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					December 6, 2012


License number: 1054521 R203                                                                         CERTIFIED MAIL


Denise Giese
17932 Danson Rd
Grand Rapids, MN 55744

                                              ORDER TO PAY A FINE
                                          ORDER OF CONDITIONAL LICENSE

Dear Ms. Giese:

Based upon information received from Itasca County Health and Human Services, pursuant to Minnesota
Statutes, sections 245A.07 and 245A.06, the Commissioner of the Department of Human Services (DHS) is
taking two actions against your license to provide Adult Foster Care under the provisions of Minnesota Rules,
parts 9555.5105 to 9555.6265. The Commissioner is ordering you to pay a fine of $600. The Commissioner is
also placing your license to provide Adult Foster Care on conditional status for a period of one year. The
reasons for the actions are as follows:

The Order to Pay a Fine and the Order of Conditional License are the result of violations of Minnesota Statutes,
Chapter 245A and 245C, Minnesota Statutes, section 626.557, and Minnesota Rules, parts 9555.5105 to
9555.6265.

I.      ORDER TO PAY A FINE

        A.         Reason for the Order to Pay a Fine

                   Pursuant to Minnesota Statutes, section 245A.07, subdivision 3, the Commissioner of Human
                   Services may fine license holders $200 for each occurrence of a violation of law or rule
                   governing matters of health, safety, or supervision, including but not limited to the failure to
                   submit a background study.

                   Citation One: Minnesota Statutes, section 245C.03, subdivision 1, BACKGROUND STUDY;
                   INDIVIDUALS TO BE STUDIED; Minnesota Statutes, section 245C.04, subdivision 1,
                   paragraph (g), (h), WHEN BACKGROUND STUDY MUST OCCUR; Minnesota Statutes, section
                   245C.09, subdivision 1, FAILURE OR REFUSAL TO COOPERATE WITH BACKGROUND
                   STUDY.

                   Violation: On October 20, 2010, Itasca County determined that you failed to submit a
                   background study as required for caregiver who had direct contact with persons served by your
                   adult foster care program. In addition, on October 21, 2010, you informed Itasca County of
                   another individual residing in your home. Itasca County informed you that a background study
                   was required to be submitted immediately. You did not submit the background study until
                   November 30, 2010.

                   On October 5, 2011, Itasca County determined that you failed to submit a background study on
                   another individual as required. You were issued a correction order for this licensing violation. On
                   November 15, 2011, and February 29, 2012, you were issued additional correction orders for
                   failure to submit a background study on this individual as required.


             PO Box 64242 * Saint Paul, Minnesota * 55164-0242 * An Equal Opportunity and Veteran-Friendly Employer
                                               http://www.dhs.state.mn.us/licensing
Denise Giese
December 6, 2012
Page 2

              Fine: $600 ($200 per occurrence- three occurrences)

       B.     Total Fine amount: $600

       C.     Payment of Fine

              The Department of Human Services will send you an invoice for the $600 fine. Payment should
              be made as directed on the invoice. Please note that, according to Minnesota Statutes, section
              245A.07, subdivision 3, paragraph (c), clause (2), failure to correct the violation noted may
              result in an additional fine. The Commissioner may also seek a court order, deny an
              application, suspend, revoke, or make conditional the license in addition to imposing a fine.

              Also, according to 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.

II.    ORDER OF CONDITIONAL LICENSE

       The Commissioner is also placing your license to provide Adult Foster Care under the provisions of
       Minnesota Rules, parts 9555.5105 to 9555.6265, on conditional status for a period of one year. The
       reasons for the action are as follows:

       A.     Reasons for the Order of Conditional License

              Minnesota Statutes, section 245A.06 CORRECTION ORDER AND CONDITIONAL
              LICENSE.

