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May 02, 2025 Troy Pederson, Authorized Agent Bethesda Day Break 901 Southeast Willmar Avenue License Number: 810468 (Rule 223) CORRECTION ORDER Dear Troy Pederson: On April 9, 2025, a licensing review of Bethesda Day Break located at 901 Southeast Willmar Avenue, Willmar, 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, paragraph (b) and Minnesota Rules, part 9555.9700, subpart 3. Violation: For four of four participants whose records were reviewed (P1-P4), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). a. The license holder failed to develop an IAPP for P1 and P2 that included an individualized assessment of: · the person’s susceptibility to abuse by other individuals, including other vulnerable adults; · the person’s risk of abusing other vulnerable adults; and · statements of the specific measures to be taken to minimize the risk of abuse to that person and other vulnerable adults. b. The license holder failed to review P3 and P4’s IAPPs quarterly as part of the review of the program plan or service plan. c. The license holder failed to review P3 and P4’s IAPPs with P3 and P4’s interdisciplinary teams, at least annually, using the individual assessment and any reports of abuse relating to the person.
· review P3 and P4’s IAPPs quarterly as part of the review of the program plan or service plan; and · review P3 and P4’s IAPP annually with P3 and P4’s interdisciplinary teams 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 (P1), the license holder did not include information in the participants’ written record as required. The license holder failed to maintain a medical report for P1 dated within the 3 months prior to or 30 days after P1’s admission to the center. P1 was admitted to the center July 16, 2024. The license holder maintained a medical report for P1 that was dated March 18, 2025. Repeat Violation: In a Correction Order that DHS issued on November 3, 2022, you were previously found in violation of this same rule. 3. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For two participants whose records were reviewed (P1 and P2), the license holder did not complete initial service planning as required. a. The license holder failed to · conduct a needs assessment for P1 that addressed P1’s physical status, determined by observation, from the intake screening interview, and from the medical report received from P1’s physician; and · develop a preliminary service plan for P1 that included the role of the P1’s caregiver or caregivers in carrying out the service plan. b. The license holder failed to develop a preliminary service plan for P2 that included: · transportation arrangements for getting P2 to and from the center; and · the role of P2’s caregiver or caregivers in carrying out the service plan.
· update P1’s needs assessment to include P1’s physical status based on information received from P1’s medical report; and · update P1 and P2’s preliminary service plans to include the information as detailed above. On an ongoing basis, you must maintain compliance as required in this subpart. 4. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For two participants whose records were reviewed (P1 and P2), 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 and P2 that included an update of the preliminary service plan and additional services required by the person.
5. Citation: Minnesota Rules, part 9555.9690, subpart 4. Violation: For one of three staff persons whose record was reviewed (SP3), the license holder did not provide in-service training annually as required. The license holder failed to provide SP3 in-service training annually in 2024 in areas related to care of center participants, including review of parts 9555.9600 to 9555.9730.
6. Citation: Minnesota Rules, part 9555.9720, subpart 8. Violation: The license holder did not ensure safety as required. The license holder failed to ensure the areas used by participants were free from loose plaster and peeling paint, including areas with chipped sheetrock and peeling paint within the center.
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. Alexandra Devick, HCBS Human Services Licensor Licensing Division Office of Inspector General 651-431-4626
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