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MALTREATMENT INVESTIGATION MEMORANDUM Minnesota Statutes, section 626.557, subdivision 1 states, “The legislature declares that the public policy of this state is to protect adults who, because of physical or mental disability or dependency on institutional services, are particularly vulnerable to maltreatment.”
License Number and Program Type: 1123292-H_CRS (Home and Community-Based Services-Community Residential Setting) Investigator(s): Lindsay Arth 651-431-6537 Suspected Maltreatment Reported: It was reported that a vulnerable adult (VA) passed away while at the facility. There were concerns that a staff person (SP) did not perform supervision checks as trained; that the SP did not perform cardiopulmonary resuscitation (CPR); and that the SP called a supervisory staff person, prior to calling 9-1-1, delaying the VA’s care. Date of Incident(s): July 29, 2024 Nature of Alleged Maltreatment Pursuant to Minnesota Statutes, section 626.557, subdivision 9c, paragraph (b), and Minnesota Statutes, section 626.5572, subdivision 15, and subdivision 17, paragraph (a): The failure or omission by a caregiver to supply a vulnerable adult with care or services, including but not limited to food, clothing, shelter, health care, or supervision which is reasonable and necessary to obtain or maintain the vulnerable adult's physical or mental health or safety, considering the physical and mental capacity or dysfunction of the vulnerable adult and which is not the result of an accident or therapeutic conduct. Summary of Findings: Pertinent information was obtained during two site visits conducted on November 26 and December 6, 2024; from documentation at the facility and law enforcement records; and through three interviews conducted with a facility supervisory staff person (P1), a staff person (SP), and the VA’s family member (FM1). Attempts were made to contact and interview the VA’s case manager (CM) and the VA’s family member (FM2), but the attempts were unsuccessful. Additionally, this investigator set up a time to talk to the VA’s family member (FM3) but at the prearranged time, FM3 did not respond to this investigator's call and did not call this investigator back. The facility was one level with a finished basement. The VA’s bedroom was in the basement. Prior to April 1, 2024, the facility was licensed by the Minnesota Department of Health as an assisted living facility. The facility applied for, and was granted, an exception to the licensing moratorium for new community residential settings, and on April 1, 2024, the facility’s assisted living license was closed, and it became licensed by the Department of Human Services as a home and community-based services-community residential setting (HCBS-CRS). Any paperwork prior to April 1, 2024, was not relevant to this investigation because the paperwork/document requirements for an assisted living are different than those of a HCBS-CRS. The VA was diagnosed with bipolar disorder, anxiety disorder, depressive disorder, impulse disorder, and schizophrenia. The VA also had a history of chemical use. The VA was not subject to guardianship. The VA enjoyed spending time with his/her family members, swimming, and going on walks. The VA’s Support Plan Addendum dated April 2, 2024, signed by the VA and the CM, stated that the VA did not require a staff person who was trained on cardiopulmonary resuscitation (CPR) to be available when the VA was present. (Note: A review of the plans of the other clients who lived at the facility showed that none required a staff person who was trained on CPR.) The VA had two hours of unsupervised time at the facility and 24 hours of unsupervised time in the community. The VA had a “long” history of drug use and staff persons were to educate the VA on the importance of not using and the “dangers” associated with drug use. The VA had a phone and computer and could navigate both independently. Staff persons were to remind the VA to call 9-1-1 when s/he felt unsafe and educated and redirected the VA to not go “out” with persons s/he met online. The VA did not have any restrictions on his/her rights, including regarding visitors. In addition, there was nothing outlined in the VA’s plans regarding periodic welfare checks on the VA by staff persons. The VA’s Rights of Persons Served dated May 2, 2024, said that the VA had the right to choose to spend time with others of his/her choice and have “private” visits with them. The VA had the right to privacy, including the use of a lock on his/her bedroom door. The VA had the right to visitors with persons of his/her choosing and may do so in the privacy of his/her bedroom. There was nothing outlined in the VA’s plans regarding periodic welfare checks on the VA by staff persons when the VA had visitors. Law enforcement records and a recording of the 9-1-1 call provided the following information: · On July 29, 2024, at 7:45 