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November 21, 2024 Va Wendy Xiong, Authorized Agent Wellness Adult Day Services Inc. 689 Dale Street North License Number: 1059415 (Rule 223) CORRECTION ORDER Dear Va Wendy Xiong: On October 27, 2024, a licensing review of Wellness Adult Day Services located at 689 Dale Street North, Saint Paul, 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.
a. The license holder failed to review P2 and P3’s IAPP quarterly as part of the review of the program plan or service plan. b. The license holder failed to review P1, P2 and P3’s IAPPs with their interdisciplinary team, at least annually in 2023, using the individual assessment and any reports of abuse relating to P1, P2 or P3.
2. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For two participants whose records were reviewed (P1and P2), the license holder did not include information in the participant’s written record as required. The license holder failed to include the following information in P1 and P2’s record: · an application form that included P1’s source of referral; and · a medical report, dated within the three months prior to or 30 days after P1 and P2’s admission to the center signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on a physical examination, updated annually; o a medical history of P1 and P2; o indication of dietary restrictions and medication regimen, including the need for medication assistance, that apply to P1 and P2; o a release signed by the physician indicating whether P1 and P2 may engage in a structured exercise program; and o documentation that P1 and P2 were free of communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants. Corrective Action Ordered: Within 30 days of receipt of this order, you must maintain all information detailed above in P1 andP2’s participant record. On an ongoing basis, you must maintain compliance as required in this subpart. 3. Citation: Minnesota Rules, part 9555.9700, subpart 2.
The license holder failed to conduct a needs assessment for P1 that addressed P1’s physical status, determined by observation, from the intake screening interview, and from the medical report received from P1’s physician. Corrective Action Ordered: Within 30 days of receipt of this order, you must update P1’s needs assessment to include P1’s physical status based on information received from P1’s medical report. On an ongoing basis, you must maintain compliance as required in this subpart. 4. Citation: Minnesota Rules, part 9555.9700, subpart 3.
The license holder failed to include provisions for quarterly review and quarterly revisions of the individual plan of care for P2 and P3. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subpart. 5. Citation: Minnesota Rules, part 9555.9650, item A.
The license holder failed to maintain documentation of an annual performance evaluation in SP2’s personnel record in 2023. Corrective Action Ordered: Within 30 days of receiving this order, you must complete a performance evaluation for SP2 and maintain documentation of the evaluation in SP2’s personnel record. On an ongoing basis, you must maintain compliance as required in this item. 6. Citation: Minnesota Rules, part 9555.9690, subpart 4. Violation: For one staff person whose record was reviewed (SP2), the license holder did not provide in-service training annually as required. The license holder failed to provide SP2 a minimum of eight hours of in-service training annually in areas related to care of center participants, including provision of medication assistance, and review of parts 9555.9600 to 9555.9730 in 2023 and 2024. Corrective Action Ordered: Within 30 days of receiving this order, you must provide the required in-service training detailed above to SP2. On an ongoing basis, you must maintain compliance as required in this subpart.
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. Kristopher Oberg, HCBS Human Services Licensor Licensing Division Office of Inspector General 651-431-6589
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