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November 27, 2024
Sahra Mohmoud, Authorized Agent Nicollet Adult Center Inc 425 20th Avenue Northeast Minneapolis, Minnesota 55418 License Number: 1116161 (Rule 223) CORRECTION ORDER Dear Sahra Mohmoud: On October 14, 2024, a licensing review of Nicollet Adult Center Inc, located at 2614 Nicollet Avenue, 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.02, subdivision 2a and Minnesota Rules, part 9555.9710, subpart 6. Violation: The license holder did not provide adult day services and offer daily program activities as required. "Adult day care," "adult day services," and "family adult day services" means a program operating less than 24 hours per day that provides functionally impaired adults with an individualized and coordinated set of services including health services, social services, and nutritional services that are directed at maintaining or improving the participants' capabilities for self-care. Adult day care, adult day services, and family adult day services do not include programs where adults gather or congregate primarily for purposes of socialization, education, supervision, caregiver respite, religious expression, exercise, or nutritious meals. Although the license holder had a monthly plan for diversified daily program activities, the license holder failed to implement the plan. At the time of the licensing review from 9am to 12:00pm, DHS licensors observed participants sleeping or resting on chairs and couches and eating a snack. There was no staff facilitation or assistance with activities. The authorized agent stated participants did not want to engage in exercise because the licensors were present. Corrective Action Ordered: Immediately, you must provide adult day services and offer daily program activities as required. On an ongoing basis, you must maintain compliance as required in this subdivision and subpart. 2. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For two of two participants whose records were reviewed (P1 and P2), the license holder did not include information in the participant’s written record as required. a. The license holder failed to include the following information in P1’s record: · an application formed signed by P1 that included: o P1’s telephone number; o the name and telephone number of the person to call in case of an emergency involving P1 and the name and number of another person to call if that person cannot be reached; and o the name and telephone number of P1’s physician or medical provider; · a medical report, dated within the three months prior to or 30 days after P1’s admission to the center signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician. P1 was admitted on June 1, 2024, and the license holder maintained a medical report for P1 on September 25, 2024, that was signed by a physician’s assistant. b. The license holder failed to include the following information in P2’s record: · an application formed signed by P2 that included: o P2’s telephone number; and o the name and telephone number of a second person to call in case of an emergency involving P2 if the first person cannot be reached. · a medical report, dated within the three months prior to or 30 days after P2’s admission to the center signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician. P2 was admitted on June 1, 2024, and the license holder maintained a medical report for P2 on September 30, 2024, that was signed by a nurse practitioner. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain all information detailed above in P1 and P2’s participant record. 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 (SP1) and one consultant whose records were reviewed, the license holder did not maintain personnel files as required. a. The license holder failed to maintain documentation of an annual performance evaluation in SP1’s personnel record in 2024. SP1 was hired in April 2023. b. The license holder failed maintain a personnel file for the registered nurse that included a copy of a singed contract or letter of appointment specifying conditions and terms of employment. Corrective Action Ordered: Within 30 days of receiving this order, you must: · complete a performance evaluation for SP1 and maintain documentation of the evaluation in SP1’s personnel record; and · maintain a personnel file for the registered nurse that includes a copy of a signed contract or letter of appointment specifying conditions and terms of employment. 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 provide orientation to a mandated reporter as required. The license holder failed to provide SP2 orientation to 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 service within 72 hours of first providing direct contact. SP2’s first direct contact with individuals receiving services was May 11, 2024, however, SP2 received orientation to the reporting requirements and definitions on May 24, 2024. Corrective Action Ordered: 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 (SP1), the license holder did not provide orientation to the center as required. The license holder failed to provide SP1 with 20 hours of orientation to the center within the employee’s first 40 hours of employment at the center. SP1 was hired in April 2023 and completed their orientation to the center May 2024. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subpart. 6. Citation: Minnesota Rules, part 9555.9690, subpart 4. Violation: For one staff person whose record was reviewed (SP1), the license holder did not provide in-service training annually as required. The license holder failed to provide SP1 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 2024. Corrective Action Ordered: Within 30 days of receiving this order, you must provide the required in-service training detailed above to SP1. On an ongoing basis, you must maintain compliance as required in this subpart. 7. Citation: Minnesota Rules, part 9555.9720, subparts 7, 8, and 9. Violation: The license holder did not ensure safety as required. a. The license holder failed to ensure equipment was in good repair, including: · a door with a large hole in it; and · bathroom sink that was detaching from the wall. b. The license holder failed to ensure the areas used by participants were free from debris and litter, including: · damaged ceiling tiles; · several tv’s leaning against walls; · extra rugs, boxes, and other debris in the quiet room; · pill bottle laying on ottoman by the couch; and · soiled toilet paper and garbage on bathroom floor. c. The license holder failed to ensure plans for emergencies caused by fire, blizzards, and tornadoes were posted in a visible place in the center. Corrective Action Ordered: Within 30 days of receiving this order, you must ensure equipment is in good repair and that areas used by participants are free from debris and litter. At the time of the licensing review, the authorized agent posted the emergency plans in a visible place within the center, therefore, no further corrective action is needed. On an ongoing basis, you must maintain compliance as required in these subparts. 8. Citation: Minnesota Rules, part 9555.9730, subpart 3. 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: At the time of the review, the authorized agent changed the mechanisms that participants use to signal staff members if they need assistance. 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. Katie Johnson, HCBS Human Services Licensor Licensing Division Office of Inspector General 651-431-4113
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