p.m., the SP called 9-1-1 stating that the VA was “not responding” and CPR was “in progress.” The 9-1-1 dispatcher asked the SP if the VA was awake or sleeping and the SP said, “Sleeping.” The dispatcher then asked the SP if the VA was sleeping or unconscious and during this time, the SP stated “out loud” [Note: It did not say who the SP told this to] to “do CPR on [the VA] please.” The dispatcher asked the SP if the VA was breathing and the SP stated, “Let me check [his/her] pulse.” The dispatcher again asked the SP if the VA was breathing, including if the VA’s chest was “going up and down,” and the SP stated, “I am not sure.” · The 9-1-1 dispatcher then “patched” the SP into “North Memorial Dispatch” who asked the SP “what happened.” It was noted that “it sounded like” the SP said that s/he checked on the VA “around 6 p.m.” [Note: The SP did not arrive for his/her scheduled shift until closer to 7:15 p.m.] The “dispatch” then asked the SP if s/he had a defibrator, automated external defibrillator, or something that “shocks people” and the SP said the facility did not. The dispatch then asked the SP if s/he was near the VA and the SP said, “Yes. We are doing CPR [on the VA] right now.” The dispatch told the SP to lay the VA on the floor with nothing behind his/her head and the SP said, “Okay. Let’s put [the VA] back on the ground.” The dispatch then began to give the SP “chest compression instructions” but the 9-1-1 call “ended abruptly.” [Note: There was no information as to why the call was ended and no information that the SP or 9-1-1 called one another back. The call lasted 3 minutes and 16 seconds]. · The law enforcement report stated that law enforcement “officers arrived about one minute after receiving the call.” The SP opened the front door and law enforcement saw that the SP was on the phone. [Note: The police report did not say who the SP was talking to.] The SP then took law enforcement to the VA’s bedroom in the lower level of the facility. When law enforcement entered the VA’s bedroom, the VA was lying on his/her back on his/her bed and no one was preforming CPR on the VA. A community person (CP) (who was visiting the VA) was also present. Law enforcement checked the VA for a pulse but did not find one. · The law enforcement officer said s/he would wait for another officer to arrive and then move the VA from his/her bed to the floor to begin CPR. Once a second officer arrived, the VA was moved from his/her bed to the floor. At that time, the VA was “cold” to the touch. Law enforcement then began CPR. At some point, paramedics arrived and “took over life saving efforts.” The VA’s family members also arrived. At 8:32 p.m., the VA was pronounced deceased. The Hennepin County medical examiner’s report said that the VA’s cause of death was an accidental overdose of fentanyl and methamphetamines. · The CP told law enforcement that “a few minutes” prior to the VA’s “death,” the VA and the CP went on a walk. Once they returned, the VA inhaled “cocaine,” and then “fell asleep” in his/her bed and was “snoring.” After approximately ten minutes, the CP realized that the VA was “not breathing” and “tried” to give the VA CPR. The CP then told the SP who “confirmed” that the VA was “unconscious” and the SP called 9-1-1. The CP did not “hear” the CPR instructions from dispatch but performed “mouth to mouth” and compressions on the VA. · Additionally, the CP told a law enforcement officer that the SP had been to the VA’s bedroom ten minutes prior to the CP realizing that the VA was not breathing and at that time, the VA was snoring. However, the CP told another law enforcement officer that after about 35 to 45 minutes of the VA sleeping, the SP came downstairs and knocked on the VA’s door. The CP told the SP that the VA was sleeping so the SP did not enter the VA’s bedroom. · The SP told law enforcement that when s/he arrived at the facility at approximately 7 p.m., the VA was sleeping. · An unidentified staff person told law enforcement that the CP “continuously” told them that the VA was sleeping so they had not “physically checked on” the VA. However, at some point after, the staff person checked on the VA and found the VA “unconscious.” [Note: Information obtained showed that the SP was the sole staff person at the facility so it was most likely that the unidentified staff person was the SP.] · On August 15, 2024, law enforcement spoke to P1. P1 said that on July 29, 2024, the SP was the only staff person at the facility at the time of the incident. At 7:58 p.m., the SP called P1 to notify him/her of the incident. The SP told P1 that s/he had already called 9-1-1. P1 also told law enforcement that the SP was not a “certified first responder” and not trained in CPR. The facility policy was “only [to] call 9-1-1.” · On November 20, 2024, law enforcement again spoke to the SP about the incident. The SP said that on July 29, 2024, at 7:15 p.m., s/he arrived at the facility. A