D.071, subdivision 4. Violation: For two persons whose records were reviewed (P2 and P3), the license holder did not meet the requirements for intensive support services regarding outcome and support development as required. The license holder failed to document the supports and methods to be implemented to support P2 and P3 and accomplish outcomes related to acquiring, retaining, or improving skills and physical, mental, and emotional health and well-being. This documentation must include: · methods or actions that will be used to support the person and to accomplish the service outcomes, including information about: o any changes or modifications to the physical and social environments necessary when the service supports were provided; o any equipment and materials required; and o techniques that were consistent with the person’s communication mode and learning style; · the measurable and observable criteria for identifying when the desired outcomes had been achieved and how data would be collected; · the projected starting date for implementing the supports and methods and the date by which progress towards accomplishing the outcomes would be reviewed and evaluated; and · the names of the staff or position responsible for implementing the supports and methods. Corrective Action Ordered: Within 60 days of receiving this order, you must submit documentation of the above requirements to your licensor. On an ongoing basis, you must maintain compliance as required in this subdivision. 7. Citation: Minnesota Statutes, 245D.071, subdivision 5. Violation: For one person whose record was reviewed (P2), the license holder did not meet requirements for service plan review and evaluation. a. The license holder failed to meet with P2 and P2’s case manager, and other people as identified by P2 to participate in service plan review meetings at least once per year to determine whether changes were needed to the service plan based on: · the assessment information; · the license holder's evaluation of progress toward accomplishing outcomes; or · other information provided by the support team or expanded support team. a. The license holder failed to provide P2 and P2’s team reports that: · summarized P2’s status and progress toward achieving the identified outcomes; · made recommendations; and · identified the rationale for changing, continuing, or discontinuing implementation of supports and methods identified in subdivision 4. a. The license holder failed to, at least once per year, in coordination with P2’s support team or expanded support team, meet with P2 and P2’s case manager, and other people as identified by P2 to: · discuss how technology might be used to meet the P2’s desired outcomes and include a summary of this discussion that includes a statement regarding any decision made related to the use of technology and a description of any further research that must be completed before a decision regarding the use of technology can be made in P2’s support plan addendum; and · discuss options for transitioning out of a community setting controlled by a provider and into a setting not controlled by a provider and include a summary of the discussion that includes a statement about any decision made regarding transitioning out of a provider-controlled setting and a description of any further research or education that must be completed before a decision can be made in P2’s support plan addendum. Corrective Action Ordered: Within 30 days of this order, you must: · meet with P2 and P2’s support team to: o determine whether changes are needed to the service plan; and o discuss the requirements in part “c” of this citation; and · include a summary of the discussion required in part “c” of this citation in P2’s support plan addendum. On an ongoing basis, you must maintain compliance as required in this subdivision. 8. Citation: Minnesota Statutes, section 245D.10, subdivision 4. Violation: For one person whose record was reviewed (SP3), the license holder did not inform and provide copies of the policies and procedures as required. The license holder failed to inform and provide copies of the following policies and procedures to P3 and P3’s case manager within five working days of service initiation: · grievance policy; · service suspension policy; · service termination policy; · emergency use of manual restraints; and · data privacy. Corrective Action Ordered: Within 30 days of receiving this order, you must provide P3 and P3’s case manager with a copy of the above policies. On an ongoing basis, you must maintain compliance as required in this subdivision. 9. Citation: Minnesota Rule, part 9544.0030, subpart 1. Violation: For two persons whose records were reviewed (P2 and P3), the license holder did not incorporate and evaluate positive supports strategies and person-centered planning as required. The license holder failed to implement positive support strategies and person-centered planning into service plans by: · assessing the person’s strengths, needs, and preferences to identify and create a positive support strategy; · selecting positive support strategies that: o are evidence based; o are person-centered; o are ethical; o integrate the person in the community; o are the least restrictive to the person; and o are effective; · at least every six months, evaluate with the person the identified positive support strategies, and · determine whether changes are needed in the positive support strategies used, and, if so, make appropriate changes. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 10. Citation: Minnesota Statutes, section 245D.081, subdivision 2 and 3. Violation: The license holder did not meet the requirements for program management and oversight. a. The license holder failed to ensure that the designated coordinators (SP3 and SP4) provided delivery and evaluation of services provided. See citations 1 through 9 for the designated coordinators’ failure to: · provide oversight of the license holder’s responsibilities assigned in the person’s support plan and the support plan addendum; · take the action necessary to facilitate the accomplishment of the outcomes according to the requirements in section 245D.07; · provide instruction and assistance to direct support staff implementing the support plan and the service outcomes, including direct observation of service delivery sufficient to assess staff competency; and · evaluation of the effectiveness of service delivery, methodologies, and progress on the person’s outcomes based on the measurable and observable criteria for identifying when the desired outcome has been achieved according to the requirements in section 245D.07. b. The license holder failed to ensure that the designated managers (SP5 and SP6) provided program management and oversight of the services provided. See citations 1 through 9, 11 and 12 for the designated managers’ failure to: · maintain a current understanding of the licensing requirements sufficient to ensure compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph (e), and when applicable, as identified in section 256B.04, subdivision 21, paragraph (b); · ensure the duties of the designated coordinator are fulfilled according to the requirements in subdivision 2; · evaluation of satisfaction of persons served by the program, the person's legal representative, if any, and the case manager, with the service delivery and progress towards accomplishing outcomes identified in sections 245D.07 and 245D.071, and ensuring and protecting each person's rights as identified in section 245D.04; · ensuring staff competency requirements are met according to the requirements in section 245D.09, subdivision 3, and ensuring staff orientation and training is provided according to the requirements in section 245D.09, subdivisions 4, 4a, and 5; · ensuring corrective action is taken when ordered by the commissioner and that the terms and conditions of the license and any variances are met; and · evaluating the information identified in clauses (1) to (6) to develop, document, and implement ongoing program improvements. Corrective Action Ordered: Within 60 days of receiving this order, you must submit a plan to your licensor detailing how the designated manager will provide program management and oversight of the services provided. On an ongoing basis, you must maintain compliance as required in this subdivision. 11. Citation: Minnesota Statutes, section 245D.09, subdivision 4. Violation: For two of two staff persons whose records were reviewed (SP1 and SP2), the license holder did not provide orientation training as required. The license holder failed to provide orientation training within 60 calendar days of hire to SP1 and SP2 on: · the principles of person-centered service planning and delivery and how it applies to the direct support service provided; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities. SP1 and SP2 received training on strategies to minimize the risk of sexual violence after 60 days of hire. Corrective Action Ordered: Within 30 days of receiving this order, you must provide SP1 and SP2 training on the principles of person-centered service planning and delivery and how it applies to the direct support service provided. On an ongoing basis, you must maintain compliance as required in this subdivision. 12. Citation: Minnesota Statutes, section 245D.09, subdivision 5. Violation: For two staff persons whose records were reviewed (SP1 and SP2), the license holder did not provide annual training as required. The license holder failed to provide annual training to SP1 and SP2 on the principles of person-centered service planning and delivery and how it applies to the direct support service provided. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 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. Submissions required as part of a corrective action ordered must be sent to your Licensor at: 1. By secure email at kristopher.oberg@state.mn.us; or 2. If you are unable to submit corrective action ordered securely through email, you can mail or fax using the information below: Commissioner, Department of Human Services ATTN: Kristopher Oberg Licensing Division PO Box 64242 St. Paul, MN 55164-0242 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 at 651-431-6589 as soon as possible. Kristopher Oberg, Home and Community-Based Services Licensor Licensing Division Office of Inspector General
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