Minnesota

December 11, 2025

Leanne Negley, Authorized Agent

Rural Living Environments Inc

105 Central Boulevard

Babbitt, Minnesota 55706-1247

1068090 (245D – Home and Community-Based Services)

CORRECTION ORDER

Dear Leanne Negley

On October 22, 23, and 24, 2025, a licensing review of Rural Living Environments Inc, located at 105 Central Boulevard, Babbitt, 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. 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 Statues, section 245A.65, subdivision 2.

Violation: For one of four persons whose records were reviewed (P3), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP), as required.

P3 has a history of panhandling. The license holder stated to DHS that P3’s panhandling is upsetting to members of the community which could leave P3 susceptible to both verbal and physical abuse from others. The license holder did not include P3’s panhandling in P3’s IAPP dated September 19, 2025.

Corrective Action Ordered: Within 30 days of receiving this order, you must:

· complete an individualized assessment of P3’s susceptibility to abuse by others and P3’s risk of abusing others that includes P3’s history of panhandling; and

· document a statement of the specific measures that would be taken to minimize the risk of abuse in P3’s IAPP.

On an ongoing basis, you must maintain compliance as required in this subdivision.

2. Citation: Minnesota Statutes, section 245D.04, subdivision 1.

Violation: For four persons whose records were reviewed (P1-P4), the license holder did not provide a written notice that identified the service recipient rights 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 provide P1-P4 with a written notice and explanation of the service recipient rights annually that included the following rights:

· access to the person’s personal possessions at any time, including financial resources;

· have access to three nutritionally balanced meals and nutritious snacks between meals each day;

· have freedom and support to access food and potable water at any time;

· have the freedom to furnish and decorate the person’s bedroom or living unit;

· a setting that is free from hazards that threaten the person’s health or safety; and

· a setting that meets the definition of a dwelling unit within a residential occupancy as defined in the State Fire Code.

Corrective Action Ordered: Within 30 days of receiving this order, you must:

· provide P1-P4 with the service recipient rights including the above mentioned;

· maintain written acknowledgement of receipt in P1’s-P4’s service recipient record; and

· audit all person served records to ensure all of the required service recipient rights have been provided.

On an ongoing basis, you must maintain compliance as required in this subdivision.

3. Citation: Minnesota Statutes, section 245D.05, subdivision 1a and 1b.

Violation: For three persons whose records were reviewed (P1, P2, and P4), the license holder did not document medication setup as required.

a. The license holder was assigned the responsibility for medication setup according to P2’s and P4’s support plan addendum. The license holder did not document the dates of setup in P2’s or P4’s medication administration record.

b. The license holder assigned themselves the responsibility for medication set up and assistance in P1’s support plan addendum. DHS licensors determined the license holder was providing medication set-up and medication administration to P1. The license holder did not accurately document how P1’s health needs would be met.

c. The license holder did not maintain the following information in P1’s medication administration record (MAR):

· dates of setup;

· name of medication;

· quantity of dose;

· times to be administered; and

· route of administration at time of setup.

Corrective Action Ordered: Within 30 days of receiving this order, you must:

· update P1’s support plan addendum to accurately document how P1’s health needs will be met;

· document the following information in P1’s MAR for medication setup:

o dates of setup;

o name of medication;

o quantity of dose;

o times to be administered; and

o route of administration at time of setup;

· maintain the dates of set up in P2’s and P4’s medication administration record; and

· audit all person served medication administration records that receive medication setup to ensure the following information has been documented:

o dates of setup;

o name of medication;

o quantity of dose;

o times to be administered; and

o route of administration at time of setup.

On an ongoing basis, you must maintain compliance as required in this subdivision.

3. Citation: Minnesota Statutes, section 245D.05, subdivision 2, paragraph (c).

Violation: For three persons whose records were reviewed (P1, P2, and P4), the license holder did not maintain a medication administration record (MAR) as required.

a. The license holder was assigned medication administration responsibilities for P2 and P4. The license holder did not ensure the following information was documented in P2’s and P4’s MAR:

· information on any risks or other side effects that are reasonable to expect, and any contraindications to its use;

· the possible consequences if the medication or treatment is not taken or administered as directed;

· instruction on when and to whom to report the following:

o if a dose of medication is not administered or treatment is not performed as prescribed, whether by error by the staff or the person or by refusal by the person; and

o the occurrence of possible adverse reactions to the medication or treatment;

· notation of any occurrence of a dose of medication not being administered or treatment not performed as prescribed, whether by error by the staff or the person or by refusal by the person, or of adverse reactions, and when and to whom the report was made; and

· notation of when a medication or treatment was started, administered, changed, or discontinued.

b. The license holder did not ensure the following information was maintained in P1’s MAR:

· information on any risks or other side effects that are reasonable to expect, and any contraindications to its use; and

· instruction on when and to whom to report the following:

o if a dose of medication is not administered or treatment is not performed as prescribed, whether by error by the staff or the person or by refusal by the person; and

o the occurrence of possible adverse reactions to the medication or treatment.

