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October 7, 2025 CERTIFIED MAIL Rahma Aboker Kassim, Authorized Agent Amana 3790 Eastwood Road Southeast Rochester, Minnesota, 55904-3121 License Number: 1088316 (245D - HCBS) 1086510 (AFC) ORDER OF CONDITIONAL LICENSE Dear Rahma Aboker Kassim: The Department of Human Services (DHS) is placing your license to provide at Amana, 3790 Eastwood Road Southeast, Rochester, Minnesota, 55904-3121, on conditional status for two years, beginning October 7, 2025. This means you must meet certain conditions to maintain your license, detailed below. This order applies to all services licensed under Chapter 245D and the service sites detailed in the “Applicability of Conditional License” section below. This order is based on your noncompliance with Home and Community-Based Services licensing requirements. Details of our findings are also provided below. Our next steps and your options are also detailed. REASON FOR THE CONDITIONAL LICENSE On July 18, 2025, and July 25, 2025, DHS licensors conducted a licensing review at your facility located at 3790 Eastwood Road Southeast, Rochester, Minnesota, 55904-3121. As a result of this licensing visit, the DHS licensors determined that your program did not comply with the laws and rules that apply to licensed Home and Community-Based Services, citing 20 violations. Licensing Violations DHS determined that your program did not follow licensing rules and statutes, as described below. Program Coordination, Evaluation, and Oversight Violation 1. Violation: The license holder did not ensure the designated coordinator and the designated manager (SP3) provided program management and oversight of the services provided by the license holder as required. a. The license holder designated SP3 as the designated coordinator. See citations 2 through 20 regarding the license holder’s inability to ensure SP3 met the following responsibilities: · provide oversight of the license holder’s responsibilities assigned in the person’s support plan and support plan addendum; · take the action necessary to facilitate the accomplishment of the outcomes according to the requirements in section 245D.07; · provide instruction and assistance to direct support staff implementing the support plan and the service outcomes, including direct observation of service delivery sufficient to assess staff competency; and · evaluate the effectiveness of service delivery, methodologies, and progress on the person’s outcomes based on the measurable and observable criteria for identifying when the desired outcomes have been achieved according to the requirements in section 245D.07. b. The license holder designated SP3 as the designated manager. See citations 2 through 20 regarding the license holder’s inability to ensure SP3 met the following responsibilities: · maintain 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; · ensuring staff competency requirements are met according to the requirements in section 245D.09, subdivision 3, including ensuring periodic performance evaluations of the direct support staff’s ability to perform the job functions based on direct observation are completed by the license holder; · ensuring corrective action was taken when ordered by the commissioner; and · evaluate the information identified in clauses (1) to (6) to develop, document, and implement ongoing program improvements. Statute Violated: Minnesota Statutes, section 245D.081, subdivisions 2 and 3. Repeat Violation: In a Correction Order that DHS issued on July 20, 2020, you were previously found in violation of this same statute. Service Recipient Violations 2. Violation: For one of one person whose record was reviewed (P1), the license holder did not provide the commissioner access to documents and records as required. During a licensing visit on July 18, 2025, the license holder did not provide the commissioner with access to documents and records. The license holder provided access to the commissioner on July 25, 2025. Statute Violated: Minnesota Statutes, section 245A.04, subdivision 5. 3. Violation: For one person whose record was reviewed (P1), the license holder did not establish and enforce individual abuse prevention plans (IAPP) as required. Minnesota Statutes, section 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 document the review of P1’s IAPP with P1’s interdisciplinary team annually in 2022, 2023, and 2024. The license holder did not include statements of measures for self-abuse that included specific actions the program would take to minimize the identified risks of abuse within the scope of the licensed service in P1’s IAPP. Statute Violated: Minnesota Statutes, section 245A.65, subdivision 2. 4. Violation: For one person whose record was reviewed (P1), the license holder did not provide service recipient rights as required. The license holder did not provide P1 with a written notice that identified the service recipient rights annually in 2022, 2023, and 2024. Statute Violated: Minnesota Statutes, section 245D.04, subdivision 1. Repeat Violation: In a Correction Order that DHS issued on July 20, 2020, you were previously found in violation of this same statute. 5. Violation: For one person whose record was reviewed (P1), the license holder did not ensure the protection and exercise of the person’s rights when the person resides in a residential site licensed according to chapter 245A, as required. The license holder did not ensure the exercise and protection of P1’s rights to: · receive services in a clean and safe environment when the license holder is the owner, lessor or tenant of the service site; · receive services in a setting that is clean and free from insects; and · receive services in a setting that is free from hazards that threaten the person’s health or safety. During a site visit on July 18, 2025, DHS licensors observed the following at P1’s place of residence (AFC: 1086510): · flies throughout the program including the kitchen and living room; · a bottle of insect repellant placed next to P1’s plate of breakfast; · a damaged toilet seat; and · splatter of unknown substance on medication labels. Statute Violated: Minnesota Statutes, section 245D.04, subdivision 3. 