Minnesota Department of Human Services

May 20, 2014

Anne Barry, Authorized Agent

Minnesota Security Hospital

540 Cedar Street

Saint Paul, MN 55101-2208

RE: License Number 801558 – Residential Treatment Services to Persons with Mental Illness

Maltreatment Investigation Report Number 20140264

CERTIFIED MAIL

DETERMINATION OF MALTREATMENT

ORDER TO PAY A FINE AND ORDER EXTENDING

THE FACILITY’S CONDITIONAL LICENSE

Dear Ms. Barry:

You are hereby notified that the Department of Human Services (DHS) Office of Inspector General (OIG), Licensing Division, has made a determination of substantiated maltreatment for which the facility and a staff person were determined responsible. Based on the determination of substantiated maltreatment by the facility, the Commissioner of Human Services is ordering the Minnesota Security Hospital (MSH) to pay a $1,000 fine. The Commissioner is also extending the conditional status of MSH’s license to provide residential treatment services to persons with mental illness for two years which continues the conditional status of MSH’s license until
December 22, 2016.

In January 2014, OIG received a report that MSH failed to provide adequate supervision, care, and services to two vulnerable adults (VA1 and VA2). As a result, VA1 assaulted VA2 causing VA2’s death.

MSH’s failure to provide necessary care or services, including supervision, to VA1 and VA2 resulting in VA2’s death is an unacceptable failure by MSH. No corrective action can adequately address the tragedy of VA2’s death.

This latest finding of maltreatment is one in a sequence of maltreatment findings at MSH. Since MSH’s license was placed on conditional status on December 22, 2011, based on two findings of maltreatment, there have been three other findings of maltreatment for which the facility was determined responsible.

• Report number 20123304 issued on August 28, 2013, substantiated maltreatment by the facility and two health care professionals.

• Report number 20130242 issued on August 28, 2013, substantiated maltreatment by the facility and two health care professionals.

• Report number 20133320 issued on October 31, 2013, substantiated maltreatment by the facility.

In addition, there are several maltreatment investigations currently being conducted at MSH.

The OIG has considered the regulatory options available to address the serious ongoing problems at MSH. Other than the $1,000 fine for substantiated maltreatment, Minnesota statutes provide two options: (1) issuing an order of license revocation; or (2) placing the license on conditional status. Since MSH’s license is currently on conditional status, the second option requires extending or modifying the current conditional status of the license.

As required under Minnesota Statutes, section 245A.07, the licensing sanction decision is based on a careful consideration of “the nature, chronicity, or severity of the violation of law or rule and the effect of the violation on the health, safety, or rights of persons served by the program.” An order to revoke a license to provide services is issued when the intent of the Licensing Division is to close a program, and that is not the case in this situation.

Some of the challenges faced by this facility stem, at least in part, from the problematic physical condition of the construction and design of the buildings on the upper campus. The significant detrimental impact of these buildings on the health and safety for both the clients and the employees has been recognized by the Legislature and the Governor this year in their approval of more than $56 million in the 2014 bonding bill for a number of significant improvements, construction and redesign of the facility. This recent allocation of significant funds for Phase I of rehabilitating the facility is specifically dedicated toward creating a safer, more therapeutic treatment environment for clients; creating a safer working environment for staff; and physically separating vulnerable adults from predatory populations.

However, while the deficits in the physical environment have certainly contributed to the challenges at this facility, there remain significant issues directly related to the personnel, education, training, and leadership.

It is recognized that this facility is undergoing a very significant change to its culture and the practices used to manage a high needs population. As noted in the August 28, 2013, order extending the conditional license to December 22, 2014, the historical problem of responding to situations with over-use of seclusion, restraint, and protective isolation has now become a problem of under-involvement with patients.

