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December 12, 2024 CERTIFIED MAIL Cedric Key, Authorized Agent Key 360 Support Services LLC 4124 Quebec Avenue North Suite 103 New Hope, Minnesota 55427 License Number: 1090600 (Home and Community-Based Services) ORDER OF A CONDITIONAL LICENSE (EXTENDING AN EXISTING CONDITIONAL LICENSE FOR ONE YEAR) Dear Cedric Key, The Department of Human Services (DHS) is extending your license to provide Home and Community-Based Services at Key 360 Support Services LLC, 4124 Quebec Avenue North, New Hope, Minnesota on conditional status for one year, beginning December 16, 2024. This means you must meet certain conditions to maintain your license, detailed below. This order is based on your noncompliance with Home and Community-Based Services licensing requirements. Details of our findings are also provided below. Our next steps and your options are also detailed. REASON FOR THE CONDITIONAL LICENSE · December 16, 2022 Order of Conditional License 23 violations · July 25, 2023 Correction Order 1 violation · January 11, 2024 Correction Order 5 violations · June 13, 2024 Correction Order 4 violations · December 12 Order of Conditional License 7 violations, 4 repeated violations As a result of your noncompliance with licensing requirements, DHS is issuing a new Order of Conditional License to extend the existing conditional license for one year or until December 15, 2025.
1. Violation: The license holder did not provide program coordination, evaluation, and oversight as required. The license holder failed to ensure: · coordination of service delivery and evaluation for each person served by the program as identified in subdivision 2; · program management and oversight that includes evaluation of the program quality and program improvement for services provided by the license holder as identified in subdivision 3; and · corrective action was taken when ordered by the commissioner. In a correction order dated June 13, 2024, the license holder was ordered to ensure that the designated manager and/or designated coordinator provide the oversight necessary to ensure the compliance of service delivery related to service recipient rights, prohibited procedures, emergency use of manual restraints, and any other requirements of 245D and the Minnesota Positive Support Rule. The license holder was ordered to maintain weekly documentation of the review and evaluation of service delivery documents and any necessary retraining of staff persons. This corrective action was to be reviewed on site at subsequent licensing reviews by a DHS licensor. During the licensing review conducted on October 3, 2024, the license holder provided information that the required weekly review of service delivery ordered on June 13, 2024 was only conducted on September 1 and October 1. Additionally, based on the results of the review, the license holder identified numerous areas of staff retraining that was necessary; however, the license holder failed to provide the retraining of staff persons. Statute Violated: Minnesota Statutes, section 245D.081, subdivision 1, paragraph (a) and subdivision 3, paragraph (a), part (6). Repeat Violation: In a Correction Order that DHS issued on June 13, 2024, you were previously found in violation of this same statute.
2. Violation: For two persons whose records were reviewed (P1 and P2), the license holder did not exercise the protection related rights as required. The license holder failed to exercise P1 and P2’s right to receive services in a clean and safe environment. During a licensing review at community residential setting (CRS) license number 1097300 on October 2, 2024, DHS licensors observed the following conditions: · the carpet on the main floor, including the stairs, was dirty, worn, and covered with small pieces of garbage and an accumulation of dust and dirt; · the bathroom on the upper level had: o a urine odor; and o broken and missing cupboard doors and drawers and contained an accumulation of dust and dirt; · the bedroom on the lower level had: o trash on the floor; o broken blinds; and o a large hole in the wall; · the laundry area had spilled rice on the floor, an accumulation of trash and standing water; · P1’s bedroom on the upper level smelled of urine; · P1’s mattress was stained, worn, and ripped; · P1’s screen on window was broken; · the blinds throughout the upper level were broken on many windows; · the fireplace on the upper level had a significant accumulation of thick dust; · the bottom of the dishwasher was broken off and there was debris collecting in the exposed space; and · there were numerous holes in the walls throughout the house that had not been properly repaired. Statute Violated: Minnesota Statutes, section 245D.04, subdivision 3, clause (4). Corrective Action Ordered: Immediately, you must exercise and protect P1 and P2’s right to receive services in a clean and safe environment. This corrective action will be reviewed on site. On an ongoing basis, you must maintain compliance throughout your program, as required in this subdivision. 3. Violation: For one person whose record was reviewed (P1), the license holder did not meet the person’s health needs as required. The license holder was assigned the responsibility for meeting health service needs for P1. The license holder maintained a document in P1’s support plan addendum titled “[P1]’s Seizure Plan of Care.” According to the plan, the license holder was required to report any seizures to P1’s parent, case manager, and the program coordinator. Additionally, the license holder was required to complete a seizure report. A DHS licensor reviewed P1’s log notes and discovered P1 experienced a seizure on August 19, 2024. The license holder failed to meet P1’s health needs and implement “[P1]’s Seizure Plan of Care” by failing notify P1’s parent, case manager, and program coordinator and failing to complete a seizure report. Statute Violated: Minnesota Statutes, section 245D.05, subdivision 1. Corrective Action Ordered: Within 10 days of receiving this order, you must review the daily log notes for P1 for the past 12 months to identify any other seizure activity. You must follow the instructions in P1’s support plan addendum and notify P1’s parent and case manager and complete a seizure report for any unreported seizures identified, including the one mentioned above. This corrective action will be reviewed on site. On an ongoing basis, you must maintain compliance throughout your program, as required in this subdivision. 