Corrective Action Ordered: Within 30 days of receiving this order, you must:

· ensure the above-mentioned information is documented in P1’s, P2’s, and P4’s MAR; and

· audit all person served MARs to ensure the above-mentioned information has been documented.

On an ongoing basis, you must maintain compliance as required in this subdivision.

5. Citation: Minnesota Statutes, section 245D.05, subdivision 4, paragraph (b).

Violation: For one person whose record was reviewed (P1), the license holder did not report when a dose of medication was not administered as prescribed, as required.

On May 21, 2025, the license holder administered another individual’s medication to P1. The license holder did not report the medication error to P1’s legal representative and case manager.

Corrective Action Ordered: Within 30 days of receiving this order, you must report the above-mentioned medication error to P1’s legal representative and case manager. You must maintain documentation of this notification in P1’s service recipient record. On an ongoing basis, you must maintain compliance as required in this subdivision.

6. Citation: Minnesota Statutes, section 245D.051, subdivision 1.

Violation: For two persons whose records were reviewed (P2 and P4), the license holder was assigned responsibility for administration of medication in the CSSP addendum for P2 and P4. The license did not develop, implement, and maintain documentation regarding psychotropic medications as required.

P2 and P4 were prescribed psychotropic medications. The license holder indicated the diagnoses for which the medications were prescribed to P2 and P4; however, the license holder did not maintain documentation that included a description of the target symptoms that each psychotropic medication was to alleviate for P2 and P4.

Corrective Action Ordered: Within 30 days of receiving this order, you must maintain documentation in P2’s and P4’s CSSP addendum that includes a description of the target symptoms that each psychotropic medication was to alleviate. On an ongoing basis, you must maintain compliance as required in this subdivision.

7. Citation: Minnesota Statutes, section 245D.061, subdivision 5, paragraph (b).

Violation: For one person whose record was reviewed (P1), the license holder did not report the use of an emergency use of manual restraint (EUMR), as required.

The license holder did not report the use of an EUMR for incidents involving P1 that occurred on the following dates:

· March 16, 2024;

· October 12, 2024; and

· December 10, 2024.

Corrective Action Ordered: Within 30 days of receiving this order, you must:

· report the above-mentioned incidents to the Department of Human Services and the Office of the Ombudsman for Mental Health and Developmental Disabilities using the Behavior Intervention Reporting Form (BIRF); and

· maintain documentation of this notification in P1’s service recipient record.

On an ongoing basis, you must maintain compliance as required in this subdivision.

8. Citation: Minnesota Statutes, section 245D.061, subdivision 7.

Violation: For one person whose record was reviewed (P1), the license holder did not complete an expanded support team review following the use of an emergency use of manual restraint, as required.

The license holder initiated an emergency use of manual restraint on May 8, 2025. The license holder did not complete an expanded support team review of the incident within five days after the internal review, following the emergency use of manual restraint.

Corrective Action Ordered: Within 30 days of receiving this order, you must complete an expanded support team review of the incident involving an emergency use of manual restraint to:

· discuss the incident reported in subdivision 5, to define the antecedent or event that gave rise to the behavior resulting in the manual restraint and identify the perceived function the behavior served;

· determine whether the person's support plan addendum needs to be revised according to sections 245D.07 and 245D.071 to positively and effectively help the person maintain stability and to reduce or eliminate future occurrences requiring emergency use of manual restraint; and

· maintain a written summary of the expanded support team's discussion and decisions in the P1's service recipient record.

On an ongoing basis, you must maintain compliance as required in this subdivision.

9. Citation: Minnesota Statutes, section 245D.071, subdivision 3, paragraph (d).

Violation: For one person whose record was reviewed (P3), the license holder did not meet initial service planning requirements for an intensive support service.

The license holder did not discuss with P3 and P3’s support team how technology might be used to meet P3’s desired outcomes at P3’s initial service planning meeting.

Corrective Action Ordered: Corrective action for this citation is documented in citation number 10. On an ongoing basis, you must maintain compliance as required in this subdivision.

10. Citation: Minnesota Statutes, section 245D.071, subdivision 5, paragraph (b).

Violation: For two persons whose records were reviewed (P1 and P3), the license holder did not meet service plan review and evaluation requirements for an intensive support service.

a. The license holder did not discuss with P1 and P3, P1’s legal representatives, and members of P1’s and P3’s support team about how technology might be used to meet P1’s and P3’s desired outcomes at least once per year.

b. The license holder assigned themselves the responsibility of quarterly meetings for P1. The license holder held annual meetings for P1. The license holder did not participate in service plan review meetings following stated timelines established in P1’s support plan addendum.