6. Violation: For one person whose record was reviewed (P1), the license holder did not provide services as assigned in the support plan as required. The license holder did not provide services to P1 as assigned in the support plan. P1’s support plan documented that P1 was required to have awake overnight supervision. During an interview, SP1 stated that they have slept several days during the overnight while providing services to P1. Statute Violated: Minnesota Statutes, section 245D.07, subdivision 1. 7. Violation: For one person whose record was reviewed (P1), the license holder did not complete assessments for intensive services as required. The license holder did not include information that describes P1’s overall strengths, functional skills and abilities and behaviors or symptoms when completing assessments for P1. Statute Violated: Minnesota Statutes, section 245D.071, subdivision 3. Repeat Violation: In a Correction Order that DHS issued on July 20, 2020, you were previously found in violation of this same statute. 8. Violation: For one person whose record was reviewed (P1), the license holder did not develop service outcomes and supports as required. The license holder did not develop supports and methods to be implemented to support P1 to accomplish outcomes related to acquiring, retaining, or improving skills and physical, mental, and emotional health and well-being that documented the following: · the methods or actions that will be used to support the person and to accomplish the service outcomes, including information about: o any changes or modifications to the physical and social environments necessary when the service supports are provided; o any equipment and materials required; and o techniques that are consistent with the person's communication mode and learning style; · the measurable and observable criteria for identifying when the desired outcome has been achieved and how data will be collected; · the date by which progress towards accomplishing the outcomes will be reviewed and evaluated; and · the names of the staff or position responsible for implementing the supports and methods. Statute Violated: Minnesota Statutes, section 245D.071, subdivision 4. Repeat Violation: In a Correction Order that DHS issued on July 20, 2020, you were previously found in violation of this same statute. 9. Violation: For one person whose record was reviewed (P1), the license holder did not complete service plan review and evaluation as required.
· how technology might be used to meet P1’s desired outcomes; and · options for transitioning out of a community setting controlled by a provider and into a setting not controlled by a provider. Statute Violated: Minnesota Statutes, section 245D.071, subdivision 5. Repeat Violation: In a Correction Order that DHS issued on July 20, 2020, you were previously found in violation of this same statute. 10. Violation: For one person whose record was reviewed (P1), the license holder did not maintain service recipient records as required. a. The license holder was assigned responsibility for scheduling and reminding P1 of all medical appointments. The license holder did not maintain a medical appointment schedule for P1. b. The license holder did not maintain progress or daily log notes for P1. Statute Violated: Minnesota Statutes, section 245D.095, subdivision 3. 11. 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 evaluate the identified positive support strategies with P1 at least every six months. Rule Violated: Minnesota Rules, 9544.0030 subpart 1. Repeat Violation: In a Correction Order that DHS issued on July 20, 2020, you were previously found in violation of this same statute. 12. Violation: For one person whose record was reviewed (P1), the license holder did not meet the responsibilities for health needs as required. The license holder was assigned responsibility in P1’s support plan addendum to provide medication assistance and to assist with medical equipment, devices, or adaptive aids or technology safely and correctly for P1. The license holder did not provide reminders to P1 to administer insulin as prescribed. Furthermore, it was observed by DHS licensors on July 18, 2025, that P1 was not wearing leg wraps to treat a medical condition as ordered by P1’s physician and as documented in P1’s support plan addendum. Statute Violated: Minnesota Statutes, section 245D.05, subdivision 1. Repeat Violation: In a Correction Order that DHS issued on July 20, 2020, you were previously found in violation of this same statute. 13. Violation: For one person whose record was reviewed (P1), the license holder did not report medication issues as required. The license holder was assigned responsibility for medication assistance. During a site visit on July 18, 2025, DHS licensors observed a weekly medication-set for P1 still had medication present from the previous evening. The license holder did not report the medication error to P1’s case manager. Statute Violated: Minnesota Statutes, section 245D.05, subdivision 4. 14. Violation: For one person whose record was reviewed (P1), the license holder did not report and maintain information about incidents as required. The license holder did not maintain information about and report incidents to P1’s case manager within 24 hours of an incident occurring on the following dates: · February 23, 2025; · March 19, 2025; · June 22, 2025; and · June 29, 2025. At the time of the licensing review, the above-mentioned incidents had not been reported to P1’s case manager. Statute Violated: Minnesota Statutes, section 245D.06, subdivision 1, paragraph (b). 