                   Subd. 1. Contents of correction orders and conditional licenses. (a) If the
                   commissioner finds that the applicant or license holder has failed to comply with an
                   applicable law or rule and this failure does not imminently endanger the health, safety, or
                   rights of the persons served by the program, the commissioner may issue a correction
                   order and an order of conditional license to the applicant or license holder. When issuing a
                   conditional license, the commissioner shall consider the nature, chronicity, or severity of
                   the violation of law or rule and the effect of the violation on the health, safety, or rights of
                   persons served by the program. The correction order or conditional license must state: (1)
                   the conditions that constitute a violation of the law or rule; (2) the specific law or rule
                   violated; (3) the time allowed to correct each violation; and (4) if a license is made
                   conditional, the length and terms of the conditional license. (b) Nothing in this section
                   prohibits the commissioner from proposing a sanction as specified in section 245A.07,
                   prior to issuing a correction order or conditional license.

                   Subd. 3. Failure to comply. If the commissioner finds that the applicant or license holder
                   has not corrected the violations specified in the correction order or conditional license, the
                   commissioner may impose a fine and order other licensing sanctions pursuant to section
                   245A.07.


              Minnesota Statutes, section 245A.04 APPLICATION PROCEDURES.

                   Subd. 6. Commissioner's evaluation. Before issuing, denying, suspending, revoking, or
                   making conditional a license, the commissioner shall evaluate information gathered under
                   this section. The commissioner's evaluation shall consider facts, conditions, or
                   circumstances concerning the program's operation, the well-being of persons served by
Denise Giese
December 6, 2012
Page 3

                   the program, available consumer evaluations of the program, and information about the
                   qualifications of the personnel employed by the applicant or license holder.

                   Subd. 14. Policies and procedures for program administration required and
                   enforceable. (a) The license holder shall develop program policies and procedures
                   necessary to maintain compliance with licensing requirements under Minnesota Statutes
                   and Minnesota Rules.

                   (b) The license holder shall:

                         (1) provide training to program staff related to their duties in implementing the
                         program's policies and procedures developed under paragraph (a);
                         (2) document the provision of this training; and
                         (3) monitor implementation of policies and procedures by program staff.

                   (c) The license holder shall keep program policies and procedures readily accessible to
                   staff and index the policies and procedures with a table of contents or another method
                   approved by the commissioner.

              Minnesota Statutes, section 245C.03 BACKGROUND STUDY; INDIVIDUALS TO BE
              STUDIED.

                   Subd. 1. Licensed programs. (a) The commissioner shall conduct a background study
                   on:

                      (1) the person or persons applying for a license;
                      (2) an individual age 13 and over living in the household where the licensed program
                      will be provided;
                      (3) current or prospective employees or contractors of the applicant who will have direct
                      contact with persons served by the facility, agency, or program;
                      (4) volunteers or student volunteers who will have direct contact with persons served by
                      the program to provide program services if the contact is not under the continuous,
                      direct supervision by an individual listed in clause (1) or (3);
                      (5) an individual age ten to 12 living in the household where the licensed services will
                      be provided when the commissioner has reasonable cause;
                      (6) an individual who, without providing direct contact services at a licensed program,
                      may have unsupervised access to children or vulnerable adults receiving services from
                      a program, when the commissioner has reasonable cause; and
                      (7) all managerial officials as defined under section 245A.02, subdivision 5a.

              Minnesota Statutes, section 245C.20 LICENSE HOLDER RECORD KEEPING.

                    Subd. 1. Background studies initiated by program. A licensed program shall document
                   the date the program initiates a background study under this chapter in the program's
                   personnel files. When a background study is completed under this chapter, a licensed
                   program shall maintain a notice that the study was undertaken and completed in the
                   program's personnel files. Except when background studies are initiated through the
                   commissioner's online system, if a licensed program has not received a response from the
                   commissioner under section 245C.17 within 45 days of initiation of the background study
                   request, the licensed program must contact the human services licensing division to
                   inquire about the status of the study. If a license holder initiates a background study under
                   the commissioner's online system, but the background study subject's name does not
                   appear in the list of active or recent studies initiated by that license holder, the license
                   holder must either contact the human services licensing division or resubmit the
                   background study information online for that individual.
Denise Giese
December 6, 2012
Page 4

              Minnesota Rules, part 9555.6105 APPLICABILITY AND PURPOSE.

                   Parts 9555.5105 and 9555.6105 to 9555.6265, as authorized by Minnesota Statutes,
                   chapter 245A, govern the licensure of the operator of an adult foster home. The purpose
                   of parts 9555.5105 and 9555.6105 to 9555.6265 is to establish procedures and standards
                   for licensure and operation of an adult foster home so minimum levels of care are provided
                   and the health, safety, and rights of residents are assured.

