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Date issued: April 12, 2023 Date reissued: May 5, 2023 CERTIFIED MAIL Hawa Abdulle, Authorized Agent Ayan Home Health Care LLC 1500 1st Ave NE STE 212 Rochester, MN 55906-4170 Hawa Abdulle 4506 Arctic Fox Road NW Rochester, MN 55901-3914 License Number 1105433 – Home and Community-Based Services License Number 1109841 – Adult Foster Care AMENDED ORDER OF LICENSE REVOCATION Notice: This Amended Order of License Revocation supersedes the original Order of License Revocation dated April 12, 2023. This document is amended to correctly identify SP’s in the first two bullets of section 2 titled Failure to comply with family adult foster care home laws and rules. Additionally, citation 18 has been rescinded. Citations have been renumbered to accommodate the removal of this citation. The original Order of License Revocation dated April 12, 2023, must be destroyed. Dear Hawa Abdulle: The Department of Human Services (DHS) is revoking your licenses to provide home and community-based services (HCBS) and family adult foster care (AFC) at 4506 Arctic Fox Road Northwest, Rochester, Minnesota. This revocation is based on the Commissioner’s evaluation and failure to comply with licensing laws and rules. Details of our findings are provided below. Our next steps and your options are also detailed. The revocation goes into effect on April 27, 2023 at 5:00 PM to allow time for delivery of this order and ten days for you to inform the Commissioner whether you intend to appeal the license revocation explained below. REASON FOR LICENSE REVOCATION 1. Commissioner’s evaluation of program In determining whether a licensing action is warranted, DHS evaluated the facts, conditions, and circumstances concerning your program’s operation. This includes consideration of the well-being of persons served by your program, and information about the qualifications of staff that are working in your program. DHS has determined that revocation of your license is appropriate based on the violations identified below and the program evaluation. The Commissioner is required to revoke your license because your program does not meet the requirements of a family adult foster care program. You were initially licensed to provide family adult foster care (AFC) on July 16, 2021. On August 24, 2020, you were licensed to provide home and community-based services (HCBS), and on July 26, 2021, you requested that foster care/family residential services be added to your HCBS license because you had recently been issued a family AFC license. Under the foster care licensing moratorium, if a family adult foster care license is issued during the moratorium and the license holder changes their primary residence away from the physical location of the foster care license, Minnesota Statutes, section 245A.03, subdivision 7, requires the Commissioner to revoke the license. Minnesota Statutes, section 245A.02, subdivision 6f, requires the license holder to be the primary caregiver. The family AFC is not your primary residence and are not the primary provider of caregiver. On January 25, 2023, DHS licensors conducted a HCBS licensing review at your family AFC program located at 4506 Artic Fox Road Northwest, Rochester, Minnesota resulting in 17 violations which are included in this order. Legal Authority: Minnesota Statutes, section 245A.04, subdivision 6. 2. Failure to comply with family adult foster care home laws and rules Your licensed AFC program at 4506 Arctic Fox Road Northwest, Rochester, Minnesota, does not meet the definition of a family AFC home because the home is not your primary residence. On January 25, 2023, DHS conducted a licensing review. It was determined the foster home is not your primary place of residence from the following statements and information provided by a staff person (SP3) during the licensing review: · SP3 stated that the license holder had another house just down the road which SP3 referenced as the “family home.” · When asked who lives at the “family home,” SP3 stated “We all do,” then listed themselves and three additional staff persons (SP1, SP2, SP3). · SP3 stated the “family home” was directly across the street and stated if they opened the window blinds they could see the family home from the family AFC home. SP3 led a DHS licensor to the window and pointed to the house located at the other address. · SP3 stated when they see their younger sibling coming off the bus, they are dropped off at the family AFC home and walk over to the “family house.” · SP3 stated that food for the AFC is cooked at the family home, as it was easier to just transport it to the family AFC home. · SP3 stated they were very lucky having their house and then their “group home” across the street. · SP3 stated that SP1 does overnights and SP2 and SP4 work there as well. SP1 stated that SP4 works the second shift. SP3 stated SP1 and SP2 work the overnight and added, “The family stays at the family home, this is just the foster.” · SP3 referenced a bedroom as a “staff room.” SP3 stated that