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January 9, 2026
Emadeldin Ibrahim, Authorized Agent Mercy Adult Day Care LLC 6129 Tahoe Circle Apartment A Woodbury, Minnesota 55125 License Number: 1094960 (Rule 223) CORRECTION ORDER Dear Emadeldin Ibrahim: On December 3, 2025, a licensing review of Mercy Adult Day Care LLC, located at 814 White Bear Avenue, 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 Statutes, section 245A.14, subdivision 14, paragraph (c). Violation: The license holder did not meet the requirements for attendance record documentation. The license holder did not maintain documentation of actual attendance for each adult day service recipient for which the license holder for which the license holder was reimbursed by a governmental program that included: · the first and last name of the recipient; · the time of day that the recipient was dropped off; and · the time of day that the recipient was picked up.
2. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b) and Minnesota Rules, part 9555.9700, subpart 3. Violation: For two of two participants whose records were reviewed (P2 and P3), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). a. The license holder did not develop an IAPP for P2 as part of P2’s initial individual program plan or service plan that included: · an individualized assessment of P2’s susceptibility to abuse by other individuals, including other vulnerable adults; · P2’s risk of abusing other vulnerable adults; and · statements of the specific measures to be taken to minimize the risk of abuse to P2 and other vulnerable adults. b. The license holder did not review P3’s IAPP quarterly as part of the review of the program plan or service plan. c. The license holder did not review P3’s IAPP with P3’s interdisciplinary team, at least annually, using the individual assessment and any reports of abuse relating to the person. Repeat Violation: In a Correction Order that DHS issued on March 10, 2023, you were previously found in violation of this same rule. · review P3’s IAPP quarterly as part of the review of the program plan or service plan and document the review and date the review occurred; · review P3’s IAPP annually with P3’s interdisciplinary team and document the review; · complete an audit of all participants’ IAPPs to ensure the requirements in Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b) are maintained; and · for participants whose IAPPs are not developed and reviewed as required, you must develop a plan detailing how your program will maintain IAPPs as required within 60 calendar days of receiving this order. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subdivision and subpart. 3. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For three participants whose records were reviewed (P1, P2, and 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: · an application form that included P1’s address; · a medical report that was dated within the three months prior to or 30 days after P1’s admission to the center that included indication of dietary restrictions and medication regimen, including the need for medication assistance that apply to P1. P1 was admitted to the center September 2, 2014. The license holder maintained a medical report June 30, 2025. b. The license holder did not include the following information in P2’s participant record: · P2’s address; · the name and telephone number of P2’s physician or medical provider; and · attendance and progress notes for P2 that are recorded at least monthly. c. The license holder did not include the following information in P3’s participant record: · a medical report that was dated within the three months prior to or 30 days after P3’s admissions to the center, signed by a physician pr signed by a physician assistant or registered nurse and cosigned by a physician that included: o a report on a physical examination, updated annually; o medical history for P3; o indication of dietary restrictions and medication regimen, including the need for medication assistance that apply to P3; o a release signed by the physician indicating whether P3 can engage in a structured exercise program; and o documentation that P3 is free from communicable disease or infestations, as specified in parts 4605.700 to 4605.7090, that would endanger the health of other participants. · attendance and participation reports and progress notes that are recorded at least monthly; and · notes on special problems, medication changes, and need for medication assistance for P3.
4. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For two participants whose records were reviewed (P1 and P2), the license holder did not complete initial service planning as required. a. The license holder did not conduct a need assessment for P1 that included P1’s physical status, determined by observation, from the intake screening interview, and from the medical report received from P1’s physician. b. The license holder did not conduct a needs assessment for P2 within 30 days of P2’s admission to the center that included: · P2’s psychosocial status (for example, awareness level, personal care needs, need for privacy or socialization); · P2’s functional status (for example, endurance and capability for ambulation, transfer, and managing activities of daily living); and · P2's physical status, determined by observation, from the intake screening interview, and from the medical report received from P2's physician. c. The license holder did not develop a preliminary service plan for P2 that included the role of P2’s caregiver or caregivers in carrying out the service plan.
