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October 1, 2025 Mathew Amusan, Authorized Agent Sefertt 3621 85th Avenue North Suite 103 Brooklyn Park, Minnesota 55443 License Number: 1079100 (245D – HCBS) CORRECTION ORDER Dear Mathew Amusan: On September 10, 2025, a licensing review of Sefertt, located at 3621 85th Avenue North, Suite 10, Brooklyn Park, Minnesota, was conducted to determine compliance with state and federal laws and rules governing the provision of home and community-based services to persons with disabilities and age 65 and older under Minnesota Statutes, Chapter 245D. 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. 1. Citation: Minnesota Statutes, section 245A.65, subdivision 1. Violation: For one of one person whose record was reviewed (P1), the license holder did not provide an orientation to the internal and external reporting procedures related to suspected or alleged maltreatment within 24 hours as required. The license holder did not provide P1 with an orientation to the internal and external reporting procedures related to suspected or alleged maltreatment within 24 hours of admission. Corrective Action Ordered: Within 30 days of receiving this order, you must: · provide P1 with an orientation to the internal and external reporting procedures related to suspected or alleged maltreatment; and · maintain documentation of this orientation in P1’s service recipient record as required in section 245D.095, subdivision 3. Compliance with this order will be monitored onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section 245A.65, subdivision 2. Violation: For one person whose record was reviewed (P1), the license holder did not develop an individual abuse prevention plan (IAPP) as required. The license holder did not develop an IAPP for P1 as part of the initial individual program or service plan. Additionally, the license holder failed to review P1 IAPPs at least annually with their interdisciplinary teams. Corrective Action Ordered: Within 30 days of receiving this order, you must: · establish and enforce IAPPs for P1 that meet the requirements of this section; · review P1’s IAPPs with the person, their legal representative, and their case manager; and · maintain documentation of this review in P1’s record. Compliance with this order will be monitored onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Statutes, section 245D.04, subdivision 1. Violation: For one person whose record was reviewed (P1), the license holder did not provide a written notice that identified the service recipient rights as required. The license holder did not provide P1 and their legal representatives a written notice that identified the service recipient rights, and an explanation of those rights within five working days of service initiation and annually thereafter. Corrective Action Ordered: Within 30 days of receiving this order, you must: · provide P1 and their legal representatives a written notice that identifies the service recipient rights and an explanation of those rights; · audit all service recipient records to ensure they have received written notice that identifies the service recipient rights in subdivisions 2 and 3 and an explanation of those rights; · if any service recipient has not received these rights, or has not received these rights in the last annual year, provide these rights to the person or their legal representative, if applicable; and · maintain documentation of the person or their legal representative’s receipt of these rights as required in Minnesota Statutes, section 245D.095, subdivision 3. Compliance with this order will be monitored onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. 4. Citation: Minnesota Statutes, section 245D.07, subdivision 1a. Violation: For one person whose record was reviewed (P1), the license holder did not provide services in response to the person’s identified needs, interests, preferences, and desired outcomes as specified in the support plan and the support plan addendum. The license holder did not provide services to P1 with principles of person-centered service planning and delivery that: · identified and supported what is important to the person as well as what is important for the person, including preferences for when, how, and by whom direct support service is provided; and · used that information to identify outcomes the person desires. Corrective Action Ordered: Within 30 days of receiving this order, you must: · review and revise, with P1, P1’s person-centered service planning and delivery with the identified topics above; and · maintain documentation of this review in P1’s support plan addendum. Compliance with this order will be monitored onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. 5. Citation: Minnesota Statutes, section 245D.07, subdivision 2. Violation: For one person whose record was reviewed (P1), the license holder did not meet service planning requirements for basic support services as required.
The license holder did not complete a preliminary support plan addendum based on P1’s support plans within 15 calendar days of service initiation. Additionally, the license holder failed to review and revise the preliminary support plan addendum within 60 calendar days to document the services that will be provided including how, when, and by whom services will be provided, and the person responsible for overseeing the delivery and coordination of services. Corrective Action Ordered: Within 30 days of receiving this order, you must: · complete a preliminary support plan addendum for P1 based on their support plans; and · provide it to P1, their legal representative and case manager. Compliance with this order will be monitored onsite. On an ongoing basis, you must maintain compliance as required in this subdivision.
