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August 8, 2025
Yorn Yan, Authorized Agent United Cambodian Association of Minnesota 1385 Mendota Heights Road, Suite 500 Mendota Heights, Minnesota 55120 License Number: 1066340 (Rule 223) CORRECTION ORDER Dear Yorn Yan: On July 16, 2025, a licensing review of United Cambodian Association of Minnesota, located at 1385 Mendota Heights Road, Mendota Heights, 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.05, subdivision 7a. Violation: The license holder did not provide notification to the commissioner before making a change in the location of the program or service licensed as required. The license holder did not notify the commissioner and obtain the commissioner’s approval before making a change to the location of the program or service licensed under this chapter. During a licensing review conducted on July 16, 2025, DHS licensors became aware that the license holder was utilizing suites that were not licensed by DHS. Corrective Action Ordered: Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section 245A.14, subdivision 14, paragraph (c).
Violation: The license holder did not meet the requirements for attendance record documentation. The license holder did not maintain documentation of actual attendance for each adult day service recipient for which the license holder was reimbursed by a governmental program that included: · the time of day that the recipient was dropped off; and · the time of day that the recipient was picked up. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain documentation of actual attendance for each adult day service recipient. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b). Violation: For one of three participants whose records were reviewed (P3), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). The license holder did not review P3’s IAPP with their interdisciplinary team, at least annually in 2024 and 2025, using the individual assessment and any reports of abuse relating to the person. The most recent review of P3’s IAPP was dated March 16, 2023. Corrective Action Ordered: Within 30 days of receiving this order, you must review P3’s IAPP with P3’s interdisciplinary team and document the review. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subdivision. 4. Citation: Minnesota Rules, part 9555.9640. Violation: For two of three participants whose records were reviewed (P1 and P2), the license holder did not distribute policies and procedures to participants as required. The license holder did not distribute the correct telephone number of the department’s licensing division to P1 and P2. The license holder informed P1 and P2 that the department’s licensing division telephone number was (651) 296-3971 and the correct telephone number is (651) 431-6500. Repeat Violation: In a Correction Order that DHS issued on November 23, 2022, you were previously found in violation of this same subpart. Corrective Action Ordered: Immediately, you must distribute the correct telephone number of the department’s licensing division to P1 and P2. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this part. 5. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For two participants whose records were reviewed (P1 and P2), 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 P1’s living arrangement; and · a medical report dated within the three months prior to or 30 days after P1’s admission to the center. P1 was admitted to the center on January 6, 2025 and the license holder maintained a medical report for P1 on April 9, 2025. b. The license holder did not include a medical report in P2’s record dated within the three months prior to or 30 days after P2’s admission to the center. P2 was admitted to the center on June 17, 2024 and the license holder maintained a medical report for P2 on January 2, 2025. Repeat Violation: In a Correction Order that DHS issued on November 23, 2022, you were previously found in violation of this same subpart. Corrective Action Ordered: Within 30 days of receiving this order, you must update P1’s record to include P1’s living arrangement. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this part. 6. 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 did not: · conduct needs assessments for P1 and P2 that addressed the participant’s physical status using information from the medical report received from the participant’s physician. o The license holder conducted P1’s needs assessment on January 6, 2025. The license holder did not receive the medical report from P1’s physician until April 9, 2025. o The license holder conducted P2’s needs assessment on June 17, 2024. The license holder did not receive the medical report from P2’s physician until January 2, 2025; and · develop a preliminary service plan for P1 and P2 that included: o the role of the participant’s caregiver or caregivers in carrying out the service plan; and o services and activities in which the person will take part immediately upon admission. Repeat Violation: In a Correction Order that DHS issued on November 23, 2022, you were previously found in violation of this same subpart. Corrective Action Ordered: Within 30 days of receiving this order, you must: · update P1 and P2’s needs assessments to address the participant’s physical status determined from the medical report received from the participant’s physician; and · update P1 and P2’s preliminary service plans to include the information listed above. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. 7. 