Program Abuse Prevention Plan (PAPP)

Program: Koinonia
Program Address: 5971 134th St. Ct.
Apple Valley, MN 55124
Date plan 1-1-2021
Developed/Revised:

The Human Services Licensing Act (HSLA), Minnesota Statutes 245A.65, subdivision 2, governs what is required
in the adult foster care (AFC) and community residential setting (CRS) program abuse prevention plan. License
holders must develop and enforce a written program abuse prevention plan in accordance with the HSLA, and
the Reporting of Maltreatment of Vulnerable Adults Act (VAA), Minnesota Statures 626.557, subdivision 14.

I. POPULATION ASSESSMENT:
Describe the persons the program is planning to serve. Assess the possible risk of harm and/or
abuse to persons served in the assessed area.

1. Age: We serve individuals age 18 years and older.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no identified risks due to the age of the residents.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

2. Gender: Male

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no identified risks due to the gender of the residents.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

3. Mental Functioning:
We have a history of providing services to individuals with ADHD, mild to moderate DD, Autism, Anxiety
Disorder, Epilepsy, Congenital Brain Anomaly-NOS, Cerebral Palsy, Impulse Control Disorder, Obsessive
Compulsive Disorder, PTSD, Oppositional Defiant Disorder, PDD-NOS, Intermittent Explosive Disorder
and Disruptive Behavior. The cognitive emotional and behavioral responses of some of the residents are
impaired and immature relative to their ages.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
Aggressive behaviors in the form of physical abuse, self abuse, property destruction, elopement and
verbal abuse can occur when the residents are experiencing life’s challenges and stressors.

Page 1 of 6
Last revised: 1/1/2020
 Describe the Plan to Reduce the Risk to Persons Served by the Program:
Tools, chemicals, and sharp knives are stored in locked areas. Staff are available to discuss and supervise
the usage of any of the restricted items that a resident requests (for cooking, cleaning, etc). After use of
the item, staff would return the item and safely secure it into locked storage. Staff are oriented to each
individual’s abuse prevention plan, CSSP, CSSP Addendum, and trained on specific approaches relevant
to each individual’s needs and mental functioning. GraceLyn Group has a Relational Leader Certification
Program which all staff participates in on some level. The following are the main components of the
program: 60-100 hrs. of annual training; 1:1 and group coaching and mentoring sessions; participation in
three master classes annually on the topics of 15 Laws of Growth, Relationship Approach, Intentional
Living, and Becoming A Person of Influence. The certification program equips staff to support the
residents from a Relationship Approach, principle based and positive relationship approach. Staff are
present 24 hours a day. There is one overnight awake staff. The number of staff present at any given
time depends on the individual needs and how many residents at home during the day and evening.
There is an on-call and crisis back up structure in place.

4. Physical and Emotional Health:

Koinonia serves individuals who may have a variety of emotional health support needs. These can range
from ADHD, mild to moderate DD, Autism, Anxiety Disorder, Epilepsy, Congenital Brain Anomaly-NOS,
Cerebral Palsy, Impulse Control Disorder, Obsessive Compulsive Disorder, PTSD, Oppositional Defiant
Disorder, PDD-NOS, Intermittent Explosive Disorder and Disruptive Behavior. Koinonia serves individuals
who are ambulatory and can navigate stairs. We serve individuals with seizure disorders.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
Aggressive behaviors in the form of physical abuse, self abuse, property destruction, elopement and
verbal abuse can occur when the residents are experiencing life’s challenges and stressors. Risk for
seizures is present.

Describe the Plan to Reduce the Risk to Persons Served by the Program:
All staff are provided training on their responsibilities to address each person’s physical and emotional
health as outlined in his Individual Abuse Prevention Plan, CSSP, and CSSP Addendum. Staff are trained
and certified in Medication Administration, First Aid, and CPR. Seizure Protocols have been put into
place, and staff are trained at least once a year to show competency in how to respond and provide
treatment for a seizure incident. Staff are trained in Physical Intervention strategies and techniques and
positive behavior supports. GraceLyn Group has a Relational Leader Certification Program which all staff
participates in on some level. The following are the main components of the program: 60-100 hrs. of
annual training; 1:1 and group coaching and mentoring sessions; participation in three master classes
annually on the topics of 15 Laws of Growth, Relationship Approach, Intentional Living, and Becoming A
Person of Influence. The certification program equips staff to support the residents from a Relationship
Approach, principle based and positive relationship approach. Staff are present 24 hours a day. There is
one overnight awake staff. The number of staff present at any given time depends on the individual
needs and how many residents at home during the day and evening. There is an on-call and crisis back
up structure in place.

