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.

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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. (b) In the absence of legal authority a person: (1) willfully uses, withholds, or disposes of funds or property of a vulnerable adult; (2) obtains for the actor or another the performance of services by a third person for the wrongful profit or advantage of the actor or another to the detriment of the vulnerable adult; (3) acquires possession or control of, or an interest in, funds or property of a vulnerable adult through the use of undue influence, harassment, duress, deception, or fraud

Vulnerable Adult interviewed: Yes Family/Responsible Party interviewed: Yes (client representative) Alleged Perpetrator interviewed: Yes

Action taken by facility: None noted at the time of the on‐site visit.

Action taken by the Minnesota Department of Health: The facility was found to be in noncompliance. To view a copy of the Statement of Deficiencies and/or correction orders, please visit: https://www.health.state.mn.us/facilities/regulation/directory/provcompselect.html, or call 651‐201‐4890 to be provided a copy via mail or email. If you are viewing this report on the MDH website, please see the attached Statement of Deficiencies.

The responsible party will be notified of their right to appeal the maltreatment finding. If the maltreatment is substantiated against an identified employee, this report will be submitted to the nurse aide registry for possible inclusion of the finding on the abuse registry and/or to the Minnesota Department of Human Services for possible disqualification in accordance with the provisions of the background study requirements under Minnesota 245C.

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cc: Health Regulation Division – Home Care and Assisted Living Program The Office of Ombudsman for Long‐Term Care Department of Human Service – Surveillance and Integrity Review Section Office of Inspector General St. Paul Police Department St. Paul City Attorney Ramsey County Attorney PRINTED: 10/24/2019 FORM APPROVED Minnesota Department of Health STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: ______COMPLETED C H28659 B. WING ______05/09/2019

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE A1 RELIABLE HOME CARE 2353 RICE STREET SUITE 107 SAINT PAUL, MN 55113 (X4) ID SUMMARY STATEMENT OF DEFICIENCIES ID PROVIDER'S PLAN OF CORRECTION (X5) PREFIX (EACH DEFICIENCY MUST BE PRECEDED BY FULL PREFIX (EACH CORRECTIVE ACTION SHOULD BE COMPLETE TAG REGULATORY OR LSC IDENTIFYING INFORMATION) TAG CROSSREFERENCED TO THE APPROPRIATE DATE DEFICIENCY)

0 000 Initial Comments 0 000

******REVISED on October 24, 2019****** The Minnesota Department of Health documents the State Licensing Correction Orders using federal software. Tag ******ATTENTION****** numbers have been assigned to Minnesota State Statutes for Home Care Providers. The assigned tag number HOME CARE PROVIDER LICENSING appears in the far left column entitled "ID CORRECTION ORDER Prefix Tag." The state statute number and the corresponding text of the state statute In accordance with Minnesota Statutes, section out of compliance are listed in the 144A.43 to 144A.482, this correction order has "Summary Statement of Deficiencies" been issued pursuant to a survey. column. This column also includes the findings that are in violation of the state Determination of whether a violation has been requirement after the statement, "This corrected requires compliance with all Minnesota requirement is not met as requirements provided at the statute number evidenced by." Following the surveyors ' indicated below. When a Minnesota Statute findings is the Time Period for Correction. contains several items, failure to comply with any of the items will be considered lack of Per Minnesota Statute § 144A.474, Subd. compliance. 8(c), the home care provider must document any action taken to comply with INITIAL COMMENTS: the correction order. A copy of the provider ' s records documenting those actions may be requested for followup surveys. On May 9, 2019, a complaint investigation was The home care provider is not required to initiated to investigate complaint #HL28659005M, submit a plan of correction for approval; HL28659006C, HL28659007M, and please disregard the heading of the fourth HL28659008C. No correction orders are issued column, which states "Provider ' s Plan of for HL28659005M and HL28659006C. The Correction." following correction order is issued for #HL28659007M, and HL28659008C. The letter in the left column is used for tracking purposes and reflects the scope and level issued pursuant to Minn. Stat. § 144A.474, Subd. 11 (b).