Recent investigations have shown that there are direct care employees who continue to believe they do not have the necessary tools to manage disruptive and dangerous behavior by patients. There is a belief among some staff that a “person centered approach” means that “patients can do anything they want to do, and staff are unable to redirect or intervene.” As a result, some staff choose not to be involved and some even elect to spend long hours inside the office, rather than interact with patients on the living unit.

This investigation showed that while Unit 800 is considered to be the appropriate unit to treat patients in crisis, Unit 800 staff had not been required to become familiar with the Individual Abuse Prevention Plans (IAPP), Individual Treatment Plans, or specific histories of the patients they serve. The result is a living unit that serves oftentimes volatile mentally ill patients with some staff members who:

(1) Worked with a staff-to-patient ratio similar to other units of the facility;

(2) Were unfamiliar with the recent history of the patients;

(3) Were unfamiliar with the assessed treatment needs and treatment plans for the patients;

(4) Were unfamiliar with the specific abuse prevention plans of the patients;

(5) Mistakenly believed they are unable to intervene under new policies implemented at the facility; and,

(6) Spent large amounts of time interacting with each other in the office rather than interacting and maintaining a “high level of observation and attentiveness to the environment” as directed in the Unit Rounds and Monitoring Policy.

Due to the high-risk outcomes for patients, the facility’s effort to address staff uncertainty and increase staff/patient interaction must be significantly enhanced. The investigation showed that other patients were aware of precursors to this incident involving VA1 and VA2, and at least one other patient was aware that these individuals had fought. Yet despite seven staff on duty serving 14 patients, it was likely that 1½ hours passed before staff were aware that a patient was lying on the floor, dying, in this locked living unit.

This order follows a completed investigation of the specific incident on Unit 800. However, as mentioned above, there have been multiple incidents at the facility warranting investigation by the Licensing Division, and the investigations have involved multiple living units. A finding of the facility’s Root Cause Analysis stated that “this event could happen on any unit at MSH,” and the Licensing Division has also determined that some of the conditions on Unit 800 were not unique to that living unit. Therefore, some of the corrective action ordered in this letter requires implementation first on Unit 800, and then throughout the rest of the living units in the facility.

As MSH is implementing new approaches to patient care, the facility’s on-site executive team needs to strengthen its leadership and equip the direct care staff with the necessary training, clarified expectations, and tools to address the challenging situations they face. The Executive Director of Forensic Services needs the full participation and commitment of all managers and supervisors in the facility.

In light of these considerations and concerns, the Commissioner has decided to extend MSH’s conditional license to December 22, 2016, with clear instruction that this facility must show significant and concrete improvement from the top on-site leadership and throughout the staff at all levels. The first new condition on page eight is intended to direct the leadership improvements needed.

MSH’s conditional license is being extended with the expectation that MSH will fully comply with the terms of the conditional license set forth in this order, and with all licensing requirements governing residential services to persons with mental illness. As noted below in Section III B, this conditional order includes both existing terms already placed on MSH’s license and adds new terms arising from this investigation.

I. DETERMINATION OF MALTREATMENT

It was reported that the facility failed to provide adequate supervision, care, and services to two vulnerable adults (VA1 and VA2). As a result, VA1 assaulted VA2, causing VA2’s death.

DHS investigated the allegation as maltreatment under Minnesota Statutes, section 626.557, subdivision 9c, paragraph (b), and Minnesota Statutes, section 626.5572, subdivision 15, and subdivision 17, paragraph (a):

The failure or omission by a caregiver to supply a vulnerable adult with care or services, including but not limited to food, clothing, shelter, health care, or supervision which is:

(1) Reasonable and necessary to obtain or maintain the vulnerable adult's physical or mental health or safety, considering the physical and mental capacity or dysfunction of the vulnerable adult and

(2) Which is not the result of an accident or therapeutic conduct.

Based on the maltreatment investigation, DHS has substantiated maltreatment and has determined that the facility and a staff person were responsible for the maltreatment (neglect) of the two VAs. See the conclusion in the Investigation Memorandum for report 20140264, a copy of which is enclosed.