              Minnesota Rules, part 9555.5105 DEFINITIONS.

                   Subp. 8. Caregiver. “Caregiver” means an adult who meets the qualifications in part
                   9555.6125, subpart 4, and gives care to a resident in an adult foster home.

                   Subp. 16. Household member. "Household member" means any person living in the adult
                   foster home more than 30 consecutive calendar days in any 12 month period who is not a
                   resident.

              Minnesota Rules, part 9555.5605 ASSESSMENT.

                   Subp. 2. Mobility access assessment. Before placement, or after placement if the local
                   agency has reasonable cause to believe a mobility access, seizure, or disability problem
                   has developed, the social worker shall determine, in consultation with the prospective
                   resident and the resident's representative and any other person knowledgeable about the
                   resident's needs, whether accessibility aides or modifications to the residence are needed.
                   The need for accessibility aides or modifications to the residence shall be determined for
                   persons with regular seizures or physical disabilities using an accessibility checklist
                   approved by the commissioner in consultation with persons knowledgeable about the
                   accessibility and mobility needs of the resident and persons knowledgeable about
                   accessibility modifications to residential occupancies. A person confined to a wheelchair
                   must be housed on a level with an exit directly to grade.

              Minnesota Rules, part 9555.6125 LICENSING STUDY.

                   Subp. 2. Inspections. The residence must be inspected by a fire marshal within 12
                   months before initial licensure to verify that the residence is a dwelling unit within a
                   residential occupancy as defined in section 9.117 of the Minnesota Uniform Fire Code and
                   that the residence complies with the fire safety standards for that residential occupancy
                   contained in the Minnesota Uniform Fire Code. A home safety checklist, approved by the
                   commissioner, must be completed by the operator and the commissioner before licensure
                   each year a fire marshal inspection is not made. The residence shall be inspected
                   according to the licensed capacity specified on the initial application form. If the
                   commissioner has reasonable cause to believe that a potentially hazardous condition may
                   be present or the licensed capacity is increased to four residents, the commissioner shall
                   request a subsequent inspection and written report by a fire marshal to verify the absence
                   of hazard. Any condition cited by a fire marshal, building official, or health authority as
                   hazardous or creating an immediate danger of fire or threat to health and safety must be
                   corrected before a license is issued or renewed by the department.

              Minnesota Rules, part 9555.6175 COOPERATE AND REPORT TO AGENCIES.

                   Subp. 3. Reporting to local agency. The operator shall ensure that the local agency is
                   told:

                   A. within five calendar days of any change in the regular membership of the household or
                   caregiver’s employment status;
Denise Giese
December 6, 2012
Page 5

                   F. at least 30 days before the involuntary discharge of a resident who does not have an
                   individual service plan; and

                   G. within seven days after the transfer or voluntary discharge of a resident who does not
                   have an individual service plan.

                   Subp. 4. Reporting to service agency. The operator shall ensure that the service agency
                   is told:

                   B. at least 30 days before the involuntary discharge of a resident. When a resident wants
                   to voluntarily leave the adult foster home, the operator must notify the service agency
                   within three days. In this instance, the resident's legal representative, if any, shall also be
                   notified by the service agency.

              Minnesota Rules, part 9555.6185 FOSTER CARE TRAINING.

                   Subp. 2. Training requirements. 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.

                   A. Caregivers with zero to five years of licensure or experience as an adult foster home
                   caregiver must complete 12 hours training a year.

              Minnesota Rules, part 9555.6205 PHYSICAL ENVIRONMENT.

                   Subpart 1. Residential occupancy. The residence must meet the definition of a dwelling
                   unit in a residential occupancy and be free of any plumbing, electrical, ventilation,
                   mechanical or structural hazard that would threaten the health or safety of a resident.

              Minnesota Rules, part 9555.6225 SANITATION AND HEALTH

                   Subpart 1. Sanitation and cleanliness. The residence must be clean, as specified in part
                   4625.0100, subpart 2, and free from accumulations of dirt, rubbish, peeling paint, vermin,
                   or insects.