staff person (P2) was the “outgoing” staff person and P2 told the SP that the VA was in his/her bedroom with the CP. The SP then went to the VA’s bedroom and saw the VA sleeping and the CP sitting on the VA’s bed. The SP then went upstairs to check on the other clients. After approximately 15 minutes, around 7:30 p.m., the SP went back downstairs to check on the VA. At that time, the VA was “still snoring” and the CP was still sitting on the VA’s bed. The SP left the VA’s bedroom and went to do paperwork. Approximately 15 minutes later, the CP came and told the SP that the VA was “not responding.” The SP went to the VA’s bedroom, tried to wake the VA, and the CP “started CPR” on the VA. The SP went upstairs and called 9-1-1 who arrived “right away” and “took over CPR.” The SP then notified P1, who notified the VA’s family members. · The SP also told law enforcement that s/he was trained to check on the clients every two hours. However, if the clients had “visitors,” s/he was trained to check every 15 minutes. The SP denied waiting 30 to 45 minutes before checking on the VA. The SP also said that s/he was not trained on CPR and was “not sure” if anyone at the facility was trained on CPR. Law enforcement told the SP that the VA’s documents stated that the VA wanted “full resuscitation” and that the VA’s “code status was CPR.” The SP said that s/he was not “aware” that the VA’s paperwork said that the VA wanted “full resuscitation.” [Note: The VA’s documents that were related to code status were documents required when the facility was licensed as an assisted living prior to April 1, 2025. These documents were not required nor a part of the license requirements for the HCBS/CRS license.] However, the SP said that s/he told the CP to start CPR, which the CP did. The SP also “rushed” to call 9-1-1. The SP told law enforcement that the 9-1-1 operator told the SP to move the VA from his/her bed to the floor and that s/he and the CP “attempted” but were not able to because of the VA’s size and the VA’s bed was “too high.” The SP also said that although the first law enforcement officer to arrive at the facility did not see anyone doing CPR, the SP said that s/he “believed” the CP was doing CPR when the officer arrived. The SP also said that s/he was on the phone with P1 when the officer arrived. · Law enforcement sent the report to the county attorney for criminal neglect felony deprivation charges, which were pending at the time of this investigation. FM1 provided the following information: · On July 29, 2024, at approximately 7:49 p.m., P1 called and notified FM1 of the incident. At that time, FM1 was out of town but said that the VA’s family members, including FM2 and FM3, went to the facility. When FM2 and FM3 arrived, they called and told FM1 that the paramedics were “working” on the VA and at some point, FM1 was told that the VA was deceased. · FM1 believed and “felt in [his/her] heart” that the SP called P1 prior to calling 9-1-1. FM1 also said that law enforcement told him/her that P1 called 9-1-1, even though P1 was not at the facility. (Note: The 9-1-1 transcript and law enforcement records both showed that the SP called 9-1-1). Based on the time on the police report of when 9-1-1 was called to when P1 notified FM1 of the incident, FM1 thought that the SP notified P1 prior to 9-1-1 being called. [Note: Law enforcement records showed that the SP called 9-1-1 at 7:45 p.m. and that law enforcement arrived approximately one minute later (approximately 7:46 p.m.). When law enforcement arrived, the SP was on the phone and the SP told this investigator that s/he was on the phone with P1.] · Following the incident, the facility told FM1 that because the CP was at the facility, they put the VA on 15-minute checks because they did not know the CP. FM1 had concerns that the SP did not check on the VA every 15 minutes prior to the incident because an unknown client told FM2 and FM3 that “no one went downstairs to check on [the VA].” [Note: The CP and the SP each told law enforcement that the SP had gone downstairs to check on the VA.] Additionally, on July 30, 2024, FM1 went to the facility to ask for “records” of the 15-minute checks and the facility “did not have any records.” · FM1 was also concerned that the CP started CPR and not the SP and that the facility did not have Narcan available to be administered in the event of an overdose. [Note: Narcan is an over-the-counter drug that can reverse opioid overdose. Minnesota Statutes 245A (Human Services Licensing) and 245D (Home and Community Based Services Standards) does not require a HCBS-CRS to have Narcan available at the facility.] P1, the Internal Review and the Incident Report Follow Up Sheet each written by P1, provided the following information: · On July 29, 2024, around 8 p.m., the SP called P1 to let him/her know that s/he found the VA “unconscious” and called 9-1-1, who was “already” at the facility. · At