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Last revised: 1/1/2020
5. Behaviors:
We serve individuals with a range of adaptive and maladaptive behaviors (mild to severe physical
aggression and property damage, mild self injurious behaviors, sexual inappropriateness, mild to severe
verbal abuse, elopement) requiring low to high level of support needs. The program can serve up to four
individuals.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
Aggressive behaviors in the form of physical abuse, self abuse, property destruction, elopement and
verbal abuse can occur when the residents are experiencing life’s challenges and stressors.

Describe the Plan to Reduce the Risk to Persons Served by the Program:
Residents are oriented to and guided in taking safety measures (going into personal bedrooms or other
locked rooms) when another resident is posing a possible risk to safety. The physical environment has
been modified and adapted, reducing the need for physical intervention and risk of personal injury.
Staff is trained in physical intervention strategies, positive behavior support strategies, emergency use
of manual restraint, and to each individual’s adaptive/maladaptive behaviors. GraceLyn Group has a
Relational Leader Certification Program which all staff participates in on some level. The following are
the main components of the program: 60-100 hrs. of annual training; 1:1 and group coaching and
mentoring sessions; participation in three master classes annually on the topics of 15 Laws of Growth,
Relationship Approach, Intentional Living, and Becoming A Person of Influence. The certification
program equips staff to support the residents from a Relationship Approach, principle based and
positive relationship approach. Staff are present 24 hours a day. There is one overnight awake staff. The
number of staff present at any given time depends on the individual needs and how many residents at
home during the day and evening. There is an on-call and crisis back up structure in place.

6. Need for Specialized Programs:

We have not assessed the need for specialized programs of care at Koinonia in addition to what has
been addressed above or indicated in each person’s Individual Abuse Prevention Plan, CSSP, and CSSP
Addendum.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks in this area.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

7. Specific Staff Training for Individual Needs:

All staff are provided training on their responsibilities to address each person’s physical and emotional
health as outlined in his Individual Abuse Prevention Plan, ISSA, CSSP, and CSSP Addendum. Staff are
trained and certified in Medication Administration, First Aid, and CPR, Physical Intervention
strategies/techniques and positive behavior supports. Additional training topics include seizure
disorders (and how to respond to a seizure event), Autism, and Mental Health Training. The core
foundation of support at Koinonia is providing coaching and mentoring to the residents we serve in
developing personal responsibility, creating life goals, and raising awareness in thinking, and regulating
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Last revised: 1/1/2020
 emotional responses to life’s stressors. This specific staff training is continuous to create and sustain a
positive and growth-oriented program, which reduces the potential of abuse/harm.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks in this area.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

8. Knowledge of Previous Abuse:

Sexual, Financial

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
Resident may seek others to sexually and/or financially abuse. Resident is also at risk for being abused
sexually and/or financially by others.

Describe the Plan to Reduce the Risk to Persons Served by the Program:

Staff are oriented to each individual’s abuse prevention plan, CSSP, CSSP Addendum, and trained on
specific approaches relevant to each individual’s needs and mental functioning. These approaches and
processes are in effect to minimize the known areas of risk. Any resident involved in any suspected acts
of maltreatment, abuse, or neglect are immediately reported as mandated in GraceLyn’s Vulnerable
Adult, and Maltreatment of Minors Reporting policies.

II. PHYSICAL PLANT ASSESSMENT:

Describe the physical plant in which the program is located. Assess the possible risk of harm and/or abuse to
persons served based on the physical plant. Describe the program’s plan to reduce the risk of harm
and/or abuse to persons served in the assessed area.