You have the right to request reconsideration of the determination of maltreatment where MSH was found responsible for the maltreatment. See Section V of this letter for your reconsideration and appeal rights.

II. ORDER TO FORFEIT A FINE

A. Reason for the Fine

Substantiated maltreatment for which the facility was found responsible.

Pursuant to Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause (4), a license holder shall forfeit $1,000 for each determination of maltreatment of a vulnerable adult under section 626.557.

B. Statutory Citation and License Violation

Citation: Minnesota Statutes, section 626.5572, subdivision 17, paragraph (a).

Violation: A determination of substantiated maltreatment of a vulnerable adult by MSH. See the conclusion in report number 20140264. A copy of report number 20140264 is enclosed.

Corrective Action Taken by the Facility: The facility completed a Root Cause Analysis that reviewed 24 areas of possible contributing factors to the incident. The facility determined that several areas may have been part of the root cause of the incident, and the facility created a plan of action to respond to each of the potential areas of concern. The facility made the following determinations and plans of action:

• There were no sign-out logs for IAPPs and treatment plans on Unit 800. The facility addressed this issue by having all staff review and signoff that they had reviewed IAPPs and treatment plans. The facility’s ongoing plan of action is documented as “audit and education.”

• VA1’s treatment plan did not specify in detail the exact nature, timing, and precipitating events of his/her previous assaults. These facts may not have been considered sufficiently with VA1’s diagnoses when developing his/her IAPP. Staff persons had a lack of detailed information about previous assaults, and a lack of understanding of VA1’s diagnoses. The facility’s ongoing plan is to encourage more detail in IAPPs regarding patient history of aggression and/or self-harm.

• The Day Rounds Form did not have an area for documenting a specific time of observation and did not require a second sign-off. Additionally, the facility determined that a security counselor responsible for the completion of patient and room checks had a “very vague account of [his/her] understanding of the rounding requirements.” The facility updated the “rounding procedure,” developed a new form that allows specific times to be entered, and implemented a requirement that patient checks include eye contact with each patient.

• Staff had difficulty with the recent change to trauma-informed care and the person-centered approach, and expressed problems with understanding what tools were acceptable and appropriate for managing the environment. This concern resulted in staff inaction related to intervention. The ongoing plan of action is for “additional staff training.” Additionally, a restraint and seclusion committee will look at “best options,” and the facility will create an environment that balances safety and security while helping patients with recovery. The action plan calls for training, coaching, observing, and “reinforcing movement.”

• The facility has increased staff presence on Unit 800 through a new unit protocol.

• The facility was housing patients in crisis with patients in admission, and has now determined that the populations are very different and should not be co-located given that admissions patients are frequently more vulnerable to abuse. The short-term plan is to reorganize the unit; in the long term, the bonding bill will enable new construction to separate the two units.

• The facility did not have clear guidelines around physician availability for staff and patients. The plan of action is to develop a protocol and education.

• Unit 800 has blind spots that prevent staff from seeing all areas of the unit. The plan of action is to seek funding approval to install cameras.

Corrective Action Ordered by OIG: See the terms under the Order of Conditional License.

Fine: $1,000 ($1,000 for each maltreatment determination – one determination)

C. Total fine to be paid: $1,000

D. Billing and Payment of Fine

DHS will send you an invoice for the $1,000 fine. Payment must be made as directed on the invoice.

A timely request for a contested case hearing under Section V, item B, C, D, or E stays the payment of the fine until the Commissioner issues a final order. If you decide to exercise your right to a contested case hearing, do not pay the fine. Following the contested case hearing, the Commissioner will issue a final order concerning the fine.

E. Right to Request a Contested Case Hearing to Appeal the Fine

You have the right to request a contested case hearing to appeal the fine under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. See Section V of this letter for your right to appeal the fine.