15. Violation: For one person whose record was reviewed (P1), the license holder did not report serious injuries as required. The license holder did not report the serious injury of P1 as required in paragraph (b) and to the Department of Human Services Licensing Division, and the Office of Ombudsman for Mental Health and Developmental Disabilities as required under section 245.94, subdivision 2a, within 24 hours of the serious injury. During the licensing review, it was discovered within P1’s after visit summaries that P1 fractured his foot in 2022, and the license holder did not report this as a serious injury within 24 hours. Additionally, P1 had a heart attack on June 23, 2025, and the license holder did not report this as a serious injury as required. Statute Violated: Minnesota Statutes, section 245D.06, subdivision 1, paragraph (e). Staffing Standards Violations 16. Violation: For one of three staff persons whose record was reviewed (SP2), the license holder did not provide and ensure completion of orientation training as required. SP2 was hired on March 20, 2024. The license holder did not provide and ensure completion of the following orientation training within 60 days of hire: · the job description and how to complete specific job functions, including: o responding to and reporting incidents as required under section 245D.06, subdivision 1; and o following safety practices established by the license holder and as required in section 245D.06, subdivision 2; · 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 and procedures; · data privacy requirements according to sections 13.01 to 13.10 and 13.46, the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), 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; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities. Statute Violated: Minnesota Statutes, section 245D.09, subdivision 4. Repeat Violation: In a Correction Order that DHS issued on July 20, 2020, you were previously found in violation of this same statute. 17. Violation: For two staff persons whose records were reviewed (SP1 and SP2), the license holder did not provide annual training as required. a. The license holder did not provide the following training to SP1 annually in 2022, 2023, and 2024: · data privacy requirements according to sections 13.01 to 13.10 and 13.46, the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), 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, 626.557 and chapter 260E governing maltreatment reporting and service planning for 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 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; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities. b. The license holder did not provide the following training to SP2 annually in 2025: · data privacy requirements according to sections 13.01 to 13.10 and 13.46, the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), 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, 626.557 and chapter 260E governing maltreatment reporting and service planning for 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 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; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities. Statute Violated: Minnesota Statutes, section 245D.09, subdivision 5. Repeat Violation: In a Correction Order that DHS issued on July 20, 2020, you were previously found in violation of this same statute. 18. Violation: For one person whose record was reviewed (SP2), the license holder did not provide training on medication assistance as required. The license holder was assigned responsibility for medication assistance for P1. SP2 provided direct support to P1. The license holder did not provide instruction on medication assistance to SP2. Statute Violated: Minnesota Statutes, section 245D.09, subdivision 4a, paragraph (d). 19. Violation: For one staff person whose record was reviewed (SP2), the license holder did not provide adequate supervision of staff providing direct support as required. The license holder did not provide adequate supervision of SP2 to ensure the health, safety, and protection of rights of P1 and implementation of the responsibilities assigned to the license holder in P1’s support plan or support plan addendum. The license holder was not present in the country from January 2025 through July 2025, including at the time of the licensing review on July 18, 2025.Statute Violated: Minnesota Statutes, section 245D.09, subdivision 1. 20. Violation: For one staff person whose record was reviewed (SP1), the license holder did not maintain a personnel record as required. The license holder did not maintain a personnel record for SP1 that documented and verified staff qualifications, orientation, and training. Statute Violated: Minnesota Statutes, section 245D.095, subdivision 5. Repeat Violation: In a Correction Order that DHS issued on July 20, 2020, you were previously found in violation of this same statute. Nature, chronicity, or severity of violations and effect of violation(s) on health, safety, or rights of persons served by the program The Commissioner considered the nature, chronicity, or severity of the violations of law or rule and the effect of the violations on the health, safety or rights of persons served by the program. Based on this analysis, the Commissioner has determined that a conditional license is appropriate. · Nature: The license holder was issued a correction order on July 21, 2020, that cited 20 violations. Despite the corrective action that was ordered in correction order, the license holder continued to demonstrate noncompliance and did not provide program coordination, evaluation, and oversight of services at the time of the licensing review on July 18, 2025, and July 25, 2025. · Chronicity: Your program received its license on October 5, 2017. During the application process you affirmed that you understood licensing rules and laws. DHS provided you direction and resources regarding these rules and laws, including the importance of compliance. Since October 5, 2017, your program has demonstrated a history of noncompliance with licensing rules and statutes. The information below summarizes this history: o October 