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July 24, 2026 Ahmed Hassan, Authorized Agent Java Health Services Inc 900 American Boulevard East, Suite 102A Bloomington, Minnesota 55420 License Number: 1112378 (245D – Home and Community-Based Services) CORRECTION ORDER Dear Ahmed Hassan: On July 1, 2026, a licensing review of Java Health Services Inc, located at 900 American Boulevard East, Suite 102A, Bloomington, 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. Violation: For one of two persons whose records were reviewed (P1), the license holder did not provide vulnerable adult maltreatment orientation as required. The license holder initiated P1’s services on August 19, 2025. The license holder did not provide P1 or P1’s legal representative with an orientation to their internal and external reporting procedures of alleged or suspected maltreatment of vulnerable adults within 24 hours of admission. The license holder provided this orientation on September 2, 2025. 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 as part of the initial individual program plan or service plan prior to or upon service initiation on August 19, 2025. The license holder developed an IAPP for P1 on August 27, 2025. Corrective Action Ordered: On an ongoing basis you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Statutes, section 245D.04, subdivision 1. Violation: For two persons whose records were reviewed (P1 and P2), the license holder did not provide a written notice that identified the service recipient rights and an explanation of those rights 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. a. The license holder did not provide P1 or P1’s legal representative with a written notice that identified the service recipient rights, and an explanation of those rights with five working days of service initiation on August 19, 2025. The license holder provided the notice and explanation of right to P1’s legal representative on September 2, 2025. b. The license holder did not provide P2 with a written notice that identified the service recipient rights, and an explanation of those rights annually in 2025. P2 received the service recipient rights on July 22, 2024, then again on January 29, 2026. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 4. 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 the responsibility of medication administration for P1 in P1’s support plan and support plan addendum. The license holder did not obtain written authorization from P1’s legal representative to administer medication or treatment. Corrective Action Ordered: Within 30 days of receiving this order, you must obtain a written authorization from P1’s legal representative to administer medication or treatment to P1. You must maintain a copy of the authorization in P1’s record. On an ongoing basis you must maintain compliance as required in this subdivision. 5. Citation: Minnesota Statutes, section 245D.05, subdivision 5. Violation: For one person whose record was reviewed (P1), the license holder did not meet the requirements for injectable medications as required. The license holder was assigned the responsibility of administering insulin to P1. The license holder did not ensure injectable medications were administered according to a prescriber’s order with written instructions when one of the following conditions were met: · a registered nurse or licensed practical nurse will administer the injection; · a supervising registered nurse with a physician's order has delegated the administration of injectable medication to an unlicensed staff member and has provided the necessary training; or · there is an agreement signed by the license holder, the prescriber, and the person or the person's legal representative specifying what injections may be given, when, how, and that the prescriber must retain responsibility for the license holder's giving the injections. A copy of the agreement must be placed in the person's service recipient record. Corrective Action Ordered: Within 30 days of receiving this order, you must ensure P1’s injectable medications are administered according to the prescriber’s written instructions and one of the above mentioned conditions. You must document the administration of this medication in P1’s medication administration record. On an ongoing basis, you must maintain compliance as required in this subdivision. 6. Citation: Minnesota Statutes, section 245D.071, subdivision 5. Violation: For one person whose record was reviewed (P2), the license holder did not meet service plan review and evaluation requirements for an intensive support service. · The license holder assigned themselves the responsibility of annual meetings for P2. The license holder did not complete a service plan and review meeting with P2, P2’s legal representative, P2’s case manager, and other people identified by P2 to determine whether changes were needed to the service plan based on the assessment information, the license holder's evaluation of progress toward accomplishing outcomes, or other information provided by the support team or expanded support team in 2026. The license holder last held an annual meeting for P2 on June 17, 2025. · The license holder did not meet with P2, P2’s legal representative, P2’s case manager, and other people identified by