approximately 8:02 p.m., P1 called FM1 to notify him/her about the VA because FM1 was the VA’s emergency contact. · P1 then called P2, who had worked prior to the SP’s shift, to get additional information. P2 told P1 that around 5 p.m., the CP came to the facility. P2 then told a supervisory staff person (P3), who was at the facility doing maintenance, who told P2 that P2 should “closely monitor” the VA because they did not know the CP. Additionally, the VA had a history of smoking in his/her room with visitors so P3 told P2 to check on the VA every 15 minutes. P2 told P1 that around 6 p.m., the VA and the CP went on a walk and returned around 6:30 or 6:45 p.m. P2 last checked on the VA at 7 p.m. and the VA was in bed “sleeping” and “snoring,” and the CP was sitting on the VA’s bed. Once the SP arrived at 7:10 p.m., P2 left because his/her shift was over. · Around 9 p.m., the SP called P1 again and said that the VA was deceased and that two supervisory staff persons and the VA’s family members were at the facility during this time. · P1 stated that the VA had two hours of unsupervised time at the facility, which was documented in the VA’s plans. Additionally, staff persons checked on the VA every 15 minutes when the VA had “visitors” because the VA had a history of smoking in his/her bedroom with them. However, because the 15-minute checks were “temporary supervision,” the 15-minute checks were not a part of the VA’s written plans. · P1 did not have any concerns regarding staff persons response to the incident and the SP documented the VA’s safety checks as s/he was trained to do, including every 15 minutes. Staff persons followed the “9-1-1 protocol” by calling 9-1-1 before notifying P1 or any other supervisory staff person. At some point, law enforcement told P1 that FM1 told them that the SP called P1 first which was “absolutely not true” and P1 did not know why FM1 thought that. · Staff persons were not trained on CPR. Some client files, including the VA’s, said that they required “full code CPR,” but that was for law enforcement and medical personnel and not staff persons. However, if a 9-1-1 operator directed a staff person to do CPR over the phone, then staff persons should “follow” the instructions. · Following the incident, the SP told P1 that the 9-1-1 operator directed him/her and the CP to move the VA to the floor and start CPR, but when they attempted to move the VA, the bed was “too high” and the VA was too “heavy.” The CP did CPR on the VA as the VA lay in bed and while the SP was on the phone with 9-1-1 and when the SP answered the door for law enforcement. (Note: The Incident Report Follow Up Sheet completed by P1 on July 29, 2024, at 9 p.m., said that the SP “called 9-1-1 right away and started CPR.”) The SP provided the following information: · On July 29, 2024, around 7:15 p.m., the SP arrived at the facility for his/her scheduled shift. P2 was at the facility and told the SP that the VA had a “visitor [the CP].” P2 then left because his/her shift was over. The SP then went downstairs to the VA’s bedroom to “check” on the VA. The VA’s bedroom door “was not closed” and the SP saw that the VA was sleeping and “snoring heavily.” The CP was also in the VA’s bedroom sitting on the VA’s bed, so the SP “greeted” the CP, and the CP told the SP that the VA was “sleeping.” The SP did not have any concerns, including because the VA had a history of snoring, so the SP went upstairs to check on the other clients. · After approximately 15 minutes, the SP went downstairs to check on the VA again and there were no concerns or changes. The VA was still in bed sleeping and snoring. The SP then went upstairs to begin his/her “daily job routine,” including doing paperwork. · At approximately 7:40 or 7:45 p.m., the CP “ran upstairs” and said that the VA was not “responding.” The SP “rushed” downstairs and saw that the VA was not responding so the SP checked the VA’s oxygen with a pulse oximeter which showed 84. The SP then “immediately” ran upstairs to call 9-1-1. The SP said that there was “no time” to check if the VA had a pulse or was breathing. The 9-1-1 operator told the SP to begin CPR, and the SP told the CP to start CPR while the SP remained on the phone with 9-1-1. The CP began CPR including compressions and mouth to mouth resuscitation. The 9-1-1 operator also told the SP and the CP to move the VA from his/her bed to the floor but when they tried to do so the VA’s bed was “high” and the VA was “heavy.” Additionally, around this time, the SP heard a “siren” so s/he “ran upstairs” to let law enforcement in and direct them to the VA’s bedroom. · Law enforcement then “took over” and the SP called P1, who said that s/he would notify FM1. At some point after, the VA’s family members and P3 came to the facility. · The VA had 15-minute checks when s/he had “visitors” at the facility. When the VA did not have “visitors,” staff persons checked on the VA every one to two hours. · The