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January 10, 2025 Hassen Jama, Authorized Agent Emerson Adult Day Care Center Inc 8143 Curtis Lane Eden Prairie, Minnesota 55347 License Number: 1117293 (Rule 223) CORRECTION ORDER Dear Hassen Jama: On January 7, 2025, a licensing review of Emerson Adult Day Care Center Inc located at 3108 Emerson Avenue North, Minneapolis, 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 Rules, part 9555.9660, subpart 1. Violation: For three of 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. The license holder failed to maintain the following information in P1, P2, and P3’s record: · a medical report that included a report on a physical examination; · a medical history of the participant; and · notes on special problems, medication changes, and need for medication assistance. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain the information detailed above in P1, P2, and P3’s record. On an ongoing basis, you must maintain compliance as required in this subpart. 2. 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. The license holder failed to conduct needs assessments for P1, P2, and P3 that addressed the participant’s physical status using information from the medical report received from the participant’s physician. · The license holder conducted P1’s needs assessment on November 7, 2024; however, the license holder did not receive the medical report from P1’s physician until December 11, 2024. · The license holder conducted P2’s needs assessment on November 7, 2024; however, the license holder did not receive the medical report from P2’s physician until November 18, 2024. · The license holder conducted P3’s needs assessment on November 7, 2024; however, the license holder did not receive the medical report from P3’s physician until December 13, 2024. Corrective Action Ordered: Within 30 days of receiving this order, you must update P1, P2, and P3’s needs assessments to include the participant’s physical status based on information received from the participant’s medical report. On an ongoing basis, you must maintain compliance as required in this subpart. 3. Citation: Minnesota Rules, part 9555.9650, item B. Violation: For three consultants whose records were reviewed, the license holder did not include all required information in the personnel record. a. The license holder failed to maintain a copy of a signed contract or letter of appointment specifying conditions and terms of employment in the registered nurse, physical therapist and registered dietician’s personnel record. b. The license holder failed to maintain documentation that the physical therapist and registered dietician met any licensure, registration, or certification requirements required to perform services. · The license holder maintained documentation that the physical therapist’s license expired December 31, 2024. · The license holder maintained documentation that the registered dietician’s license expired November 30, 2024. Corrective Action Ordered: Within 30 days of receiving this order, you must: · maintain a copy of a signed contract or letter of appointment with your registered nurse, physical therapist and registered dieticians specifying conditions and terms of employment; and · maintain documentation that your physical therapist and registered dietician meets licensure, registration, or certification requirements to perform services specified in the contract. On an ongoing basis, you must maintain compliance as required in this subpart. 4. Citation: Minnesota Rules, part 9555.9710, subpart 3. Violation: The license holder failed to ensure a registered nurse provided consultation and review of the health services at least monthly since August 2024. Corrective Action Ordered: Within 30 days of receiving this order, you must ensure a registered nurse provides consultation and review of the health services. On an ongoing basis, you must maintain compliance as required in this subpart. 5. Citation: Minnesota Rules, part 9555.9720, subpart 1. Violation: The license holder did not ensure safety as required. The license holder failed to have a first aid kit that contained a thermometer. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subpart. 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. Desiree Tiller, HCBS Licensor Licensing Division Office of Inspector General 651-431-4622
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