7,2025 Conditional License (this order): 20 violations (10 repeat) o July 21, 2020, Correction Order: 20 violations · Severity: The designated coordinator and designated manager did not provide the coordination of service delivery and evaluation of program management and oversight which is required to ensure your program remains in compliance with licensing requirements. License holders are required to hire qualified and competent individuals for these roles to ensure licensing compliance is maintained. As a result of your inability to hire a qualified and competent designated coordinator and designated manager, you were found in violation of the twenty citations described in this order. The license holder did not provide access to records pertaining to the person served and personnel files. According to regulations, the commissioner must be granted access to these documents at any time, without prior notice. Inability to fully comply constitutes reasonable cause for the commissioner to take immediate action, including suspension or revocation of the license. Denying immediate access to required records compromises the license holder's integrity and raises significant concerns regarding compliance and transparency. The license holder did not meet the responsibilities related to individual abuse prevention plans by not reviewing the existing plans as required annually with persons served and their support teams. This could negatively impact the health and safety of persons served, as their identified vulnerabilities change, the review of the individual abuse prevention plan provides staff with knowledge of potential risks and the proactive strategies the staff will utilize to reduce these risks. Many of the violations involve your inability to ensure persons and/or their legal representatives were informed of and provided copies of the service recipient rights. This lack of disclosure has the potential to have a direct adverse effect on the life, health and well-being of persons receiving services. A lack of knowledge of and/or understanding of the rights afforded them could prevent persons served from utilizing and advocating for their rights to the fully extent as well as identifying and reporting when these rights could be violated. Your inability to comply with the established supervision plan has results in multiple health and safety concerns for the person served. The individual’s support plan explicitly requires awake overnight supervision. However, you acknowledged that you were asleep during overnight hours while services were being provided, which constitutes a serious deviation from the required level of care. You did not complete assessments for persons served, both at initiation for services and annually. Assessments are a core component to person centered service planning and delivery as they provide a picture of the person’s served strengths, functional skills and abilities and behavior or symptoms. This information is integral for identifying and implementing the appropriate level of supports and care that is unique to each person. Furthermore, you did not incorporate positive support strategies into the person’s individual plan. Positive supports are approaches that offer respectful and effective ways to help individuals increase quality of life and prevent or reduce behavioral risk. Without these strategies, the person’s behaviors related to their health and medical needs, as well as emotional well-being and personal growth could be negatively impacted. You did not prepare service outcomes and supports based on assessments of the person’s needs. Because the person’s level of need required intensive support services, you were required to do more than supervise him/her but to access his/her needs and to document supports and methods to support the person in acquiring, retaining, or improving skills. You did not have any documentation showing how you would address the person’s needs which included measurable and observable criteria for identifying when the desired outcome has been achieved. You did not show you provided any services beyond basic support services when you were legally required and paid to provide intensive support services. You did not fulfill your documented responsibilities to provide reminders the person served to take medication as prescribed. This could lead to persons served not taking their medication, which in turn could have an adverse effect on their health and safety. The medications that were not taken were prescribed to treat a variety of serious health conditions. Furthermore, you did not fulfill your documented responsibility in assisting persons served with treatments such as prescribed leg wrapping for a medical condition. This failure could contribute to negative health outcomes. Additionally, there was no documentation showing staff were trained on how to provide medication assistance or how to complete the leg wrapping. The license holder did not provide orientation and annual training to direct support staff persons, including training on maltreatment reporting requirements. When direct support staff are not provided with orientation and annual training, staff may not be competent to provide services to persons and there is an increased risk of neglect or abuse to persons served by the program. Training staff is a critical part of ensuring persons served are kept safe and to ensure their rights are protected. The failure to provide staff training directly relates to health, safety, and well-being of persons served by the program. Commissioner’s evaluation of program In determining whether a licensing action is warranted, DHS evaluated the facts, conditions, and circumstances concerning your program’s operation. This includes consideration of: · the program’s operation; · well-being of persons served by your program; · information about the qualifications of the direct support staff employed by you; and · the ability to demonstrate competent knowledge of applicable laws and rules.