· develop a need assessment for P1 and P2 that includes the information detailed above; · develop a preliminary service plan for P2 that includes the information detailed above. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subpart. 5. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For three participants whose records were reviewed (P1, P2, and P3), the license holder did not develop a written plan of care as required. a. The license holder did not develop a written plan of care for P1 that included short and long-term objectives for P1 stated in concrete, measurable and time specific outcomes. b. The license holder did not develop a written plan of care for P2 that included: · an update of the preliminary service plan and additional services required by P2; · short and long term objectives for P2 stated in concrete, measurable and time specific outcomes; · the staff members responsible for implementing the individual plan of care; · the anticipated duration of the individual plan of care as written; and · provisions for quarterly reviews and quarterly revisions of the individual plan of care. c. The license holder did not develop a written plan of care for P3 that included provisions for quarterly reviews and quarterly revisions of the individual plan of care. Repeat Violation: In a Correction Order that DHS issued on March 10, 2023, you were previously found in violation of this same rule. 6. Citation: Minnesota Rules, part 9555.9650, items A and B. Violation: For one of two staff person and three consultants whose records were reviewed (SP1), the license holder did not maintain personnel files are required. a. The license holder did not maintain a job description in SP1’s personnel record. b. The license holder did not maintain a personnel file for the registered physical therapist that included documentation that the physical therapist met any licensure, registration, or certification required to perform the services specified in the contract. c. The license holder did not maintain a personnel file for the registered nurse that included a copy of a signed contract or letter of appointment specifying conditions and terms of employment. d. The license holder did maintain a personnel file for the registered dietician that included: · a copy of a signed contract or letter of appointment specifying conditions and terms of employment; and · documentation that the registered dietician meets any licensure, registration, or certification requirements required to perform the services specified in the contract. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain the information detailed above in SP1, physical therapist, registered nurse, and registered dietician’s personnel records. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in these items. 7. Citation: Minnesota Rules, part 9555.9690, subpart 4. Violation: For one of two staff person whose record was reviewed (SP2), the license holder did not provide in-service training annually as required. The license holder did not provide SP2 training annually in the following areas in 2025: · areas related to care of center participants, including provision of medication assistance and review of parts 9555.9600 to 9555.9730; and · Minnesota Statutes, section 626.557. Corrective Action Ordered: Within 30 days of receiving this order, you must provide the required in-service training detailed above to SP2. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subpart. 8. Citation: Minnesota Rules, part 9555.9710, subparts 1, 3, 4, and 7.
a. The license holder did not maintain a contract with the food service provider. b. The license holder did not have the menus for all meals and snacks approved by a registered dietician. c. The license holder did not ensure a registered nurse provided consultation and review of the health services at least monthly, that included: · monitoring a person’s health status and reporting changes to the person’s caregiver, physician, and center director; · educating and counseling persons on good health practices; · maintaining a listing of professional health resources available for referrals as needed by people; · developing policies and monitoring procedures for participant self-administration of medications for training unlicensed personnel who provide medication assistance; and; · supervising staff distribution of medication and assistance with a person’s self-administration of medication and ensuring compliance with 9555.9680, subpart 2, item C. d. The license holder did not ensure a registered physical therapist provided consultation and review of the exercise program, at least quarterly, in 2024 and 2025. e. The license holder did not maintain a family and social history that was updated annually for P1 and P3. Repeat Violation: In a Correction Order that DHS issued on March 10, 2023, you were previously found in violation of this same rule. · maintain a contract with the food service provider; · ensure menus for all meals and snacks are approved by a registered dietician; · ensure a registered nurse provides consultation and review of the health services at least monthly; · ensure a registered physical therapist provides consultation and review of the exercise program at least quarterly; and · maintain and update P1 and P3’s family and social histories, as applicable. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in these subparts. 9. Citation: Minnesota Rules, part 9555.9720, subparts 5, 7, 8, and 9. Violation: The license holder did not ensure safety as required. a. The license holder did not ensure chemicals that are poisonous when swallowed or inhaled or that are damaging to eyes or skin were stored in an area not accessible to participants. At the time of the licensing review, licensors observed windex, bleach, and all purpose cleaners that were in an area that was accessible to participants. b. The license holder did not ensure equipment and furniture were in good repair, including: · a metal toilet paper holder that was broken off from the wall; · a handicap bar in the bathroom behind a toilet that was unscrewed and falling off the wall; · water damage on the ceiling around the skylight; and · a broken shoe rack. c. The license holder did not ensure the areas used by participants were free from debris, loose plaster, peeling paint, and litter, including: · heavily stained carpet throughout the center; and · peeling paint and chipped sheetrock throughout the center. d. The license holder did not have written plans for emergencies caused by fire that included: · identification of primary and secondary exits; · identification of building evacuation routes; · identification of an emergency shelter area within the center; · procedures for the quarterly fire drill; and · instructions on location of fire extinguishers. Corrective Action Ordered: Immediately, you must: · ensure all chemicals are stored in a manner not accessible to participants; · ensure all equipment and furniture used by participants is in good repair; and · ensure all areas used by participants are free from peeling paint and chipped sheetrock; and · develop written plans for emergencies cause by fire that include the information detailed above. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in these subparts. 10. Citation: Minnesota Rules, part 9555.9730, subpart 3. Violation: The license holder did not ensure physical plant and space requirements. The license holder did not ensure restrooms used by participants were equipped with a mechanism that participants can use to signal staff members by light or by sound if participants need assistance. Corrective Action Ordered: Within 30 days of receiving this order, you must ensure restrooms used by participants are equipped with a mechanism that participants can use to signal staff member by light or by sound if participants need assistance. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subpart. 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. Katie Johnson, HCBS Human Services Licensor Licensing Division Office of Inspector General 651-431-4113
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