5/3/12 LLO_14292 : 1048663 April 25, 2012 Jennifer Klass Heartland Homes of Duluth LLC 1086 88th Avenue West Duluth, MN 55808-1427 License Number: 1059953 (Adult Foster Care) License Number: 1044682 (Adult Foster Care) License Number: 1048663 (Adult Foster Care) License Number: 1050436 (Adult Foster Care) Report Number: 20111875 CERTIFIED MAIL ORDER OF CONDITIONAL LICENSE Dear Ms. Klass: You are hereby notified that the Department of Human Services (DHS) has made a determination of substantiated maltreatment by a staff person at the adult foster care program with license number 1059953 located at 3501 Morris Thomas Road, Duluth, Minnesota. Although DHS found a staff person responsible for the maltreatment, the Commissioner has found the facility's handling of the internal review to be of great concern. Based on three recent maltreatment determinations involving the facility or staff at two homes operated by Heartland Homes of Duluth LLC, the inability or unwillingness to www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMeth... 1/8 5/3/12 LLO_14292 : 1048663 recognize possible maltreatment, and because program staff and management personnel float among four adult foster care homes licensed to Heartland Homes of Duluth LLC, the Commissioner is placing the four adult foster care licenses on conditional status for two years beginning April 25, 2012. The adult foster care homes affected by this order include: o License Number 1059953 located at 3051 Morris Thomas Road, Duluth o License Number 1044682 located at 4712 Peabody Street, Duluth o License Number 1048663 located at 1533 Morningside Avenue, Duluth o License Number 1050436 located at 522 West Faribault Street, Duluth A. Reason for the Order of Conditional License Pursuant to Minnesota Statutes, section 245A.06, subdivision 1, the Commissioner of Human Services may make a license conditional if the license holder fails to comply fully with applicable laws or rules. During investigation of report 20111875, the facility completed an internal review of an incident involving a staff person and three vulnerable adults. The incident included a 20 minute audio recording where a staff person can be heard verbally abusing three vulnerable adults. The facility's internal review stated that administrative staff persons listened to the first five minutes of the audio recording of the incident and could "only assume" that the staff person was abiding by all policies and procedures. Administrative staff persons came to this conclusion because VA1's and the staff person's comments in the first five minutes of the audio recording and during interviews were "contradicting" and VA1 had a history of "fabrication." The facility identified that there was no need for additional training but felt that the staff person's "sarcastic/tone/comments" and power www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMeth... 2/8 5/3/12 LLO_14292 : 1048663 struggle with the vulnerable adults were areas of "communication strategies" that could be addressed through a crisis prevention intervention (CPI) training. During investigation of reports 20111015 and 20111016 completed in August 2011, the facility conducted an internal review and concluded that facility staff persons "Followed through with protocols and/or training in regard to what deems 911 emergency phone calls." The facility also concluded that the facility policies and procedures were adequate including CPR, first aid, and emergency procedures (whom to call and when). The internal review stated that Heartland Homes "does not believe there is a need for additional training for our staff at this time." However, DHS determined in those reports that given that staff persons at all levels of authority were unable to identify VA1's and VA2's individual diagnoses, how to address breathing difficulties, what the signs and symptoms of serious illness were, and when to telephone 9-1-1, the individual staff person's responsibility was mitigated and the facility was responsible for the maltreatment of VA1 and VA2 who each died at the facility on March 19 and March 20, 2011, respectively. 1. Citation: Minnesota Statutes, section 245A.65, subdivision 1(b)(1). Violation: Under Minnesota Statutes, section 245A.65, subdivision 1, paragraph (b), clause (1), the license holder shall establish and maintain policies and procedures to ensure that an internal review is completed and that corrective action is taken as necessary to protect the health and safety of vulnerable adults when the facility has reason to know that an internal or external report of alleged or suspected maltreatment has been made. The review must include an evaluation of 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 www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMeth... 3/8 5/3/12 LLO_14292 : 1048663 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. Based on the results of this review, the license holder must develop, document, and implement a corrective action plan designed to correct current lapses and prevent future lapses in performance by individuals or the license holder, if any. As determined in two recent internal reviews (internal review for reports 20111015 and 2011016, and the internal review for report 20111875) the facility's internal review process is grossly inadequate and increases the likelihood that similar events will occur in the future. 