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February 20, 2026 Hamdi Farah, Authorized Agent High Superior Adult Day Care 14908 Crystal Lake Road West License Number: 1123083 (Rule 223) CORRECTION ORDER Dear Hamdi Farah: On January 28, 2026, a licensing review of High Superior Adult Day Care located at 8503 Jefferson Lane North, Brooklyn Park, 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.65, subdivision 2, paragraph (b) and Minnesota Rules, part 9555.9700, subpart 3. Violation: For one of three participants whose record was reviewed (P2), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). The license holder did not review P2’s IAPP quarterly as part of the review of the program plan or service plan.
2. 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: o P1’s telephone number; and o the name and telephone number of the person to call in case of emergency involving P1, and name and number of another person to call if that person cannot be reached. · a medical report that was 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. The license holder maintained a medical report for P1 that was signed by a physician assistant, and was not cosigned by a physician; and · participation reports and progress notes that are recorded at least monthly. b. The license holder did not include the following information in P2’s participant record: · a medical report that was signed by a physician or signed by a physician assistant or registered nurse and cosigned by a physician. The license holder maintained a medical report for P2 that was signed by a physician assistant, and was not cosigned by a physician; and · participation reports and progress notes that are recorded at least monthly. c. The license holder did not include the following information in P3’s participant record: · an application form that included, the name and telephone number of the person to call in case of emergency involving P3, and name and number of another person to call if that person cannot be reached; and · participation reports and progress notes that are recorded at least monthly. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain the information for P1, P2, and P3 as detailed above. On an ongoing basis, you must maintain compliance as required in this subpart. 3. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For three participants whose records were reviewed (P1, P2 and P3), the license holder did not complete initial service planning as required. a. The license holder did not conduct a needs assessment for P1-P3 that included, P1-P3’s physical status, determined by observation, from the intake screening interview, and from the medical reports received from P1- P3’s physicians. b. The license holder did not develop a preliminary service plan for P1-P3 that included the role of P1-P3’s caregiver or caregivers in carrying out the service plan.
· develop needs assessments for P1-P3 that includes the information detailed above; and · develop a preliminary service plan for P1-P3 that includes the information detailed above. On an ongoing basis, you must maintain compliance as required in this subpart. 4. 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 and P3 that included provisions for quarterly reviews and quarterly revisions of the individual plan of care. 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. Corrective Action Ordered: Within 30 days of receiving this order, you must develop a written plan of care for P1-P3 that includes the information detailed above. On an ongoing basis, you must maintain compliance as required in this subpart. 5. Citation: Minnesota Rules, part 9555.9650, item B. Violation: For two consultants whose records were reviewed, the license holder did not include all required information in the personnel record. The license holder did not maintain documentation that the registered dietician and physical therapist met any licensure, registration, or certification requirements required to perform services. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain documentation that your registered dietician and physical therapist meet any licensure, registration, or certification requirements required to perform services. On an ongoing basis, you must maintain compliance as required in this item. 6. Citation: Minnesota Rules, part 9555.9720, subparts 8 and 9.
a. The license holder did not ensure the areas used by participants were free from loose plaster and peeling paint. b. The license holder did not post emergency plans in a visible place in the center. Corrective Action Ordered: Within 30 days of receiving this order, you must: · ensure the areas used by participants are free from loose plaster and peeling paint; and · post emergency plans in a visible place in the center. On an ongoing basis, you must maintain compliance as required in these subparts. 7. Citation: Minnesota Statutes, section 245A.04, subdivision 14, paragraph (b). Violation: The license holder did not monitor implementation of policies and procedures by program staff as required. The license holder maintained a policy for population we serve and conditions which we do not accept that stated, “We do not accept individuals who have a communicable disease.” Corrective Action Ordered: 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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