4. Violation: For one person whose record was reviewed (P2), the license holder did not meet the requirements for medication administration as required. The license holder was assigned the responsibility of medication administration for P2. The license holder failed to implement medication administration procedures to ensure that P2 received medication as prescribed. The license holder conducted reviews of P2’s medication administration records for the month of July on August 2, 2024 and for the month of August on September 6, 2024. The reviews identified a pattern of medications that were not documented as being administered. The reviews stated that it was determined that the medications were given, but not documented as administered. A DHS licensor asked the license holder how they were verifying that a medication that had not been signed off a month prior was administered, the license holder stated that they checked the bubble packs and also called the staff to ask them. Based on the DHS licensor’s observation of the bubble packs, it would not be possible to determine if a medication had been administered. A DHS licensor also asked the license holder if it was reasonable to expect that a staff person would remember giving a medication a month prior. The licensor agreed that it was not reasonable. The license holder acknowledged that the method used to review medication administration records may not accurately determine whether an error was a documentation error or an administration error. Additionally, the license holder failed to develop and implement a plan to correct patterns of medication administration errors, including documentation errors. Statute Violated: Minnesota Statutes, section 245D.05, subdivisions 2 and 3. Repeat Violation: In a Conditional Order that DHS issued on December 16, 2023, you were previously found in violation of this same statute. Corrective Action Ordered: Within 30 days of receiving this order, you must: · assign either the designated manager or the designated coordinator to review P1’s and P2’s medication administration records for the months of June 2024 through November 2024 for errors; o if errors are determined, you must report the medication errors as required; and o you must maintain documentation of this review; and · retrain all staff responsible on medication administration and your safe medication administration policy and maintain documentation of this retraining. Throughout the duration of your conditional license, you, your designated coordinator, or your designated manager must conduct weekly medication administration record reviews to ensure that the information maintained in the medication administration record is current and to identify medication administration errors, including documentation errors. Based on the review, you must develop and implement a plan to correct patterns of medication administration errors when identified.
5. Violation: For one person whose record was reviewed (P1), the license holder did not develop a positive support transition plan (PSTP) as required. The license holder failed to develop a PSTP for P1 in the manner prescribed by the commissioner. In the Correction Order issued by DHS on June 13, 2024, the license holder was required to review daily log notes for P1 for the past 12 months to identify any previously unreported emergency use of manual restraints (EUMRs). The license holder conducted this review on June 24, 2024 and identified numerous unreported EUMRs, including three within a 90 day time span. The license holder developed a PSTP for P1 on September 27, 2024. Therefore, the license holder failed to develop a PSTP for P1 within 30 days of discovering the need for a PSTP, which is the manner prescribed by the commissioner. Statute Violated: Minnesota Statutes, section 245D.06, subdivision 8.
Corrective Action Ordered: On an ongoing basis, you must ensure that all EUMRs are reviewed to meet compliance with this subdivision. 6. Violation: For one person whose records were reviewed (P1), the license holder did not prohibit the use of a behavioral or therapeutic program to reduce or eliminate behavior or as punishment as required. The license holder developed an outcome for P1 that included the opportunity for P1 to earn a desired item. In daily log notes for P1, there were entries on July 12, 2024 and August 13, 2024 that described staff persons taking away the desired item and threatening to take away the desired item as a result of an undesired behavior. The license holder failed to ensure the protection standards for P1 when staff persons implemented the prohibited procedure of using punishment of any kind. Statute Violated: Minnesota Rules, part 9544.0060, subpart 2. Repeat Violation: In a Correction Order that DHS issued on June 13, 2024, you were previously found in violation of this same rule. Corrective Action Ordered: Immediately upon receiving this order, you must discontinue the use of prohibited procedures. Within 30 days of receiving this order, you must: · revise the supports and methods used to support P1 in achieving their outcome, to include positive support strategies; · retrain all staff persons on how to implement P1’s outcomes using the supports and methods identified and maintain documentation of the retraining; and · retrain all staff persons on the prohibited procedures identified in Minnesota Rule 9544.0060. On an ongoing basis, you must maintain compliance with this rule. 7. Violation: For two persons whose records were reviewed (P1 and P2), the license holder did not report and review the use of a restrictive intervention as required. Daily log notes recorded by the program for P1 and P2 described an incident that occurred on August 24, 2024 that resulted in the use of an EUMR for P1 and P2. The license holder failed to submit a behavior intervention report form for P1 and P2 to the commissioner for this incident. Additionally the license holder failed to: · have the staff person who implemented the emergency use report in writing to the designated coordinator the following information about the emergency use: o the staff and persons receiving services who were involved in the incident leading up to the emergency use of manual restraint; o a description of the physical and social environment, including who was present before and during the incident leading up to the emergency use of manual restraint; o a description of what less restrictive alternative measures were attempted to de-escalate the