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1073297 December 19, 2024 David Hancox 12600 Whitewater Dr. Ste. 100 Minnetonka, MN 55343 Report No. 202401691 Accra Care License Number: 1073297 (245D – HCBS) Dear Mr. Hancox: The Minnesota Department of Human Services (DHS), Division of Licensing, received your request for reconsideration regarding 1 of 2 citations in the Correction Order (Attachment A) issued to you on May 22, 2024. After an independent review of the record, the Commissioner has determined that there is sufficient evidence to support the citation. Reconsideration Determination Citation 2 Citation 2 was issued because the license holder did not meet the requirement of program coordination, evaluation, and oversight. a. During a maltreatment investigation the license holder stated that persons who received services from the program were responsible for the supervision of staff persons that provided their services. The license holder failed to ensure that the designated coordinators provided supervision, support, and evaluation of activities that included: · oversight of the license holder’s responsibilities assigned in the person’s support plan and support plan addendum; and · instruction and assistance to direct support staff persons implementing the support plan and the service outcomes. b. The license holder failed to ensure that the designated manager provided program management and oversight of the services provided by the license holder that include: · maintaining a current understanding of the licensing requirements sufficient to ensure compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph (e), and when applicable, as identified in section 256B.04, subdivision 21, paragraph (g); and · ensuring the duties of the designated coordinator are fulfilled according to the requirements in subdivision 2. Applicable Law Under Minnesota Statutes, section 245D.081, subdivision 1, paragraph (a), the license holder is responsible for (1) coordination of service delivery and evaluation for each person served by the program as identified in subdivision 2; and (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. Minnesota Statutes, section 245D.081, subdivision 2, paragraph (a), states: Delivery and evaluation of services provided by the license holder must be coordinated by a designated staff person. Except as provided in clause (3), the designated coordinator must provide supervision, support, and evaluation of activities that include: (1) oversight of the license holder's responsibilities assigned in the person's support plan and the support plan addendum; (2) taking the action necessary to facilitate the accomplishment of the outcomes according to the requirements in section 245D.07; (3) instruction and assistance to direct support staff implementing the support plan and the service outcomes, including direct observation of service delivery sufficient to assess staff competency. The designated coordinator may delegate the direct observation and competency assessment of the service delivery activities of direct support staff to an individual whom the designated coordinator has previously deemed competent in those activities; and (4) evaluation of the effectiveness of service delivery, methodologies, and progress on the person’s outcomes based on the measurable and observable criteria for identifying when the desired outcome has been achieved according to the requirements of section 245D.07. Minn. Stat § 245D.081, subd. 2(a). Minnesota Statutes, section 245D.081, subdivision 3, paragraph (a), states, in pertinent part: The license holder must designate a managerial staff person or persons to provide program management and oversight of the services provided by the license holder. The designated manager is responsible for the following: (1) maintaining a current understanding of the licensing requirements sufficient to ensure compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph (e), and when applicable, as identified in section 256B.04, subdivision 21, paragraph (g); (2) ensuring the duties of the designated coordinator are fulfilled according to the requirements in subdivision 2. Minn. Stat § 245D.081, subd. 3(a) Your Response You contend that the law allows for elements of supervision to include the person or their representative, and that you complied with the statutory requirements. You state that the compliance specialist’s statements are “more complicated and requires a deeper understanding of 245D rules and regulation then may have been reported during interviews conducted for said investigation.” You argue that through a signed service agreement, Accra and the person’s responsible party share supervision responsibilities and that the client and their designated representative’s involvement in staff supervision and training occurs only after Accra deems them competent. You also state DHS did not interview a 245D representative of Accra. Reconsideration Determination You did not meet the Designated Coordinator and Designated Manager requirements. The Designated Coordinator may delegate the direct observation and competency assessment of the service delivery activities of direct support staff to an individual whom the Designated Coordinator has previously deemed competent in those activities. Accra cannot delegate other Designated Coordinator responsibilities to another person. Accra is still responsible for the oversight responsibilities in statute that include: · Oversight of the license holder’s responsibilities assigned in the person’s support plan and support plan addendum; and · Instruction and assistance to direct support staff persons implementing the support plan and the service outcomes. In an interview with DHS and on reconsideration you acknowledge you delegated more than the observation and competency assessment of service delivery activities. On reconsideration you stated you delegated the training of the staff person to the client or their designated representative. The 245D Service Agreement you attached stated, the “Responsible Party, with assistance from the Agency, will train each employee to the specific needs of the client, set employee schedules, set employee expectations, and be responsible for the direct supervision of the employee and reviewing employee performance.” Although the agreement says, “with the assistance of the Agency,” during the investigation, a compliance specialist from Accra stated that Accra did not assist in supervising and training the staff person and that this was the sole responsibility of the client or designated representative. Since Accra delegated oversight of its responsibilities in the person’s support plan and support plan addendum and did not assist in the instruction and assistance to staff to implement the support plan and service outcomes, it did not meet its responsibilities of program coordination, evaluation and oversight. You contend that an interview was not conducted directly with a 245D representative. As shown above, the investigator spoke to a compliance specialist from Accra, who stated that Accra did not supervise or oversee the staff person. Disposition The Commissioner has reviewed the relevant laws and all of the information you submitted in response to the Correction Order. The record supports Citation 2, and that citation is affirmed. This is a final agency decision. Sincerely,
Kofi Montzka, Attorney Legal Counsel’s Office Office of Inspector General
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