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July 23, 2025 CERTIFIED MAIL Stephanie Kalbach, Authorized Agent REM River Bluffs Inc 600 France Ave S Suite 350 Edina MN 55435-1810 License Number 1071879-HCBS (Home and Community-Based Services) License Number 1071891-H_CRS (Home and Community-Based Services-Community Residential Setting) Report Number 202310446 DETERMINATION OF MALTREATMENT AND ORDER TO PAY A FINE Dear Stephanie Kalbach: The Department of Human Services (DHS) determined that REM River Bluffs Inc- Sequoia located at 369 Frenn Avenue, Red Wing, Minnesota, is responsible for serious maltreatment by neglect. Based on this determination, DHS is ordering you to pay a fine of $5000. Details of our findings are provided below and in the enclosed Investigation Memorandum for report 202310446. Our next steps and your options are also detailed. I. Determination of Maltreatment It was reported that a vulnerable adult (VA) did not receive his/her prescribed long-acting insulin on December 9 and 10, 2023, because staff persons (SP1 and SP2) did not reorder the insulin. On December 11, 2023, the VA was transported to a hospital where his/her blood sugar was over 1000 milligrams per deciliter (mg/dL), and s/he was diagnosed with ketoacidosis. Based on the maltreatment investigation, DHS determined that that REM River Bluffs Inc-Sequoia was responsible for neglect of the VA. See the enclosed Investigation Memorandum for more information. Legal Authority: Minnesota Statutes, section 626.557, subdivision 9c. Fine: $5000 Citations 1. Citation: Minnesota Statutes section 245D.11, subdivision 2, clause (3). Violation: The license holder did not Implement their Health Needs Coordination/Safe Medication Assistance and Administration Policy as required. Despite a client’s (C) ongoing issues with his/her diabetes management, there was no information that anyone at the facility followed up with the C’s physician and/or the facility health care professional regarding multiple missed blood sugar checks and/or insulin doses, the C’s refusal to take insulin as prescribed, or concerns about the C’s self-administration of insulin. Corrective Action Required: On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section245D.05, subdivision 1, paragraph (a) and subdivision 4, paragraph (a). Violation: The license holder did not meet the health care needs of the C or the C’s medication administration as assigned in the C’s support plan addendum. Multiple staff persons did not ensure the C’s long-acting insulin was refilled and administered. Corrective Action Required: On an ongoing basis, you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Statutes section 245D.09, subdivision 4a, paragraphs (a) and (c). Violation: The license holder did not ensure that prior to unsupervised direct contact with a person served by a program that a staff person was trained on the person’s coordinated service and support plan or coordinated service and support plan addendum as it relates to the responsibilities assigned to the license holder, and when applicable, the person's individual abuse prevention plan, to achieve and demonstrate an understanding of the person as a unique individual, and how to implement those plans. A staff person (P) worked alone the entire weekend of December 8-10, 2023, with the C and was not trained on the C’s program plans. Corrective Action Required: On an ongoing basis, you must maintain compliance as required in this subdivision. II. Order to Pay a Fine Because DHS determined that REM River Bluffs Inc-Sequoia is responsible for serious maltreatment by neglect, you must pay a $5000 fine. The act of maltreatment was determined to be serious because the VA required the care of a physician that included insulin infusion and fluid resuscitation on an intensive care unit. The VA was hospitalization from December 11-18, 2023. Legal Authority: Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), subparagraph (4). Billing and Payment of the Fine DHS will send you an invoice for the $5000 fine. Payment must be made as directed on the invoice. If you request a contested case hearing, as described below, do not pay the fine at this time. After the contested case hearing, the Commissioner of DHS will issue a final order. Please note, you may not avoid payment of this fine by closing, selling, or otherwise transferring the license to a third party. If this occurs, each controlling individual is personally and jointly responsible for payment. If you do not pay the fine on or before the date specified on the invoice and you did not request a contested case hearing, as described below, the Commissioner may issue a second fine, may not issue or reissue a license, or may suspend the license until the license holder pays the fine. III. YOUR RIGHT TO APPEAL You have right to appeal the maltreatment determination and/or fine. Please see options below. Should you exercise your rights to appeal send: 1.