III. ORDER OF CONDITIONAL LICENSE

A. Reason for the Order of Conditional License

Pursuant to Minnesota Statutes, section 245A.06, subdivision 1, the Commissioner of Human Services may make a license conditional if the license holder fails to fully comply with applicable laws or rules.

Based on the maltreatment determination, the Commissioner is extending the period of your conditional license for two years. Therefore your license is being placed on conditional status until December 22, 2016.

Citation: Minnesota Statutes, section 626.5572, subdivision 17, paragraph (a).

Violation: A determination of substantiated maltreatment for which the facility was determined to be responsible.

B. Terms of the Conditional License

MSH serves highly complex individuals who present with multiple diagnoses and/or multiple disabilities. These individuals also have a history of legal problems, public safety concerns, and personal safety concerns due to significant behavioral disturbances such as aggressive behavior towards others, property destruction, and self-injurious behavior, along with poorly managed medical conditions. Given the population being served, the conditional license expectations being placed on MSH reflect similar expectations that the Licensing Division sets for other intensive residential mental health treatment programs program serving highly complex individuals.

Because the conditional status of the license is being extended for two additional years and some of the earlier terms have been completed, the terms listed below indicate new terms and those which are continued and remain in effect from the earlier orders. The terms listed below now constitute the complete set of terms for the conditional license in effect until December 22, 2016, unless modified in the future.

1. New Term: Strengthened on-site executive leadership team. The Executive Director of Forensic Services must develop and implement a strategic leadership plan to provide guidance, transparency and integrity to the facility. The plan must identify the membership of the facility’s on-site executive leadership team who are accountable for the daily operations and improvements required in this letter.

a. Through interviews it was determined that, along with some direct care staff, some supervisors may not fully embrace the facility’s move to a person centered approach. While the changes in approach to patient care are very significant, about 60% of the staff, some of whom were managers and supervisors, had not yet attended and participated in the facility’s two-day training on Person Centered Planning.

Within 30 days from receipt of this order, the executive leadership team must submit a plan with dates by which all employees in the facility will have received the two-day training on Person Centered Planning.

Within 45 days from receipt of this order, all managers and supervisors in the facility must have completed this training. As part of this training, each manager’s and supervisor’s commitment to the facility’s direction in this area must be assessed, and employee coaching must occur as necessary.

b. The facility’s on-site executive leadership team needs more than a part-time medical director. The current medical director is physically on-site only two days per week at this facility, and that is not enough time. The facility is currently in the process of hiring a full-time medical director, and that effort must continue as quickly as possible. The on-site executive team must submit progress reports on the hiring activity to the Licensing Division at least every two weeks.

c. The facility’s on-site executive team must be responsible for communicating and demonstrating the expectation that all personnel maintain appropriate standards of professionalism, accountability, and integrity. Within 30 days, the on-site executive leadership team must develop a code of conduct and identify professional resources and supports so that staff concerns and suggestions are reported to upper management and responded to by the on-site executive team. The on-site executive team also must formulate and submit to the Licensing Division an action plan that:

Ÿ Clearly defines for all staff the meaning of a “person centered” approach, and how it must be appropriately tailored to specific situations such as that which resulted in VA2’s death;

Ÿ Outlines how the on-site executive team will provide more consistent guidance, clarity, and support to the staff at MSH related to a person centered approach in high tension situations and the manner in which this authority to intervene is communicated, expected, monitored, supported, and ultimately demanded by the highest level of management; and

Ÿ Is signed by all members of the on-site executive leadership team.