6. Citation: Minnesota Statutes, section 245D.095, subdivision 3. Violation: For one person whose record was reviewed (P1), the license holder did not maintain service recipient records as required. The license holder did not maintain the following information for P1: · an admission form signed by the person or the person’s legal representative that included the name, address, and telephone number of the person’s legal representative, if any, and a primary emergency contact, the case manager, and family members or others as identified by the person or case manager; · health information, including medical history, special dietary needs, and allergies; · the person's current support plan or that portion of the plan assigned to the license holder; · documentation to show a signed statement authorizing the license holder to act in a medical emergency when P1’s legal representative could not be reached; · a record of other service providers serving the person when the person's support plan or support plan addendum identifies the need for coordination between the service providers, that includes a contact person and telephone numbers, services being provided, and names of staff responsible for coordination; and · documentation of orientation to service recipient rights according to section 245D.04, subdivision 1, and maltreatment reporting policies and procedures according to section 245A.65, subdivision 1. Corrective Action Ordered: Within 30 days of receiving this order, you must ensure the information detailed above is maintained in P1’s service recipient records and any other service recipients you are providing services to in your program. Compliance with this order will be monitored onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. 7. Citation: Minnesota Statutes, section 245D.10, subdivision 4. Violation: For one person whose record was reviewed (P1), the license holder did not inform and provide copies of the policies and procedures affecting their rights within five working days of service initiation. The license holder did not inform and provide copies of the following policies and procedures affecting a person’s rights to P1 and their case manager within five working days of service initiation: · grievance policy and procedure; · service suspension and termination policy and procedure; and · emergency use of manual restraints policy and procedure. Corrective Action Ordered: Within 30 days of receiving this order, you must provide the policies and procedures identified above to P1 and P1’s case manager. Compliance with this order will be monitored on site. On an ongoing basis, you must maintain compliance as required in this subdivision. 8. Citation: Minnesota Rules, part 9544.0030, subpart 1. Violation: For one person whose record was reviewed (P1), the license holder did not evaluate positive support strategies as required. The license holder did not incorporate, in writing, positive support strategies to an existing treatment, service, or other individual plans for P1. Additionally, the license holder did not evaluate these strategies with P1 at least every six months. Corrective Action Ordered: Within 30 days of receiving this order, you must incorporate, in writing, positive support strategies to an existing treatment, service, or other individual plan for P1. Compliance with this order will be monitored onsite. On an ongoing basis, you must maintain compliance as required in this subpart. 9. Citation: Minnesota Statutes, section 245D.09, subdivision 4. Violation: For one staff person whose record was reviewed (SP2), the license holder did not provide orientation training as required. The license holder did not provide SP2 with an orientation to the following within 60 calendar days of hire: · data privacy requirements according to sections 13.01 to 13.10 and 13.46, the federal Health Insurance Portability and Accountability Act of 1996 (HIPPA), and staff responsibilities related to complying with data privacy practices; · the service recipient rights and staff responsibilities related to ensuring the exercise and protection of those rights according to the requirements in section 245D.04; · sections 245A.65, 245A.66, and 626.557 and chapter 260E governing maltreatment reporting and service planning for children and vulnerable adults, and staff responsibilities related to protecting persons from maltreatment and reporting maltreatment. This orientation must be provided within 72 hours of first providing direct contact services and annually thereafter according to section 245A.65, subdivision 3; · the principles of person-centered service planning and delivery as identified in section 245D.07, subdivision 1a, and how they apply to direct support services provided by the staff person; · the safe and correct use of manual restraint on an emergency basis according to the requirements in section 245D.061 or successor provisions, and what constitutes the use of restraints, time out, and seclusion, including chemical restraint; · staff responsibilities related to prohibited procedures under section 245D.06, subdivision 5, or successor provisions, why such procedures are not effective for reducing or eliminating symptoms or undesired behavior, and why such procedures are not safe; · the license holder's current policies and procedures required under this chapter, including their location and access, and staff responsibilities related to implementation of those policies; · basic first aid; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities. Corrective Action Ordered: Within 30 days of receiving this order, you must provide SP1 with an orientation and training to the license holder’s policies and procedures and maintain documentation of this training in their personnel record. Compliance with this order will be monitored onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. 10. Citation: Minnesota Statutes, section 245D.09, subdivision 4a. Violation: For two staff persons whose records were reviewed (SP1 and SP2), the license holder did not provide orientation to individual service recipient needs training as required. The license holder did not provide SP1 and SP2 with the following training before having unsupervised direct contact with a person served by the program: · orientation to the individual service recipient needs; · the person’s support plan or support plan addendum; and · the person’s individual abuse prevention plan (IAPP), to achieve and demonstrate an understanding of the person as a unique individual, and how to implement those plans. Corrective Action Ordered: Within 30 days of receiving this order, you must ensure SP1 and SP2 have reviewed and received instruction on the requirements identified above for each service recipient they are providing direct support services to. Compliance with this order will be monitored onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. 