this is where SP1 sleeps when they do overnights. SP3 added that if SP1 is not doing the overnight shift then SP2 plays videos in the staff room. DHS licensors asked if SP1 stays at the family home and SP2 will fill in, at which point SP3 assented and added, they stay at the family home until their shifts. · SP1 is the license holder of the family adult foster care license. Upon reviewing SP1’s staff personnel training record, DHS licensors observed a copy of SP1’s current driver’s license. The driver’s license was issued on December 7, 2022 and listed the permanent address as the address of the “family home.” The driver’s license was issued, after SP1 requested that foster care/family residential services be added to SP1’s HCBS license on July 26, 2021. Legal Authority: Minnesota Statutes, section 245A.02, subdivision 6f, paragraphs 2 and 3; Minnesota Statutes, section 245A.03, subdivision 7 (a). 3. Failure to comply with HCBS laws and rules You failed to comply with the laws and rules that apply to licensed home and community-based services and family adult foster care. DHS considered the nature, chronicity, or severity of these violations that lead to the revocation of your license. Legal Authority: Minnesota Statutes, section 245A.07, subdivision 1 and 3(a)(1). HCBS LICENSING VIOLATIONS DETERMINED ON JANUARY 25, 2023 DHS determined that your program failed to follow licensing rules and statutes, as described below. PROGRAM COORDINATION, EVALUATION, AND OVERSIGHT 1. Violation: The license holder did not meet the requirements for program coordination, evaluation, and oversight. a. The license holder failed to ensure that the designated coordinator provided coordination of service delivery and evaluation for each person served by the program. See citations 2 through 20 for the designated coordinator’s failure to provide supervision, support, and evaluation of activities including: · Oversight of the license holder’s responsibilities assigned in the person’s support plan and support plan addendum; · Taking the action necessary to facilitate the accomplishment of the outcomes according to the requirements in section 245D.07; · 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 · Evaluation of 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 outcome has been achieved according to the requirements in section 245D.07. b. The license holder failed to ensure that the designated manager provided program management and oversight of the services provided by the license holder. See citations 2 through 20 for the designated manager’s failure to: · maintain a 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 (b); · ensure the duties of the designated coordinator are fulfilled according to the requirements in subdivision 2; · evaluation of satisfaction of persons served by the program, the person's legal representative, if any, and the case manager, with the service delivery and progress towards accomplishing outcomes identified in sections 245D.07 and 245D.071 and ensuring and protecting each person's rights as identified in section 245D.04; · 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 · evaluating the information identified in clauses (1) to (6) to develop, document, and implement ongoing program improvements. Rule/Statute Violated: Minnesota Statutes, section 245D.081. SERVICE RECIPIENT VIOLATIONS 2. Violation: For one of one person whose record was reviewed (P1), the license holder did not provide an orientation to the internal and external reporting procedures of alleged or suspected maltreatment of vulnerable adults as required. Regarding P1, whose admission date was July 30, 2021, the license holder failed to provide orientation to the internal and external reporting procedures of alleged or suspected maltreatment of vulnerable adults within 24 hours of admission. P1 received this orientation on November 24, 2021, almost four months after admission. Rule/Statute Violated: Minnesota Statutes section 245A.65, subdivision 1, paragraph (c). 3. Violation: For one person whose record was reviewed (P1), the license holder did not provide orientation to the license holder’s program abuse prevention plan (PAPP) within 24 hours of admission as required. P1’s services were initiated on July 30, 2021. The license holder failed to provide orientation to the PAPP within 24 hours of service initiation. Orientation to the PAPP was provided on November 24, 2021, almost four months after admission. Rule/Statute Violated: Minnesota Statutes section 245A.65, subdivision 2, paragraph (a), clause (4). 4. Violation: For one person whose record was reviewed (P1), the license holder did not develop an individual abuse prevention plan (IAPP) as required. The license holder failed to develop an IAPP for P1 as part of initial individual program plan or service plan. The IAPP was developed on April 6, 2022. Additionally, the license holder failed to develop an IAPP that contained an individualized assessment of P1’s susceptibility to abuse. P1’s county support plan dated, April 6, 2022, stated that P1 required monitoring for weather appropriate clothing; however, P1’s IAPP stated P1 was not susceptible to abuse in this area. Rule/Statute Violated: Minnesota Statutes section 245A.65, subdivision 2, paragraph (b). 