1. Condition and Design of the Physical Plant:

Koinonia is a single-family home built in the 1980’s. It is a large split entry with bedrooms on both levels.
Extra rooms exist that can be accessed for additional personal or common use. There are three
bathrooms in the home. The home is in good condition and is situated on a large lot with woods and
walking paths adjacent to the property. The backyard is fenced. The garage was renovated into staff
offices and a dayroom. Building Modifications: windows are tempered glass; an alarm system-indicating
when doors and windows are opened; wainscoting on walls-some floor to ceiling; furniture bolted to
floor in common areas; solid core wood and some steel doors; steel door frames; tank-less toilets; and
fenced back yard. The exterior has been renovated with vinyl siding and all windows have been
replaced. The home is not wheelchair accessible.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks in this area.

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Last revised: 1/1/2020
 Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

2. Areas Difficult to Supervise:

The split entry has two levels separated by a stairway. You cannot visually see one level when on the
other. Two residents have bedrooms on the lower level and two on the upper level. Staff can hear
residents from all areas of the home and routinely walk around and access rooms on both levels.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

III. ENVIRONMENT and COMMUNITY:

Describe the physical plant in which the program is located. Assess the possible risk of harm and/or abuse to
persons served based on the physical plant. Describe the program’s plan to reduce the risk of harm
and/or abuse to persons served in the assessed area.

1. Neighborhood and Community:

Koinonia is located in a suburb and on a quiet cul-de-sac adjacent to woods and public walking paths. A
small church is located at the beginning of the street leading to the cul-de-sac. Most of the neighbors
have made acquaintances with the residents and do engage in casual conversations time to time. There
are public parks within walking distance. A public outdoor waterpark and sporting facilities are 1-2 miles
from the home. Shopping and dining options are nearby as well as the Minnesota Zoo. There is a busy
road at the end of the street.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

2. Grounds and Terrain:

Koinonia is situated at the end of a cul-de-sac with woods and rolling hills and paths in the backyard,
adjacent to the property. The home is located on a city lot in a residential community. The terrain in
front of the home is flat.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

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Last revised: 1/1/2020
3. Type of Internal Programming:

The internal programming and support at Koinonia are providing coaching and mentoring to the
residents we serve in developing personal responsibility, creating life goals, and raising awareness in
thinking, and regulating emotional responses to life’s stressors. We provide a range of support tailored
to individual residents’ goals (cooking, house cleaning, exercise, community inclusion, job
development/training, and transportation). We encourage the residents to create and practice healthy
living habits.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

4. Staffing Pattern:

There is staffing to address each resident’s specific needs. Staff are present and awake 24 hours a day.
There is one awake overnight staff and two to three support staff working during the day and evening.
The staffing pattern reflects the resident’s daily activities and behavioral support needs. There are both
male and female employees who work rotating shifts. There is a leadership team comprised of five
directors. They work various shifts and are the on-call and crisis back-up team.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

Lynn Nauth 1/1/21

Print name of License-Holder Signature of License Holder Date

Page 6 of 6
Last revised: 1/1/2020
 Program Abuse Prevention Plan (PAPP)

Program: Redwood
Program Address: 895 Redwood Drive
Apple Valley, MN 55124
Date plan 1-1-2021
Developed/Revised:

The Human Services Licensing Act (HSLA), Minnesota Statutes 245A.65, subdivision 2, governs what is required
in the adult foster care (AFC) and community residential setting (CRS) program abuse prevention plan. License
holders must develop and enforce a written program abuse prevention plan in accordance with the HSLA, and
the Reporting of Maltreatment of Vulnerable Adults Act (VAA), Minnesota Statures 626.557, subdivision 14.

I. POPULATION ASSESSMENT:
Describe the persons the program is planning to serve. Assess the possible risk of harm and/or
abuse to persons served in the assessed area.

1. Age: We provide services to individuals age 11 years and older.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
Physical abuse, Sexual abuse, Psychological abuse, Financial exploitation.

Describe the Plan to Reduce the Risk to Persons Served by the Program:
Any minor(s) receiving services will be supported through staff supervision throughout the home. At no
point will the minor(s) be left unsupervised when they are with other adult housemate(s). All residents
will have their own private bedroom.

Any property or cash funds declared for safekeeping will be clearly labeled and separated from each
resident’s storage. At no point will any of the residents’ money be combined.

2. Gender: We provide services to males.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no identified risks due to the gender of the residents.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

3. Mental Functioning:
We serve individuals with histories of mental illness, nonverbal learning disorder, and developmental
disabilities. The cognitive emotional and behavioral responses of some of the residents are impaired and
immature relative to their ages.

