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November 15, 2024 Paul Thao, Authorized Agent 5 Star Adult Day Center Inc 2966 White Bear Avenue North Maplewood, Minnesota 55109 License Number: 1103165 (Rule 223) CORRECTION ORDER Dear Paul Thao: On November 12, 2024, a licensing review of 5 Star Adult Day Center Inc, located at 2966 White Bear Avenue North, Maplewood, 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). Violation: For two of three participants whose records were reviewed (P2 and P3), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). The license holder failed to review P2 and P3’s IAPPs with their interdisciplinary teams, at least annually in 2024, using the individual assessment and any reports of abuse relating to the person. Repeat Violation: In an Order of License Revocation that DHS issued on June 24, 2024, you were previously found in violation of this same statute. Corrective Action Ordered: Within 30 days of receiving this order, you must review P2 and P3’s IAPPs with the person and their interdisciplinary team and document the review. On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For one participant whose record was reviewed (P1), the license holder did not include information in the participant’s written record as required.
The license holder failed to include participation reports and progress notes in P1’s record that were recorded at least monthly. Repeat Violation: In an Order of License Revocation that DHS issued on June 24, 2024, you were previously found in violation of this same rule. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subpart. 3. Citation: Minnesota Rules, part 9555.9650, item A.
The license holder failed to maintain accurate documentation of annual training for 2024 in SP1 and SP2’s personnel records. The license holder maintained documentation SP1 completed 72 hours of annual training on May 9, 2024 and May 13, 2024. Additionally, the license holder maintained documentation SP2 completed 72 hours of annual training on May 9, 2024. Repeat Violation: In an Order of License Revocation that DHS issued on June 24, 2024, you were previously found in violation of this same rule. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this item. 4. 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 P3’s record that was updated annually in 2024. Repeat Violation: In an Order of License Revocation that DHS issued on June 24, 2024, you were previously found in violation of this same rule. Corrective Action Ordered: Within 30 days of receiving this order, you must update P3’s family and social history, as applicable. On an ongoing basis, you must maintain compliance as required in this subpart. 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. 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. Desiree Tiller, Senior Human Services Licensor Licensing Division Office of Inspector General 651-431-4622
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