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. a. The license holder did not develop a written plan of care for P1 that included: · an update of the preliminary service plan and additional services required by P1; · short and long term objectives for P2 stated in concrete, measurable and time specific outcomes; · the staff members responsible for implementing the individual plan of care; · the anticipated duration of the individual plan of care as written; and · provisions for quarterly review and quarterly revisions of 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 P2; · the staff members responsible for implementing the individual plan of care; and · the anticipated duration of the individual plan of care as written. Repeat Violation: In a Correction Order that DHS issued on November 23, 2022, you were previously found in violation of this same subpart. Corrective Action Ordered: Within 30 days of receiving this order, you must: · develop written plans of care for P1 and P2 that include the information listed above; · complete an audit of all participants’ written plans of care to ensure the requirements in Minnesota Rules, part 9555.9700, subpart 3 are maintained; and · for participants who do not have a written plan of care that includes all required information, you must develop a plan detailing how your program will maintain a complete written plan of care within 60 days of receiving this order. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. 8. Citation: Minnesota Rule, part 9555.9650, item B. Violation: For one consultant whose record was reviewed, the license holder did not maintain a personnel record as required. The license holder did not maintain a copy of a signed contract or letter of appointment specifying conditions and terms of employment in the registered dietician’s personnel record. Repeat Violation: In a Correction Order that DHS issued on November 23, 2022, you were previously found in violation of this same subpart. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain a copy of a signed contract or letter of appointment with your registered dietician specifying conditions and terms or employment. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this item. 9. Citation: Minnesota Rules, part 9555.9690, subpart 3. Violation: For one of two staff persons whose record was reviewed (SP2), the license holder did not provide orientation to the center as required.
The license holder did not provide SP2 with orientation training related to the kinds of functional impairments of current center participants and the safety requirements and procedures in part 9555.9720. Corrective Action Ordered: Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. 10. Citation: Minnesota Rules, part 9555.9690, subpart 4. Violation: For one staff person whose record was reviewed (SP1), the license holder did not provide in-service training annually as required. The license holder did not provide SP1 with 8 hours of annual training as required. Corrective Action Ordered: Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. 11. Citation: Minnesota Rules, part 9555.9710, subpart 1. Violation: The license holder did not offer services as required. a. The license holder did not offer a midmorning snack. b. The license holder did not have the menus for all meals and snacks approved by a registered dietician. Repeat Violation: In a Correction Order that DHS issued on November 23, 2022, you were previously found in violation of this same subpart. Corrective Action Ordered: Within 30 days of receiving this order, you must: · offer a midmorning snack; and · ensure menus for all meals and snacks are approved by a registered dietician. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subpart. 12. Citation: Minnesota Rules, part 9555.9720, subpart 5, 8, and 9. Violation: The license holder did not ensure safety as required. a. The license holder did not ensure chemicals that are poisonous when swallowed or inhaled or that are damaging to eyes or skin were stored in an area not accessible to the participants. b. The license holder did not ensure areas used by participants were free from debris and peeling paint. c. The license holder did not have written plans for emergencies caused by fire that include: · instructions for calling the fire department and emergency phone numbers; · procedures for the quarterly fire drill; · instructions on use of fire extinguishers; and · instructions on closing off the fire area. Repeat Violation: In a Correction Order that DHS issued on November 23, 2022, you were previously found in violation of this same subpart. Corrective Action Ordered: Within 30 days of receiving this order, you must: · ensure all chemicals that are poisonous when swallowed or inhaled or that are damaging to eyes of skin are stored in an area not accessible to the participants; · ensure all areas used by participants are free from debris and peeling paint; and · develop written plans for emergencies caused by fire that 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 these subparts. 13. Citation: Minnesota Statutes, section 245A.65, subdivision 1, paragraph (a), part (2). Violation: The license holder did not establish written policies and procedures related to suspected or alleged maltreatment as required. The license holder did not identify a consistent primary person or position and secondary person or position to whom internal reports may be made and responsible for forwarding the internal reports to the common entry point. Corrective Action Ordered: Within 30 days of receiving this order, you must update your policies and procedures related to suspected or alleged maltreatment of vulnerable adults. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subdivision. 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. Katie Johnson, HCBS Human Services Licensor Licensing Division Office of Inspector General 651-431-4113
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