5. Violation: For one person whose record was reviewed (P1), the holder did not ensure the exercise and protection of the service recipient rights. A document titled, “[license holder name] house rules” was maintained in P1’s record. Implementation of rules in this document restricted or limited the right for P1 to engage in chosen activities. The license holder failed to ensure the exercise and protection of the service recipient rights. Rule/Statute Violated: Minnesota Statutes section 245D.04. 6. Violation: For one person whose record was reviewed (P1), the license holder did not provide a written notice that identified the service recipient rights as required. The license holder failed to provide P1’s legal representative with a written notice that identifies the service recipient rights and an explanation of those rights within five working days of service initiation. P1’s legal representative received the written notice and explanation on April 6, 2022. Rule/Statute Violated: Minnesota Statutes section 245D.04, subdivision 1. 7. Violation: For one person whose record was reviewed (P1), the license holder did not meet the requirements for medication administration as required. The license holder was assigned responsibility for medication administration in P1’s support plan addendum. The license holder failed to obtain written authorization from P1’s legal representative to administer medication or treatment. The license holder obtained written authorization on April 6, 2022; however, medication was being administered prior to this date. Additionally, the license holder failed ensure the following information was documented in P1’s medication administration record: · information on any risks other side effects that are reasonable to expect, and any contraindications to its use. This information must be readily available to all staff administering the medication; · the possible consequences if the medication or treatment is not taken or administered as directed; and · instruction on when and to whom to report the following: o if a dose of medication is not administered or treatment not performed as prescribed, whether by error by the staff person or the person or by refusal by the person; and o the occurrence of possible adverse reaction to the medication or treatment. Rule/Statute Violated: Minnesota Statutes section 245D.05, subdivision 2. 8. Violation: For one person whose record was reviewed (P1), the license holder did not meet the requirements for reviewing the medication administration record as required. The license holder was assigned responsibility for medication administration in P1’s support plan addendum. The license holder failed to ensure information maintained in the medication administration record was regularly reviewed at a minimum of every 3 months. Rule/Statute Violated: Minnesota Statutes section 245D.05, subdivision 4, paragraph (a). 9. Violation: For one person whose record was reviewed (P1), the license holder did not develop, implement, and maintain documentation regarding psychotropic medications as required. The license holder was assigned responsibility for medication administration in P1’s support plan addendum. P1 was prescribed a psychotropic medication; however, the license holder failed to maintain documentation that included a description of the target symptoms that the psychotropic medication was to alleviate. Rule/Statute Violated: Minnesota Statutes section 245D.051, subdivision 1, paragraph (b). 10. Violation: For one person whose record was reviewed (P1), the license holder did not complete service planning and delivery for intensive support services as required. Regarding P1 the license holder failed to do the following: · complete a preliminary support plan addendum based on the support plan within 15 days of service initiation; · complete assessments in the following areas before the 45-day planning meeting: o the person’s ability to self-manage health and medical needs to maintain or improve physical, mental, and emotional well-being, including, when applicable, allergies, seizures, choking, special dietary needs, chronic medical conditions, self-administration of medication or treatment orders, preventative screening, and medical and dental appointments; o the person's ability to self-manage personal safety to avoid injury or accident in the service setting, including, when applicable, risk of falling, mobility, regulating water temperature, community survival skills, water safety skills, and sensory disabilities; and o the person's ability to self-manage symptoms or behavior that may otherwise result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to (7), suspension or termination of services by the license holder, or other symptoms or behaviors that may jeopardize the health and welfare of the person or others. · meet with the