November 13, 2015
Patrick Masyga, Authorized Agent
REM River Bluffs, Inc.
6600 France Avenue South, Suite 500
Minneapolis, MN 55435
RE:
Maltreatment Investigation Report Number 20155276
License Number 1071879 (Home and Community-Based Services)
License Number 1071900 (Community Residential Setting)
CERTIFIED MAIL
DETERMINATION OF MALTREATMENT
AND ORDER TO PAY A FINE
Dear Mr. Masyga:
You are hereby notified that the Department of Human Services (DHS) has made a
determination of substantiated maltreatment by REM River Bluffs, Inc. which provides
community residential setting services at 4821 Salley Lane North West, Rochester, Minnesota,
under license number 1071900, and supported living and community residential setting services
under the home and community-based services license number 1071879. Based on the
determination of substantiated maltreatment by REM River Bluffs, Inc., the Commissioner of
Human Services is ordering REM River Bluffs, Inc. to pay a $1,000 fine.
I.
DETERMINATION OF MALTREATMENT
It was reported that on September 21, 2015, a vulnerable adult (VA) accessed the facility
medication cabinet, obtained another consumer’s Oxycodone 5 milligram (mg) bubble
pack and consumed the medication. It was also reported that the VA became physically
aggressive, caused property damage, and tried to injure him/herself.
DHS investigated the allegation as maltreatment under Minnesota Statutes, section
626.557, subdivision 9c, paragraph (b), and Minnesota Statutes, section 626.5572,
subdivision 15, and subdivision 17, paragraph (a):
The failure or omission by a caregiver to supply a vulnerable adult with care or
services, including but not limited to food, clothing, shelter, health care, or
supervision which is reasonable and necessary to obtain or maintain the
vulnerable adult's physical or mental health or safety, considering the physical
Division of Licensing, PO Box 64242, St. Paul, MN 55164-0242 An Equal Opportunity Employer
Patrick Masyga
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November 13, 2015
and mental capacity or dysfunction of the vulnerable adult and which is not the
result of an accident or therapeutic conduct.
Based on the maltreatment investigation, DHS has substantiated maltreatment and has
determined that the facility was responsible for the maltreatment. See the conclusion in
report number 20155276. A copy of the Investigation Memorandum for report number
20155276 is enclosed.
You have the right to request reconsideration of the determination of maltreatment where
REM River Bluffs, Inc. as the community residential setting license holder and the home
and community-based services license holder was found responsible for maltreatment.
See Section III of this letter for your reconsideration / appeal rights.
II.
ORDER TO PAY A FINE
A.
Reason for the Fine
REM River Bluffs, Inc. as the community residential setting license holder and
the home and community-based services license holder was responsible for
maltreatment of a vulnerable adult.
Under Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause
(4), the license holder shall forfeit $1,000 for each determination of maltreatment
of a vulnerable adult under section 626.557.
B.
Statutory Citation and Maltreatment Determination
Citation: Minnesota Statutes, section 626.5572, subdivision 17, paragraph (a).
Violation: A determination of substantiated maltreatment by the facility. See the
conclusion in report number 20155276 which is enclosed.
Corrective Action Taken by the Facility: The facility completed an internal
review, retrained staff persons on medication administration and safe guarding of
medication. The facility also replaced the medication cabinet with a working
lock, purchased additional lock boxes for controlled medications, required staff
persons to carry facility keys on their person at all times and additional facility
keys were removed from consumer’s accessibility.
Corrective Action Ordered by DHS: No additional corrective action is being
ordered at this time.
Fine: $1,000
Patrick Masyga
Page 3
November 13, 2015
C.
Total fine to be paid: $1,000
D.
Billing and Payment of the Fine
DHS will send you an invoice for the $1,000 fine. Payment must be made as
directed on the invoice.
A timely request for a contested case hearing under Section III, item A or C stays
the payment of the fine until the Commissioner issues a final order. If you decide
to exercise your right to a contested case hearing, do not pay the fine. Following
the contested case hearing, the Commissioner will issue a final order concerning
the fine.
Under Minnesota Statutes, section 245A.07, subdivision 3, paragraph (c), clause
(5), when a fine has been assessed, the license holder may not avoid payment by
closing, selling, or otherwise transferring the licensed program to a third party. In
such an event, the license holder will be personally liable for payment. In the
case of a corporation, each controlling individual is personally and jointly liable
for payment.
E.
Right to Request a Contested Case Hearing to Appeal the Fine
You have the right to request a contested case hearing to appeal the fine under
Minnesota Statutes, chapter 14 and Minnesota Rules, parts 1400.8505 to
1400.8612. See Section III of this letter for your right to appeal the fine.
III.
RECONSIDERATION AND APPEAL RIGHTS
A.
Right to Request a Contested Case Hearing to Appeal the Fine and
Maltreatment Determination
You have the right to request a contested case hearing under Minnesota Statutes,
chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612 to appeal the fine
and maltreatment determination. If you choose to exercise this right, your request
must be made in writing by certified mail or personal service. If mailed, the
appeal must be postmarked and sent to the Commissioner within 15 calendar days
after you receive this order. If a request is made by personal service, it must be
received by the Commissioner within 15 calendar days after you receive this
order.
Your request for a contested case hearing must be sent to:
Patrick Masyga
Page 4
November 13, 2015
Commissioner, Department of Human Services
c/o Office of Inspector General, Licensing Division
ATTN: Legal Unit
PO Box 64242
St. Paul, MN 55164-0242
B.
Reconsideration of only the Maltreatment Determination
You have the right to request reconsideration of the determination of
maltreatment where the facility was found responsible for the maltreatment. If
you choose to exercise this right, your request must be submitted in writing within
15 calendar days after you receive this notice. In your request, you must identify
what is inaccurate or incomplete about the information in the investigation
memorandum, supply the information that is accurate or more complete, and state
why the finding of maltreatment should be changed.
If your request for reconsideration is mailed, the request for reconsideration must
be postmarked and sent to DHS within 15 calendar days of your receipt of the
final determination. If the request for reconsideration is made by personal
service, it must be received by DHS within 15 calendar days after your receipt of
the final determination.
Your request for reconsideration of the final determination of maltreatment must
be sent to:
Commissioner, Department of Human Services
c/o Office of Inspector General, Licensing Division
ATTN: Legal Unit
PO Box 64242
St. Paul, MN 55164-0242
A response to your request for reconsideration of the maltreatment determination
will be mailed within 15 working days after the Division of Licensing receives
your request. If a response is not mailed within 15 working days, you are entitled
to request a fair hearing.
C.
Right to Appeal only the Order to Pay a Fine
You have the right to request a contested case hearing under Minnesota Statutes,
chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612 to only appeal the
fine. If you choose to exercise this right, your request must be made in writing by
certified mail or personal service. If mailed, the appeal must be postmarked and
sent to the Commissioner within 10 calendar days after you receive this order. If
Patrick Masyga
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November 13, 2015
a request is made by personal service, it must be received by the Commissioner
within 10 calendar days after you receive this order.
Your request for a contested case hearing must be sent to:
Commissioner, Department of Human Services
c/o Office of Inspector General, Licensing Division
ATTN: Legal Unit
PO Box 64242
St. Paul, MN 55164-0242
If you have any questions regarding the maltreatment determination or fine, please contact
Alyssa Dotson, Unit Supervisor, at (651) 431-6560.
Sincerely,
Regina Wagner, Deputy Inspector General – Licensing Division
Office of Inspector General
Enclosure
cc:
Nicole Duchelle, Olmsted County Adult Foster Care Licensor