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January 13, 2026 Margaret Sia Tolbert, Authorized Agent Guaranteed Home Health Care LLC 8525 Edinbrook Xing, Ste 102B Brooklyn Park, Minnesota 55443 License Number: 1077901 (245D – HCBS) CORRECTION ORDER Dear Margaret Sia Tolbert: On September 17, 2025, a licensing review of Guaranteed Home Health Care LLC, located at 8525 Edinbrook Xing, Suite 102B, Brooklyn Park, 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 Statutes, section 245A.65, subdivision 1, and subdivision 2, paragraph (a). Violation: For one of one person whose record was reviewed (P1), the license holder did not provide an orientation to the license holder’s internal and external maltreatment reporting procedures and program abuse prevention plan (PAPP) as required. The license holder did not provide P1 with an orientation to the following within 24 hours of admission: · the license holder’s internal and external maltreatment reporting procedures; and · the PAPP. P1’s services were initiated on November 1, 2023. The license holder provided these orientations to P1 on October 8, 2024. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b). Violation: For one person whose record was reviewed (P1), the license holder did not develop an individual abuse prevention plan (IAPP) as required. The license holder did not develop an IAPP for P1 that included an individualized assessment of P1’s susceptibility to abuse. P1’s IAPP assessed that P1 was not susceptible to self-abuse. This assessment was not consistent with other information maintained in P1’s record. Corrective Action Ordered: Within 30 days of receiving this order, you must: · review and revise P1’s IAPP to include an accurate assessment of P1’s susceptibility to self-abuse; · include a statement of measures, including specific actions, that will be taken to minimize the risk of self-abuse within the scope of the licensed service; · review P1’s IAPP with their interdisciplinary team and maintain documentation of this review in P1’s record; and · provide training on P1’s revised IAPP to all staff persons that provide direct support services to P1. On an ongoing basis, you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Statutes, section 245D.04, subdivision 1. Violation: For one person whose record was reviewed (P1), the license holder did not provide the service recipient rights as required. The license holder did not provide P1 with a written notice and explanation of the service recipient rights in subdivision 2 and 3, within five working days of service initiation. P1’s services were initiated on November 1, 2023. The license holder provided this orientation to P1 on October 8, 2024. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 4. Citation: Minnesota Statutes, section 245D.05, subdivision 1, paragraph (b). Violation: For one person whose record was reviewed (P1), the license holder did not maintain documentation on how the person’s health needs would be met as required. The license holder was assigned responsibility for meeting P1’s health needs in P1’s support plan addendum. The license holder did not maintain written instructions from a licensed health professional that included a description of the procedures the license holder would follow in order to monitor P1’s diabetes. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain documentation in P1’s record that includes a description of the procedures you will follow in order to monitor P1’s diabetes according to written instructions from a licensed health professional. On an ongoing basis, you must maintain compliance as required in this subdivision. 5. Citation: Minnesota Statutes, section 245D.05, subdivision 2, paragraph (c). Violation: For one person whose record was reviewed (P1), the license holder did not ensure information was documented in the person’s medication administration record as required. The license holder did not ensure that the following information was documented in P1’s medication administration record: · notation of any occurrence of a dose of medication not being administered or treatment not performed as prescribed; and · notation of when a medication or treatment is administered. The license holder maintained a “Med Admin Summary” in P1’s record that documented P1’s prescribed medications and whether or not they were administered as prescribed. On multiple dates between July 1, 2025, and September 15, 2025, P1’s “Med Admin Summary” had no entries that included a notation of whether or not P1’s medications or treatments were administered or performed as prescribed. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 6. Citation: Minnesota Statutes, section 245D.051, subdivision 1, paragraph (b).
