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March 12, 2026 Hasan Abshir, Authorized Agent Ultimate Home Health Services LLC 9217 Seventeenth Avenue South, Suite 203 Bloomington, Minnesota 55425 License Number: 1112106 (245D – HCBS) Licensing Investigation Report Number: 202508066 CORRECTION ORDER Dear Hasan Abshir: On October 23, 2025, a licensing review and investigation of Ultimate Home Health Services LLC, located at 9217 Seventeenth Avenue South, Suite 203, 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 and investigation a Correction Order is being issued. A. Reason for Correction Order The Department of Human Services (DHS) issued an Order of Temporary Immediate Suspension of your license to provide home and community-based services (HCBS) on December 5, 2025. The immediate suspension was based on a determination that persons served by your program were at an imminent risk of harm and because the holder and controlling individual were the subjects of a pending administrative action related to fraud against the program which is administered by a state agency. The license holder appealed the Order of Temporary Immediate Suspension on December 9, 2025. The Department of Human Services and the license holder reached a settlement agreement, effective January 9, 2026. The license holder agreed to surrender and close the license effective January 9, 2026. The License holder and its controlling individuals agreed that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. The following violation(s) of state or federal laws and rules were determined as a result of the licensing review and investigation. False and misleading information 1. Citation: Minnesota Statutes, section 245A.07, subdivision 3(a)(3). Violation: For one of seven persons whose records were reviewed (P3), the license holder knowingly withheld relevant information or provided false or misleading information related to compliance with licensing rules and laws. The license holder maintained information in P3’s record that documented the license holder provided P3’s case manager with the required policies and procedures at the time P3’s services were initiated, and participated in an initial service planning meeting with P3’s case manager. The license holder provided documents to DHS licensors titled “Policy Receipt and Signature Page” and “45-Day Meeting Signature Page”. The documents maintained typed signatures to indicate that P3’s case manager received a copy of these policies on May 15, 2024, and participated in P3’s initial service planning meeting on June 25, 2024. The department contacted P3’s case manager to verify if P3’s case manager received these policies, participated in P3’s initial service planning meeting, and signed the documents. P3’s case manager confirmed these were never received, the case manager did not sign the “Policy Receipt and Signature Page” and did not participate in P3’s initial service planning meeting. The license holder provided false or misleading information to DHS when s/he stated s/he provided the policies to P3’s case manager and participated in P3’s initial service planning meeting, when the evidence shows s/he did not do so. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agreed that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. Failure to Report Maltreatment 2. Citation: Minnesota Statutes, section 245D.06, subdivision 1 and Minnesota Statues 626.557, subdivision 4a. Violation: For one person whose records were reviewed (P3), the license holder did not report suspected or alleged abuse of vulnerable adults as required. The license holder maintained information in P3’s record that documented incidents of suspected or alleged abuse of vulnerable adult occurred while services were being provided or within 24 hours of discovery or receipt of information that the incidents occurred. The license holder maintained daily log notes for P3 that documented two occasions where the license holder was made aware of suspected or alleged abuse of a vulnerable adult, including financial exploitation and sexual abuse, and the license holder failed to report these incidents. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agreed that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. Service Recipient Violations 3. Citation: Minnesota Statutes, section 245A.65, subdivision 1, paragraph (b). Violation: For three persons whose records were reviewed (P1, P3 and P6), the license holder did not complete an internal review of alleged or suspected maltreatment as required. The license holder did not complete an internal review for incidents involving P1, P3, and P6 that included an evaluation of the following: · whether related policies and procedures were followed; · whether the policies and procedures were adequate; · whether there is a need for additional staff training; · whether the reported event is similar to past events with the vulnerable adults or the services involved; and · whether there is a need for corrective action by the license holder to protect the health and safety of vulnerable adults. