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October 21, 2024
Mohamed Sahal, Authorized Agent Ultimate Adult Daycare Inc 9760 Oliver Avenue North Brooklyn Park, Minnesota 55444 License Number: 1110402 (Rule 223) CORRECTION ORDER Dear Mohamed Sahal: On August 29, 2024, a licensing review of Ultimate Adult Daycare Inc, located at 1304 East Lake Street, Suite 106, 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 Rules, part 9555.9660, subpart 1. Violation: For one of three participants whose record was reviewed (P3), the license holder did not include information in the participant’s written record as required. The license holder failed to include a medical report that included a physical examination for P3 that was updated annually in 2024. Repeat Violation: In a Correction Order that DHS issued on December 20, 2022, you were previously found in violation of this same rule. Corrective Action Required: Within 30 days of receiving this order, you must maintain a physical examination for P3. On an ongoing basis, you must maintain compliance as required in this subpart. 2. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For two participants whose records were reviewed (P1 and P2), 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 and P2 that included: · short and long term objectives stated in concrete, measurable, and time specific outcomes; · the anticipated duration of the individual plan of care as written; and · provisions for quarterly review and quarterly revisions of the individual plan of care. Repeat Violation: In a Correction Order that DHS issued on December 20, 2022, you were previously found in violation of this same rule. Corrective Action Required: Withing 30 days of receiving this order, you must develop written plans of care for P1 and P2 that include the information listed above. On an ongoing basis, you must maintain compliance as required in this subpart. 3. Citation: Minnesota Rules, part 9555.9650, items A and B. Violation: For one of two staff persons whose records were reviewed (SP2) and two consultants whose records were reviewed, the license holder did not maintain a personnel record as required. a. The license holder failed to maintain documentation of annual performance evaluation in SP2’s personnel record in 2024. b. The license holder failed to maintain a copy of a signed contract or letter of appointment specifying conditions and terms of employment for the registered nurse. c. The license holder failed to maintain documentation that the dietitian under contract meets any licensure, registration, or certification requirements required to perform the services specified in the contract. Repeat Violation: In a Correction Order that DHS issued on December 20, 2022, you were previously found in violation of this same rule. Corrective Action Ordered: Within 30 days, you must: · maintain documentation of annual performance evaluations for SP2 in SP2’s personnel record; · maintain a copy of a signed contract or letter of appointment for the registered nurse specifying conditions and terms of employment; and · maintain documentation of the dietitian’s 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. 4. Citation: Minnesota Statutes, section 245A.65, subdivision 3. Violation: For one staff person whose record was reviewed (SP2), the license holder did not provide orientation to a mandated reporter as required. The license holder failed to provide SP2 the reporting requirements and definitions in sections 626.557 and 626.5572, the requirements of this section, the license holder's program abuse prevention plan, and all internal policies and procedures related to the prevention and reporting of maltreatment of individuals receiving services within 72 hours of first providing direct contact. Corrective Action Ordered: Immediately, you must provide SP2 the orientation detailed above and document the training in SP2’s personnel record. On an ongoing basis, you must maintain compliance as required in this subdivision. 5. Citation: Minnesota Rules, part 9555.9690, subpart 3. Violation: For one staff person whose record was reviewed (SP2), the license holder did not provide orientation to the center as required. The license holder failed to provide SP2 with 20 hours of orientation to the center within the employee’s first 40 hours of employment at the center, including: · at least four hours of supervised orientation before SP2 worked directly with persons at the center; · training related to the kinds of functional impairments of persons currently at the center; and · safety requirements and procedures in part 9555.9720, Corrective Action Ordered: Within 30 days of receiving this order, you must provide SP2 orientation to the center as detailed above. On an ongoing basis, you must maintain compliance as required in this subpart. 6. Citation: Minnesota Rules, part 9555.9710, subpart 7. Violation: The license holder did not offer services as required. The license holder failed to maintain a family and social history in P1 and P3’s records that was updated annually in 2024. Repeat Violation: In a Correction Order that DHS issued on December 20, 2022, you were previously found in violation of this same rule. Corrective Action Ordered: Within 30 days of receiving this order, you must updateP1 and P3’s family and social history, as applicable. . On an ongoing basis, you must maintain compliance as required in this subpart. 7. Citation: Minnesota Rules, part 9555.9720, subpart 8. Violation: The license holder did not ensure safety as required. a. The license holder failed to ensure the areas used by participants were free from peeling paint. b. The license holder failed to ensure rugs had a nonskid backing. Repeat Violation: In a Correction Order that DHS issued on December 20, 2022, you were previously found in violation of this same rule. Corrective Action Ordered: Immediately, you must ensure rugs in the center have a nonskid backing. Within 30 days of receiving this order, you must ensure areas used by participants are free from peeling paint. On an ongoing basis, you must maintain compliance as required in this subpart. 8. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (a). Violation: The license holder did not review the program abuse prevention plan (PAPP) at least annually as required. Corrective Action Ordered: Within 30 days of receiving this order, you must review your PAPP and revise the plan, if necessary, to reflect the review results. On an ongoing basis, you must maintain compliance as required in this subdivision. 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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