SP said s/he did as s/he was trained to do regarding the incident. The SP was also trained on the VA’s The facility Hourly Safety Visual Check Log dated July 29, 2024, showed that P2 checked on the VA at 6:39 p.m. and the VA was in his/her bedroom with a “guest.” At 7:20 and 7:35 p.m., the SP checked on the VA and the VA was “sleeping.” The Policy and Procedure on Emergencies said that to be “prepared” for emergencies, when it was “required” in a person’s Support Plan and/or Support Plan Addendum, staff persons were to be able to provide CPR. Staff persons were to call 9-1-1 for emergency situations. The Empathy Home Care Inc. 911 Protocols dated January 1, 2024, said that staff persons were to call 9-1-1 “immediately” prior to calling “anyone.” Facility documentation showed that the SP and P1 were each trained on the VA’s care plans, first-aid, the Policy and Procedure on Emergencies, and the Empathy Home Care Inc. 911 Protocols, prior to the incident. Relevant Rules and Statutes: Minnesota Statutes section 245D.06, subdivision 2, stated that a staff person was available at the service site who was trained in basic first aid and when required in a person’s support plan or support plan addendum, cardiopulmonary resuscitation (CPR), whenever staff persons were required to be at the site to provide direct support service. Minnesota Statutes section 245D.04, subdivision 3, paragraph (b), clause (4), states in part that a person’s protection related rights include the right to choose the person’s visitors and time of visits and privacy for the visits with the person’s spouse, next of kin, legal counsel, religious advisor or others in accordance with section 363A.09 of the Human Rights Act, including privacy in the person’s bedroom. Conclusion: On July 29, 2024, the CP notified the SP that the VA was not responding. The SP immediately checked the VA and then called 9-1-1. At 8:32 p.m., the VA was pronounced deceased. Concerns were raised regarding supervision checks, the SP calling 9-1-1, and the SP not doing CPR. Regarding the supervision checks: The VA’s plans said that the VA had two hours unsupervised time at the facility. Although law enforcement, the SP, FM1, and P1 said that the VA also had 15-minute checks at the time of the incident, there was nothing in the VA’s plans that required them. P1 said that the VA only had 15-minute checks when the VA had visitors, due to a history of the VA smoking in his/her bedroom when s/he had visitors. The CP provided conflicting information to law enforcement regarding the SP checking on the VA. The CP said that the SP had been to the VA’s bedroom ten minutes prior to the CP realizing that the VA was not responding and that at that time, the VA was snoring. The CP also told law enforcement that after about 35 to 45 minutes of the VA sleeping, the SP knocked on the VA’s bedroom door and the CP told the SP that the VA was sleeping, but that the SP did not enter the VA’s bedroom. The law enforcement report also showed that an unidentified staff person, most likely the SP, told them that because they thought the VA was sleeping and the CP told them so, they had not “physically checked on” the VA but at some point, they did and they found the VA “unconscious.” The SP provided consistent information to law enforcement, P1, and this investigator and in documentation that s/he checked on the VA at least twice and that each time the VA was sleeping and snoring and the CP was on the VA’s bed. Although there were concerns that the SP had not checked on the VA, that the CP provided conflicting information regarding when the SP checked on the VA, and that the SP and documentation from the SP showed that the SP checked on the VA at least twice between approximately 7:15 and 8 p.m., there was nothing in the VA’s plans that required 15 minute checks or any other welfare checks on the VA when the VA was at the facility and/or with visitors. So while it was routine practice for staff persons to conduct welfare checks, any checks conducted by the SP on the VA, were above what the VA’s plans required. Therefore, there was not a preponderance of the evidence whether there was a failure to provide reasonable and necessary care to the VA. It was not determined whether neglect occurred (the failure or omission by a caregiver to supply a vulnerable adult with care or services, including but not limited to food, clothing, shelter, health care, or supervision which is reasonable and necessary to obtain or maintain the vulnerable adult's physical or mental health or safety, considering the physical and mental capacity or dysfunction of the vulnerable adult and which is not the result of an accident or therapeutic conduct.) Regarding the SP calling 9-1-1: The Empathy Home Care Inc. 911 Protocols said that staff persons were to call 9-1-1 “immediately” prior to calling “anyone.” The law enforcement report showed that on July 29, 2024, at 7:45 p.m., the SP