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 4. Citation: Minnesota Statutes, section 245A.65, subdivision 1, paragraph (c). Violation: For six persons whose records were reviewed (P1, P2, P3, P4, P5 and P7), the license holder did not provide orientation to vulnerable adult maltreatment reporting procedures as required. The license holder did not provide P1 through P5 and P7 with orientation to the license holder’s internal and external reporting procedures of alleged or suspected maltreatment of vulnerable adults within 24 hours of admission. · the license holder initiated P1’s services on June 24, 2024, and provided this orientation on October 8, 2025; · the license holder initiated P2’s services on May 9, 2024, and provided this orientation on October 2, 2025; · the license holder initiated P3’s services on June 1, 2024, and provided this orientation on October 2, 2025; · the license holder initiated P4’s services on September 1, 2024, and provided this information on October 13, 2025; · the license holder initiated P5’s services on July 31, 2025, and provided this orientation on October 13, 2025; and · the license holder initiated P7’s services on June 5, 2024. At the time of the licensing review, the license holder had not provided this orientation to P7. P7 was no longer receiving services from the license holder. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 5. Citation: Minnesota Statutes, section 245A.65, subdivision 2. Violation: For six persons whose records were reviewed (P1, P2, P3, P4, P5 and P7), the license holder did not meet the requirements for abuse prevention plans as required. a. The license holder did not provide P1, P2, P3, P4 and P5 with orientation to the program abuse prevention plan within 24 hours of admission. · the license holder initiated P1’s services on June 24, 2024, and provided this orientation on October 8, 2025; · the license holder initiated P2’s services on May 9, 2024, and provided this orientation on October 2, 2025; · the license holder initiated P3’s services on June 1, 2024, and provided this orientation on October 2, 2025; · the license holder initiated P4’s services on September 1, 2024, and provided this information on October 13, 2025; and · the license holder initiated P5’s services on July 31, 2025, and provided this orientation on October 13, 2025. b. The license holder did not develop an individual abuse prevention plan for P1, P2, P4, P5, and P7 as part of the initial individual program plan or service plan as required. · the license holder initiated P1’s services on June 24, 2024, and developed an individual abuse prevention plan for P1 on October 8, 2025; · the license holder initiated P2’s services on May 9, 2024, and developed an individual abuse prevention plan for P2 on October 2, 2025; · the license holder initiated P4’s services on September 1, 2024, and developed an individual abuse prevention plan for P4 on October 13, 2025; · the license holder initiated P5’s services on July 31, 2025, and developed individual abuse prevention plans for P4 and P5 on October 13, 2025; and · the license holder initiated P7’s services on June 5, 2024. At the time of the licensing review, the license holder had not developed an individual abuse prevention plan for P7. P7 was no longer receiving services from the license holder. c. The license holder did not develop an individual abuse prevention plan for P3 that contained an individualized assessment of P3’s susceptibility to abuse. The license holder developed an individual abuse prevention plan for P3 on May 15, 2024, that documented there were no areas where P3 was susceptible to abuse, which did not match information maintained elsewhere in P3’s record. The license holder later updated P3’s individual abuse prevention plan on October 2, 2025, that contained an individualized assessment of P3’s susceptibility to abuse and statements of the specific measures to be taken to minimize the risk of abuse. Additionally, the license holder did not review P3’s individual abuse prevention plan annually in 2025. The license holder developed P3’s individual abuse prevention plan on May 15, 2024, and reviewed P3’s individual abuse prevention plan on October 2, 2025. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 6. Citation: Minnesota Statutes, section 245D.04, subdivision 1. Violation: For six persons whose records were reviewed (P1, P2, P3, P4, P5, and P7), the license holder did not provide service recipient rights as required. a. The license holder did not provide P1, P2, P4, P5, and P7 with a written notice that identified the service recipient rights, and an explanation of those rights within five working days of service initiation. · the license holder initiated services for P1 on June 24, 2024 and provided the service recipient rights to P1 on October 8, 2025; · the license holder initiated P2’s services on May 9, 2024, and provided the service recipient rights to P2 on October 2, 2025; · the license holder initiated services for P4 on September 1, 2024, and provided the service recipient rights to P4 on October 13, 2025; · the license holder initiated P5’s services on July 31, 2025, and provided the service recipient rights to P5 on October 13, 2025; and · the license holder initiated P7’s services on June 5, 2024. At the time of the licensing review, the license holder had not provided service recipient rights to P7. P7 was no longer receiving services from the license holder. b. The license holder did not provide P3 with a written notice that identified the service recipient rights, and an explanation of those rights annually. The license holder provided P3 with service recipient rights on June 1, 2024, and provided the annual rights to P3 October 2, 2025. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 7. Citation: Minnesota Statutes, section 245D.04, subdivision 3, paragraph (a). Violation: For one person whose record was reviewed (P2), the license holder did not ensure the exercise and protection of service recipient rights as required. The license holder did not ensure the exercise and protection of P2’s right to personal privacy. The license holder maintained information in P2’s daily log notes that documented the license holder entered P2’s apartment, including when P2 was sleeping on multiple occasions. