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November 26, 2025 Blia Vang, Authorized Agent Tso Siab Adult Daycare Center 5660 Julep Way Lake Elmo, Minnesota 55042 License Number: 1097769 (Rule 223) CORRECTION ORDER Dear Blia Vang: On November 9, 2025, a licensing review of Tso Siab Adult Daycare Center located at 2090 11th Avenue East, North Saint Paul, Minnesota was conducted to determine compliance with Minnesota Statutes and Rules governing adult day care services under Minnesota Rules, parts 9555.9600 through 9555.9730 (Rule 223). As a result of this licensing review, a Correction Order is being issued. A. Reason for Correction Order Pursuant to Minnesota Statutes, section 245A.06, if the Commissioner of the Department of Human Services (DHS) finds that the license holder has failed to comply with an applicable law or rule and this failure does not imminently endanger the health, safety, or rights of the persons served by the program, the Commissioner may issue a Correction Order to the license holder. The following violation(s) of state or federal laws and rules were determined as a result of the licensing review. Corrective action for each violation is required by Minnesota Statutes, section 245A.06 and is hereby ordered by the Commissioner of Human Services. 1. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For three or three participants whose records were reviewed (P1-P3), 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 participant record: · P1’s source of referral; · a medical report, dated within the three months prior to or 30 days after P1’s admission to the center signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician; and · P1’s service agreement with the center, that specified the responsibilities of P1 and the center with respect to payment for and provision of services. b. The license holder did not include the name and telephone number of the person to call in case of emergency involving P2 and name and number of another person to call if that person cannot be reached in P2’s participant record. c. The license holder did not include the following information in P3’s participant record: · P3’s source of referral; and · P3’s service agreement with the center, that specified the responsibilities of P3 and the center with respect to payment for and provision of services. Repeat Violation: In a Correction Order that DHS issued on November 17, 2022, you were previously found in violation of this same rule. 2. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For two participants whose records were reviewed (P1 and P3), the license holder did not complete initial service planning as required. The license holder did not conduct a needs assessment for P1 and P3 within 30 days of P1 and P3’s admission to the center that included; · P1 and P3’s psychosocial status (for example, awareness level, personal care needs, need for privacy or socialization); · P1 and P3’s functional status (for example, endurance and capability for ambulation, transfer, and managing activities of daily living); and · P1 and P3's physical status, determined by observation, from the intake screening interview, and from the medical report received from P1 and P3's physicians.
3. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For two participants whose records were reviewed (P1 and P3), the license holder did not develop a written plan of care as required. The license holder did not develop written plans of care for P1 and P3 that included: · an update of the preliminary service plan and additional services required by P1 and P3; and · short and long term objectives for P1 and P3 stated in concrete, measurable and time specific outcomes. Repeat Violation: In a Correction Order that DHS issued on November 17, 2022, you were previously found in violation of this same rule. 4. Citation: Minnesota Statutes, section 245A.02, subdivision 2a. Violation: The license holder did not offer adult day services as required. Minnesota Statutes, section 245A.02, subdivision 2a defines adult day care as providing an individualized and coordinated set of services including health services, social services, and nutritional services that are directed at maintaining or improving the participants’ capabilities for self-care. Adult day care, adult day services, and family adult day services do not include programs where adults gather or congregate primarily for purposes of socialization, education, supervision, caregiver respite, religious expression, exercise, or nutritious meals.
5. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (a).
Violation: The license holder did not establish and enforce their program abuse prevention plan (PAPP) as required.
The license holder failed to ensure the license holder’s governing body or the governing body’s delegated representative reviewed the PAPP at least annually. The license holder last reviewed the PAPP in September 2024.
Corrective Action: Within 30 days of receiving this order, you must have your governing body, or the governing body’s delegated representative, review the PAPP and document the review of the PAPP. 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. Kristopher Oberg, HCBS Human Services Licensor Licensing Division Office of Inspector General 651-431-6589
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