P2 at least once per year to discuss how technology might be used to meet P2’s desired outcomes in 2025 and 2026. The license holder last had this discussion on August 15, 2024. Corrective Action Ordered: Within 30 days of receiving this order, you must meet with P2, P2’s legal representative, P2’s case manager, and other members of the support team to participate in the ongoing review and development of the service plan to determine whether changes were needed to the support plan addendum. The annual review must include a discussion of how technology might be used to meet the person's desired outcomes, including a summary of this discussion, a statement regarding any decision that is made regarding the use of technology and a description of any further research that needs to be completed before a decision regarding the use of technology can be made. On an ongoing basis, you must maintain compliance as required in this subdivision. 7. Citation: Minnesota Statutes, section 245D.095, subdivision 3. Violation: For one person whose record was reviewed (P1), the license holder did not maintain a service recipient record as required. The license holder was assigned the responsibility of medication administration for P1, including insulin in P1’s support plan and support plan addendum. The license holder did not maintain the following information for P1: · current orders for medication, treatments, or medical equipment; · medication administration procedures; and · a medication administration record documenting the implementation of the medication administration procedures. Corrective Action Ordered: Within 30 days of receiving this order, you must: · maintain current orders for P1’s medication, treatments, and medical equipment, as applicable; · a description of the procedures you will follow in order to provide medication administration according to this chapter. · maintain a medication administration record (MAR) for P1 with the following information documented: o the information on the current prescription label or the prescriber's current written or electronically recorded order or prescription that includes the person's name, description of the medication or treatment to be provided, and the frequency and other information needed to safely and correctly administer the medication or treatment to ensure effectiveness; o information on any risks or other side effects that are reasonable to expect, and any contraindications to its use. This information must be readily available to all staff administering the medication; o the possible consequences if the medication or treatment is not taken or administered as directed; o instruction on when and to whom to report the following: (i) if a dose of medication is not administered or treatment is not performed as prescribed, whether by error by the staff or the person or by refusal by the person; and (ii) the occurrence of possible adverse reactions to the medication or treatment; o notation of any occurrence of a dose of medication not being administered or treatment not performed as prescribed, whether by error by the staff or the person or by refusal by the person, or of adverse reactions, and when and to whom the report was made; and o notation of when a medication or treatment is started, administered, changed, or discontinued · ensure unlicensed staff responsible for medication administration complete training according to section 245D.09, subdivision 4a, paragraph (d). Maintain documentation of this training in staff personnel records. On an ongoing basis you must maintain compliance as required in this subdivision. 8. Citation: Minnesota Statutes, section 245D.10, subdivision 4. Violation: For one person whose record was reviewed (P1), the license holder did not inform and provide policies and procedures as required. The license holder did not inform P1’s case manager of the policies and procedures affecting a person’s rights and provide copies of those policies and procedures within five working days of service initiation on August 19, 2025. The license holder provided these to P1’s case manager on September 2, 2025. Corrective Action Ordered: On an ongoing basis you must maintain compliance as required in this subdivision. 9. Citation: Minnesota Rules, part 9544.0030, subpart 1. Violation: For one person whose record was reviewed (P2), the license holder did not evaluate positive support strategies as required. The license holder did not review and evaluate the identified positive support strategies with P2 at least every six months. Corrective Action Ordered: Within 30 days of receiving this order, you must: · review and evaluate the identified positive support strategies with P2; and · based upon the results of the evaluation determine whether changes are needed in the positive support strategies used with P2, and if so, make appropriate changes. On an ongoing basis, you must maintain compliance as required in this subdivision. 