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March 24, 2025 Robert Sweeney, Authorized Agent Progressive Living, Inc. 832 North Second Street Mankato, Minnesota 56001 License Number: 1068675 (245D – HCBS) CORRECTION ORDER Dear Robert Sweeney: Between January 15, 2025, and January 17, 2025, a licensing review of Progressive Living, Inc., located at 832 North Second Street, Mankato, Minnesota, was conducted to determine compliance with state and federal laws and rules governing the provision of home and community-based services to persons with disabilities and age 65 and older under Minnesota Statutes, Chapter 245D. 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 245D.04, subdivision 3, paragraph (c). Violation: For three persons whose records were reviewed (P1, P3, and P4), the license holder did not document and implement the restriction of a person’s rights as required. a. The license holder maintained rights restriction documentation in P1’s support plan addendum that restricted P1’s right to have daily, private access to a non-coin operated telephone. This right is afforded to persons residing in a residential site or where the license holder is the owner, lessor, or tenant of the residential site. P1 lived in their own home and was not receiving residential services from the license holder. The license holder restricted P1’s access to P1’s cell phone. The license holder failed to document the following to restrict P1’s access to their personal possessions: · the justification for the restriction based on an assessment of P1’s vulnerability related to exercising the right without restriction; · the objective measures set as conditions for ending the restriction; · a schedule for reviewing the need for the restriction based on the conditions for ending the restriction to occur semiannually from the date of initial approval, at a minimum, or more frequently if requested by P1's legal representative, and case manager; and · signed and dated approval for the restriction from P1's legal representative. A restriction may be implemented only when the required approval has been obtained. b. The license holder documented restrictions to P3’s rights to: · have daily, private access to and use of a non-coin-operated telephone for local calls and long-distance calls made collect or paid for by P3; · access to P3’s personal possessions at any time, including financials resources; and · personal privacy, including the right to use the lock on P3’s bedroom or door unit. The license holder failed to document objective measures set as conditions for ending each of these restrictions. c. The license holder documented a restriction to P4’s right to access personal possessions at any time. The license holder failed to document: · the justification for the restriction based on an assessment of P4's vulnerability related to exercising the right without restriction; and · the objective measures set as conditions for ending the restriction. Additionally, the license holder failed to exercise P4’s right to have free access to common areas in the residence. On January 17, 2025, DHS licensors observed the laundry room was locked and was not freely accessible to persons served at Community Residential Settings (CRS) licenses 1107958. Corrective Action Ordered: Immediately, you must: · discuss with P1’s team whether a restriction of P1’s rights is necessary to ensure the health, safety, and well-being of the person; · immediately cease the restriction of P1’s rights if the rights restriction is not necessary to ensure the health, safety, and well-being of the person; · if it is determined a rights restriction is necessary for P1, you must document the above-mentioned information in P1’s support plan addendum; · document P3’s, and P4’s rights restrictions, including all above mentioned areas; and · restore P4’s right to have use and free access to common areas in the residence. On an ongoing basis, you must maintain compliance as required in this subdivision. 1. Citation: Minnesota Statutes, section 245D.05, subdivision 1, paragraph (b). Violation: For three persons whose records were reviewed (P1, P3, and P4), the license holder did not meet the requirements for health needs as required. a. The license holder was responsible for meeting P1’s health needs. The license holder failed to maintain documentation on how P1’s health needs would be met including a description of the procedures the license holder would follow in order to: · provide medication administration according to this chapter, including P1’s injectable medication and pro re nata (PRN) psychotropic medication; and · use medical equipment safely and correctly according to written instructions from a licensed health professional, including P1’s continuous positive airway pressure (CPAP) machine. b. The license holder was assigned responsibility for medication set-up for P3. The license holder failed to maintain documentation on how P3’s health needs would be met including a description of the procedures the license holder would follow in order to provide: · medication set-up; and · medication administration, including the administration of P3’s PRN psychotropic medications. c. The license holder was assigned responsibility for meeting P4’s health needs. The license holder failed to maintain documentation on how P4’s health needs would be met including a description of the procedures the license holder would follow in order to provide medication administration according to this chapter, including how to administer P4’s PRN psychotropic medications. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain a description of how P1’s, P3’s, and P4’s health needs will be met as detailed above. On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section 245D.05, subdivision 1a. Violation: For two persons whose records were reviewed (P1 and P3), the license holder did not meet the requirements for medication setup as required. The license holder was assigned responsibility for medication setup for P1 and P3. The license holder failed to document the dates of setup in P1’s and P3’s medication administration records (MAR). Corrective Action Ordered: Within 30 days of receiving this order, you must document the dates of setup in P1’s and P3’s MARs. On an ongoing basis, you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Statutes, section 245D.06, subdivision 5. Violation: For one person whose record was reviewed (P1), the license holder failed to prohibit the use of prohibited procedures as required. Minnesota Statutes, section 245A.02, subdivision 5a defines "Deprivation procedure" as the removal of a positive reinforcer following a response resulting in, or intended to result in, a decrease in the frequency, duration, or intensity of that response. Oftentimes the positive reinforcer available is goods, services, or activities to which the person is normally entitled. The removal is often in the form of a delay or postponement of the positive reinforcer. The license holder maintained documentation in P1’s support plan addendum that stated staff were to remove P1’s personal items, including CDs, DVDs, sweatshirt strings, etc. for a minimum of 72 hours if P1 presented an unsafe behavior. The license holder failed to prohibit the use of a deprivation procedure for a behavioral program when the license holder removed P1’s personal items for a period of time after having an unsafe behavior. Corrective Action Ordered: Immediately upon receiving this order, you must discontinue the use of prohibited procedures for P1. If removal of an object is approved by P1’s expanded support team, it must be temporary according to 9544.0050 and documented in P1’s support plan addendum. On an ongoing basis, you maintain compliance as required. 5. Citation: Minnesota Statutes, section 245D.07, subdivision 1a. Violation: For one person whose records were reviewed (P3), the license holder did not provide services in response to P3’s identified needs, interests, preferences, and desired outcomes as specified in the support plan and support plan addendum as required. P3’s interests were identified in P3’s support plan as doing artwork, animals, cooking and looking up recipes. The license holder identified P3’s outcome as “[P3] will learn how to keep [his/her] room organized according to the task sheet.” The license holder failed to use information consistent with the principals of person-centered service planning and delivery to identify outcomes P3 desired. Corrective Action Ordered: Within 30 days of receiving this order, you must meet with P3’s expanded support team to review and revise P3’s support plan addendum to ensure it includes person-centered planning and delivery that identifies and supports what is important to P3 as well as what is important for P3 and use the information to identify outcomes P3 desires. On an ongoing basis, you must maintain compliance as required in this subdivision. 6. Citation: Minnesota Statutes, section 245D.071, subdivision 3. Violation: For one person whose record was reviewed (P1), the license holder did not complete assessments as required. P1’s self-management assessment documented an inability for P1 to self-manage their allergies and staff were responsible for all medication administration. It was confirmed by the license holder at the time of the review that P1 can self-manage the epi-pen injection. The license holder failed to complete accurate assessments for P1 on P1’s ability to self-manage self-administration of medication. Corrective Action Ordered: Within 30 days upon receiving of this order, you must revise P1’s self-management assessment to reflect the above information regarding P1’s ability to self-manage the epi-pen injection. On an ongoing basis, you must maintain compliance as required in this subdivision. 7. Citation: Minnesota Statutes, section 245D.071, subdivision 4, paragraph (b). Violation: For two persons whose records were reviewed (P3 and P4), the license holder did not meet the requirements for service outcomes and supports as required. The license holder documented multiple outcomes for P3 and P4. The license holder failed to document any changes or modifications to the physical and social environments when services were provided in P3 and P4’s supports and methods for each outcome. Corrective Action Ordered: Within 30 days of receiving this order, you must document any changes or modifications to the physical and social environment when services are provided for each of P3 and P4’s outcomes. On an ongoing basis, you must maintain compliance as required in this subdivision. 