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February 27, 2025 Heaylan Omer, Authorized Agent Second Home Adult Day Center 2933 Pentagon Drive Saint Anthony, Minnesota 55418 License Number: 1117829 (Rule 223) CORRECTION ORDER Dear Heaylan Omer: On December 30, 2024, a licensing review of Second Home Adult Day Center located at 2933 Pentagon Drive, Saint Anthony, 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.14, subdivision 14, paragraph (c). Violation: The license holder did not meet the requirements for attendance record documentation. The license holder failed to maintain documentation of actual attendance for each adult day service recipient for which the license holder was reimbursed by a governmental program that included: · the time of day that the recipient was dropped off; and · the time of day that the recipient was picked up. Corrective Action Ordered: Immediately, you must maintain documentation of actual attendance for each adult day service recipient. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section 245A.65, subdivision 2, paragraph (b) and Minnesota Rules, part 9555.9700, subpart 3. Violation: For one of two participants whose record was reviewed (P1), the license holder did not meet the requirements for an individual abuse prevention plan (IAPP). The license holder failed to review P1’s IAPP quarterly as part of the review of P1’s program plan or service plan. The license holder maintained documentation that P1’s IAPP was most recently reviewed on July 22, 2024. Corrective Action Ordered: Within 30 days of receiving this order, you must review P1’s IAPP with P1’s interdisciplinary team and document the review. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subdivision and subpart. 3. Citation: Minnesota Rules, part 9555.9660, subpart 1. Violation: For two participants whose records were reviewed (P1 and P2), the license holder did not include information in the participant’s written record as required. The license holder failed to include the following information in P1 and P2’s participant records: · an application form that included P1 and P2’s source of referral; and · a medical report dated within three months prior to or 30 days after P1 and P2’s admission to the center. P1 was admitted on January 10, 2024, and the license holder maintained a medical report for P1 on March 21, 2024. P2 was admitted on March 28, 2024, and the license holder maintained a medical report for P2 on May 6, 2024.
4. Citation: Minnesota Rules, part 9555.9700, subpart 2. Violation: For two participants whose records were reviewed (P1 and P2), the license holder did not complete initial service planning as required. The license holder failed to conduct needs assessments for P1 and P2 that addressed P1 and P2’s physical status using information from the medical report received from the participant’s physician. · The license holder conducted P1’s needs assessment on February 1, 2024; however, the license holder did not receive the medical report from P1’s physician until March 21, 2024. · The license holder conducted P2’s needs assessment on April 26, 2024; however, the license holder did not receive the medical report from P2’s physician until May 6, 2024. Corrective Action Ordered: Within 30 days of receiving this order, you must update P1 and P2’s needs assessments to include P1 and P2’s physical status based on information received from the participant’s medical report. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subpart. 5. Citation: Minnesota Rules, part 9555.9700, subpart 3. Violation: For one participant whose record was reviewed (P1), the license holder did not develop a written plan of care as required. The license holder failed to develop a written plan of care for P1 that included provisions for quarterly review and quarterly revisions of the individual plan of care. Corrective Action Ordered: Within 30 days of receiving this order, you must review P1’s written plan of care with P1 and revise the plan of care, if necessary. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subpart. 6. Citation: Minnesota Rules, part 9555.9650, item A. Violation: For two of two staff persons whose records were reviewed (SP1 and SP2), the license holder did not maintain a personnel record as required. The license holder failed to maintain the following information in SP1 and SP2’s personnel record: · a job description; and · an employment application or resume indicating that the employee meets the requirements in part 9555.9680. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain a job description and an employment application or resume in SP1 and SP2’s personnel record. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this item. 7. Citation: Minnesota Rules, part 9555.9690, subpart 3. Violation: For two staff persons whose records were reviewed (SP1 and SP2), the license holder did not provide orientation to the center as required. The license holder failed to provide SP1 and SP2 with 20 hours of orientation to the center within the employee’s first 40 hours of employment at the center. The license holder provided SP1 with 12.5 hours of orientation to the center and SP2 with 14.5 hours of orientation to the center. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subpart. 8. Citation: Minnesota Rules, part 9555.9650, item B. Violation: For one consultant whose record was reviewed, the license holder did not include all required information in the personnel record. The license holder failed to maintain documentation that the registered dietician 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 meets any licensure, registration, or certification requirements required to perform services. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this item. 9. Citation: Minnesota Rules, part 9555.9710, subparts 1, 3. Violation: The license holder did not offer services as required. a. The license holder failed to maintain a current and accurate contract with their food service provider that prepared food off-site. The license holder maintained a contract that expired on May 31, 2024. b. The license holder failed to maintain a record indicating the menu for all meals and snacks served for at least six months. c. The license holder failed to ensure a registered nurse provide consultation and review of the health services at least monthly, including: · monitoring participants’ health status and reporting changes to the participant’s caregiver and physician and the center director; and · educating and counseling participants on good health practices. Corrective Action Ordered: Immediately, you must: · maintain a current and accurate contract with a food service provider; · maintain a record indicating the menu for all meals and snacks for at least six months; and · ensure your registered nurse provides consultation and review of your health services at least monthly. Compliance with this order will be reviewed onsite. On an ongoing basis, you must maintain compliance as required in this subpart. 10. Citation: Minnesota Rules, part 9555.9720, subparts 7 and 9. Violation: The license holder did not ensure safety as required. a. The license holder failed to ensure equipment and furniture was in good repair including: · several ceiling tiles with water stains; and · dirty and torn carpet. b. The license holder failed to post emergency plans in a visible place in the center.
· ensure equipment and furniture is in good repair; and · post your emergency plans in a visible place in the center. Compliance with this order will be reviewed on site. On an ongoing basis, you must maintain compliance as required in these subparts. 11. Citation: Minnesota Rules, part 9555.9730, subpart 7. Violation: The license holder did not ensure physical plant and space requirements as required. The license holder failed to ensure a minimum temperature of 70 degrees Fahrenheit was maintained in indoor areas used by people receiving services at all times. At the time of the licensing review, the temperature was 56 degrees Fahrenheit when licensors arrived at the center and was 64 degrees Fahrenheit at the conclusion of the licensing review.
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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