Right to appeal the fine and maltreatment determination You have the right to appeal the fine and maltreatment determination. Your request must be in writing and clearly state that you are requesting a contested case hearing for this matter. Your request must be made before the deadlines provided below. If you do not meet this deadline, you lose your right to an administrative appeal. The timeline to appeal began when you received this order. If you are mailing your request, it must be sent by certified mail and postmarked within 15 calendar days from when you received this order. See address Section III. If your request is being personally delivered, it must be received by DHS within 15 calendar days from when you received this order. See address Section III. Upon DHS’ receipt of your timely appeal, your case would be scheduled for a contested case hearing in front of an Administrative Law Judge. After this hearing, the Commissioner of DHS will issue a final order. 2. Request for reconsideration of the maltreatment determination only If you do not appeal the fine, you may still request reconsideration of the maltreatment determination. Your request must be made before the deadlines provided below. If you do not meet this deadline, you lose your right to request reconsideration. The timeline to request reconsideration began when you received this order. Your request must: · Be in writing · Clearly state that you are requesting reconsideration of the maltreatment determination · Identify what is inaccurate or incomplete about the information in the Investigation Memorandum · Supply information that is accurate or more complete · State why you believe the finding of maltreatment should be changed · Be made before the deadlines provided below. Your request must be postmarked within 15 calendar days from when you received this order. See address Section III. A response to your reconsideration request will be mailed within 15 working days after DHS receives your request. You have the right to request a fair hearing if a response is not mailed within 15 working days. 3. Right to appeal the order to pay a fine only You have the right to only appeal the fine. Your request must be in writing and clearly state that you are requesting a contested case hearing for this matter. Your request must be made before the deadlines provided below. If you do not meet this deadline, you lose your right to an administrative appeal. The timeline to appeal began when you received this order. If you are mailing your request, it must be sent by certified mail and postmarked within 10 calendar days from when you received this order. See address Section III. If your request is being personally delivered, it must be received by DHS within 10 calendar days from when you received this order. See address Section III. Upon DHS’ receipt of your timely appeal, your case would be scheduled for a contested case hearing in front of an Administrative Law Judge. After this hearing, the Commissioner of DHS will issue a final order. 4. Legal representation at the contested case hearing You do not need a lawyer to appeal. However, a lawyer can help you with your appeal. The state or county will not get you a lawyer and will not pay for a lawyer. If you cannot afford a lawyer, you may be able to get free legal advice or help with your appeal. To find out if free help is available, contact: Volunteer Lawyers Network at 612-752-6677; Central Minnesota Legal Services at 612-332-8151; Southern Minnesota Legal Services at 651-222-4731; or go to www.justice4mn.org to find a local legal services program that may be able to help you. You can also find information on contested cases from the Office of Administrative Hearings website at https://mn.gov/oah/self-help. Click on Administrative Law Overview, then click on Administrative Law Contested Case Hearing Guide for a list of frequently asked questions. Legal authority for this licensing action · This action is taken under Minnesota Statutes, section 245A.07, subdivision 1, paragraph (a), which describes under which conditions DHS may impose a fine against a license. · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (4), item (iI) provides that DHS may impose a $5000 fine for each determination of maltreatment of a vulnerable adult under section 626.557 which meets the definition of serious maltreatment for which the license holder is determined responsible. · In determining whether the facility, an individual, or both are responsible for substantiated maltreatment, DHS must consider the mitigating factors provided in Minnesota Statutes, section 626.557, subdivision 9c, paragraph (c). · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (5) states that license holders may not avoid payment of a fine by closing, selling, or transferring a license. · License holders have a right to appeal licensing actions and request a contested case hearing, under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. · License holders have a right to request reconsideration of a maltreatment determination, under Minnesota Statutes, section 626.557, subdivision 9d. · Minnesota Statutes, section 245A.04, subdivision 7, paragraph (d), clause (4), states that DHS shall not issue or reissue a license if the applicant, license holder, or controlling individual has an outstanding debt related to a license fee, licensing fine, or settlement agreement for which payment is delinquent. · Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (2), states that that the license holder shall pay the fine assessed on or before the payment date specified, and if the license holder does not do so the commissioner may issue a second fine or suspend the license until the license holder complies. Questions If you have any further questions regarding this matter, you may contact Sarah Schumacher, Supervisor, at 651-431-6555. Sincerely,
Maggie Hanson, Intake & Investigations Unit Manager Licensing Division Office of Inspector General Enclosure
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