2. Citation: Minnesota Rules, part 9555.6185, subpart 2. Violation: Under Minnesota Rules, part 9555.6185, in addition to the orientation training, caregivers must complete the training designed to meet the needs of the residents in care in any of the subject areas and in the amount specified in subpart 4. The operator must ensure that a record of training completed is maintained. The facility completed an internal review. This review stated that administrative staff persons listened to the first five minutes of the audio recording of the incident and could "only assume" that the SP was abiding by all policies and procedures. Administrative staff persons came to this conclusion because VA1's and the SP's comments in the first five minutes of the audio recording and during interviews were "contradicting" and VA1 had a history of "fabrication." The facility identified that there was "no need for additional training" but felt that the SP's "sarcastic/tone/comments" and power struggle with the VAs were areas of "communication strategies" that could be addressed through a crisis prevention intervention (CPI) training. The Commissioner is placing your licenses to provide adult foster care on conditional status for two years with the full expectation that www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMeth... 4/8 5/3/12 LLO_14292 : 1048663 the violations related to internal reviews will be corrected immediately, and that there will be no further violations of adult foster care laws and rules while your license is on conditional status. B. Terms of the Conditional License 1. Within 20 days from receipt of this order, you must provide written notification of the conditional status of your license to all residents receiving services from Heartland Homes of Duluth LLC, to all resident guardians, and to all parties who refer residents to your program. For new prospective residents of your program, you must provide notice of the conditional status of your license to the prospective resident and prospective resident's guardian before admission. The notification required under this term must include an offer to provide a copy of the Order of Conditional License upon request. Within 30 days after receipt of this order, you must submit to your adult foster care licensor a copy of the notice and a list of all individuals and referral sources that received the notice. 2. Heartland Homes of Duluth, LLC, must ensure that each caregiver obtains a minimum of six hours of additional training by March 31, 2012. The training is in addition to the annual training requirements as listed in Minnesota Rules, part 9555.6185, subpart 2. a. Four of the six hours of training must include information about how to identify signs and symptoms of serious illness and how to determine when to telephone 9-1-1. b. Two of the six hours of training must focus on respectful treatment of individuals receiving services, and how to effectively communicate and avoid power struggles with individuals receiving services. Prior to caregivers attending the training, Heartland Homes of www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMeth... 5/8 5/3/12 LLO_14292 : 1048663 Duluth, LLC, must obtain approval from St. Louis County Public Health and Human Services that the training is appropriate. Heartland Homes of Duluth, LLC, must submit documentation of each caregiver's attendance to Saint Louis County Public Health and Human Services within ten days of the training being completed. 3. Heartland Homes of Duluth, LLC, must ensure that, prior to providing direct contact services, each caregiver receives adequate training that is specific to each client being served in the adult foster care program where the caregiver will provide direct contact services. This training is in addition to the annual training requirements as listed in Minnesota Rules, part 9555.6185, subpart 2. The training must include information about each client's diagnosis and any special cares or procedures that are specific to each client's needs as addressed in each client's care plans including the individual resident placement agreement, and individual abuse prevention plan. Heartland Homes of Duluth, LLC, must document the completion of this training in each caregiver's personnel file and make the documentation available to Saint Louis County Public Health and Human Services and the Commissioner upon request. Your licensor will monitor your compliance with all applicable laws and rules and compliance with the terms of the conditional license. Verification of compliance may include unannounced visits. Failure to comply with the requirements in Minnesota Rules, parts 9555.5105 to 9555.6265 (DHS Rule 203), Minnesota Statutes, chapter 245A (Human Services Licensing Act), Minnesota Statutes, chapter 245C (Human Services Background Study Act), Minnesota Statutes, sections 626.557 and 626.5572 (Vulnerable Adults Act), and with the terms of your conditional license may result in further negative action, including revocation of your license. C. Requesting reconsideration of the conditional license only. www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMeth... 6/8 5/3/12 LLO_14292 : 1048663 You have the right to request that the Commissioner of Human Services reconsider the Order of Conditional License. If you choose to exercise this right, your request must be made in writing by certified mail or personal service. If sent by certified mail, the request must be postmarked and sent to the commissioner within 10 calendar days after you receive this order. If a request is made by personal service, it must be received by the commissioner within 10 calendar days after you receive this order. You should submit written argument or evidence in support of your request. (See Minnesota Statutes, section 245A.06, subdivision 4.) A timely request for reconsideration of the conditional license shall stay the terms of the conditional license until the Commissioner issues a decision on the request for reconsideration of the order. Please note that if the terms of the conditional license are stayed, you are still required to comply with all applicable laws and rules governing the provision of adult foster care. The request for reconsideration of the Order of Conditional License must be sent to: Commissioner, Department of Human Services ATTN: Legal Unit c/o Licensing Division PO Box 64242 St. Paul, MN 55164-0242 If you have any questions regarding the conditional status of your adult foster care licenses, please contact Nancy Sackett, Family Systems Unit Manager, at (651) 431-6602. Sincerely, www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMeth... 7/8 5/3/12 LLO_14292 : 1048663 Maura McNellis-Kubat, Supervisor Division of Licensing cc: Kathy Esson, St. Louis County Adult Foster Care PO Box 64242 o Saint Paul, Minnesota o 55164-0242 o An Equal Opportunity and Veteran Friendly Employer http://www.dhs.state.mn.us/licensing www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMeth... 8/8