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July 23, 2025 Mohamud Mohamud, Authorized Agent Minnehaha Adult Day Services 4549 124th Court Northeast Blaine, Minnesota 55449 License Number: 1082876 (Rule 223) CORRECTION ORDER Dear Mohamud Mohamud: On June 24, 2025, a licensing review of Minnehaha Adult Day Services located at 3950 Minnehaha Avenue, Minneapolis, 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 Rules, part 9555.9660, subpart 1. Violation: For four of four participants whose records were reviewed (P1, P2, P3, and P4), the license holder did not include information in the participant’s written record as required. a. The license holder did not include the following information in P1’s record: · an application form that included: o P1’s telephone number and source of referral; and o the name and telephone number of the person to call in case of emergency involving P1 and the name and number of another person to call if that person cannot be reached; · a medical report, dated within the three months prior to or 30 days after P1’s admission to the center that included: o a report on a physical examination; o P1’s medical history; o indication of dietary restrictions that apply to P1; o a release signed by the physician indicating whether P1 may engage in a structured exercise program; and o documentation that P1 was free from communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants. b. The license holder did not include the following information in P2’s record: · an application form that included: o P2’s living arrangement, telephone number, and source of referral; and o the name and telephone number of the person to call in case of emergency involving P2 and the name and number of another person to call if that person cannot be reached; and · a report on a physical examination, updated annually. c. The license holder did not include a report on a physical examination, updated annually, in P3’s record. d. The license holder did not include the following information in P4’s record: · an application form that included: o P4’s living arrangement, telephone number, and source of referral; o the name and telephone number of the person to call in case of emergency involving P4 and the name and number of another person to call if that person cannot be reached; and o the name and telephone number of P4’s physician or medical provider; · a medical report, dated within the three months prior to or 30 days after P4’s admission to the center, signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician, that included: o a report on a physical examination, updated annually; o P4’s medical history; o indication of dietary restriction and medication regimen, including the need for medication assistance that apply to P4; o a release signed by the physician indicating whether P4 may engage in a structured exercise program; and o documentation that P4 was free from communicable disease or infestations, as specified in parts 4605.7000 to 4605.7090, that would endanger the health of other participants; and · participation reports and progress notes that are recorded at least monthly. Repeat Violation: In a Correction Order that DHS issued on July 10, 2023, you were previously found in violation of this same rule. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain all information detailed above in P1, P2, P3, and P4’s participant records. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. 2. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For two participants whose records were reviewed (P1 and P4), the license holder did not complete initial service planning as required. a. The license holder did not conduct needs assessments for P1 and P4 within 30 days of admission that addressed: · the participant’s psychosocial status (for example, awareness level, personal care needs, need for privacy or socialization); · the participant's functional status (for example, endurance and capability for ambulation, transfer, and managing activities of daily living); and · the participant's physical status, to be determined by observation, from the intake screening interview, and from the medical report received from the participant's physician. b. The license holder did not develop a preliminary service plan for P1 within 30 days of admission that included: · scheduled days of the participant’s attendance at the center; · transportation arrangements for getting the participant to and from the center; · the participant’s nutritional needs and, where applicable, dietary restrictions; · role of the participant’s caregiver or caregivers in carrying out the service plan; and · services and activities in which the participant would take part immediately upon admission. c. The license holder did not develop a preliminary service plan for P4 that included: · the participant’s nutritional needs and, where applicable, dietary restrictions; · role of the participant’s caregiver or caregivers in carrying out the service plan; and · services and activities in which the participant would take part immediately upon admission. Corrective Action Ordered: Within 30 days of receiving this order, you must: · conduct needs assessments for P1 and P4 as detailed above; and · develop preliminary service plans for P1 and P4 that include the information and specifications detailed above. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. 3. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For four participants whose records were reviewed (P1, P2, P3, and P4), the license holder did not develop a written plan of care as required. a. The license holder did not develop written plans of care for P1 and P4, within 90 days of admission, that included: · an update of the preliminary service plan and additional services required by the participant; · short and long-term objectives for the participant stated in concrete, measurable, and time specific outcomes; and · the staff members responsible for implementing the individual plan of care. b. The license holder did not develop a written plan of care for P2 that included: · an update of the preliminary service plan and additional services required by the participant; and · the staff members responsible for implementing the individual plan of care. c. The license holder did not develop a written plan of care for P3 that included the staff members responsible for implementing the individual plan of care. Repeat Violation: In a Correction Order that DHS issued on July 10, 2023, you were previously found in violation of this same rule. Corrective Action Ordered: Within 30 days of receiving this order, you must develop written plans of care for P1-P4 to include the information detailed above. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. 4. Citation: Minnesota Rules, part 9555.9710, subpart 7.
Violation: The license holder did not offer services as required. The license holder did not maintain family and social histories for P1, P2, P3, and P4 that were updated annually.
Repeat Violation: In a Correction Order that DHS issued on July 10, 2023, you were previously found in violation of this same rule. Corrective Action Ordered: Within 30 days of receiving this order: you must maintain and update P1, P2, P3, and P4’s family and social history, as applicable. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. 5. Citation: Minnesota Rules, part 9555.9650, item A. Violation: For two of two staff persons whose records were reviewed (SP1 and SP2), the license holder did not maintain a personnel record as required. a. The license holder did not maintain the following information in SP1’s personnel record: · a job description; and · an employment application or resume indicating that the employee meets the requirements in part 9555.9680. b. The license holder did not maintain a job description in SP2’s personnel record. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain the above information in SP1 and SP2’s personnel record. On an ongoing basis, you must maintain compliance as required in this item. 6. Citation: Minnesota Rules, part 9555 .9710, subparts 1 and 6.
Violation: The license holder did not offer services as required. a. The license holder did not maintain a current and accurate contract with their food service provider that prepared food off-site. b. The license holder did not provide meals within 4 ½ hours of participants being in the center. For example, participants arrived as early as 8:00 AM and were not offered a meal until 1:00 pm. c. The license holder did not maintain a monthly plan for daily program activities between 2:00 PM and 7:00 PM when the center was open. Repeat Violation: In a Correction Order that DHS issued on July 10, 2023, you were previously found in violation of this same rule. Corrective Action Ordered: Within 30 days of receiving this order, you must: · maintain a current and accurate contract with a food service provider; · maintain menus for all meals and snacks approved by a registered dietitian that matches the center’s hours of operation; and · maintain a monthly plan for daily program activities between 2:00 PM and 7:00 PM when the center was open. On an ongoing basis, you must maintain compliance as required in this subpart. 7. Citation: Minnesota Rules, part 9555.9720, subparts 3 and 8.
a. The license holder did not have the emergency phone numbers of the caregiver, the persons to be called if the caregiver cannot be reached, and the participant’s physician for each participant readily available at the center. b. The license holder did not ensure areas used by participants were free from loose plaster. Corrective Action Ordered: Within 30 days of receiving this order, you must: · ensure all areas used by participants are free from loose plaster; and · ensure emergency phone numbers of the caregiver, the persons to be called if the caregiver cannot be reached, and the participant’s physician for each participant are readily available at the center. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. 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. Kristopher Oberg, HCBS Human Services Licensor Licensing Division Office of Inspector General 651-431-6589
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