2. New Term: Within 30 days from receipt of this order, the facility must provide clinical supervision on Unit 800 for all staff on all shifts as outlined below. The clinical supervision must allow for exchanging information necessary to carry out the patients’ Individual Treatment Plans (ITP), responding to the patients’ goals, informing updates and revisions to the patients’ ITP and Individual Abuse Prevention Plan, and addressing concerns raised by staff.

a. A licensed mental health professional, as defined in Minnesota Statutes, section 245.462, subdivision 18, clauses (1) to (6), must conduct at least one clinical supervision meeting to review and discuss the ITPs and IAPPs of all patients on the living unit each calendar week and be physically present at the meeting. All unit staff, including those who work part-time and intermittently, are required to participate in a minimum of one group clinical supervision meeting each and every calendar week they work. The license holder must maintain documentation of the weekly meetings, including the names of staff who attended as well as those who were supposed to attend but failed to do so. The meetings must review each patient’s current clinical presentation, review and revise the ITP and IAPP as needed, and allow for the exchange of information between all staff.

b. Staff who do not participate in the weekly group clinical supervision meeting must participate in an ancillary meeting during each week in which they work. During the ancillary meeting, the same information that was shared at the most recent weekly clinical supervision meeting must be verbally reviewed, including revisions to the patients’ ITPs and IAPPs and other information that was exchanged.

The ancillary meeting must be conducted by a mental health professional or a staff person working in the classifications approved by the DHS Licensing Division and who participated in the weekly group meeting. The individuals in the approved classifications must meet the definition of a mental health practitioner as outlined in Minnesota Statutes, section 245.462, subdivision 17.

The facility must maintain documentation of the ancillary meetings, including the names of staff who attended and those who were supposed to attend but failed to do so.

c. Within 30 days, the facility must submit a written plan describing how these clinical supervision requirements will be met on all other units at MSH, including the names and qualifications of the licensed mental health professionals who may provide clinical supervision at the weekly group clinical supervision meeting, as well as designating classifications for the mental health practitioner. The plan must include a definition of the week period, such as Wednesday through Tuesday.

3. New Term: Within 30 days from receipt of this order, the facility must assign to each shift in Unit 800 a “mentor” who will observe, coach, and demonstrate person centered thinking and trauma-informed care to unit staff. The role of the mentor will be to promote the appropriate application of all new policies, procedures, techniques, and approaches related to the person centered approach, and identify if and where additional policy development and training is needed. The designated mentor must:

a. Be in a classification approved by DHS Licensing;

b. Meet the definition of a mental health practitioner as outlined in Minnesota Statutes, section 245.462, subdivision 17;

c. Be trained in person centered thinking and designated as an official coach; and

d. Be evaluated by the on-site executive leadership team at least every 60 days, in an evaluation that includes a review of the incidents and interventions that occurred on the shifts for which the individual was assigned to be the mentor.

4. New Term: Within 30 days from receipt of this order, the facility must

ensure the following:

a. Within eight hours of an admission or transfer to a new unit, a patient must have an initial or a revised ITP and IAPP written that identifies specific measures to minimize risk of abuse as noted in assessments, referral information, or collateral information. When behaviors are exhibited that pose a risk of abuse to self or others, modifications to the ITP and IAPP must be considered.

b. Within 24 hours of writing the initial or updated ITP and IAPP, each must be dated, signed and approved by a licensed mental health professional.

c. All staff must review and document that they have reviewed the initial and revised ITP and IAPP within two hours of the start of their first shift following signing of the ITP and IAPP by the licensed mental health professional.

5. New Term: Within 30 days from receipt of this order, the facility must review and submit a plan for aligning the organizational structure of each unit in a way that integrates the responsibilities of the whole treatment team, including nursing care staff, direct care staff and other health-related professionals. The organizational structure must also provide for enhanced unit cohesiveness, increased communication, and increased employee accountability.

6. New Term: Within 30 days from receipt of this order, the facility must submit an updated Program Abuse Prevention Plan for all units that identifies physical areas in the units which are difficult to supervise and provides specific measures to minimize risk of abuse for patients in these areas. The plan must identify specific measures the facility will immediately take to minimize the risks presented by these architectural challenges.