0 325 144A.44, Subd. 1(14) Free From Maltreatment 0 325 SS=G Subdivision 1. Statement of rights. A person who receives home care services has these rights: Minnesota Department of Health LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE

STATE FORM 6899 8TPN11 If continuation sheet 1 of 6 PRINTED: 10/24/2019 FORM APPROVED Minnesota Department of Health STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: ______COMPLETED C H28659 B. WING ______05/09/2019

0 325 Continued From page 1 0 325 (14) the right to be free from physical and verbal abuse, neglect, financial exploitation, and all forms of maltreatment covered under the Vulnerable Adults Act and the Maltreatment of Minors Act;

This MN Requirement is not met as evidenced by: Based on observations, interviews and documents reviewed, the licensee failed to keep one client, C1, free from maltreatment, when C1 was left in the care and supervision of a housekeeper. The housekeeper had not received any client cares training and slept while working, leaving C1 unsupervised and at risk for elopement or selfharm, due to C1's mental illnesses.

This practice resulted in a level three violation (a violation that harmed a client's health or safety, not including serious injury, impairment, or death, or a violation that has the potential to lead to serious injury, impairment, or death), and was issued at a isolated scope.

The findings include:

During an observation on May 9, 2019 at 9:00 am, entry was made to conduct an onsite investigation. The licensee had one staff member present, who identified herself as the housekeeper (HK). HKC said she was the only one there, but only did the cleaning and cooking. HKC said she was not responsible for the client's cares.

C1's medical record was reviewed. C1's service agreement, dated June 26, 2018, indicated C1 Minnesota Department of Health STATE FORM 6899 8TPN11 If continuation sheet 2 of 6 PRINTED: 10/24/2019 FORM APPROVED Minnesota Department of Health STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: ______COMPLETED C H28659 B. WING ______05/09/2019

0 325 Continued From page 2 0 325 received services from the comprehensive home care provider for nursing assessments and monitoring, and medication management.

A document review, titled 24hour customized living services Daily, dated July 1, 2018 through June 20, 2019, indicated C1 was supposed to receive homemaking services, shopping, assistance making appointment, 1:1 individual staffing for two hours a day, meals, assistance with walking, medication management and management of anxiety, agitation, behaviors, and aggression.

A document review, titled BiWeekly time sheets, dated May 13 through May 26, indicated HKC was scheduled to work 24 hours a day for 14 days straight. The document indicated on May 13, 14, 15, 16, 17, 20, 21, 22, 23, 24, 25, and 26th, HKC was scheduled to work alone.

A document review, titled Biweekly time sheets, dated April 29 through May 12, indicated HKC either worked, or was scheduled to work 24 hours a day for those two weeks straight. On April 29, 30, and May 1, 2, 3, 6, 7, 8, 9, 10, 11, and 12, HKC worked alone or was scheduled to work alone.

A document review, titled time sheet assigned to HKC, dated April 25 through May 8, 2019, indicated HKC worked every day, 24 hours each.

A document review, from photos, titled Attendant Book, dated April 15, 2019 through May 5, 2019, indicated HKC worked alone on multiple shifts from 7 am to 3 pm, 3 pm to 11 pm, and 11 pm to 7 am.

HKC's employment file was reviewed. HKC was Minnesota Department of Health STATE FORM 6899 8TPN11 If continuation sheet 3 of 6 PRINTED: 10/24/2019 FORM APPROVED Minnesota Department of Health STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: ______COMPLETED C H28659 B. WING ______05/09/2019

0 325 Continued From page 3 0 325 hired on April 9, 2019. HKC's employment file contained no documentation on training for cares of clients, as required under the comprehensive home care license statutes. A form inside HKC's employment file, titled new hire personnel file checklist had home health aide (HHA) skills checklist, HHA skills assessment test, and HHA competency evaluation unchecked. Under orientation paperwork, HIPPA, vulnerable adult/child quiz, safety orientation quiz, bloodborne pathogens quiz, and orientation to home care regulations quiz were unchecked.

