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January 26, 2026 Margot Kelsey, Authorized Agent Northern Minnesota Addiction Wellness Center LLC 4851 Stacy Ann Dr NW Bemidji, MN 56601-0009 License Number: 1103246
CORRECTION ORDER Dear Margot Kelsey: On November 18 through 21, 2025, a Department of Human Services (DHS) licensor conducted a licensing review at your facility, Northern Minnesota Addiction Wellness Center located at 4851 Stacy Ann Dr NW, Bemidji, Minnesota, 56601. This review was conducted to determine compliance with state and federal laws and rules governing the provision of substance use disorder treatment services under Minnesota Statute, chapter 245G. As a result, 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 VIOLATIONS DHS determined that your program failed to follow licensing rules and statutes, as described below. Policies, Practices, and Procedures 1. Violation: The license holder did not meet requirements governing provider policies and procedures. The policies and procedures manual contained an assessment policy that was not consistent with current statute requirements. Statute Violated: Minnesota Statutes, section 245G.12, clause (1). Corrective Action Required: Immediately, and on an ongoing basis, the license holder must maintain an assessment policy that meets all applicable requirements. Within 30 days, submit an assessment policy that meets all applicable requirements. 2. Violation: The license holder did not meet requirements governing visitors for residential treatment. Posted visiting hours did not include evening times. Statute Violated: Minnesota Statutes, section 245G.21, subdivision 2. Correction Action Required: Immediately, and on ongoing basis, the license holder must ensure that visitor hours meet all applicable requirements. 3. Violation: The license holder did not meet requirements governing maltreatment of vulnerable adults. There was no documentation that an internal review was completed within 30 days when the facility had reason to know that an internal or external report of alleged or suspected maltreatment had been made on August 15, 2025. Statute Violated: Minnesota Statutes, section 245A.65, subdivision 1, paragraph (b), clause (1). Corrective Action Required: Immediately, and on an ongoing basis, the license holder must ensure that maltreatment of vulnerable adult policies and procedures meet all applicable requirements. Personnel Files 4. Violation: One of three personnel files (personnel file numbered 1) reviewed for requirements governing staff orientation did not meet requirements. There was no documentation of orientation for the following: a. Within 24 working hours: i. Policies and procedures; and ii. Client needs; b. Within 72 hours of employment: i. The reporting requirements and definitions in Minnesota Statutes, sections 245A.65, 626.557, and 626.5572; and ii. All internal policies and procedures related to the reporting of maltreatment of individuals receiving services; and c. Training on the maltreatment of minors reporting requirements and definitions in Minnesota Statute, chapter 260E before the mandatory reporter has direct contact with persons served by the program. Statute Violated: Minnesota Statutes, sections 245A.65, subdivision 3, and 245G.13, subdivisions 1, clause (7) and 2, paragraph (e). Repeat Violation: The license holder was cited for a similar violation in the following orders: · Correction Order dated April 8, 2025; and · Order for Conditional License dated March 15, 2024 Corrective Action Required: Immediately, and on an ongoing basis, the license holder must ensure staff orientation meets all applicable requirements. 5. Violation: One of three personnel files (personnel file numbered 6) reviewed for requirements governing personnel file contents did not meet requirements. The personnel file did not contain a written annual review for calendar year 2025. Statute Violated: Minnesota Statutes, section 245G.13, subdivision 1, clause (3). Corrective Action Required: Immediately and on an on-going basis, the license holder must ensure that personnel file contents meet all applicable requirements. Client Files 6. Violation: One of three client files (client file numbered 3) reviewed for requirements governing client orientation did not meet requirements. There was no documentation that the client received: a. A written statement of and a staff member reviewed the client rights and responsibilities from Minnesota Statutes, sections 144.651 and 148F.165 on the day of service initiation; and b. An explanation of the grievance procedure on the day of service initiation. Statute Violated: Minnesota Statutes, sections 245G.09, subdivision 3, paragraph (a), clause (1), and 245G.15, subdivisions 1 and 2. Corrective Action Required: Immediately, and on an ongoing basis, the license holder must ensure that client orientation meets all applicable requirements. 7. Violation: One of three client files (client file numbered 3) reviewed for requirements governing comprehensive assessments did not meet requirements. The comprehensive assessment did not include the client’s evaluation of the quality of each family andsignficant personal relationships. Statute Violated: Minnesota Statutes, section 245G.05, subdivision 3. Corrective Action Required: Immediately, and on an ongoing basis, the license holder must ensure that comprehensive assessments meet all applicable requirements. 8. Violation: One of three client files reviewed (client file numbered 3) for requirements governing documentation of treatment services did not meet requirements. Documentation of treatment services: a. Did not include the client response on October 9, 2025; and b. Was not completed within 7 days of providing a treatment service from September 25, 2025. Statute Violated: Minnesota Statutes, section 245G.06, subdivision 2a. Repeat Violation: The license holder was cited for a similar violation in a correction order dated April 8, 2025. Corrective Action Required: Immediately, and on an ongoing basis, the license holder must ensure that documentation of treatment services meets 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 at Jennifer.White@state.mn.us or by mail: Commissioner, Department of Human Services ATTN: Jennifer White 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: 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 - Licensing 444 Lafayette Road North St. Paul, MN 55155 Legal authority This action is taken under Minnesota Statutes, section 245A.06, subdivision 1. 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) 431-6282 or at Jennifer.White@state.mn.us Sincerely,
Jennifer White, Licensor 2 Licensing Division Office of Inspector General
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