                   Subp. 10. Weapons. Weapons and ammunition must be stored separately in locked areas
                   that are inaccessible to residents and prevent contents from being visible to residents.
                   "Weapons" means firearms and other instruments or devices designed for and capable of
                   producing bodily harm.

              Violation(s): On August 31, 2010, Itasca County made a visit to your adult foster care home
              for the purpose of relicensing. You were issued a correction order for the following licensing
              violations:

                      Failure to inform the agency at least 30 days before the involuntary discharge of a
                       resident who does not have an individual service plan.
                      Failure to inform the agency within 7 days of the voluntary transfer of a resident without
                       an individual service plan.
                      Failure to notify the agency at least 30 days before the involuntary discharge of a
                       resident, or within three days of a resident wanting to voluntarily leave the adult foster
                       home.

              On September 1, 2010, a follow-up visit was made to your adult foster care home home. On
              October 20, 2010, you were issued a correction order for the following licensing violations
              determined August 31, 2010, and September 1, 2010:
Denise Giese
December 6, 2012
Page 6


                      Failure to submit a background study for an individual as required prior to having direct
                       contact with individuals served by your adult foster care program. You failed to submit
                       background studies for two individuals who had direct contact with persons served by
                       the program.
                      Failure to have a well water test.
                      Failure to assure the residence was free of structural hazards. Two unapproved and
                       unsafe ramps were being used in the home.
                      Failure to have a mobility access assessment for a resident with mobility issues.

              You failed to timely respond to the correction order.

              On December 6, 2010, Itasca County made a visit to your adult foster care home. On March 3,
              2011, you were issued a correction order for the following licensing violations:

                      Failure to respond to violations outlined in the October 20, 2010, correction order.
                      Failure to correct violations cited by the Fire Marshal.
                      Failure to have a mobility access assessment for a resident with mobility issues.
                      Failure to have a well water test.
                      Failure to assure the residence was free of structural hazards. Two unapproved and
                       unsafe ramps were being used in the home.
                      Failure to submit background studies as required. Failure to complete required training.

              You failed to timely respond to the correction order.

              On May 31, 2011, Itasca County made a visit to your adult foster home. On June 1, 2011, you
              were issued a correction order for the following licensing violations:

                      Failure to have a battery powered radio in the home for emergencies.
                      Failure to have keys accessible for two interior doors in case of an emergency.
                      Failure to keep combustible items at least 36” from any heating source.
                      Failure to respond to violations in correction orders dated October 20, 2010, and
                       March 3, 2011.
                      Failure to keep weapons and ammunition in separate locked areas and to keep
                       weapons from being visible to residents.
                      Failure to keep residence clean and free from accumulations of dirt and rubbish. The
                       entry from the garage to the house contained garbage intermixed with various objects
                       and the resident’s bedroom was piled with clothes and person articles with little or no
                       walkway in or out of the room.

              On October 5, 2011, Itasca County issued you a correction order for the following violation:

                      Failure to submit a background study for an individual as required.

              On November 15, 2011, Itasca County issued you a correction order for the following violations:

                      Failure to submit a background study for an individual requiring a study.
                      Failure to respond to licensing violations outlined in a correction order dated October 5,
                       2011.

              On February 29, 2012, Itasca County issued a correction order for the following violations:

                      Failure to submit a background study for an individual requiring a study.
                      Failure to respond to licensing violations outlined in correction orders dated October 5,
                       2011, and November 15, 2011.
Denise Giese
December 6, 2012
Page 7


              Due to the serious and chronic nature of the above licensing violations; because you have
              repeatedly failed to submit background studies as required; because you have repeatedly failed
              to respond to correction orders; because you failed to complete required training; because you
              failed to complete a required mobility access assessment; because you failed to maintain your
              adult foster care program in a clean, safe, and hazard free manner; and, in order to protect the
              health, safety and rights of individuals receiving services in DHS-licensed programs, your adult
              foster care license is placed on conditional status for one year.