As noted above, the recently approved 2014 bonding bill appropriates more than $56 million for this facility’s comprehensive redesign and construction of a treatment environment that is more conducive to effective, safe, and healthy living for this population and employees. However, these measures are needed in the short term to address the physical challenges and adequate measures to address these risks in the interim.

The Licensing Division supports the installation of additional cameras that would aid in the oversight of activity in areas that are currently difficult or impossible to monitor from inside the office. However, this support is tempered by the concern that enhanced ability to visually monitor more corners of the living unit from inside the office may inadvertently support more staff time spent in the office, rather than directly observing and interacting with patients on the living unit. Cameras are not a substitute for the necessary interaction between direct care staff and patients in a psychiatric treatment program, particularly a unit serving high acuity patients.

7. New Term: Within 45 days from receipt of this order, the facility must submit a plan detailing how it will meet the requirements in term 3 for all other units of the hospital within 90 days following submission of the plan.

8. New Term: Within 60 days from receipt of this order, the facility must develop and implement a plan to conduct unscheduled observations of Unit 800 to determine compliance with the orders contained herein and with corrections identified in the license holder’s Root Cause Analysis. Within 90 days from receipt of this order, the license holder must submit a progress report to the Licensing Division detailing findings of the observations and submit additional progress reports every 90 days thereafter while MSH’s license is on conditional status. After the initial report relating to Unit 800 is submitted, subsequent reports must include the same information for all other living units.

9. New Term: With the assistance of DHS Adult Mental Health Division, MDH, and any other agency or entity with familiarity with MSH, the facility must identify an appropriate consultant to assist with assessing and determining the most appropriate settings for admissions patients and crisis patients. As identified in the Action Plan of the Root Cause Analysis, while the co-location of these two groups of patients might not have been a root cause, it is a contributing factor that requires further attention and evaluation.

It may be clinically sound to co-locate patients with similar and particularly high acuity, whether they are recently admitted to this facility or transferred from another living unit of this facility. However, the facility must tailor the services on this unit, particularly the care and supervision provided by direct care staff, to meet these higher acuity needs. This must be accomplished whether newly admitted patients are co-located with patients in crisis or not.

In addition, the facility must undertake an analysis and make recommendations as to whether the facility’s treatment units that serve primarily high acuity patients would be more appropriately licensed under different standards. Options to be considered include: a psychiatric hospital or an intensive residential treatment service, as other adult mental health treatment programs operated by the Commissioner of Human Services are licensed; or a specialized set of licensing standards developed specifically to address the unique population and services of MSH. The analysis with recommendations must include a comparison of the acuity level of patients served and treatment services provided at MSH with other Department of Human Services programs, and it must be submitted to the Licensing Division by January 15, 2015.

10. Continued Term: On an ongoing basis, all contacts with on-call staff regarding a patient must be documented in the patient record.  The documentation must include a written record of each contact with an on-call staff person and must be recorded by both the staff person at the facility and the on-call staff person.  The staff person at the facility and the on-call staff person must document the reason for the contact and any instructions or orders given or received. 

11. Continued Term – Modified: On an ongoing basis, the facility must continue to submit new or revised policies, procedures, or forms for the use of restraint, seclusion, and restraints outside the secure perimeter.

12. Continued Term – Modified: While the license is on conditional status, the facility must quarterly submit documentation of quality assurance activities related to restraint and seclusion. This documentation must include a review of the use of restraint and seclusion and the aggregated data, including but not limited to, the number of uses of restraint and seclusion during the previous quarter, patterns or trends in the use of restraint and seclusion, and any concerns or problems with the use of restraint and seclusion.

13. Continued Term: The facility must provide written notification of the extended period of conditional license to all patients currently receiving services from MSH, to all parties who refer patients to MSH, and to all new patients that begin treatment while the facility’s license is on conditional status.

a. Current patients and parties who refer patients to MSH must receive notice of the extended period of the conditional license within 20 days from receipt of this order.

b. New patients must receive notice of the conditional status of the facility’s license before they begin receiving treatment services. The notice to new patients must include an offer to provide a copy of the order extending the conditional license upon request.

c. Within 30 days from receipt of this order, you must submit to the DHS Licensing Division a copy of the notice provided and a list of all referral sources that received the notice.

