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August 27, 2025 Jama Mohamod, Authorized Agent American Home Maker Services 10103 Shadyview Lane North Maple Grove, Minnesota 55311 License Number: 1096117 (245D – HCBS) Complaint Numbers: 202405983; 202408772 CORRECTION ORDER Dear Jama Mohamod: On January 9, 2025, a licensing review of American Home Maker Services, located at 10101 Bren Road East, Minnetonka, 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.10, subdivision 4, paragraph (b). Violation: For one of five people whose record was reviewed (P3), the license holder did not provide policies and procedures affecting a person’s rights as required. The license holder initiated P3’s services on August 23, 2024. The license holder did not inform P3’s case manager of the following policies and procedures that affect a person’s rights and provide copies of those policies and procedures, within five working days of service initiation: · grievance policy; · service suspension policy; · service termination policy; · emergency use of manual restraints policy; and · data privacy. The license holder provided these policies and procedures to P3’s case manager on September 4, 2024. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 2. Citation: Minnesota Statutes, section 245D.05, subdivision 1, paragraph (b). Violation: For one person whose record was reviewed (P3), the license holder did not maintain documentation of how the person’s health needs would be met as required. The license holder assigned themselves the responsibility to provide medication assistance to P3. The license holder did not maintain a description of the procedures the license holder would follow in order to provide medication assistance. Corrective Action: Within 30 days of receiving this order you must document the above mentioned information for P3. On an ongoing basis, you must maintain compliance as required in this subdivision. 3. Citation: Minnesota Statutes, section 245D.07, subdivision 1. Violation: For two persons whose records were reviewed (P1, P2, and P4), the license holder did not provide services as assigned in the support plan that complied with the requirements of this chapter and the federal waiver plans as required. a. Regarding complaint number 202408772, the license holder was to provide P1 with 4.75 direct and two remote service hours daily. The documentation the license holder maintained for September 2024 indicated that P1 was not in the facility from September 13- September 15, 2024. Staff timesheets indicated that staff provided services during this timeframe. Additionally, there were multiple instances between June 30, 2024- October 5, 2024 in which P1 did not receive services or was only provided remote services that were recorded on staff timesheets as in person services provided to P1. The license holder did not provide services in compliance with the requirements of the federal waiver plan. b. Regarding complaint number 202405983, the license holder was to provide P2 with six direct and two remote service hours daily. The documentation the license holder maintained for the month of July 2024 indicated dates when the license holder only provided remote check ins for P2. The license holder did not provide services as assigned to P2. c. P4 lived in a provider controlled setting. The license holder’s program abuse prevention plan (PAPP) documented that all service recipients who resided at that service location had a 1:3 staffing ratio. P4’s service was 1:1. The license holder did not provide services in compliance with the federal waiver plan. Corrective Action Ordered: On an ongoing basis, you must maintain compliance as required in this subdivision. 4. Citation: Minnesota Statutes, section 245D.071, subdivision 3. Violation: For one person whose record was reviewed (P4), the license holder did not meet service planning requirements for intensive support services as required. The license holder did not maintain a summary of the conversation discussing how technology might be used to meet the person’s desired outcomes at P4’s initial planning meeting in P4’s support plan addendum that included a statement regarding any decision that was made regarding the use of technology and a description of any further research that needed to be completed before a decision regarding the use of technology could be made. Corrective Action Ordered: Within 30 days of receiving this order, you must maintain the above mentioned information in P4’s support plan addendum. On an ongoing basis, you must maintain compliance as required in this subdivision. 5. Citation: Minnesota Statutes, section 245D.071, subdivision 4. Violation: For one person whose record was reviewed (P5), the license holder did not implement service outcomes and supports as required. P5’s record included an untitled document for December 2024 that identified the supports and methods to be implemented to assist P5 in achieving their identified outcome of participating in community activities. This document indicated that data on P5’s outcome would be collected on a data sheet with a “Yes” when P5 participated in a community activity. The activities documented included the following: · staff calling the police for welfare check; · addressed paperwork for lease; and · assisted with paperwork for a passport. The license holder did not implement the supports and methods identified as the license holder did not collect data on this outcome. Corrective Action Ordered: Within 30 days of receiving this order, you must begin collecting data on P5’s outcome per the supports and methods identified in P5’s support plan addendum. Within 30 days of receiving this order, you must: · retrain all staff who work with P5 on P5’s identified outcomes; and · maintain documentation of this retraining in the staff’s personnel records. On an ongoing basis, you must maintain compliance as required in this subdivision. 6. Citation: Minnesota Statutes, section 245D.09, subdivision 4a, paragraph (d). Violation: For one of four staff persons whose records were reviewed (SP1), the license holder did not provide medication assistance training as required. The license holder did not provide SP1 with instruction on medication assistance procedures established when assigned to the license holder. Corrective Action Ordered: Within 30 days of receiving this order you must: · provide SP1 with the above mentioned training; · audit all staff records to ensure they have receiving training on medication setup, assistance, or administration as required; · maintain documentation of the audit and its results. On an ongoing basis you must maintain compliance as required in this subdivision. 7. Citation: Minnesota Statutes, section 245D.09, subdivision 5. Violation: For one staff person 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 training on 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 in 2024. Corrective Action Ordered: Within 30 days of receiving this order, you must provide SP1 with the above mentioned training. 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. Nicole Riley, Human Services Licensor Licensing Division Office of Inspector General 651-431-3657
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