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 8. Citation: Minnesota Statutes, section 245D.05, subdivision 1. Violation: For one person whose record was reviewed (P2), the license holder did not maintain documentation of health service needs as required. The license holder was assigned the responsibility of providing medication assistance to P2. The license holder did not maintain documentation on how P2’s health needs will be met, including a description of the procedures the license holder will follow in order to: · provide medication assistance according to this chapter; and · use medical equipment, devices, or adaptive aides or technology safely and correctly according to written instructions form a licensed health professional. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 9. Citation: Minnesota Statutes, section 245D.06, subdivision 1 and Minnesota Statutes, section 245D.11, subdivision 2. Violation: For two persons whose records were reviewed (P3 and P7), the license holder did not meet the protection standards of incident response, reporting, and enforcing policies and procedures regarding incidents as required. a. The license holder did not maintain information about and report an incident to P3’s case manager within 24 hours of incidents that occurred on September 12, 2024, July 19, 2025, August 4, 2025, September 7, 2025, September 25, 2025, and September 27, 2025, while services were being provided or within 24 hours of discovery or receipt of information that an incident occurred. Additionally, the license holder did not follow requirements in section 245D.11 when they did not maintain an incident report that included: · the name of the person or persons involved in the incident; · the date, time, and location of the incident or emergency; · a description of the incident or emergency; · a description of the response to the incident or emergency and whether a person's support plan addendum or program policies and procedures were implemented as applicable; · the name of the staff person or persons who responded to the incident or emergency; and · the determination of whether corrective action is necessary based on the results of the review.
b. The license holder did not report P7’s death as required in paragraph (b) and to the Department of Human Services Licensing Division, and the Office of Ombudsman for Mental Health and Developmental Disabilities as required under section 245.94, subdivision 2a, within 24 hours of the death, or receipt of information that the death occurred. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 10. Citation: Minnesota Statutes, section 245D.07, subdivision 1 and Minnesota Statues, section 245D.07, subdivision 1a. Violation: For six persons whose records were reviewed (P1, P2, P3, P4, P5 and P7), the license holder did not provide services in response to the person’s identified needs and in compliance with the federal waiver plans as required. a. The license holder did not provide services in response to P1, P2, P3, P4, P5 and P7’s identified needs as specified in their support plans, and in compliance with the requirements of this chapter and the federal waiver plans. The license holder was assigned to provide integrated community supports (ICS) to P1, P2, P3, P4, P5 and P7, which included training, habilitation and support to meet the person’s individualized assessed needs and goals in at least one or more of the community living service categories that included community participation, health, safety, and wellness, household management, and adaptive skills. · The license holder maintained information in P1’s record that documented P1 was to receive five hours of in person support and one hour remote service delivery. Multiple daily log notes maintained in P1’s record documented that the direct support staff called to “check in”, however, no support was provided beyond that in any of the community living service categories where P1 was assessed to have needs and goals. P1’s companionship document indicated that P1 needed assistance with transportation on an average of one hour per day, scheduling and attending medical appointments, daily medication reminders, and personal safety. Based on the log notes that were reviewed, these supports were not being provided to P1 as assigned. · The license holder maintained information in P2’s record that documented P2 was to receive twelve hours of in person support and one hour remote service delivery. Multiple daily log notes maintained in P2’s record documented staff shifts ranging from one to eight hours per day. Additionally, the license holder maintained documentation in P2’s record titled, “Supports and Outcome Methods for Intensive Support Services,” dated June 18, 2024. The license holder documented that the data was to be collected and charted daily in P2’s daily log notes. The daily log notes for P2 did not contain the data outcome and tracking information as the license holder had indicated. · The license holder maintained information in P3’s record that documented P3 was to receive nine hours of in person support and two hours of remote service delivery. Additional information in P3’s record documented that P3 desired outcomes related to obtaining a driver’s license, assistance with budgeting, and assistance with reminders to follow physicians’ orders. Multiple daily log notes maintained in P3’s record documented that the direct support staff called to “check in”, however, no support was provided beyond that in any of the community living service categories where P3 was assessed to have needs and goals. · The license holder maintained information in P4’s