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March 3, 2025 Tia Yang, Authorized Agent Pebmoob Senior Center 8119 26th Street North Lake Elmo, Minnesota 55042 License Number: 1041494 (Rule 223) CORRECTION ORDER Dear Nou Vang: On January 28, 2025, a licensing review of Pebmoob Senior Center located at 899 Payne Avenue, 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.
Violation: For one of four participants whose record was reviewed (P4), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP).
The license holder failed to review P4’s IAPP with the interdisciplinary team, at least annually in 2024.
Corrective Action Ordered: Within 30 days of receiving this order, you must review P4’s IAPPs with the 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 (P4), the license holder did not include information in the participant’s written record as required. The license holder failed to include an application form in P4’s record that included the name and telephone number of a secondary person to call in case of an emergency involving P4. Corrective Action Ordered: Within 30 days of receiving this order, you must update P4’s record to include the name and telephone number of a secondary person to call in case of an emergency involving P4. On an ongoing basis, you must maintain compliance as required in this subpart. 3. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For four participants whose records were reviewed (P1, P2, P3, and P4), the license holder did not develop a written plan of care as required. The license holder failed to develop a written plan of care for P1, P2, P3, and P4 that included: · an update to the preliminary service plan and additional services required by the participant; and · short and long term objectives for the person stated in concrete, measurable, and time specific outcomes. Corrective Action Ordered: Within 30 days of receiving this information, you must: · develop written plans of care for P1, P2, P3, and P4 that includes the information detailed above; · complete an audit of all participants’ written plans of care to ensure the requirements in Minnesota Rules, part 9555.9700, subpart 3 are maintained; and · for participants who do not have a written plan of care that includes all required information, you must develop a plan detailing how your program will maintain a complete written plan of care within 60 days of receiving this order. 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. Desiree Tiller, HCBS Licensor Licensing Division Office of Inspector General 651-431-4622
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