Page 1 of 7
Last revised: 1/1/2020
 Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
Behaviors in the form of physical abuse, aggression towards others, verbal abuse, self-harm, suicidal acts
or ideation, property destruction, elopement, drug abuse, and financial abuse are all potential risks the
residents may engage in when experiencing life’s challenges and stressors.

Describe the Plan to Reduce the Risk to Persons Served by the Program:
Tools, medications, chemicals, flammable/ignitable objects, and sharp objects are stored in locked areas
that are inaccessible to all current residents. Products packaged in glass containers and canned goods
(which have sharp edges), are emptied by staff into plastic containers. The residents are then given the
contents of the containers. The cans and glass are then stored for disposal in the locked area. Each
resident served has an extensive, individualized behavioral plan which documents comprehensive
protocols for all areas that the individual is at risk for. Staff are oriented to these individual needs and
are trained on specific approaches relevant to each individual’s needs and mental functioning. As the
program is revised and/or updated, staff receive continual training through debriefs, mentoring
sessions, team trainings, and other various forms of competency checks to ensure the resident’s
program is being followed to minimize risk.

GraceLyn Group has a Relational Leader Certification Program which all staff participates in on some
level. The following are the main components of the program: 60-100 hrs. of annual training; 1:1 and
group coaching and mentoring sessions; participation in three master classes annually on the topics of
15 Laws of Growth, Relationship Approach, Intentional Living, and Becoming A Person of Influence. The
certification program equips staff to support the residents from a person centered, principle based and
positive relationship approach.

Staff are present 24 hours a day at the ratio each individual has been assigned. There are two awake
staff, and one asleep staff during the overnight hours. The number of staff present at any given time
depends on the individual needs and how many residents at home during the day and evening.
GraceLyn utilizes an on-call protocol to ensure staffing ratios are always maintained, and to provide
additional support in crisis or emergency situations.

4. Physical and Emotional Health:

Severe mood swings, alcohol or drug abuse, theft/financial exploitation of others, self-harm, suicidal
ideation, suicide attempts, hyperactivity, impulsivity, inattentiveness, argumentative, depressive
tendencies.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
Behaviors in the form of physical abuse, aggression towards others, verbal abuse, self-harm, suicidal acts
or ideation, property destruction, elopement, drug abuse, and financial abuse are all potential risks the
residents may engage in when experiencing life’s challenges and stressors.

Describe the Plan to Reduce the Risk to Persons Served by the Program:
Tools, medications, chemicals, flammable/ignitable objects, and sharp objects are stored in locked areas
that are inaccessible to all current residents. Products packaged in glass containers and canned goods
Page 2 of 7
Last revised: 1/1/2020
 (which have sharp edges), are emptied by staff into plastic containers. The residents are then given the
contents of the containers. The cans and glass are then stored for disposal in the locked area. Each
resident served has an extensive, individualized behavioral plan which documents comprehensive
protocols for all areas that the individual is at risk for. Staff are oriented to these individual needs and
are trained on specific approaches relevant to each individual’s needs and mental functioning. As the
program is revised and/or updated, staff receive continual training through debriefs, mentoring
sessions, team trainings, and other various forms of competency checks to ensure the resident’s
program is being followed to minimize risk.

GraceLyn Group has a Relational Leader Certification Program which all staff participates in on some
level. The following are the main components of the program: 60-100 hrs. of annual training; 1:1 and
group coaching and mentoring sessions; participation in three master classes annually on the topics of
15 Laws of Growth, Relationship Approach, Intentional Living, and Becoming A Person of Influence. The
certification program equips staff to support the residents from a person centered, principle based and
positive relationship approach.

Staff are present 24 hours a day at the ratio each individual has been assigned. There are two awake
staff, and one asleep staff during the overnight hours. The number of staff present at any given time
depends on the individual needs and how many residents at home during the day and evening.
GraceLyn utilizes an on-call protocol to ensure staffing ratios are always maintained, and to provide
additional support in crisis or emergency situations.

5. Behaviors:
We serve individuals with a range of adaptive and maladaptive behaviors. These include physical
aggression towards others, property damage, self-injurious behaviors, drug and alcohol seeking
behaviors, suicide attempts and ideation, illegal financial activity (theft, piracy), sexual
inappropriateness (touching, gesturing, verbalizing), verbal abuse, and elopement.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
Behaviors in the form of physical abuse, aggression towards others, verbal abuse, self-harm, suicidal acts
or ideation, property destruction, elopement, drug abuse, and financial abuse are all potential risks the
residents may engage in when experiencing life’s challenges and stressors.