person, the person’s legal representative, the case manager, other members of the support team or expanded support team, and other people as identified by the person or the person’s legal representative to determine the following based on information obtained from the assessments identified in paragraph (b), the person's identified needs in the support plan, and the requirements in subdivision 4 and section 245D.07, subdivision 1a: o the scope of the services to be provided to support the person’s daily needs and activities; o the person’s desired outcomes and the supports necessary to accomplish the person’s desired outcomes; o the person’s preferences for how services and supports and provided, including how the provider will support the person to have control of the person’s schedule; o whether the current service setting is the most integrated setting available and appropriate for the person; o opportunities to develop and maintain essential and life-enriching skills, abilities, strengths, interests and preferences; o opportunities to develop and strengthen personal relationships with other persons of the person’s choice in the community; o opportunities to seek competitive employment and work at competitively paying jobs in the community; and o how services must coordinated across other providers licensed under this chapter serving the person and the members of the support team or expanded support team to ensure continuity of care and coordination of services for the person; o a discussion of how technology might be used to meet the person’s desired outcomes. The support plan or support plan addendum must include a summary of this discussion. The summary must include the following: § 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. Rule/Statute Violated: Minnesota Statutes section 245D.071, subdivision 3, paragraph (a). 11. Violation: For one person whose record was reviewed (P1), the license holder did not develop service outcomes and supports based on assessments as required. The license holder failed to develop a service plan for P1 that documented the service outcomes and supports based on assessments within 10 working days of the 45-day planning meeting. Rule/Statute Violated: Minnesota Statutes section 245D.071, subdivision 4, paragraph (a). 12. Violation: For one person whose record was reviewed (P1), the license holder did not inform the person and case manager of the policies and procedures affecting a person’s rights under section 245D.04, and provide copies of those policies and procedures, within five working days of service initiation. Regarding P1, whose service initiation date was July 30, 2021, the license holder failed to inform P1 and P1’s case manager of the policies and procedures affecting a person’s rights under section 245D.04, and provide copies of those policies and procedures, within five working days of service initiation. P1 and P1’s case manager received these policies on November 24, 2021 Rule/Statute Violated: Minnesota Statutes, section 245D.10, subdivision 4, paragraph (b) 13. Violation: For one person whose record was reviewed (P1), the license holder did not evaluate the identified positive support strategies every six months as required. The license holder failed to evaluate with P1, at least every six months, if any positive support strategies used needed changes, and, if so make appropriate changes. Rule/Statute Violated: Minnesota Rules, part 9544.0030, subpart 1. Record Keeping Violations 14. Violation: The license holder did not maintain an admission record as required. The license holder failed to keep a written or electronic register, listing in chronological order the dates and names of all persons served by the program who have been admitted, discharged, or transferred, including service terminations initiated by the license holder or deaths. Rule/Statute Violated: Minnesota Statutes 245D.095, subdivision 2. 15. Violation: For one person whose record was reviewed (P1), the license holder did not maintain a service recipient record as required. Although the license holder maintained an admission for P1, the license holder failed to obtain P1’s legal representative’s signature on the form. Rule/Statute Violated: Minnesota Statutes 245D.095, subdivision 3. Staffing Standards 16. Violation: For two of two staff persons whose records were reviewed (SP1 and SP2), the license holder did not provide orientation training as required. a. Regarding SP1 hired on July 25, 2021, the license holder failed to provide the following orientation training within 60 days of hire: · 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; and · 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. b. Regarding SP2, whose hire date is not documented in SP’s training record, the license holder failed to provide the following orientation training within 60 days of hire: · the job description and how to complete specific job functions including: o responding to and reporting incidents as required under section 245D.06, subdivision 1; and o following safety practices