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April 22, 2025 Jody Miller, Authorized Agent Lutheran Social Services 2485 Como Avenue Saint Paul, Minnesota 55108-1445 License Number: 1069963 (245D – HCBS) 1070043 (CRS) Investigation Report Number: 202501766 CORRECTION ORDER Dear Jody Miller: On April 1, 2025, a licensing investigation of Lutheran Social Services, Georgia’s Place, located at 1968 Foxridge Road, Saint Paul, 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 investigation 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.06, subdivision 5. Violation: For one person whose record was reviewed (P1), the license holder used a prohibited procedure as a behavioral or therapeutic program to reduce or eliminate behavior. Minnesota Statutes, section 245A.02, subdivision 3b defines “chemical restraint” to mean the administration of a drug or medication to control the person’s behavior or restrict the person’s freedom of movement and is not a standard treatment or dosage for the person’s medical of psychological condition. The license holder was responsible for P1’s health needs, including administering medications. P1’s support plan stated that staff would administer his/her pro re nata (PRN) medications for anxiety or sedation prior to testing or stressful procedures. In an internal review completed by the license holder dated February 5, 2025, the license holder indicated that P1’s medication appeared to have been administered as a chemical restraint. The license holder failed to administer a medication according to their support plan and used the PRN as a behavioral or therapeutic program to reduce or eliminate behaviors on multiple dates between December 2024 and January 2025. Corrective Action Ordered: Upon completion of an internal review, the license holder updated the PRN protocol for P1 and provided re-training to all staff. On an ongoing basis, you must maintain compliance as required in this subdivision. 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 at 651-431-3661 as soon as possible. Jenna Johnson, Home and Community-Based Services Licensor Licensing Division Office of Inspector General
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