record that documented P4 was to receive five hours of in person support and eight hour remote service delivery. The license holder did not maintain any log notes that would indicate any remote service delivery was being provided. · The license holder maintained information in P5’s record that documented P5 was to receive eight hours of in person support and seven hour remote service delivery. Multiple daily log notes maintained in P5’s record documented that the direct support staff called to “check in”, however, no support was provided beyond that in any of the community living service categories where P5 was assessed to have needs and goals. · The license holder maintained information in P7’s record that documented P7 was to receive nine hours of in person support and four hours remote service delivery. Multiple daily log notes maintained in P7’s record documented that the direct support staff called to “check in”, however, no support was provided beyond that in any of the community living service categories where P7 was assessed to have needs and goals. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 11. Citation: Minnesota Statutes, section 245D.071, subdivision 3. Violation: For five persons whose records were reviewed (P1, P2, P3, P4 and P5), the license holder did not complete assessments and initial service planning as required. a. The license holder did not complete an assessment for P1, P4 and P5, prior to providing 45 days of service: · the license holder initiated services for P1 on June 24, 2024 and completed an assessment on October 8, 2025; · the license holder initiated services for P4 on September 1, 2024 and completed an assessment on Octboer 13, 2025; and · The license holder initiated services for P5 on July 31, 2025. Assessments were completed for both P4 and P5 on October 13, 2025. b. The license holder did not complete assessments for P3 annually in 2025. The license holder initiated P3’s services on June 1, 2024, and completed the assessments on June 25, 2024. The license holder completed the annual assessments on October 2, 2025.
c. The license holder did not hold an initial service planning meeting with P1, P2, P3, P4, and P5 and their case managers, and other members of the support team before providing 45 days of service to determine the following: · the scope of the services to be provided to support the person's daily needs and activities; · the person's desired outcomes and the supports necessary to accomplish the person's desired outcomes; · the person's preferences for how services and supports are provided, including how the provider will support the person to have control of the person's schedule; · whether the current service setting is the most integrated setting available and appropriate for the person; · opportunities to develop and maintain essential and life-enriching skills, abilities, strengths, interests, and preferences; · opportunities for community access, participation, and inclusion in preferred community activities; · opportunities to develop and strengthen personal relationships with other persons of the person's choice in the community; · opportunities to seek competitive employment and work at competitively paying jobs in the community; · how services must be coordinated across other providers licensed under this chapter serving the person and members of the support team or expanded support team to ensure continuity of care and coordination of services for the person; and · 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. d. The license holder did not complete a preliminary support plan addendum for P4 and P5 within 15 calendar days of service initiation. The license holder initiated services for P4 on September 1, 2024 and for P5 on July 31, 2025. The license holder completed preliminary support plan addendums for P4 and P5 on October 13, 2025. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 12. Citation: Minnesota Statutes, section 245D.071, subdivision 4. Violation: For four persons whose records were reviewed (P1, P3, P4 and P5), the license holder did not develop a service plan that documented service outcomes and supports as required. The license holder did not develop a service plan for P1, P3, P4 and P5 that documented the service outcomes and supports that included all of the following supports and methods to be implemented to support the person and accomplish outcomes related to acquiring, retaining, or improving skills and physical, mental, and emotional health and well-being. The license holder initiated services for P1 on June 24, 2024. Service outcomes and supports were developed for P1 on October 8, 2025. The license holder initiated services for P3 on June 1, 2024, Service outcomes and supports were developed for P3 on October 2, 2025. The license holder initiated services for P4 on September 1, 2024 and for P5 on July 31, 2025. Service outcomes and supports were developed for both P4 and P5 on October 13, 2025. · methods or actions that would be used to support the person and to accomplish the service outcomes, including information about; o any changes or modifications to the physical and social environments necessary when the service supports are provided; o any equipment and materials required; and · the measurable and observable criteria for identifying when the desired outcomes had been achieved and how data would be collected. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 13. Citation: Minnesota Statutes, section 245D.071, subdivision 5. Violation: For two persons whose records were reviewed (P2 and P3), the license holder did not conduct a service plan review and evaluation as required. a. The license holder was responsible for providing semi annual progress review reports for P2 and P3. The license holder did not summarize P2’s and P3's status and progress toward achieving the identified outcomes, make recommendations, and identify the rationale for changing, continuing, or discontinuing implementation of supports and methods on a semi annual basis. b. The license holder did not participate in service plan review and evaluation for P3, at least once per year in 2025, to determine the following: · 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; and · options for transitioning out of a community setting controlled by a provider and into a setting not controlled by a provider, including a summary of the discussion, a statement about any decision made regarding transitioning out of a provider-controlled setting and a description of any further research or education that must be completed before a decision regarding transitioning out of a provider-controlled setting can be made; Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 14. Citation: Minnesota Statutes, section 245D.095, subdivision 3. Violation: For six persons whose records were reviewed (P1, P2, P3, P4, P5, and P7), the license holder did not maintain service recipient records as required. The license holder did not maintain consistent progress or daily log notes that were recorded by the program. The license holder provided daily log notes to DHS licensors, however, several months were not maintained. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 15. Citation: Minnesota Statutes, Minnesota Statutes, section 245D.10, subdivision 3a. Violation: For one person whose record was reviewed (P6), the license holder did not enforce policies and procedures for service termination as required. The license holder issued P6 a notice of service termination on December 1, 2024. The license holder did not document the actions taken to minimize or eliminate the need for termination, including the following: · consultation with P6's support team or expanded support team to identify and resolve issues leading to issuance of the termination notice; and · a request to P6’s case manager for intervention services, or other professional consultation or intervention services to support the person in the program prior to giving P6 the notice of service termination. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 16. Citation: Minnesota Statutes, Minnesota Statutes, section 245D.10, subdivision 4. Violation: For five persons whose records were reviewed (P1, P2, P3, P4 and P5), the license holder did not provide written or electronic copies of policies and procedures as required. a. The license holder did not inform P1 through P5 and P1 through P5’s case manager’s of the policies and procedures affecting the persons rights under section 245D.04, and provide copies of the following policies and procedures, within 5 working days of service initiation: · grievance policy; · temporary service suspension policy; · service termination policy; · emergency use of manual restraint policy; and · data privacy policy. The license holder initiated services with P1 on June 24, 2024, and provided these policies to P1 on October 8, 2025. There was no documentation of P1’s case manager receiving the policies and procedures. The license holder initiated P2’s services on May 9, 2024, and provided these policies and procedures on October 2, 2025. The license holder initiated P3’s services on June 1, 2024, and provided these policies and procedures on October 2, 2025. The license holder initiated P4’s services on September 1, 2024 and provided these policies and procedures on October 13, 2025. The license holder initiated P5’s services on July 31, 2025, and provided these policies and procedures on October 13, 2025. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 17. Citation: Minnesota Rules, part 9544.0030, subpart 1. Violation: For three persons whose records were reviewed (P1, P2 and P3), the license holder did not incorporate and evaluate positive support strategies as required. a. The license holder did not incorporate positive support strategies in writing to P1’s and P3’s existing treatment, service, or other individual plan required by the commissioner. The license holder initiated P1’s services on June 24, 2024, and incorporated the positive support strategies into P1’s plans on October 8, 2025. The license holder initiated P3’s services on June 1, 2024, and incorporated the positive support strategies into P3’s plans on October 2, 2025. b. The license holder did not evaluate the identified positive support strategies with P2 and P4 at least every six months. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 18. Citation: Minnesota Rules, part 9544.0080, subpart 1. Violation: For four persons whose records were reviewed (P2, P3, P4 and P5), the license holder did not provide notice of the emergency use of manual restraint policy as required. The license holder did not provide P2, P3, P4 and P5 with notice and obtain written acknowledgment of the license holders policy on the emergency use of manual restraint at the time services were initiated. The license holder initiated P2’s services on May 9, 2024, and obtained acknowledgement of the policy on October 2, 2025. The license holder initiated P3’s services on June 1, 2024, and obtained acknowledgement of the policy on October 2, 2025. The license holder initiated P4’s services on September 1, 2024, and obtained acknowledgement of the policy on October 13, 2025. The license holder initiated P5’s services on July 31, 2025, and obtained acknowledgment of the policy on October 13, 2025. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 19. Citation: Minnesota Statutes, section 245A.041, subdivision 3. Violation: For one person whose record was reviewed (P3), the license holder did not ensure electronic records were in compliance as required. The license holder maintained multiple documents with typed signatures in P3’s record. The license holder did not ensure the electronic signatures were maintained in a form capable of being retained and accurately reproduced and the commissioner had access to information that established the date and time that data and signatures were entered into the electronic record. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 20. Citation: Minnesota Statutes, section 245D.081, subdivision 1. Violation: The license holder did not ensure the designated coordinator and the designated manager (SP7) provided program management and oversight of the services provided by the license holder as required. a. The license holder did not ensure SP7 provided coordination and evaluation of individual service delivery, including supervision, support and evaluation of activities: · provide oversight of the license holder's responsibilities assigned in the person's support plan and the support plan addendum; · take the action necessary to facilitate the accomplishment of the outcomes according to the requirements in section 245D.07; · provide instruction and assistance to direct support staff implementing the support plan and the service outcomes, including direct observation of service delivery sufficient to assess staff competency; and · evaluate the effectiveness of service delivery, methodologies, and progress on the person’s outcomes based on the measurable and observable criteria for identifying when the desired outcomes have been achieved according to the requirements in section 245D.07. b. The license holder did not ensure SP7 provided management and oversight of the services provided by the license holder, including: · maintain current understanding of the licensing requirements sufficient to ensure compliance throughout the program as identified in section 245A.04, subdivision 1, paragraph (e), and when applicable, as identified in section 256B.04, subdivision 21, paragraph (g); · ensure the duties of the designated coordinator are fulfilled according to the requirements in subdivision 2; · ensuring staff competency requirements are met according to the requirements in section 245D.09, subdivision 3, and ensuring staff orientation and training is provided according to the requirements in section 245D.09, subdivisions 4, 4a, and 5; · ensuring corrective action is taken when ordered by the commissioner and that the terms and conditions of the license and any variances are met; and · evaluate the information identified in clauses (1) to (6) to develop, document, and implement ongoing program improvements. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 21. Citation: Minnesota Statutes, Minnesota Statutes, section 245A.65, subdivision 3. Violation: For four of six staff persons whose records were reviewed (SP1, SP2, SP3, and SP4), the license holder did not provide orientation to maltreatment reporting as required. a. The license holder did not provide SP1, SP2, SP3, and SP4 with orientation on vulnerable adult maltreatment reporting including a review of the license holder’s internal policies and procedures related to prevention and reporting of maltreatment of individuals receiving services within 72 hours of first providing direct contact services. SP3 was hired on April 25, 2024, and first provided direct support services on April 29, 2024. The license holder provided the orientation to vulnerable adult reporting to SP3 on August 27, 2025. SP4 was hired on April 30, 2025, and first provided direct support services on May 1, 2025. The license holder provided the orientation to vulnerable adult reporting to SP4 on June 22, 2025. b. The license holder did not provide SP1, SP2, SP3, and SP4 with orientation to the program abuse prevention plan within 72 hours of first providing direct contact services and annually thereafter. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 22. Citation: Minnesota Statutes, section 245D.09, subdivision 4. Violation: For four staff persons whose records were reviewed (SP1, SP2, SP3, and SP4), the license holder did not provide orientation training as required. a. The license holder did not provide the following orientation to SP1, SP2, and SP3 within 60 calendar days of hire. SP1 was hired on May 27, 2024. SP2 was hired on July 2, 2024. SP3 was hired on April 25, 2024. · the job description and how to complete specific job functions, including responding to and reporting incidents, and following safety practices established by the license holder and as required; · the license holder's current policies and procedures required under this chapter, including their location and access, and staff responsibilities related to implementation of those policies and procedures; · data privacy requirements according to 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 license holder provided this orientation to SP1 on May 23, 2025. The license holder provided this orientation to SP3 on August 1, 2025; · the service recipient rights and staff responsibilities related to ensuring the exercise and protection of those rights according to the requirements in section 245D.04. The license holder provided this orientation to SP3 on August 27, 2025; · 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 license holder provided this orientation to SP3 on August 27, 2025; · the safe and correct use of manual restraint on an emergency basis according to the requirements