called 9-1-1 to notify them of the incident. When law enforcement arrived, the SP was on the phone with an unknown person, which the SP told this investigator was P1. P1 and the SP told law enforcement and this investigator that the SP called law enforcement prior to calling P1. P1 stated that when the SP called P1, the SP told P1 that law enforcement had already arrived at the facility. Although FM1 had concerns that the SP called P1 prior to 9-1-1 being called and also said that law enforcement told him/her that P1 called 9-1-1, given that the 9-1-1 transcript and law enforcement records showed that the SP called 9-1-1; that the CP told law enforcement that after the SP came and checked on the VA, the SP called 9-1-1; and that P1 and the SP provided consistent information that 9-1-1 was called prior to P1 being called, there was not preponderance of the evidence whether there was not a failure to provide reasonable and necessary care to the VA. It was not determined whether neglect occurred (the failure or omission by a caregiver to supply a vulnerable adult with care or services, including but not limited to food, clothing, shelter, health care, or supervision which is reasonable and necessary to obtain or maintain the vulnerable adult's physical or mental health or safety, considering the physical and mental capacity or dysfunction of the vulnerable adult and which is not the result of an accident or therapeutic conduct.)
Regarding CPR: Although law enforcement had concerns that the VA’s plans stated that the VA’s “code status was CPR,” the documents that were related to code status were documents required when the facility was licensed as an assisted living prior to April 1, 2025. Minnesota Statutes section 245D.06, subdivision 2, says that a staff person trained on CPR does not need to be present unless indicated in a person’s support plan or support plan addendum and the VA’s Support Plan Addendum dated April 2, 2024, and signed by the VA and the CM, said that the VA did not require a staff person who was trained on CPR to be available when the VA was present. Although the SP was not trained to do CPR and it was not required in the VA’s plans, information was consistent from the SP and the CP that the CP performed CPR on the VA while the SP was on the phone with 9-1-1. The 9-1-1 transcript showed that while 9-1-1 dispatch was in the process of giving the SP CPR instructions, the phone disconnected. However, information showed that although neither the SP nor 9-1-1 attempted to call one another back, the law enforcement report stated that law enforcement arrived at the facility approximately one minute after the SP’s call to 9-1-1. Therefore, it was most likely that law enforcement arrived either prior to or around the time the call disconnected. Additionally, although the law enforcement report said that when law enforcement first entered the VA’s bedroom no one was performing CPR, the CP and the SP each told law enforcement that the CP performed CPR on the VA. In addition, in the 9-1-1 recording the SP said, “out loud” while talking to the 9-1-1 dispatcher to “do CPR on [the VA] please,” and “Yes. We are doing CPR [on the VA] right now.” The SP also told this investigator that the CP performed CPR on the VA. Although there were concerns that the SP did not provide CPR, given that the VA’s plans did not require a staff person trained on CPR to be at the facility, and that the SP and the CP each provided consistent information that the CP performed CPR on the VA, there was not a preponderance of the evidence whether there was a failure to provide reasonable and necessary care to the VA. It was not determined whether neglect occurred (the failure or omission by a caregiver to supply a vulnerable adult with care or services, including but not limited to food, clothing, shelter, health care, or supervision which is reasonable and necessary to obtain or maintain the vulnerable adult's physical or mental health or safety, considering the physical and mental capacity or dysfunction of the vulnerable adult and which is not the result of an accident or therapeutic conduct.) Action Taken by Facility: The facility completed an internal review and determined that policies and procedures were adequate and followed, including because the safety checks were completed and the SP called 9-1-1. There were no similar prior incidents. Following the incident, Empathy Home ensured that all their facilities had Narcan on site and that staff persons were trained on Narcan. In addition, the facility reported the incident to the Minnesota Office of Ombudsman for Mental Health and Developmental Disabilities on July 29, 2024, at 9:19 p.m. Action Taken by Department of Human Services, Office of Inspector General: No further action taken at this time. The Department of Human Services will review any new/additional information as it is received.
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