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October 17, 2025 Todd Archbold, Authorized Agent PrairieCare Residential Services 12915 63rd Avenue North Maple Grove, MN 55369 License Number: 1082863 Investigation Report Number: 202504323 CORRECTION ORDER Dear Todd Archbold, On July 22 through the 25 of 2025, the Department of Human Services (DHS) conducted a licensing review and investigation at your facility, PrairieCare Residential Services, located at 12915 63rd Avenue North, Maple Grove, MN 55369. This review and investigation were conducted to determine compliance with state and federal laws and rules governing the provision of children’s residential facilities under Minnesota Rules, part 2960.0010 through 2960.0120, children's group residential facilities under Minnesota Rules, parts 2960.0130 through 2960.0220, residential mental health treatment program for child certification standards under Minnesota Rules, parts 2960.0580 through 2960.0700, with a residential program certification as a qualified residential treatment program under Minnesota Statutes, section 245A.25. As a result of this visit, DHS is issuing this order which requires you to take the correction action as described under each violation. Details of our findings are provided below. Our next steps and your options are also detailed. LICENSING VIOLATION DHS determined that your program failed to follow licensing rules and statutes, as described below. Policies and Practices 1. Violation: The license holder’s service delivery plan did not meet requirements. The plan did not describe how the program provides services according to the following ways: a. That the following staff be available 24 hours a day and seven days a week to provide care within the scope of their practice: i. A registered nurse or licensed practical nurse; and ii. Other licensed clinical staff. b. Contacting and facilitating outreach to each resident’s family members, including the resident’s siblings, and must document outreach to the resident’s family members in the resident’s file, including the contact method and each family member’s contact information; c. Recording and maintaining the contact information for all known biological family members and fictive kin of the resident; d. Documenting in the resident’s file how the program integrates family members into the treatment process for the resident, including after the resident’s discharge from the program, and how the program maintains the resident’s connections to the resident’s sibling; e. Discharge planning and family-based aftercare support to each resident for at least six months after the resident’s discharge from the program; and f. When providing aftercare to a resident, having monthly contact with the resident and the resident’s caregivers to promote the resident’s engagement in aftercare services and to regularly evaluate the family’s needs. Statute Violated: Minnesota Statutes, 245A.25, subdivision 4, paragraph (j) Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure the service delivery plan policy meets all applicable requirements. Within 30 days receipt of this order, submit a service delivery plan that demonstrates compliance. 2. Violation: The license holder’s time-out policy did not include the following required components: a. Time-outs must be used under the direction of a mental health professional, facility director, or the program manager; b. The use of time-out must be consistent with the resident’s treatment plan; c. The treatment team must include and document the review of the use of time-out for each resident during the review of the resident’s treatment plan; d. Staff must document the use of time-out in the resident’s record and include the following information: i. The factors or circumstances which caused the need for the use of time-out; ii. The resident’s response to the time-out; iii. The resident’s ability to de-escalate during the time-out procedure; and iv. The resident’s ability to maintain acceptable behavior after the time-out. Rule Violated: Minnesota Rule, part 2960.0080, subpart 5, item D. Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure the time-out policy meets all applicable requirements. Within 30 days receipt of this order, submit a time-out policy that demonstrates compliance. 3. Violation: The license holder’s restrictive procedure plan did not meet requirements. The plan did not include the following items: a. A description of the training that staff who use restrictive procedures must have prior to staff implementing the emergency use of restrictive procedures; b. A license or certification holder must not use a prone restraint on any person receiving services in a program, except if a person rolls into a prone position during the use of a restraint, the person must be restored to a nonprone position as quickly as possible; and c. How the license holder will address and document contraindicated physical restraints. Rules Violated: Minnesota Statutes, section 245A.211, subdivisions 3 and 4, and Minnesota Rules, part 2960.0710, subpart 2, item C and subpart 9 Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure the restrictive procedures plan meets all applicable requirements. Within 30 days receipt of this order, submit a restrictive procedures plan that demonstrates compliance. 4. Violation: The license holders plan for transfer of records and clients upon closure did not meet requirements. The plan was not reviewed and signed annually by a controlling individual of the program for the year of 2025. Statute Violated: Minnesota Statutes, section 245A.04, subdivision 15a, paragraph (a) Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure the plan for transfer of records and clients upon closure meets all applicable requirements. 5. Violation: The license holders provision of trauma informed care did not meet requirements. The license holder implemented “room-time” for all residents, where they were required to remain in their rooms for 30 to 60 minutes, three to four times per day. Through interviews with staff, it was determined that this practice was not modified to respond to the effects of trauma on the person receiving services, and did not acknowledge the effects of trauma on a person receiving services.
Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure trauma informed care practices meet all applicable requirements. 6. Violation: For two of two weeks reviewed, the license holder’s practice of clinical supervision did not meet requirements in the following ways: a. For December 23 through 29, 2024, five of thirty-two staff who provided program services did not receive clinical supervision from a mental health professional; and b. For July 7 through 13, 2025, nine of thirty-six staff who provided program services did not receive clinical supervision from a mental health professional. Rule Violated: Minnesota Rules, part 2960.0630, subpart 2 Corrective Action Required: Immediately and on an ongoing basis, license holder must ensure clinical supervision practice meets all applicable requirements. Repeat Violation: License holder was cited for similar violations in a Correction Order dated April 8th, 2022. Resident Files 7. Violation: Four of four resident files reviewed for requirements governing resident information did not meet requirements in the following ways: a. Admission documentation regarding the following did not occur upon or within five working days after admission (resident file numbered 1): i. Legal authority for a resident’s placement; ii. Date and time of admission; iii. Race or cultural heritage, language the resident speaks and write, tribal affiliation, if any; iv. Description of presenting problems: including medical problems, circumstances leading to admission, mental health concerns, safety, concerns including assaultive behavior, victimization concerns; v. description of assets and strengths of the resident and, if available, related information from the resident, resident's family, and concerned persons in the resident's life; and vi. spiritual or religious affiliation of the resident and the resident's family b. The resident file did not have documentation demonstrating that the license holder recorded and maintained the contact information for all known biological family members and fictive kin of the resident (resident files numbered 1, 2, 3, and 4). Rules Violated: Minnesota Rules, part 2960.0070, subpart 3 and Minnesota Statutes, section 245A.25, subdivision 4, paragraph (g) Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure resident information meet all applicable requirements. 8. Violation: Four of four resident files reviewed for requirements governing admission criteria did not meet requirements in the following ways: a. When public funds were not used to pay for services, there was no documentation to demonstrate that the resident was screened by a mental health professional using a screening process that is equivalent to that required by Minnesota Statutes, section 245.4885, subdivision 1, before admission (resident files numbered 1); and b. There was no documentation to demonstrate that the license holder determined their program could meet the developmental and mental health needs of the resident (resident files numbered 1, 2, 3, and 4). Rule Violated: Minnesota Rules, part 2960.0670, subpart 2, items C and F Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure admission determinations meet all applicable requirements. 9. Violation: Four of four resident files reviewed for requirements governing admission procedures did not meet requirements (resident files numbered 1, 2, 3, and 4). Each resident was not provided with a complete description of the applicable programs and activities available to residents in the facility. Rule Violated: Minnesota Rules, part 2960.0160, subpart 4, item B Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that admission procedures meet all appliable requirements. Within 30 days receipt of this order, submit a description of appliable programs and activities that demonstrates compliance. Repeat Violation: The license holder was cited for a similar violation in a Correction Order dated April 8th, 2022. 10. Violation: Four of four resident files reviewed for requirements governing admission screenings did not meet requirements (resident files numbered 1, 2, 3, and 4) in the following ways: a. The sexually abusive behavior screening, vulnerability assessment, and cultural screening did not include all of the required components b. Documentation about the degree to which the resident’s family desires to be involved during the residents stay at the facility did not include the family’s response. c. There was no documentation to demonstrate a trauma-specific screening was completed. Rule Violated: Minnesota Rules, part 2960.0070, subpart 5, items A through D, and Minnesota Statutes, section 245A.25, subdivision 3, paragraph (c) Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that admission screenings meet all appliable requirements. Repeat Violation: The license holder was cited for a similar violation in a Correction Order dated April 8th, 2022. 