in section 245D.061 or successor provisions, and what constitutes the use of restraints, time out, and seclusion, including chemical restraint. The license holder provided this orientation to SP3 on August 27, 2025; · staff responsibilities related to prohibited procedures under section 245D.06, subdivision 5, or successor provisions, why such procedures are not effective for reducing or eliminating symptoms or undesired behavior, and why such procedures are not safe. The license holder provided this orientation to SP3 on August 27, 2025; · basic first aid. The license holder provided this orientation to SP1 on May 23, 2025. The license holder provided this orientation to SP3 on September 23, 2025; and · strategies to minimize the risk of sexual violence, including concepts of healthy relationships, consent, and bodily autonomy of people with disabilities. The license holder provided this orientation to SP3 on August 27, 2025. b. The license holder did not provide the following orientation to SP4 within 60 calendar days of hire. SP4 was hired on April 30, 2025: · the job description and how to complete specific job functions, including responding to and reporting incidents, and following safety practices established by the license holder and as required; · the license holder’s current policies and procedures required under Minnesota Statutes, chapter 245D, including their location and access, and staff responsibilities related to implementation of those policies and procedures; and · the principles of person-centered service planning and delivery as identified in Minnesota Statutes, section 245D.07, subdivision 1a, and how they applied to direct support service provided by the staff person. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 23. Citation: Minnesota Statutes, section 245D.09, subdivision 4a. Violation: For Four staff persons whose records were reviewed (SP1, SP2, SP3, and SP4), the license holder did not provide orientation to individual service recipient needs as required. The license holder did not provide SP1, SP2, SP3, and SP4 with orientation to individual needs before having unsupervised direct contact with a person served, including the person's support plan or support plan addendum as it relates to the responsibilities assigned to the license holder, and the person’s individual abuse prevention plan, to achieve and demonstrate an understanding of the person as a unique individual, and how to implement those plans. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. Background Study Violations 24. Citation: Minnesota Statutes, section 245C.04, subdivision 1, paragraph (g). Violation: As a result of a licensing review, a DHS licensor determined that you did not request background studies for two staff persons before they began working in positions allowing direct contact with persons served. SP5 was hired and had unsupervised contact with persons served by the program on June 20, 2024. The license holder did not initiate a background study for SP5 until July 3, 2024. Under Minnesota Statutes, section 245A.07, subdivision 3, paragraph (d), the Commissioner shall not issue a fine to a license holder who self-corrects a background study violation before the Commissioner discovers the violation. A license holder who has previously exercised the provision of paragraph (d) to avoid a fine for a background study violation may not avoid a fine for a subsequent background study violation unless at least 365 days have passed since the license holder self-corrected the earlier background study violation. The license holder self-corrected the background study violation involving SP5 by initiating a background study before the Commissioner discovered the violation, therefore the license holder is not being fined for this background study violation Corrective Action Required: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. 25. Citation: Minnesota Statutes, section 245C.09, subdivision 1. Violation: As a result of a licensing review, a DHS licensor determined you did not remove an individual who did not cooperate with the completion of a background study. SP6 was hired and had unsupervised contact with persons served by the program on September 16, 2025. The license holder did not initiate a background study until September 17, 2025. On October 6, 2025, the license holder received an immediate removal notice for SP6 for not cooperating with the background study requirements. SP6 continued to have unsupervised direct contact with person served by the program. The license holder did not initiate a background study until November 1, 2025. The license holder received a clearance letter for SP6 on November 5, 2025. Corrective Action Ordered: There is no corrective action required because the license holder agreed to surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. B. No Right to Request Reconsideration You do not have the right to request reconsideration of this Correction Order because you agreed to surrender your surrender and close license as terms of their settlement agreement, effective January 9, 2026. License holder and its controlling individuals agree that they will not apply for, hold, or serve as a controlling individual for a license issued by the Department of Human Services (DHS) or Department of Children, Youth, and Families (DCYF) for period of five years from effective date of settlement agreement. If you have any questions regarding this Correction Order, please contact me as soon as possible. Amber Nielsen, Home and Community-Based Services Licensor Licensing Division Office of Inspector General 651-431-3661
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