established by the license holder as required in section 245D.06, subdivision 2; · 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 including: o grievance policy o service suspension policy o service termination policy; o prohibition on drug and alcohol use policy; o emergency use of manual restraint; o use of universal precautions and sanitary practices; o health service and coordination; o safe medication assistance and administration; o safe transportation; o service admission; and o emergency response and reporting; · 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 safe and correct use of manual restraint on an emergency basis according to the requirements in section 245D.061 and what constitutes the use of restraints, time out, and seclusion, including chemical restraint; and · staff responsibilities related to prohibited procedures under section 245D.06, subdivision 5, why such procedures are not effective for reducing or eliminating symptoms or undesired behavior, and why such procedures are not safe. Rule/Statute Violated: Minnesota Statutes, section 245D.09, subdivision 4. 17. Violation: For one staff persons whose record was reviewed (SP2), the license holder did not provide orientation to individual service recipient needs as required. The license holder failed to review and provide instruction to SP2 on 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. Rule/Statute Violated: Minnesota Statutes, section 245D.09, subdivision 4a, paragraphs (a) and (c). 18. Violation: For one staff person whose record was reviewed (SP1), the license holder did not provide annual training as required. Annual is defined as prior to or within the same month of the subsequent calendar year. The license holder provided SP1 a training titled, “Vulnerable Adult Refresher – MN” on July 24, 2021. At the time of this licensing review, the license holder failed to provide SP1 with annual training governing maltreatment reporting and service planning for children and vulnerable adults, and staff responsibilities related to protecting persons from maltreatment and reporting maltreatment. Rule/Statute Violated: Minnesota Statutes, section 245D.09, subdivision 5. 19. Violation: For one person whose record was reviewed (SP2), the license holder did not maintain personnel records as required. For SP2, the license holder failed to maintain a personnel record that documented SP2’s date of hire. Additionally, the license holder failed to maintain documentation in SP2’s personnel record or elsewhere, sufficient to determine the date of SP2’ first supervised direct contact with a person served by the program, and the date of the first unsupervised direct contact with a person served by the program. Rule/Statute Violated: Minnesota Statutes, section 245D.095, subdivision 5. Nature, Severity, Chronicity The nature, chronicity, and severity of the violations of laws and rules was considered as required by Minnesota Statutes, section 245A.07, subdivision 1(a). Nature: Many of the violations cited in this Order of License Revocation are violations of law or rule affecting the health, safety, or rights of persons served by the program. The licensing violations include: o Failure to maintain a family adult foster care home as a primary residence with a primary caregiver. o Failure to provide services in compliance with the requirements of Minnesota Statutes, chapters 245A, 245D, and Minnesota Rules, Chapter 9544 o Failure to meet initial service planning requirements o Failure to provide and ensure the exercise and protection of a person’s service-related rights o Failure to inform and provide copies of program policies and procedures, including service recipient rights o Failure to meet health service needs consistent with the person’s health needs, including administering medications o Failure to complete service planning and delivery for intensive support service o Failure to evaluate positive support strategies o Failure to maintain service recipient record o Failure to maintain personnel records o Failure to meet requirements for orientation and annual staff training o Chronicity: o Your program received its home and community-based services license, number 1105433, on August 24, 2020. o Your program received its family adult foster care license 1109841 on July 16, 2021. o In July 2021 you requested that DHS add foster care/family residential services to your HCBS license. You provided proof to DHS that you had applied for a family adult foster care license where these services would be provided. o Since that time, your program has demonstrated a history of noncompliance with licensing rules and statutes as detailed in this revocation order. Severity: The violations that led to the revocation of your license relate to the health, safety, and rights of persons served. DHS determined this history demonstrates that a systemic problem exists in the operation of your program that puts the well-being of the vulnerable adult served by the program at risk. Additionally, revocation of your AFC license is required