10. Citation: Minnesota Statutes, section 245D.09, subdivision 4. Violation: For three of four staff persons whose records were reviewed (SP1, SP2, and SP4), the license holder did not provide and ensure completion of orientation training as required. a. The license holder hired SP1 on August 20, 2025. The license holder did not ensure that SP1 received orientation training on the following topics within 60 calendar days of hire: · data privacy requirements according to Minnesota Statutes, sections 13.01 to 13.10 and 13.46, the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff responsibilities related to complying with data privacy practices; SP1 received this training on February 25, 2026; · the principles of person-centered service planning and delivery as identified in section 245D.07, subdivision 1a, and how they apply to direct support service provided by the staff person; SP1 received this training on February 25, 2026; · the safe and correct use of manual restraint on an emergency basis according to the requirements in section 245D.061 and what constitutes the use of restraints, o time out; o seclusion; o including chemical restraint; SP1 received this training on February 25, 2026; · staff responsibilities related to prohibited procedures under section 245D.06, subdivision 5; and o why such procedures are not effective for reducing or eliminating symptoms or undesired behavior; and o why such procedures are not safe; SP1 received this training on February 25, 2026; · basic first aid; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities; SP1 received this training on February 25, 2026. b. The license holder hired SP2 on December 9, 2024. The license holder did not ensure that SP2 received orientation training on the following topics within 60 calendar days of hire: · data privacy requirements according to Minnesota Statutes, sections 13.01 to 13.10 and 13.46, the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff responsibilities related to complying with data privacy practices; · the principles of person-centered service planning and delivery as identified in section 245D.07, subdivision 1a, and how they apply to direct support service provided by the staff person; · the safe and correct use of manual restraint on an emergency basis according to the requirements in section 245D.061 and what constitutes the use of restraints, o time out; o seclusion; o including chemical restraint; · staff responsibilities related to prohibited procedures under section 245D.06, subdivision 5; and o why such procedures are not effective for reducing or eliminating symptoms or undesired behavior; and o why such procedures are not safe; · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities. SP2 received the above training on March 24, 2025. c. The license holder hired SP4 on August 20, 2025. The license holder did not ensure that SP4 received orientation training on the following topics within 60 calendar days of hire: · data privacy requirements according to Minnesota Statutes, sections 13.01 to 13.10 and 13.46, the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), and staff responsibilities related to complying with data privacy practices; SP1 received this training on February 25, 2026; · the principles of person-centered service planning and delivery as identified in section 245D.07, subdivision 1a, and how they apply to direct support service provided by the staff person; SP1 received this training on February 25, 2026; · the safe and correct use of manual restraint on an emergency basis according to the requirements in section 245D.061 and what constitutes the use of restraints, o time out; o seclusion; o including chemical restraint; SP1 received this training on February 25, 2026; · staff responsibilities related to prohibited procedures under section 245D.06, subdivision 5; and o why such procedures are not effective for reducing or eliminating symptoms or undesired behavior; and o why such procedures are not safe; SP1 received this training on February 25, 2026; · basic first aid; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities; SP1 received this training on February 25, 2026. Corrective Action Ordered: Within 30 days of receiving this order you must: · provide SP1 and SP4 with basic first aid training; and · maintain training documentation in SP1’s and SP4’s personnel record. On an ongoing basis, you must maintain compliance as required in this subdivision. 11. Citation: Minnesota Statutes, section 245D.09, subdivision 4a, paragraph (d).
Violation: For two staff persons whose records were reviewed (SP1 and SP4), the license holder did not provide medication administration training as required. The license holder did not ensure SP1 and SP4 reviewed and received instruction on medication administration procedures established for the person before having unsupervised contact with persons served by the program. Corrective Action Ordered: Within 30 days of this order, you must provide SP1 and SP4 with medication administration training, from a curriculum developed by a registered nurse or appropriate licensed health professional. The training curriculum must incorporate an observed skill assessment conducted by the trainer to ensure unlicensed staff demonstrated the ability to safely and correctly follow medication procedures. You must maintain documentation of this training in SP1’s and SP4’s personnel records. 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 64953 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. Kathleen “Katie” Crowley, HCBS Licensor Licensing Division Office of Inspector General 651-431-2631
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