11. Violation: Two of two resident files reviewed for requirements governing chemical health education did not meet requirements (resident files numbered 1 and 2). There was no documentation to demonstrate that the license holder provided education about chemical health to the residents who have had a problem related to inappropriate chemical use, but who do not have a sufficient chemical use history to refer to treatment. Rule Violated: Minnesota Rules, part 2960.0080, subpart 9, item D Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that chemical health program services meet all appliable requirements. Repeat Violation: The license holder was cited for a similar violation in a Correction Order dated April 8th, 2022. 12. Violation: Four of four resident files reviewed for requirements governing program services did not meet requirements in the following ways: a. The license holder did not facilitate participation of the resident’s family members in their treatment program, consistent with their best interests (resident files numbered 1 and 2); and b. The license holder did not contact and facilitate outreach to each resident’s family members, including the resident’s siblings, and document outreach to the resident’s family members in the resident’s file, including contact method and each family member’s contact information (resident files numbered 1, 2, 3, and 4). Statute Violated: Minnesota Statutes, section 245A.25, subdivision 4, paragraphs (f) and (g) Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that program services meet all appliable requirements. 13. Violation: Four of four client files reviewed for requirements governing treatment plans did not meet requirements in the following ways: a. The individual treatment plan was not completed within 10 working days of admission (resident files numbered 1, 2, and 4); b. The plan did not identify a schedule for accomplishing treatment goals and objectives (resident files numbered 1 and 2); c. The use of psychotropic medication was not included in the resident’s individual treatment plan (resident files numbered 2); d. The plan did not include a description in observable and measurable terms of the symptoms and behaviors that the psychotropic medication is to alleviate (resident files numbered 3 and 4); and e. A mental health professional did not document involvement in the treatment planning process by signing the individual treatment plan (resident file numbered 1). Rule Violated: Minnesota Rules, parts 2960.0600, item A; 2960.0620, subpart 1, items A and B; and 2960.0630, subpart 3, item B Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that treatment plans meet all appliable requirements. Within 30 days receipt of this order, submit a treatment plan that demonstrates compliance. Repeat Violation: The license holder was cited for a similar violation in a Correction Order dated April 8th, 2022. 14. Violation: Two of four resident files reviewed for requirements governing service plan reviews did not meet requirements (resident files numbered 1 and 4). There was no documentation to demonstrate the use of time-out for each resident was reviewed during the review of their treatment plan. in the following ways: Rule Violated: Minnesota Rules, parts 2960.0080, subpart 5, item D Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that service plan reviews meet all appliable requirements. 15. Violation: One of four resident files reviewed for requirements governing health care did not meet requirements (resident file numbered 1). There was no documentation to demonstrate that the prescription medication belonging to the resident was given to the resident's parent or legal guardian upon the resident's release according to a pharmacy-approved plan. Rule Violated: Minnesota Rules, part 2960.0080, subpart 11, item F Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that health care meets all appliable requirements. 16. Violation: Four of four resident files reviewed for requirements governing psychotropic medications did not meet requirements in the following ways: a. There was no documentation identifying a list of possible side effects for a resident prescribed a psychotropic medication (resident files numbered 1, 2, 3, and 4); and b. The license holder did not document a psychotropic medication review at least monthly for the first six months (resident files numbered 1, 3, and 4). Rule Violated: Minnesota Rules, part 2960.0620, subparts 2 and 5 Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that documentation involving psychotropic medications meet all appliable requirements. 17. Violation: Two of four resident files reviewed for requirements governing informed consent for the administration of psychotropic medication did not meet requirements in the following ways: a. When oral consent was obtained, an explanation for why written informed could not be initially obtained was not documented. All psychotropic medications were listed on one informed consent form and the line for the explanation was left blank (resident files numbered 1 and 2); and b. The license holder did not provide documentation demonstrating that they provide the required information in writing to the resident’s parents, the resident’s legal representative, and, to the extent possible, the resident (resident file numbered 1). Rule Violated: Minnesota Rules, part 2960.0620, subpart 7 Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that informed consent documentation meets all appliable requirements. Repeat Violation: The license holder was cited for a similar violation in a Correction Order dated April 8th, 2022. 