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February 14, 2025 Stephanie Kalbach, Authorized Agent REM Ramsey, Inc. - Jordan 6600 France Avenue South Suite 500 Edina, MN 55435 Report No. 202405443 License Number: 1075761/1071829 (245D - HCBS) Dear Stephanie Kalbach: The Minnesota Department of Human Services (DHS), Division of Licensing, received your request for reconsideration regarding 2 of 2 citations in the Correction Order issued to you on November 7, 2024. After an independent review of the record, the Commissioner has determined that there is sufficient evidence to support the citations. Reconsideration Determination Citation 1 The license holder did not follow their policy and procedures as required. P1 and P2 were involved in an incident on June 22, 2024, that required first aid. The license holder failed to follow the facility’s first aid policy. Applicable Law A license holder providing intensive support services must establish, enforce, and maintain policies and procedures as required. Minnesota Statutes, section 245D.11, subdivision 1. Your Response You contend staff correctly followed your first aid policy because staff believed the individual had irritated skin instead of a chemical burn. You argue that staff correctly followed the policy and procedures based on the situation, and that staff would not have had the foresight or knowledge that a chemical burn was present without further medical assessment, which did not occur until two days after the incident. Reconsideration Determination Your first aid policy was not followed when staff applied the baking soda paste and did not contact a nurse or physician when the person was in pain the next day. You are correct in that staff may not have thought to apply the part of the first aid policy addressing “Burns.” However, they should have followed the “Pain Complaints” part of the policy, as staff stated the person stated s/he was in pain when the product was applied. One staff stated the person was “yelling in pain.” The “Pain Complaints” part of the policy required staff to: 1) Get a description of the pain from the person; 2) Examine the area of the pain; 3) “Administer pain medication per Standing Orders for Over-the Counter Medications list, if not contraindicated, and chart on the Medical Record”; 4) If pain continues, contact a nurse or doctor; 5) Document the status of the condition, care, and response in the person’s medical notes or the site’s format. The first aid policy was not followed because staff applied a baking soda paste when it was not in the person’s standing orders. Further, staff did not follow the first aid policy because the person was in pain the next day and they did not contact a nurse or physician. Citation 1 is affirmed. Citation 2 The license holder failed to provide program management and oversight of the services provided as required. The license holder documented in the internal review that policies and procedures were followed; however, the DHS investigation showed that the license holder’s first aid policy was not followed. The license holder did not identify this in the internal review. Applicable Law The license holder must designate a managerial staff person who ensures the program implements corrective action identified as necessary by the program following review of incident and emergency reports according to the requirements in section 245D.11, subdivision 2, clause (7). Minnesota Statutes, section 245D.081, subdivision 3, paragraph (a), clause (3). Your Response You contend that because staff would not have had the foresight or knowledge that a chemical burn was present, your internal review stating staff followed policies and procedures was correct. Reconsideration Determination Your policies and procedures were not implemented as written. Applying a baking soda paste was not allowed by any part of your first aid policy. Specifically, the “Pain Complaints” section of the first aid policy did not permit applying baking soda. It stated that only medications on the over-the counter medications list could be administered and a baking soda paste is not an over-the-counter medication, nor was it on the person’s standing orders. Further, the first aid policy stated that if pain continued, staff should contact a nurse or doctor. The person’s pain continued the next day, and a nurse or doctor was not called. It was not until two days after the incident when medical care was sought. Even if the part of the policy addressing “burns” was used it did not allow for the use of a baking soda paste. Therefore, your first aid policy was not implemented as written. Citation 2 is affirmed. Disposition The Commissioner has reviewed the relevant laws and all of the information you submitted in response to the Correction Order. Citations 1 and 2 are affirmed. This is a final agency decision. Sincerely,
James Song, Attorney Legal Counsel’s Office Office of Inspector General
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