The Licensing Division will monitor the facility’s compliance with the terms of the extended conditional license, as well as all applicable laws and rules. Verification of compliance may include unannounced visits. Failure to comply with the requirements in Minnesota Rules, parts 9520.0500 through 9520.0690 (DHS Rule 36), Minnesota Statutes, chapter 245A (Human Services Licensing Act), chapter 245C (Human Services Background Study Act), section 626.557 (Vulnerable Adult Act) and with the terms of your conditional license, may result in further negative action.

See Section V for your right to request reconsideration of the conditional license.

IV. PHYSICAL IMPROVEMENTS

With the recent passage of the bonding bill with an appropriation of more than $56 million specifically for this facility to address the identified need for physical improvements, many of the challenges related to the design and construction of the buildings should eventually be alleviated. The funding of Phase I for improvements to the facility is targeted at establishing a safer environment for staff and personnel; constructing new residential and program facilities on the St. Peter upper campus for individuals committed to MSH; and providing separate treatment units for admissions and individuals in crisis.

While the allocation of this funding to address the physical environment at MSH is important, it is equally important that there be a concerted effort to address the total treatment environment within the current physical environment.

V. RECONSIDERATION AND APPEAL RIGHTS

A. Requesting reconsideration of the maltreatment determination only.

You have the right to request reconsideration of the determination of maltreatment where the Minnesota Security Hospital was found responsible for maltreatment under report number 20140264. If you choose to exercise this right, your request must be submitted in writing within 15 calendar days after receipt of the final disposition. In your request, you must identify what is inaccurate or incomplete about the information in the investigation memorandum, supply the information that is accurate or more complete, and state why the finding of maltreatment should be changed.

If your request for reconsideration is mailed, the request for reconsideration must be postmarked and sent to DHS within 15 calendar days of receipt of the final disposition. If the request for reconsideration is made by personal service, it must be received by DHS within 15 calendar days after receipt of the final disposition. Your request for reconsideration of the determination of maltreatment must be sent to:

Commissioner, Department of Human Services

c/o Office of Inspector General, Licensing Division

ATTN: Legal Unit

PO Box 64242

St. Paul, MN 55164-0242

A response to your request for reconsideration of the maltreatment determination will be mailed within 15 working days after the Division of Licensing receives your request. If a response is not mailed within 15 working days, you are entitled to request a fair hearing.

If you wish to appeal the maltreatment determination and fine, see item B.

B. Appealing the maltreatment determination and fine.

If you choose to appeal the maltreatment determination and fine, you have the right to request a contested case hearing under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612, and a separate reconsideration of the maltreatment determination under Minnesota Statutes, section 626.557, will not be conducted as set forth under item A.

If you choose to exercise this right, your request must be made in writing by certified mail or personal service. If mailed, the appeal must be postmarked and sent to the Commissioner within 15 calendar days after you receive this order. If a request is made by personal service, it must be received by the Commissioner within 15 calendar days after you receive this order. A timely request for a contested case hearing shall stay the payment of the fine until the Commissioner issues a final order.

Your request for a contested case hearing must be sent to:

Commissioner, Department of Human Services

c/o Office of Inspector General, Licensing Division

ATTN: Legal Unit

PO Box 64242

St. Paul, MN 55164-0242

C. Appealing the maltreatment determination, fine, and order of conditional license.

If you choose to appeal the maltreatment determination, fine, and conditional license, you have the right to request a contested case hearing under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612, and a separate reconsideration of the maltreatment determination under Minnesota Statutes, section 626.557, will not be conducted as set forth under item A.

