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April 6, 2026 Yashmin Nagujja, Authorized Agent Green Lakes LLC 277 Coon Rapids Boulevard Northwest Suite 414 Coon Rapids, Minnesota 55433 License Number: 1108646 (245D – HCBS) CORRECTION ORDER Dear Yashmin Nagujja: On January 26, 2026, a licensing review of Green Lakes LLC, located at 277 Coon Rapids Boulevard Northwest Suite 414, Coon Rapids, 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 245D.05, subdivision 1. Violation: For one of one person whose record was reviewed (P1), the license holder did not document how health services would be met as required. The license holder was responsible for meeting P1’s health service needs as assigned in P1’s support plan and support plan addendum. P1 was prescribed pro re nata (PRN) psychotropic medications. The license holder did not maintain documentation on how P1’s health needs would be met in P1’s support plan addendum, including a description of the procedures the license holder would follow in order to administer P1’s PRN psychotropic medications. Corrective Action Ordered: Within 30 days of receiving this order, you must include a description of the procedures the license holder will follow in order to administer P1’s PRN psychotropic medication in P1’s support plan addendum. Compliance with this order will be reviewed onsite at an upcoming compliance monitoring visit. On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section 245D.05, subdivision 2. Violation: For one person whose record was reviewed (P1), the license holder did not implement medication administration procedures as required. The license holder was assigned responsibility for medication administration for P1. The license holder did not implement medication administration procedures to ensure P1 took medication and treatments as prescribed in the following ways: · The license holder did not notate when a medication was administered in P1’s medication administration record (MAR) on 6 instances in November 2025 and 4 instances in January 2026. · P1 was prescribed four medications according to the prescriber’s medication list dated September 15, 2025, that were not listed in P1’s MAR. The license holder did not document the above medications in P1’s MAR. The license holder did not ensure P1 took these medications as prescribed. · P1 was prescribed a medication that the prescriber’s instructions stated that P1 was to take three tablets of the medication at bedtime as needed (PRN).The license holder documented in P1’s MAR that P1 was take one tablet by mouth every night at bedtime. The license holder did not accurately document the information from the current prescription label or prescriber’s current order on P1’s MAR and did not ensure P1 took medications as prescribed. Repeat Violation: In a Correction Order that DHS issued on August 10, 2023, you were previously found in violation of this same statute. Corrective Action Ordered: Within 30 days of receiving this order, you must: · review P1’s prescriber’s medication orders and revise P1’s MAR to ensure the information on the current prescription label or the prescriber's current order is documented. The information must include the following: o person’s name; o description of the medication or treatment to be provided; and o the frequency and other information needed to safely and correctly administer the medication or treatment to ensure effectiveness. Compliance with this order will be reviewed onsite at an upcoming compliance monitoring visit. On an ongoing basis, you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Statutes, section 245D.05, subdivision 4. Violation: For one person whose record was reviewed (P1), the license holder did not review medication administration records and report medication treatment issues as required. a. The license holder was assigned responsibility for medication administration for P1. The license holder did not report P1’s failure to take medications to P1’s case manager as they occurred. b. The license holder maintained a document in P1’s record titled “Medication Administration Review Record” that was dated January 15, 2026. The document indicated that the license holder did not discover medication administration errors during the review and did not identify a pattern of medication administration errors, despite the refusals and lack of notations identified in citation 2. The license holder did not develop and implement a plan to correct patterns of medication administration errors when identified. Corrective Action Ordered: Within 30 days of receiving this order, you must: · report P1’s medication errors to their case manager; · maintain documentation of the notifications regarding medication errors in P1’s record; · review the MARs for all persons served by your program for the past six months to ensure the information maintained in the medication administration record is current and to identify medication administration errors; and · maintain documentation of the MAR reviews you complete, including the date(s) of completion, and the name of the person(s) who completed the MAR review in each person’s service recipient record. Compliance with this order will be reviewed onsite at an upcoming compliance monitoring visit. On an ongoing basis, you must maintain compliance as required in this subdivision. 4. Citation: Minnesota Statutes, section 245D.051, subdivision 1, paragraph (b), clause 1. Violation: For one person whose record was reviewed (P1), the license holder did not meet the requirements for psychotropic medication use and monitoring as required. Target symptoms refer to any perceptible diagnostic criteria for a person’s diagnosed mental disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) or successive editions, that has been identified for alleviation. The license holder was assigned responsibility of administering P1’s psychotropic medications in their support plan addendum. The license holder did not maintain documentation with the description of the target symptoms that P1’s psychotropic medications were intended to alleviate in their support plan addendum. Repeat Violation: In a Correction Order that DHS issued on August 10, 2023, you were previously found in violation of this same statute. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain documentation with the description of target symptoms that P1’s psychotropic medications are to alleviate in P1’s support plan addendum. Compliance with this order will be reviewed onsite at an upcoming compliance monitoring visit. On an ongoing basis, you must maintain compliance as required in this subdivision. 5. Citation: Minnesota Statutes, section 245D.07, subdivision 1. Violation: For one person whose record was reviewed (P1), the license holder did not provide services in compliance with federal waiver plans. The Community-Based Services Manual (CBSM) page titled “Respite” defines respite services as short-term care services provided to a person when their primary caregiver is absent or needs relief. Out-of-home 24-hour respite is limited to a maximum of 30 consecutive days per respite occurrence. The CBSM also states that respite cannot cover the cost of room and board when the person receives respite in an unlicensed setting. The license holder did not comply with federal waiver plan for out-of-home respite services for P1 in the following areas, according to the CBSM: · the license holder provided out-of-home respite continuously to P1 for over 16 months; · P1 did not have a primary caregiver that respite was used to provide a caregiver with relief; and · the license holder used the respite reimbursement to cover the cost of room and board for P1 when P1 received respite in an unlicensed setting. Repeat Violation: In a Correction Order that DHS issued on August 10, 2023, you were previously found in violation of this same statute. Corrective Action Ordered: Immediately upon receiving this order, you must: · begin providing services to P1 according to the requirements of the federal waiver plan; and · meet with P1 and P1’s case manager to ensure your service delivery planning for P1 complies with the requirements of the federal waiver plan. You must document this meeting, including what was determined at the meeting. You must maintain this documentation in P1’s service recipient record. Within 30 days of receiving this order, you must: · conduct an audit of all services you are providing to determine if the services are being provided according to the requirements of the federal waiver plan; · for any person whose services are not being provided according to the requirements of the federal waiver plan, you must: o create a detailed plan describing how to come into compliance with federal waiver plan guidelines for each service; and o meet with each person, their legal representative, if applicable, and their case manager to discuss updates to the person’s plan based on the results of your audit. You must document the meeting, including what was determined, and maintain this documentation in the person’s service recipient record. Compliance with this order will be reviewed onsite at an upcoming compliance monitoring visit. On an ongoing basis, you must maintain compliance as required in this subdivision. 6. Citation: Minnesota Statutes, section 245D.09, subdivision 5. Violation: For one of two staff persons whose record was reviewed (SP1), 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. The license holder did not provide SP1 with annual training in 2025 on the following topics: · basic first aid. The license holder provided this training to SP1 on March 5, 2024, and May 16, 2025; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities. The license holder provided this training to SP1 on March 5, 2024, and May 16, 2025. Repeat Violation: In Correction Orders that DHS issued on August 10, 2023, and September 28, 2023, you were previously found in violation of this same statute. Corrective Action Ordered: Compliance with this order will be reviewed onsite at an upcoming compliance monitoring visit. 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 64242 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. Michael Byrne, Human Services Licensor Licensing Division Office of Inspector General 651-431-6709
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