DHS’ concerns about your program’s operation and ability to demonstrate competent knowledge were also demonstrated in your inability to comply with service planning and health needs documentation requirements. These requirements protect the health and safety of persons served and are minimum standards for license holders. Inability to comply with these requirements impedes the Commissioner’s ability to ensure the level of care that is required by persons served is being provided as mandated by law. Service planning and health needs requirements are essential to keeping vulnerable adults safe and ensuring persons served are receiving necessary services. Your lack of service planning and documentation of health needs posed a risk that staff would not know about the unique needs of the vulnerable people served. DHS has determined that an Order of Conditional License is appropriate based on the violations identified above and the program evaluation. Legal Authority: Minnesota Statutes, section 245A.04, subdivision 6. Due to the serious and chronic nature of these violations and the conditions in the program, which impact the health and safety of persons served in your care, your license to provide home and community-based services is on a conditional license. Immediate corrective action required You must immediately correct the violations cited above. Compliance with this order will be reviewed onsite ongoing. If you do not demonstrate substantial compliance with home and community-based services requirements or with the terms of your conditional license that are provided below, DHS may take an additional licensing action, including revocation, against your license.
Applicability of Conditional License This Order of Conditional License applies to all of your service sites operated under this 245D license because the 20 violations (10 repeat violations) show you lack competent knowledge of the laws required to operate an HCBS program. Since the violations involved your lack of competence to hire and train competent Designated Coordinators and Designated Managers; they involved staff who could provide services at any service site; persons served at multiple service sites; and they were serious in nature, this conditional order applies to all your 245D service sites. Service site is defined in 245D.02, subdivision 32. Legal Authority: Minnesota Statutes, section 245A.06, subdivision 1a, paragraph (a). CONDITIONAL LICENSE TERMS In addition to the Home and Community-Based Services licensing rules and statutes, you are required to comply with the following terms: 1. Within 15 days of receiving this order, you must notify current persons receiving services, all parties who refer persons to the program, and all payer sources of the conditional status of your license. The notification must be approved by DHS Licensing prior to being sent to persons receiving services and all other parties. Therefore, the draft notice must be submitted to DHS for approval within 10 days of receiving this order. The notification must specify the length of time of the conditional status of your license, the reasons your license was made conditional, and it must include either a copy of the Order of Conditional License or an offer to provide a copy of the order upon request. While the license is on conditional status, you must notify new persons receiving services, referral sources, and payer sources that the license is on conditional status before they begin receiving services. The notification to new persons receiving services must specify the length of time of the conditional status of the license, the reasons the license was made conditional, and it must include either a copy of the Order of Conditional License or an offer to provide a copy of the order upon request. Within 30 days of receiving this order, you must submit to the DHS Licensing Division a list of the individuals and parties that received the notice. 2. Within 30 days of receiving this order, you must: · designate a staff person, in addition to or other than SP3 who is responsible for delivery and evaluation of services provided by the license holder; · designate a managerial staff person, in addition to or other than SP3, to provide program management and oversight of the services provided by the license holder; and · submit the names and qualifications for the persons who will fulfill the duties and responsibilities of your designated coordinator and designated manager for DHS review and approval. It is your responsibility to ensure that these persons meet the necessary qualifications. You must maintain documentation of your designated coordinator and designated manager’s qualifications in their personnel records and a signed job description. Changes to these positions may not be made without prior notification and approval by DHS. The same person may perform both functions if the work and education requirements outlined in section 245D.081, subdivisions 2 and 3 are met. 3. Within 30 days of receiving this order, you must: · submit a written plan to DHS detailing how you will ensure the corrective action ordered in this order is completed; and · audit all persons served and staff records for compliance with all applicable rules and statutes. The written plan must detail the roles and responsibilities that your designated coordinator and designated manager will have in completing corrective action and auditing all persons served records. 