If you choose to exercise this right, your request must be made in writing by certified mail or personal service. If mailed, the appeal must be postmarked and sent to the Commissioner within 15 calendar days after you receive this order. If a request is made by personal service, it must be received by the Commissioner within 15 calendar days after you receive this order. A timely request for a contested case hearing shall stay the payment of the fine and the terms of the conditional license until the Commissioner issues a final order. Please note that if the terms of the conditional license are stayed, you are still required to comply with all applicable laws and rules governing the provision of residential services to persons with mental illness.

Your request for a contested case hearing must be sent to:

Commissioner, Department of Human Services

c/o Office of Inspector General, Licensing Division

ATTN: Legal Unit

PO Box 64242

St. Paul, MN 55164-0242

D. Appealing the fine and conditional license, but not the maltreatment determination.

If you wish to appeal the fine and conditional license, you have the right to request a contested case hearing under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. Please note, if you intend to appeal the fine for substantiated maltreatment, you need to also appeal the maltreatment determination (see item B or C).

If you choose to exercise this right, your request must be made in writing by certified mail or personal service. If mailed, the appeal must be postmarked and sent to the Commissioner within 10 calendar days after you receive this order. If a request is made by personal service, it must be received by the Commissioner within 10 calendar days after you receive this order. A timely request for a contested case hearing shall stay the payment of the fine and the terms of the conditional license until the Commissioner issues a final order. Please note that if the terms of the conditional license are stayed, you are still required to comply with all applicable laws and rules governing the provision of residential services to persons with mental illness.

Your request for a contested case hearing must be sent to:

Commissioner, Department of Human Services

c/o Office of Inspector General, Licensing Division

ATTN: Legal Unit

PO Box 64242

St. Paul, MN 55164-0242

E. Right to Appeal only the Order to Forfeit a Fine

You have the right to request a contested case hearing under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612 to only appeal the fine.  If you choose to exercise this right, your request must be made in writing by certified mail or personal service.  If mailed, the appeal must be postmarked and sent to the Commissioner within 10 calendar days after you receive this order.  If a request is made by personal service, it must be received by the Commissioner within 10 calendar days after you receive this order. 

Your request for a contested case hearing must be sent to:

Commissioner, Department of Human Services

c/o Office of Inspector General, Licensing Division

ATTN: Legal Unit

PO Box 64242

St. Paul, MN 55164-0242

F. Right to request reconsideration of the conditional license only.

You have the right to request that the Commissioner of Human Services reconsider the Order of Conditional License. If you choose to exercise this right, your request must be made in writing by certified mail or personal service. If sent by certified mail, the request must be postmarked and sent to the Commissioner within 10 calendar days after you receive this order. If a request is made by personal service, it must be received by the Commissioner within 10 calendar days after you receive this order. You should submit written argument or evidence in support of your request. (See Minnesota Statutes, section 245A.06, subdivision 4.)

A timely request for reconsideration of the conditional license shall stay the terms of the conditional license until the Commissioner issues a decision on the request for reconsideration of the order. Please note that if the terms of the conditional license are stayed, you are still required to comply with all applicable laws and rules governing residential services to persons with mental illness.

The request for reconsideration of the Order of Conditional License must be sent to:

Commissioner, Department of Human Services

c/o Office of Inspector General, Licensing Division

ATTN: Legal Unit

PO Box 64242

St. Paul, MN 55164-0242

If you have any questions regarding the maltreatment determination or fine, please contact Alyssa Dotson, Investigations Unit Supervisor, at (651) 431-6560. If you have any questions regarding the conditional status of your license, please contact Julie Reger, Unit Manager, at (651) 431-6601.

Sincerely,

DHS

Laura Plummer Zrust, Director

Licensing Division

Office of Inspector General

Enclosure

cc: Carol Olson, Executive Director

PO Box 64242 Saint Paul, Minnesota 55164-0242 An Equal Opportunity and Veteran Friendly Employer
http://www.dhs.state.mn.us/licensing