Maltreatment Report #: HL28659005M Compliance

Protecting, Maintaining and Improving the Health of All Minnesotans Office of Health Facility Complaints Investigative Public Report Maltreatment Report #: HL28659005M Date Concluded: May 31, 2019 Compliance #: HL28659006C Name, Address, and County of Licensee Name, Address, and County of Housing with Investigated: Services location: A‐1 Reliable Home Care A‐1 Reliable Home Care 2353 Rice Street Suite 107 5716 42nd Avenue North Saint Paul, MN 55113 Robbinsdale, MN 55422 Ramsey County Ramsey County Facility Type: Home Care Provider Investigator’s Name: Earl F. Bakke, RN, MSOL, BSN, CEN Special Investigator Revised Date: July 30, 2019 Finding: Inconclusive Nature of Visit: An investigator from the Minnesota Department of Health investigated an allegation of maltreatment, in accordance with the Minnesota Reporting of Maltreatment of Vulnerable Adults Act, Minn. Stat. 626.557, and to evaluate compliance with applicable licensing standards for the provider type. Allegation(s): It is alleged that a client was exploited when the alleged perpetrator (AP) took money from the client’s account without permission. Investigative Findings and Conclusion: Financial exploitation was inconclusive. The AP billed a client to clean a carpet damaged due to the client urinating on the floor. The AP sent the invoice to the client’s representative payee, who paid the sum in monthly installments. The AP believed s/he had justification for billing the client for the damage under the rental agreement signed by the client. There is not a preponderance of evidence to conclude that the AP intended to financially exploit the client by billing the client for the repairs to damaged property. An equal opportunity employer. Page 2 of 5 The investigation included interviews with representatives for the client; the client; the client’s representative payee company; and facility staff members, including administrative, nursing, and unlicensed staff. The investigator completed a tour of the Facility and conducted a review of the client’s medical records. The investigator reviewed an analysis of the Facility employees' timesheets, the Facility’s employee files, training records, policies, and schedule. The investigator also reviewed the invoice for the carpet cleaning and the client’s financial ledger. The client received services from the comprehensive home care provider for nursing assessment, reassessment, and monitoring. The client’s medications were managed, and she was to receive services for behavior management with 24‐hour supervision. The client had a history of mental illness. On an unknown day in 2018, the client had a urinary incontinence episode causing the carpeting in the client’s room to be wet. The client described the wet area as the size of a regular size bed pillow. The client and another staff member cleaned the carpet to the best of their ability. The AP had a carpet cleaning company clean the entire carpet in the client’s room. The client was also moved to a different room in the Facility. Several months later, the AP sent an invoice for the carpet cleaning to the client’s representative payee. The representative payee was responsible for issuing the client’s rent and personal needs checks. The representative payee company informed the AP the client did not have extra funds for the carpet cleaning. The AP instructed the representative payee company to transfer funds from the client’s personal needs money in three payments to the monthly rent checks. The representative payee company transferred $36.66 from the client’s personal needs check to the Facility’s rent check. The transfers were to occur for three months, for a total of $109.98. The total cost of the carpet cleaning, per the invoice, was $107.53. The representative payee did not have authorization from the client to transfer funds from her personal needs to additional rent to the AP and the Facility. The AP did not receive or have any written or confirmed authorization to make requests or changes to funds received by the client on the client’s behalf. During an interview, the client said she had a room upstairs. The client had to come downstairs to use the bathroom. Frequently, staff would use a pull out bed in a couch to sleep at night. When the pull out bed was extended, it blocked the path to the bathroom. The client said she would have to climb over the bed while the staff were sleeping. The client said this happened five nights in a row, so she decided to try to hold her urine until morning. The client said she had an accidental urinary incontinence episode that caused the carpet to become wet. The client compared the total area of wetness to the size of a bed pillow. The client mentioned that she and a staff member cleaned the carpet to the best of their ability. The client said she was present when the carpet company cleaned the carpet. The client further said the carpet needed to be professionally cleaned, but due to the condition of the carpet, not just because of the incontinence episode. The entire room’s carpet was cleaned, not just the area of incontinence. Page 3 of 5 The client’s interview continued with her saying the AP had not asked for permission to take funds from her personal needs account, but instead told the client she was going to do it. The client said she finally agreed to it, but only to get the AP off of her back, and also because in the past the AP had threatened to put her out of the facility. The AP also told the client she had to pay for a broken bed box spring. The client said she had been sleeping on the broken bed since 2017, and when the Facility moved her to the basement bedroom, the broken bed was moved with her. The client said she tried to tell the AP the incontinence episode was an accident and the sleeping staff’s bed had blocked the bathroom, but the AP did not listen. The client also mentioned the carpet was not cleaned right away, and there was a lapse of time between the cleaning and the AP taking the money. The client said she even told the AP, for her own best interest, she could not take her money because the AP would get in trouble. During the investigation, the client’s bed was observed to have no bed frame. The box spring was broken and nearly flat on the floor. During an interview, a nurse said he had never heard of a client being billed or charged for accidentally or even intentionally causing damage. The nurse said it would be unethical to charge clients, and he had never worked at a Facility where a client had to replace a bed or broken items. The nurse said clients are supplied with a bed, dresser, hangers, and toiletries. The nurse was not aware of any incidents where the client had damaged or broken something. The nurse was also not aware of an incontinence episode with the client. The nurse also stated the staff were not allowed to sleep while working. During an interview, the representative payee company manager said the AP had faxed the invoice to her for the carpet cleaning. The client’s name was handwritten on it. The AP said to transfer the money in three payments instead of all at once. The manager said she had not talked to the client personally, and there were no forms or documents from the client authorizing the transfer of money. The AP had told the manager the housing rental agreement had authorization. The manager said, in her 12 years of payee business, she had never had this sort of transaction take place without the client actually being involved in the process. During an interview, the AP said the client was supposed to get $102.00 a month for personal needs but, for the past two months, she had gotten $65.34 because of the carpet cleaning. The AP produced photocopies of the checks because she cashed the checks for the client. The AP said the client had spilled urine on the floor from a full commode, but she did not know if it had been accidental or intentional. The AP said the client agreed to pay for the carpet cleaning. The AP said she assumed the client had urinated on the carpet several times, but did not know if staff had ever documented the incidents. The AP said there was no language in the housing with services agreement regarding home repairs, but that the rental agreement and a house rules document both stated that clients are liable for damages they cause to the property. The AP further mentioned the client used a commode, but it was supposed to only be used at night. The client had used it during the day, so it filled up. The AP had no physician’s order or documentation directing when the client should or should not use a commode. The AP said all Page 4 of 5 the clients in the Facility have some sort of mental illness. The AP did not have any documentation of authorization from the client, and said the client gave authorization verbally. In conclusion, financial exploitation was inconclusive. Financial exploitation: Minnesota Statutes, section 626.5572, subdivision 9 "Financial exploitation" means: (a) In breach of a fiduciary obligation recognized elsewhere in law, including pertinent regulations, contractual obligations, documented consent by a competent person, or the obligations of a responsible party under section 144.6501, a person: (1) engages in unauthorized expenditure of funds entrusted to the actor by the vulnerable adult which results or is likely to result in detriment to the vulnerable adult; or (2) fails to use the financial resources of the vulnerable adult to provide food, clothing, shelter, health care, therapeutic conduct or supervision for the vulnerable adult, and the failure results or is likely to result in detriment to the vulnerable adult.

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