During an interview with HKCon May 14, 2019 at 10:20 am, HKC said she worked dayshift, afternoon shift, and was compensated something small for the night time hours. During the night, she only really helped one client. The housekeeper repeatedly said she did not provide cares for the clients, nor had she received any training from a nurse on cares or about the client's mental illness conditions. The housekeeper said her bedroom was downstairs, but she also used the pull out bed on the main floor to sleep.

During an interview with an unlicensed personnel (ULP)D on May 14, 2019 at 10:30 am, ULPD said HKC was not providing any cares, and only responsible for cooking and cleaning. HKC could not take clients outside or to a store if the clients wanted to leave. ULPD said her understanding was HKC was working with someone else at night. ULPD mentioned since starting with the Licensee, and arriving for her shift in the morning, HKChad been the only one working, so she was not sure if a nightshift staff member had left early or if someone had actually worked the night shift.

Minnesota Department of Health STATE FORM 6899 8TPN11 If continuation sheet 4 of 6 PRINTED: 10/24/2019 FORM APPROVED Minnesota Department of Health STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: ______COMPLETED C H28659 B. WING ______05/09/2019

0 325 Continued From page 4 0 325 During an interview with C1 on May 9, 2019 at 11:05 am, C1 said staff routinely slept during the night. The staff used the pull out bed in the couch on the main floor. C1 said, once, she had to use the bathroom, and a staff member was asleep on the pull out bed. The pull out bed had blocked the path to the bathroom, and she couldn't get around the bed and caused her to become incontinent. ***Observations were made of the pull out bed used for sleeping by HKC. When the bed is extended out, there was little space to walk to the hallway where the bathroom was located (photographed).

During an interview with a registered nurse (RN)A on May 9, 2019 at 10:09 am, RNA said he had not done any client care or mental illness training with the housekeeper. HKC responsibilities were to look over the clients, provide cooking, and do cleaning. RNA said clients required 24 hour supervision, but asserted HKC provided the supervision even though she had no training in client cares. RNA said staff should not be sleeping while working, but said the housekeeper was sleeping at the Facility. RA did not allude if he meant while working or off time. RNA said management was responsible for staff planning, but he did the staff schedules.

During an interview with the owner (OWN)E on May 14, 2019 at 2:06 pm, OWNE said all the clients have mental illness and required 24 hour supervision. OWNE said HKC was living at the Facility, but, to her knowledge, was not sleeping while working. The pull out couch bed was for staff to stretch their feet. OWNE mentioned it appeared sometimes HKC was working alone, but another staff member may have floated between two of the facilities which are close to one another. OWNA said HKC was not trained Minnesota Department of Health STATE FORM 6899 8TPN11 If continuation sheet 5 of 6 PRINTED: 10/24/2019 FORM APPROVED Minnesota Department of Health STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: A. BUILDING: ______COMPLETED C H28659 B. WING ______05/09/2019

0 325 Continued From page 5 0 325 to take care of clients and had no training on the client's different diagnosed mental illnesses. OWNA said RNA did the staff's work schedules.

A policy titled, agency objectives, undated, indicated to provide home health services and training that allow clients and their caregivers to assume personal responsibility for the client's health and personal needs.

A policy titled, Licensee MN home care bill of rights, undated, indicated the right to be served by people who are properly trained and competent to perform their duties.

A policy titled, Abuse prevention plan, undated, indicated personnel selected to provide care to clients should meet agency and State requirements to assure proper qualifications including background checks, verification the individual is not on the Office of Inspector General's list of disqualified persons, reliable references, and adequate training.

TIME PERIOD FOR CORRECTION: Seven (7) Days

Minnesota Department of Health STATE FORM 6899 8TPN11 If continuation sheet 6 of 6