8. Citation: Minnesota Statutes, section 245D.071, subdivision 5, paragraphs (b) and (g). Violation: For two persons whose records were reviewed (P3 and P4), the license holder did not complete service plan review and evaluation as required. a. The license holder met with P3, P3’s legal representative and P3’s case manager on October 15, 2024, to discuss how technology might be used to meet P3’s desired outcomes. The license holder failed to include a summary of this discussion in P3’s support plan addendum. b. In reports dated October 2024 that the license holder completed for P3 and P4 the license holder failed to identify the rationale for changing, continuing or discontinuing implementation of P3’s and P4’s supports and methods identified in Minnesota Statutes, section 245D.071, subdivision 4. Corrective Action Ordered: Within 30 days of receiving this order, you must document in P3’s support plan addendum a summary of the discussion on how technology might be used to meet P3’s desired outcomes. The summary must include: · a statement regarding any decision made related to the use to technology; and · description of any further research that must be completed before a decision regarding the use of technology can be made On an ongoing basis, you must maintain compliance as required in this subdivision. 9. Citation: Minnesota Statutes, section 245D.09, subdivision 4. Violation: For four of eight staff persons whose records were reviewed (SP3, SP4, SP5, and SP7), the license holder did not provide orientation to program requirements as required. a. The license holder failed to provide SP3, SP4, and SP5 orientation on strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent and bodily autonomy of people with disabilities within 60 days of hire. · SP3’s date of hire was December 28, 2022. The license holder failed to provide this training to SP3 as of the date of the licensing review. · SP4’s date of hire was March 29, 2022. The license holder provided SP4 the required training on August 1, 2023. · SP5’s date of hire was January 14, 2021. The license holder provided SP5 the required training on September 7, 2021. b. SP7’s date of hire was on August 22, 2024. The license holder failed to provide SP7 the following orientation within 60 days of hire: · sections 245A.65, 245A.66, and 626.557 and chapter 260E governing maltreatment reporting and service planning for children and vulnerable adults, and staff responsibilities related to protecting persons from maltreatment and reporting maltreatment. This orientation must be provided within 72 hours of first providing direct contact services and annually thereafter according to section 245A.65, subdivision 3; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of peoples with disabilities. Corrective Action Ordered: Within 30 days of receiving this order, you must provide SP3 with the above-mentioned training and document the training in SP3’s personnel record. On an ongoing basis, you must maintain compliance as required in this subdivision. 10. Citation: Minnesota Statutes, section 245D.09, subdivision 4a. Violation: For three staff persons whose records were reviewed (SP2, SP3, and SP4), the license holder did not provide orientation to individual service recipient needs as required. The license holder failed to provide SP2, SP3, and SP4 with orientation to individual service recipient needs before having unsupervised contact with persons served by the program. · SP2’s first date of unsupervised contact with persons served by the program was on October 9, 2023. The license holder failed to provide this training to SP2 as of the date of the licensing review. · SP3’s first date of unsupervised contact with persons served by the program was on December 31, 2022. The license holder provided SP3 the required orientation on February 15, 2023. · SP4’s first date of unsupervised contact with persons served by the program was on April 13, 2022. The license holder provided SP4 the required orientation on December 1, 2022. Corrective Action Ordered: Within 30 days of receiving this order, you must provide SP2 with the above-mentioned training. You must ensure that all current direct support staff are provided orientation to individual service recipient needs as required. On an ongoing basis, you must maintain compliance as required in this subdivision. 11. Citation: Minnesota Statutes, section 245D.09, subdivision 5. Violation: For two staff persons whose records were reviewed (SP3 and SP6), the license holder did not provide annual training as required. Minnesota Statutes, section 245A.02, subdivision 2b defines “annual” or “annually” as prior to or within the same month of the subsequent calendar year. a. The license holder failed to provide SP3 with the following training annually in 2024: · data privacy requirements according to sections 13.01 to 13.210 and 13.45, the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff responsibilities related to complying with data privacy practices. The license holder most recently provided SP3 this training in January 2023, and December 2024; and · the service recipient rights and staff responsibilities related to ensuring the exercise and protection of those rights according to the requirements in section 245D.04. The license holder most recently provided SP3 this training in January 2023, and December 2024. b. The license provided the following annual trainings to SP6: · data privacy requirements according to sections 13.01 to 13.10 and 13.46, the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff responsibilities related to complying with data privacy practices. The license holder provided annual training to SP6 in March 2022, and February 2023; · service recipient rights and staff responsibilities related to ensuring the exercise and protection of those rights according to the requirements in section 245D.04. The license holder provided annual training to SP6 in February 2022, and November 2024; · sections 245A.65, 245A.66, and 626.557 and chapter 260E governing maltreatment reporting and service planning for children and vulnerable adults, and staff