4. Within 60 days of receiving this order, you must: · complete an audit of all participant and personnel records according to your written plan. The audit must be completed by your designated coordinator and/or designated manager; · submit the results of the audit to your DHS licensor. The results must include the name of the staff person that audited each person served and personnel record; and · submit the date to your DHS licensor that all person served and personnel records will be brought into compliance based on the results of your audit. This date must be within 90 days of receiving this order. 5. During the first three months of your conditional license, no new admissions will be allowed. After this time, you must notify your licensor and receive approval prior to admitting new persons served to your program. The notification to your licensor must include the name of the person served, the name and contact information for the person’s case manager, the service(s) you will provide to the person, the person’s anticipated service initiation date for each service, and documentation of compliance with term 1 of your conditional license. 6. You must contact and receive approval from your county licensor in advance of any time you will be away from the home for more than 48 hours. Additionally, you must provide a backup caregiver/staffing plan to your county licensor when an extended absence is approved for the duration of the conditional license. 7. You may not add additional services to this license for the duration of the conditional license. 8. You may not apply for other DHS-issued licenses without prior approval from DHS for the duration of this conditional license. 9. You will not be granted any variances for the duration of the conditional license. Submissions required as part of a corrective action ordered must be sent to your DHS licensor at: 1. By secure email at jolene.reinke@state.mn.us; or 2. If you are unable to submit corrective action ordered securely through email, you can fax 651-431-7673 or mail using the information below: Commissioner, Department of Human Services ATTN: Jolene Reinke Licensing Division PO Box 64242 St. Paul, MN 55164-0242 YOUR RIGHT TO REQUEST RECONSIDERATION You have the right to request reconsideration of this order and the cited violations. Your request must: · Be in writing · Clearly state that you are requesting reconsideration of the conditional license · List each citation you are challenging and identify what is inaccurate or incomplete about the information in the order · Supply information that is accurate or more complete · State why you believe your license should not be on a conditional status · Be made before the deadlines provided below 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. If you do not meet this deadline, you lose your right to request reconsideration. The timeline to appeal began when you received this order. Please send it to: Commissioner, Department of Human Services Office of Inspector General Legal Counsel’s Office Attn: Licensing Legal Unit PO Box 64953 St. Paul, MN 55164-0953 If your request is being personally delivered, it must be received by DHS within 10 calendar days from when you received this order. Please bring it to: Commissioner, Department of Human Services Office of Inspector General Legal Counsel’s Office Attn: Licensing Legal Unit 444 Lafayette Road North St. Paul, MN 55155 Conditional license stayed pending reconsideration If you request reconsideration within the timeframes described above, the terms of the conditional license will not take effect until a decision is issued by DHS. If the conditional license is affirmed on reconsideration, the terms would take effect on the date of the reconsideration decision, and run for two years from that date. You continue to be required to comply with all home and community-based services laws and rules. Legal authority for this licensing action · This action is taken under Minnesota Statutes, section 245A.06, subdivision 1. · Home and Community Based-Services are required to follow Minnesota Statutes 245A, 245C and 245d, and Minnesota rules, chapter 9544. · The timeline to request reconsideration of the order is provided in Minnesota Statutes, section 245A.06, subdivision 4. · If a license holder files a timely reconsideration request, the terms of the conditional license are stayed pending a decision by DHS under Minnesota Statutes, section 245A.06, subdivision 4. · Minnesota Statutes, section 245A.06, subdivision 3 states that DHS may impose additional licensing actions against a license holder that does not correct the violations cited in a conditional license order. Questions If you have any further questions regarding this matter, you may contact Leota Bemis, Supervisor, at 651-431-5637. Sincerely,
Christala Culhane, Unit Manager Licensing Division Office of Inspector General
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