because your program no longer meets the definition of a family adult foster home under Minnesota Statutes, section 245A.02, subdivision 6f. Because your primary residence is not in the physical location of the family adult foster care license that was issued during the moratorium on new foster care programs that are not the primary residence of the license holder; and due to the serious and chronic nature of licensing violations which impact the health and safety of persons served in your care, your licenses to provide home and community-based services and family adult foster care services are revoked. YOUR RIGHT TO APPEAL You have the right to appeal the revocation. Your request must be in writing and clearly state that you are requesting a contested case hearing for this matter. Your request must be made before the deadlines provided below. If you do not meet this deadline, you lose your right to an administrative appeal. The timeline to appeal began when you received this order. If you are mailing your request, it must be sent by certified mail and postmarked within 10 calendar days from when you received this order. Please send it 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 If your request is being personally delivered, it must be received by DHS within 10 calendar days from when you received this order. Please bring it to: Commissioner, Department of Human Services Office of Inspector General Legal Counsel’s Office Attention: Licensing Legal Unit 444 Lafayette Road North St. Paul, MN 55155 Upon DHS’ receipt of your timely appeal, your case would be scheduled for a contested case hearing in front of an Administrative Law Judge. Following this hearing, the Commissioner of DHS will issue a final order. If you do not appeal or if the order is affirmed by the Commissioner following a hearing, DHS is prohibited from issuing you and the controlling individuals a license for five years. In addition, any additional licenses held by you or the controlling individuals shall also be revoked. Legal representation at the contested case hearing: You do not need a lawyer to appeal. However, a lawyer can help you with your appeal. The state or county will not get you a lawyer and will not pay for a lawyer. If you cannot afford a lawyer, you may be able to get free legal advice or help with your appeal. To find out if free help is available, contact: Volunteer Lawyers Network at 612-752-6677; Central Minnesota Legal Services at 612-332-8151; Southern Minnesota Legal Services at 651-222-4731; or go to www.lawhelpmn.org to find a local legal services program that may be able to help you. You can also find information on contested cases from the Office of Administrative Hearings website at https://mn.gov/oah/self-help. Click on Administrative Law Overview, then click on Administrative Law Contested Case Hearing Guide for a list of frequently asked questions. Operating the program pending the outcome of the appeal: If you file an appeal within the timeframes described above, you may continue to operate pending the outcome of your appeal. If you continue to operate, you must do so in full compliance with all licensing laws and rules. Failure to follow a law or rule that may impact the health or safety of persons served by your program could result in the immediate suspension of your license Legal authority for this licensing action · This action is taken under Minnesota Statutes, section 245A.07, subdivision 3, which describes under which conditions DHS may revoke a license. · The timeline to appeal a revocation order is provided in Minnesota Statutes, section 245A.07, subdivision 3(b). · “Controlling individual” is defined under Minnesota Statutes, section 245A.02, subdivision 5a. · License holders have a right to appeal licensing actions and request a contested case hearing, under Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. · If a license holder files a timely appeal of a revocation order, the license holder may continue to operate the program pending a final order of the appeal under Minnesota Statutes, section 245A.07, subdivision 1(b). · Under Minnesota Statutes, section 245A.04, subdivision 7, paragraph (d), clause (3), the commissioner shall not issue or reissue a license if the applicant, license holder, or controlling individual has had a license issued under this chapter revoked within the past five years. · Under Minnesota Statutes, section 245A.04, subdivision 7, paragraph (d), clause (5), when a license issued under this chapter is revoked under clause (1) or (3), the license holder and controlling individual may not hold any license under chapter 245A for five years following the revocation, and other licenses held by the applicant, license holder, or controlling individual shall also be revoked. Questions If you have any further questions regarding this matter, you may contact Christala Culhane, HCBS Supervisor, at 651-431-6541. Sincerely,
Jill Slaikeu, HCBS Unit Manager Licensing Division Office of Inspector General
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