Corrective Action Ordered: Within 30 days of receiving this order, you must:

· discuss with P1, P1’s legal representative and P1’s case manager and members of the support team and P3, P3’s case manager and member of the support team about how technology might be used to meet P1’s and P3’s desired outcomes;

· maintain documentation of this discussion in P1’s and P3’s support plan addendums;

· discuss service plan review meeting frequency preferences with P1, P1’s legal representative, case manager and members of the support team; and

· maintain documentation of these preferences in P1’s support plan addendum.

On an ongoing basis, you must maintain compliance as required in this subdivision.

11. Citation: Minnesota Rules, part 9544.0030, subpart 1.

Violation: For four persons whose records were reviewed (P1-P4), the license holder did not meet the requirements for positive support strategies as identified.

The license holder incorporated positive support strategies for P1-P4; however, the license holder did not evaluate the identified positive support strategies with P1-P4 every 6 months as required.

Corrective Action Ordered: Within 30 days of receiving this order, you must evaluate the identified positive support strategies with P1-P4. On an ongoing basis, you must maintain compliance as required in this subdivision.

12. Citation: Minnesota Statutes, section 245D.09, subdivision 4.

Violation: For two of four staff persons whose records were reviewed (SP3 and SP4), the license holder did not provide orientation training as required.

a. The license holder did not provide SP3 with orientation training on basic first and strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities within 60 days of hire.

b. The license holder did not provide SP4 with orientation training on strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities within 60 days of hire.

Corrective Action Ordered: Corrective action ordered for this citation is documented in citation number 14. On an ongoing basis, you must maintain compliance as required in this subdivision.

13. Citation: Minnesota Statutes, section 245D.09, subdivision 4a, paragraph (a).

Violation: For one staff person whose record was reviewed (SP4), the license holder did not provide orientation to individual service recipient needs as required.

The license holder documented that SP4’s date of first unsupervised direct contact with a person served was August 01, 2023. The license holder did not provide SP4 with the following training before having unsupervised direct contact:

· appropriate and safe techniques in personal hygiene and grooming, including hair care; bathing; care of teeth, gums, and oral prosthetic devices; and other activities of daily living (ADLs) as defined under section 256B.0659, subdivision 1;

· an understanding of what constitutes a healthy diet according to data from the Centers for Disease Control and Prevention and the skills necessary to prepare that diet; and

· instruction on the person's support plan or support plan addendum as it relates to the responsibilities assigned to the license holder, and when applicable, the person's individual abuse prevention plan, to achieve and demonstrate an understanding of the person as a unique individual, and how to implement those plans.

SP4 received the above training on September 25, 2023.

Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision.

14. Citation: Minnesota Statutes, section 245D.09, subdivision 5.

Violation: For four staff persons whose records were reviewed (SP1-SP4), the license holder did not provide annual training 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.

a. The license holder did not provide SP1 with annual training in the following areas in 2024 and 2025:

· review of the license holder’s program abuse prevention plan;

· 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.

b. The license holder did not provide SP2 with annual training as required in the following areas:

· data privacy requirements according to Minnesota Statutes, 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;

· 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;

· review of the license holder’s program abuse prevention plan in 2023, 2024, and 2025;

· the safe and correct use of manual restraint on an emergency basis according to the requirements in section 245D.061 and what constitutes the use of restraints, time out, and seclusion, including chemical restraint in 2025;

· staff responsibilities related to prohibited procedures under section 245D.06, subdivision 5, why such procedures are not effective for reducing or eliminating symptoms or undesired behavior, and why such procedures are not safe in 2025;

· basic first aid in 2024 and 2025; and

· strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities 2023, 2024, and 2025.

SP2 received training on the first two bullet points outside the definition of annually per Minnesota Statutes.

c. The license holder did not provide SP3 with annual training as required in the following areas in 2025:

· review on the license holder’s program abuse prevention plan;

· 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.

d. The license holder did not provide SP4 with annual training as required in the following areas:

· a review on the license holder’s program abuse prevention plan in 2024 and 2025;

· basic first aid in 2024 and 2024; and

· strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities in 2024 and 2025.

SP4 received training on the first two bullet points outside the definition of annually per Minnesota Statutes.

Corrective Action Ordered: Within 30 days of receiving this order, you must provide SP1-SP4 with the above-mentioned training. You must maintain documentation of this training in SP1’s-SP4’s personnel records. Additionally, you must audit all employee records to ensure compliance in this subdivision. On an ongoing basis, you must maintain compliance as required in this subdivision.

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.

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

ATTN: Legal Unit

Licensing Division

PO Box 64953

St. Paul, MN 55164-0242

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.

Kathleen “Katie” Crowley, HCBS Licensor

Licensing Division

Office of Inspector General

651-431-2631

PO Box 64242 • Saint Paul, Minnesota • 55164-0242 • An Equal Opportunity and Veteran Friendly Employer
https://mn.gov/dhs/general-public/licensing/