18. Violation: Two of two resident files reviewed for requirements governing time-out procedures did not meet requirements in the following ways: a. The use of time out was not documented in the resident file (resident file numbered 1); and b. Documentation of a time-out implemented on 04/02/2025 did not include the resident’s ability to de-escalate during the time-out or their response to the time-out (resident file numbered 4). Rule Violated: Minnesota Rules, part 2960.0080, subpart 5, item D Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that documentation for time-out procedures meet all appliable requirements. 19. Violation: One of three resident files reviewed for requirements governing restrictive procedures did not meet requirements (resident file numbered 5) in the following ways: a. Documentation did not demonstrate that an immediate intervention was necessary to protect the resident or others from physical harm, for a physical hold implemented on 06/25/2025; and b. Documentation did not demonstrate that the mental health professional was contacted to inform them about the use of physical holding and to ask for permission to use physical holding. Rule Violated: Minnesota Rules, part 2960.0710, subpart 6, item A and G Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that documentation for restrictive procedures meet all appliable requirements. 20. Violation: One of two resident files reviewed for requirements governing no eject discharges did not meet requirements (resident file numbered 1) in the following ways: a. Documentation did not demonstrate that the license holder conferred with other interested persons to review the issues involved in the decision, before discharging the resident who had not reached their treatment plan goals; and b. Documentation did not identify whether any additional strategies could be developed to resolve the issues leading to the discharge and to permit the resident an opportunity to continue to receive services from the license holder. Rule Violated: Minnesota Rules, part 2960.0090, subpart 2 Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that documentation for no eject discharges meet all appliable requirements. Repeat Violation: The license holder was cited for a similar violation in a Correction Order dated April 8th, 2022. 21. Violation: Four of five resident files reviewed for requirements governing discharge did not meet requirements in the following ways: a. There was no documentation to demonstrate that all of the resident’s personal property was returned to the resident (resident files numbered 1 and 4); b. The transition services plan documentation did not demonstrate that the plan was developed with input from the resident’s family members (resident file numbered 6); and c. The license holder did not document the extent to which the resident’s stay in the facility met the goals and objectives identified in the treatment plan (resident files numbered 3, 4, and 6). Rule Violated: Minnesota Rules, parts 2960.0090, subpart 3, 2960.0190, subpart 1, item A, 2960.0140, subpart 2; and 2960.0190, subpart 2 Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that documentation for discharge procedures meet all appliable requirements. Repeat Violation: The license holder was cited for a similar violation in a Correction Order dated April 8th, 2022. 22. Violation: Three of four resident files reviewed for requirements governing aftercare did not meet requirements (resident files numbered 1, 3, and 4). There was no documentation to demonstrate family-based aftercare support was provided to the resident at least monthly. Statute Violated: Minnesota Statutes, section 245A.25, subdivision 4, paragraph (i) Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure that aftercare meet all appliable requirements. Personnel Files 23. Violation: Six of six personnel files reviewed for requirements governing ongoing training did not meet requirements (personnel files numbered 1, 2, 3, 4, 5, and 6) in the following ways: a. For calendar year 2023, there was no documentation to demonstrate staff were trained on the impacts of culture, race, gender, and sexual orientation on individual resident’s behavioral health and experiences of trauma annually; and b. The license holder did not document the name of the entity that provided the training. Statute and Rule Violated: Minnesota Statutes, section 245A.25, subdivision 3, paragraph (h) and Minnesota Rules, part 2960.0100, subpart 5 Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure provision and documentation of ongoing training meet all applicable requirements. Written Response Required If you fail to correct the violation(s) 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 the corrective action ordered must be sent to your licensor by email (hannah.horsch@state.mn.us) or mail: Commissioner, Department of Human Services ATTN: Hannah Horsch 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 · List each violation you are challenging and identify what is inaccurate or incomplete about the information in the order · Supply information that is accurate or more complete · Be made before the deadlines provided below If you are mailing your request, it must be received by DHS within 20 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 20 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 Legal authority for this licensing action · This action is taken under Minnesota Statutes, section 245A.06, subdivision 1. · This Children’s Residential Facility must maintain compliance with the licensing statutes and rules, specifically Minnesota Rules, chapter 2960. · The timeline to request reconsideration of the order is provided in Minnesota Statutes, section 245A.06, subdivision 2. Questions If you have any further questions regarding this matter, you may contact me at 651-431-5909. Sincerely, Michael Cihla, Senior Licensor Licensing Division Office of Inspector General
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