       B.     Terms of Conditional License

              You may continue to operate with a conditional license under the following stipulations:

              1. You follow and comply with all applicable Minnesota Rules and Laws.

              2. No variances will be granted during the conditional period.

              3. You are limited to your current placements during the conditional period.

              4. You must submit and comply with a detailed, written plan for how you will ensure that
                 background studies are submitted for all individuals requiring a study prior to direct contact
                 with persons served by your program. You must also include your plan for ensuring that the
                 licensing agency is notified of any changes in employee status or the regular membership
                 of the household. The plan must be submitted by December 18, 2012, and Itasca County
                 must approve the plan.

              5. You must submit and comply with a detailed plan for how you will operate your adult foster
                 care home in a clean, safe and hazard free manner by December 18, 2012. Itasca County
                 must approve the plan.

              6. You must respond to and comply with all outstanding correction orders by December 18,
                 2012. You must submit documentation of compliance to Itasca County Human Services.

              7. You must complete all outstanding training requirements by February 6, 2013, and submit
                 documentation of attendance to Itasca County Human Services. You must complete an
                 assessment on Adult Foster Care requirements to determine what additional training you
                 may need. The assessment, provided by Itasca County, must be completed by
                 December 31, 2012.

              8. You must complete 6 hours of training related to maintaining a safe, healthy adult foster
                 care environment by March 31, 2013. The training is in addition to the annual training
                 requirements as listed in Minnesota Rules, part 9555.6185, and Minnesota Statutes,
                 Chapter 245A. Prior to attending training, you must obtain approval from Itasca County that
                 the training is appropriate. You must submit documentation of your attendance to Itasca
                 County.

              9. You must either provide a copy of the Order of Conditional License to residents and/or their
                 guardians or document that each resident and/or resident’s guardian has been given an
                 opportunity to review the Order of Conditional License. You must obtain each resident or
                 resident’s guardian’s signature for each resident currently in care, verifying they have either
                 received a copy of the conditional order or had an opportunity to review the conditional
                 order. You must provide this documentation to Itasca County by December 18, 2012.
Denise Giese
December 6, 2012
Page 8


       Itasca County will monitor your compliance with these terms and with all applicable Minnesota Rules
       and Laws. This may include unannounced visits. Failure to comply with the stipulations of your
       conditional license or any other provisions of Minnesota Rules and Laws may result in revocation of
       your license.

III.   RECONSIDERATION / APPEAL RIGHTS

       A.      If You Wish to Appeal the Fine and the Conditional License, or Only the Fine

               You have the right to appeal both the fine and the order of conditional license, or only the fine,
               by requesting a contested case hearing under Minnesota Statutes, Chapter 14, and Minnesota
               Rules, parts 1400.8505 to 1400.8612.

               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 ten calendar days after you receive this order. If a request is made by personal service, it
               must be received by the Commissioner within ten calendar days after you receive this order.

               Your request for a contested case hearing must be sent to:

                            Commissioner, Department of Human Services
                            Office of Inspector General
                            Licensing Division
                            Attention: Family Systems Unit
                            PO Box 64242
                            St. Paul, MN 55164-0242

               A timely request for a contested case hearing shall stay the payment of the fine and the terms of
               the conditional license until the Commissioner issues a final 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.

       B.      If You Wish to Only Appeal the Conditional License

               If you are not appealing the fine, you do not have a right to a contested case hearing, but you
               can request that the Commissioner conduct a reconsideration of the conditional license
               pursuant to Minnesota Statutes, section 245A.06, subdivision 4.

               If you choose to exercise the right to request that the Commissioner reconsider the Order of
               Conditional License, 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
               ten calendar days after you receive this order. If a request is made by personal service, it must
               be received by the commissioner within ten 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.
Denise Giese
December 6, 2012
Page 9


                The request for reconsideration of the Order of Conditional License must be sent to:

                              Commissioner, Department of Human Services
                              Office of Inspector General
                              Licensing Division
                              Attention: Family Systems Unit
                              PO Box 64242
                              St. Paul, MN 55164-0242

If you have any questions regarding this matter, you may contact Molly Kelly at (651) 431-6548.

Sincerely,




Mary Kelsey, Supervisor
Division of Licensing
Office of Inspector General


c: Maureen Kangas, Itasca County Health and Human Services

				
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