incident and maintain safety before the manual restraint was implemented that identifies when, how, and how long the alternative measures were attempted before manual restraint was implemented; o a description of the mental, physical, and emotional condition of the person who was restrained, and other persons involved in the incident leading up to, during, and following the manual restraint; o whether there was any injury to the person who was restrained or other persons involved in the incident, including staff, before or as a result of the use of manual restraint; and o whether there was a debriefing with the staff, and, if not contraindicated, with the person who was restrained and other persons who were involved in or who witnessed the restraint, following the incident and the outcome of the debriefing. If the debriefing was not conducted at the time the incident report was made, the report should identify whether a debriefing is planned; · complete and document an internal review of each report of emergency use of manual restraint. The review must include an evaluation of whether: o the person's service and support strategies developed according to sections 245D.07 and 245D.071 need to be revised; o related policies and procedures were followed;the policies and procedures were adequate; o there is a need for additional staff training; o the reported event is similar to past events with the persons, staff, or the services involved; and o there is a need for corrective action by the license holder to protect the health and welfare of persons; · consult with the expanded support team following the emergency use of manual restraint to: o discuss the incident reported in subdivision 5, to define the antecedent or event that gave rise to the behavior resulting in the manual restraint and identify the perceived function the behavior served; and o determine whether the person's support plan addendum needs to be revised according to sections 245D.07 and 245D.071 to positively and effectively help the person maintain stability and to reduce or eliminate future occurrences requiring emergency use of manual restraint; and · submit the following to the Department of Human Services, and the Office of the Ombudsman for Mental Health and Developmental Disabilities, as required under section 245.94, subdivision 2a: o the report required under subdivision 5; o the internal review and the corrective action plan required under subdivision 6; and o the summary of the expanded support team review required under subdivision 7. Statute Violated: Minnesota Rules, part 9544.0110 and Minnesota Statutes, section 245D.061, subdivisions 5, 6, 7, and 8. Repeat Violation: In a Correction Order that DHS issued on June 13, 2024, you were previously found in violation of this same rule. Corrective Action Ordered: Within 10 days of receiving this order, you must review the daily log notes for P1 and P2 for the months of June through November. You must complete reports and reviews detailed above and use the behavior intervention reporting form to report any emergency use of manual restraints, including the one mentioned above. This corrective action will be reviewed on site. On an ongoing basis, you must maintain compliance throughout your program, as required in this subdivision. CONDITIONAL LICENSE TERMS In addition to the Home and Community-Based Services licensing rules and statutes, you are required to comply with the following terms: 1. You may not admit new participants to your program from the date of this order until you have successfully demonstrated to DHS compliance with the terms of the conditional license and have maintained substantial compliance with all licensing standards. Admission of any new participant during the duration of the conditional license is only allowed with prior approval from DHS. 2. You must provide written notification of the extension of your conditional status of your license to all current and prospective service recipients and their legal representatives and case managers. The notification must include an offer to provide a copy of the Order of Conditional License upon request. Within 30 days of receiving this order, you must provide your DHS licensor with documentation of who was provided with the written notice and the date the written notice was provided. YOUR RIGHT TO REQUEST RECONSIDERATION You have the right to request reconsideration of this order and the cited violations. Your request must: · Be in writing · List each violation you are challenging and identify what is inaccurate or incomplete about the information in the order · Supply information that is accurate or more complete · Be made before the deadlines provided below If you are mailing your request, it must be received by DHS within 20 calendar days from when you received this order. If you do not meet this deadline, you lose your right to request reconsideration. The timeline to appeal began when you received this order. Please send it to: Commissioner, Department of Human Services Office of Inspector General Licensing Division Attention: Legal Unit PO Box 64242 St. Paul, MN 55164-0242 If your request is being personally delivered, it must be received by DHS within 20 calendar days from when you received this order. Please bring it to: Commissioner, Department of Human Services Office of Inspector General Licensing Division Attention: Legal Unit 444 Lafayette Road North St. Paul, MN 55155 Legal authority for this licensing action · This action is taken under Minnesota Statutes, section 245A.06, subdivision 1. · Home and community-based services are required to follow Minnesota Statutes, chapters 245A, 245C, and 245D and Minnesota Rules, chapter 9544. · The timeline to request reconsideration of the order is provided in Minnesota Statutes, section 245A.06, subdivision 2. · If a license holder files a timely reconsideration request, the terms of the conditional license are stayed pending a decision by DHS under Minnesota Statutes, section 245A.06, subdivision 4. · Minnesota Statutes, section 245A.06, subdivision 3 states that DHS may impose additional licensing actions against a license holder that does not correct the violations cited in a conditional license order Questions If you have any further questions regarding this matter, you may contact Brittany Raddatz, HCBS Unit Supervisor, at 651-431-6591. Sincerely,
Brittany Raddatz, HCBS Unit Supervisor Licensing Division Office of Inspector General
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