responsibilities related to protecting persons from maltreatment and reporting maltreatment. This orientation must be provided within 72 hours of first providing direct contact services and annually thereafter according to section 245A.65, subdivision 3. The license holder provided annual training to SP6 in December 2023, and November 2024; · the principles of person-centered service planning and delivery as identified in section 245D.07, subdivision 1a, and how they apply to direct support service provided by the staff person. The license holder provided annual training to SP6 in August 2023, and July 2024; · the safe and correct use of manual restraint on an emergency basis according to the requirements in section 245D.061 or successor provisions, and what constitutes the use of restraints, time out, and seclusion, including chemical restraint. The license holder provided annual training to SP6 in April 2021, June 2023, and March 2024; · staff responsibilities related to prohibited procedures under section 245D.06, subdivision 5, or successor provisions, why such procedures are not effective for reducing or eliminating symptoms or undesired behavior, and why such procedures are not safe. the license holder provided annual training to SP6 in September 2023 and August 2024; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities. the license holder provided annual training to SP6 in July 2023 and June 2024. Corrective Action Ordered: Within 30 days of receiving this order, you must: · provide SP3 with training on data privacy practices and service recipient rights and staff responsibilities related to ensuring the exercise and protection of those rights; and · provide SP6 with training on data privacy practices. On an ongoing basis, you must maintain compliance as required in this subdivision. 12. Citation: Minnesota Statutes, section 245D.095. Violation: For six staff persons whose records were reviewed (SP2-SP7), the license holder did not maintain a personnel record as required. The license holder failed to maintain documentation in SP2’s-SP7’s personnel records that included the number of hours of training per subject area and the name of the trainer or instructor for each required training subject area. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 13. Citation: Minnesota Statutes, 245A.65, subdivision 3. Violation: For four staff persons whose records were reviewed (SP3, SP4, SP5, and SP8), the license holder did not provide orientation training on the license holder’s program abuse prevention plan (PAPP) as required. The license holder failed to provide SP3, SP4, SP5 and SP8 orientation to the PAPP within 72 hours of first providing direct contact services. · The license holder maintained a personnel record for SP3 that documented their date of first contact with persons served by the program as December 31, 2022. The license holder provided SP3 orientation to the PAPP on September 13, 2024. · The license holder maintained a personnel record for SP4 that documented their date of first contact with persons served by the program was April 9, 2022. SP4's personnel record documents they reviewed orientation to the PAPP on December 1, 2022. · The license holder maintained a personnel record for SP5 that documented their date of first contact with persons served by the program as January 28, 2021. SP5's personnel record documents they received orientation on the PAPP on April 19, 2021. · The license holder maintained a personnel record for SP8 that documented their date of first contact with persons served by the program as November 12, 2024. SP2’s personnel record documents they received orientation to the PAPP on December 4, 2024. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 14. Citation: Minnesota Statutes, section 245C.04, subdivision 1, paragraph (g). Violation: For one staff whose record was reviewed (SP6), the license holder did not complete background studies as required. SP6 began a position allowing direct contact with persons served by the program on August 4, 2016. SP6’s background study was completed and cleared in NETStudy. The license holder did not import the background study for SP6 into NETStudy 2.0. The license holder completed a new background study for SP6 on February 10, 2023. Under Minnesota Statutes, section 245A.07, subdivision 3, paragraph (d), except for background study violations involving the failure to comply with an order to immediately remove an individual or an order to provide continuous, direct supervision, the Commissioner shall not issue a fine to a license holder who self-corrects a background study violation before the Commissioner discovers the violation. A license holder who has previously exercised the provisions of this paragraph to avoid a fine for a background study violation may not avoid a fine for a subsequent background study violation unless at least 365 days have passed since the license holder self-corrected the earlier background study violation. Corrective Action Ordered: You must comply with the background study requirements in Minnesota Statutes, chapter 245C. If you fail to correct the violations specified in the Correction Order within the prescribed time lines the Commissioner may issue an Order of Conditional License or may impose a fine and order other licensing sanctions pursuant to Minnesota Statutes, sections 245A.06 and 245A.07. 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. Dylan Sobota, HCBS Licensor Licensing Division Office of Inspector General 651-431-2690
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