Violation: For one person whose record was reviewed (P1), the license holder did not develop, implement, and maintain documentation regarding psychotropic medications as required. The license holder was assigned responsibility for medication administration for P1, including psychotropic medications. The license holder did not to document a description of the target symptoms that each of P1’s psychotropic medications was to alleviate. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain documentation in P1’s support plan addendums that includes a description of the target symptoms that each psychotropic medication is to alleviate. On an ongoing basis, you must maintain compliance as required in this subdivision. 7. Citation: Minnesota Statutes, section 245D.071, subdivision 3. Violation: For one person whose record was reviewed (P1), the license holder did not complete initial service planning as required. P1’s services were initiated on November 1, 2023. The license holder did not complete the following initial service planning requirements according to the required timelines: · The license holder did not complete a preliminary support plan addendum for P1 based on the support plan within 15 days of service initiation. The license holder completed a support plan addendum for P1 on October 8, 2024. · The license holder did not complete the assessments required in paragraph (b), clauses (1) through (3), before providing 45 days of service. The license holder completed these assessments for P1 on October 8, 2024. · The license holder did not hold an initial planning meeting with P1, P1’s case manager, and other members of P1’s expanded support team before providing 45 days of service. The license holder held this meeting on November 19, 2024. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 8. Citation: Minnesota Statutes, section 245D.095, subdivision 4. Violation: For one person whose record was reviewed (P1), the license holder did not ensure staff providing services had access to information in the person’s record relevant to carrying out the support plan or support plan addendum. Corrective Action Ordered: Within 30 days of receiving this order, you must ensure that all staff providing direct support services to any person receiving services under this license has access to all information in the service recipient record relevant to carrying out the support plan or support plan addendum. On an ongoing basis, you must maintain compliance as required in this subdivision. 9. Citation: Minnesota Statutes, section 245D.095, subdivision 3. Violation: For one person whose record was reviewed (P1), the license holder did not maintain information in the service recipient record as required. The license holder did not maintain medication administration record reviews in P1’s service recipient record. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 10. Citation: Minnesota Statutes, section 245D.10, subdivision 4, paragraph (b). Violation: For one person whose record was reviewed (P1), the license holder did not inform and provide copies of the policies and procedures affecting a person’s rights as required. The license holder did not inform and provide P1 and P1’s case manager with copies of the following policies and procedures affecting a person’s rights under section 245D.04 within five working days of service initiation: · grievance policy and procedure; · service suspension and termination policy and procedure; · emergency use of manual restraints policy and procedure and · data privacy. P1’s services were initiated on November 1, 2023. The license holder provided these policies and procedures to P1 on October 8, 2024. Corrective Action Ordered: Within 30 days of receiving this order, you must inform and provide copies of the policies and procedures listed above to P1’s case manager. On an ongoing basis, you must maintain compliance as required in this subdivision. 11. Citation: Minnesota Statutes, section 245D.09, subdivisions 4, 4a, and 5. Violation: For two of three staff persons whose records were reviewed (SP1 and SP2), the license holder did not provide orientation and annual training as required. a. The license holder did not provide and ensure completion of orientation for SP1 and SP2 within 60 days of hire in the following areas: · the license holder’s current policies and procedures required under this chapter, their location and access, and staff responsibilities related to implementation of those policies and procedures; and · program abuse prevention plan. b. The license holder did not provide the following orientation to SP1 and SP2 before having unsupervised direct contact with a person served by the program: · the person’s support plan or support plan addendum as it related to the responsibilities assigned to the license holder; and · 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. c. The license holder did not provide SP2 with annual training on basic first aid in 2025. Corrective Action Ordered: Within 30 days of receiving this order you must: · provide SP1 and SP2 with training on the topics listed in paragraphs “a” and “b” of this violation; · provide SP2 with training on basic first aid; and · maintain documentation of these trainings in SP1’s and SP2’s personnel records according to the requirements in Minnesota Statutes, section 245D.095, subdivision 5. On an ongoing basis, you must maintain compliance as required in this subdivision. 12. Citation: Minnesota Statutes, section 245D.095, subdivision 5. Violation: For two staff persons whose records were reviewed (SP1 and SP2), the license holder did not maintain personnel records as required. a. The license holder did not include documentation of SP1 and SP2’s training that included the name of the trainer or instructor and the number of hours per subject area. b. The license holder did not maintain documentation in the personnel record or elsewhere sufficient to determine the date of SP1 and SP’2 first supervised direct contact with a person served by the program, and the date of first unsupervised direct contact with a person served by the program. Corrective Action Ordered: Within 30 days of receiving this order, you must: · conduct an audit of all staff personnel records to ensure the name of the trainer or instructor and the number of hours per subject area are documented; and · maintain documentation of the audit results at your program. On an ongoing basis, you must maintain compliance as required in this subdivision. 13. Citation: Minnesota Statutes, section 245C.07, paragraph (f). Violation: For two staff persons whose records were reviewed (SP4 and SP5), the license holder did not comply with the requirements under section 245C.07 regarding the sensitive information person as required. SP4 began working in a position allowing direct contact with persons served by the program on July 24, 2025, and SP5 began working in a position allowing direct contact with persons served by the program on July 25, 2025. A background study was submitted under license number 98722, however, SP4 and SP5 were working under the HCBS license number 1077901. The license holder did not affiliate SP4 and SP5 to all required rosters. Corrective Action Ordered: On an ongoing basis, you must comply with background study requirements in Minnesota Statutes, chapter 245C as required. 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. Submissions required as part of a corrective action ordered must be sent to your Licensor at: 1. By secure email at Elizabeth.Schiefelbein@state.mn.us; or 2. If you are unable to submit corrective action ordered securely through email, you can mail or fax using the information below: Commissioner, Department of Human Services ATTN: Liz Schiefelbein Licensing Division PO Box 64242 St. Paul, MN 55164-0242 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. Liz Schiefelbein, Senior Human Services Licensor Licensing Division Office of Inspector General 651-431-2738
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