11. Citation: Minnesota Statutes, section 245D.095, subdivision 5. Violation: For two staff persons whose records were reviewed (SP1 and SP2), the license holder did not maintain personnel records as required. The license holder did not maintain documentation in SP1 and SP2’s personnel record or elsewhere, sufficient to determine the date of first supervised direct contact with a person served by the program, and the date of first unsupervised contact with a person served by the program. Corrective Action Ordered: Within 30 days of this order, you must maintain compliance with training records for SP1 and SP2’s personnel records. Compliance with this order will be monitored onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. 12. Citation: Minnesota Statutes, section 245D.09, subdivision 5. Violation: For two staff persons whose records were reviewed (SP1 and SP2), the license holder did not provide annual training as required. 245A.02, subdivision 2b defines “annual” or “annually” to mean prior to or within the same month of the subsequent calendar year. The license holder did not provide SP1 and SP2 with annual training on the following topics as required: · data privacy requirements according to sections 13.01 to 13.10 and 13.46, the federal Health Insurance Portability and Accountability Act of 1996 (HIPPA), and staff responsibilities related to complying with data privacy practices; · the service recipient rights and staff responsibilities related to ensuring the exercise and protection of those rights according to the requirements in section 245D.04; · the principles of person-centered service planning and delivery as identified in section 245D.07, subdivision 1a, and how they apply to direct support service provided by the staff person; · the safe and correct use of manual restraint on an emergency basis according to the requirements in section 245D.061 or successor provisions, and what constitutes the use of restraints, time out, and seclusion, including chemical restraint; · staff responsibilities related to prohibited procedures under section 245D.06, subdivision 5, or successor provisions, why such procedures are not effective for reducing or eliminating symptoms or undesired behavior, and why such procedures are not safe; · basic first aid; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities. Additionally, the license holder failed to provide SP1 and SP2 with annual training on sections 245A.65, 245A.66, and 626.557 and chapter 260E governing maltreatment reporting and service planning for children and vulnerable adults, and staff responsibilities related to protecting persons from maltreatment and reporting maltreatment. Corrective Action Ordered: Within 30 days of receiving this order, you must provide SP1 and SP2 training on the topics identified above. Compliance with this order will be monitored onsite. On an ongoing basis, you must maintain compliance as required in this subdivision. 13. Citation: Minnesota Statutes, section 245D.081. Violation: For one person whose record was reviewed (SP1), the license holder did not meet the requirements of program coordination, evaluation and oversight. a. The license holder did not ensure the designated coordinator (SP1), provided coordination of service delivery and evaluation for each person served by the program. See citations 1 through 8 for the designated coordinator’s failure to provide supervision, support, and evaluation of activities including: · oversight of the license holder’s responsibilities assigned in the persons support plan and support plan addendum; and · instruction and assistance to direct support staff implementing the coordinated service and support plan, including direct observation of service delivery sufficient to assess staff competency. b. The license holder did not ensure that the designated manager (SP1) provided program management and oversight of the services provided by the license holder. See citations 1 through 8 for the designated manager’s failure to: · maintaining a current understanding of the licensing requirements sufficient to ensure compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph e, and when applicable, as identified in section 256B.04, subdivision 21, paragraph (b); · ensure the duties of the designated coordinator are fulfilled according to the requirements in subdivision 2; · evaluation of satisfaction of persons served by the program, the person's legal representative, if any, and the case manager, with the service delivery identified in sections 245D.07 and 245D.071, and ensuring and protecting each person's rights as identified in section 245D.04; · ensuring staff competency requirements are met according to the requirements in section 245D.09, subdivision 3, and ensuring staff orientation and training is provided according to the requirements in section 245D.09, subdivisions 4, 4a, and 5; and · evaluating the information identified in clauses (1) to (5) to develop, document, and implement ongoing program improvements. Corrective Action Ordered: Within 30 days of receiving this order, you must designate a staff person who is responsible for delivery and evaluation of services provided by the license holder. You must also designate a managerial staff person to provide program management and oversight of the services provided by the license holder. The same person may perform both functions if the work and education requirements are met in section 245D.081, subdivisions 2 and 3. You must submit the name(s) and qualifications of the staff person or staff persons who will act as the designated coordinator and designated manager to your licensor. On an ongoing basis, you must maintain compliance as required in this subdivision. 14. Citation: Minnesota Statutes, section 245D.10, subdivision 2. Violation: The license holder did not establish and maintain policies and procedures related to grievances as required. The license holder did not include the phone number of the highest level of authority in their grievance policy. Corrective Action Ordered: Within 30 days of receiving this order, you must establish and implement the above-stated policy to be in compliance with statutory requirements. On an ongoing basis, you must establish and enforce policies and procedures as required in this chapter. 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. Submissions required as part of a corrective action ordered must be sent to your Licensor at: 1. By secure email at kelly.bosch@state.mn.us; or 2. If you are unable to submit corrective action ordered securely through email, you can mail or fax using the information below: Commissioner, Department of Human Services ATTN: Kelly Bosch Licensing Division PO Box 64242 St. Paul, MN 55164-0242 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. Kelly Bosch, HCBS Licensor Licensing Division Office of Inspector General 651-431-6621
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