Describe the Plan to Reduce the Risk to Persons Served by the Program:
Residents are oriented to and guided in taking safety measures (going into personal bedrooms or other
locked rooms) when another resident is posing a possible risk to safety. The physical environment has
been modified and adapted, reducing the need for physical intervention and risk of personal injury.
Staff are trained in physical intervention strategies, positive behavior support strategies, emergency use
of manual restraint, and to each individual’s adaptive/maladaptive behaviors. Tools, medications,
chemicals, flammable/ignitable objects, and sharp objects are stored in locked areas that are
inaccessible to the residents. Products packaged in glass containers and canned goods (which have
sharp edges), are emptied by staff into plastic containers. The residents are then given the contents of
the containers. The cans and glass are then stored for disposal in the locked area. Each resident served
Page 3 of 7
Last revised: 1/1/2020
 has an extensive, individualized behavioral plan which documents comprehensive protocols for all areas
that the individual is at risk for.

GraceLyn Group has a Relational Leader Certification Program which all staff participates in on some
level. The following are the main components of the program: 60-100 hrs. of annual training; 1:1 and
group coaching and mentoring sessions; participation in three master classes annually on the topics of
15 Laws of Growth, Relationship Approach, Intentional Living, and Becoming A Person of Influence. The
certification program equips staff to support the residents from a person centered, principle based and
positive relationship approach.

Staff are present 24 hours a day at the ratio each individual has been assigned. There are two awake
staff, and one asleep staff during the overnight hours. The number of staff present at any given time
depends on the individual needs and how many residents at home during the day and evening.
GraceLyn utilizes an on-call protocol to ensure staffing ratios are always maintained, and to provide
additional support in crisis or emergency situations.

6. Need for Specialized Programs:

All staff are provided training on their responsibilities to address each person’s physical and emotional
health as outlined in his Individual Abuse Prevention Plan (if applicable), ISSA, CSSP, and CSSP
Addendum. Staff are trained and certified in Medication Administration, First Aid, and CPR, Physical
Intervention strategies/techniques and positive behavior supports. Additional training topics include
mental health trainings on (both children and adult) Self-Harm/Suicidal behaviors, Major
Depressive/Bipolar Disorder, Fetal Alcohol Syndrome, and Autism.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks in this area.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

7. Specific Staff Training for Individual Needs:

All staff are provided training on their responsibilities to address each person’s physical and emotional
health as outlined in his Individual Abuse Prevention Plan, CSSP, and CSSP Addendum. Staff are trained
and certified in Medication Administration, First Aid, and CPR, Physical Intervention
strategies/techniques and positive behavior supports. There is no need for additional specific staff
training to meet individual needs. The core foundation of support at Redwood is providing coaching and
mentoring to the residents we serve in developing personal responsibility, creating life goals, and raising
awareness in thinking, and regulating emotional responses to life’s stressors. This specific staff training
is continuous to create and sustain a positive and growth-oriented program, which reduces the potential
of abuse/harm.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks in this area.

Page 4 of 7
Last revised: 1/1/2020
 Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

Knowledge of Previous Abuse:

There is no known previous abuse.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks in this area.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

II. PHYSICAL PLANT ASSESSMENT:

Describe the physical plant in which the program is located. Assess the possible risk of harm and/or abuse to
persons served based on the physical plant. Describe the program’s plan to reduce the risk of harm
and/or abuse to persons served in the assessed area.

1. Condition and Design of the Physical Plant:

Redwood is a single-family home with one level and a basement. An addition was made to the home
prior to GraceLyn purchasing it. The home was modified to increase personal safety and reduce
property damage. The addition features window and door alarms, tempered glass on all but the office
windows, walls reinforced with protective wainscoting and shiplap paneling, bolted down furniture,
tankless toilets, a combination of solid core and metal doors (and frames), protective air vent covers,
and secured areas for storage of potentially dangerous items.

Several features in the kitchen and an addition to the home feature amenities for wheelchair
accessibility. These include a ramp from the back patio to the entry doors, a walk-in shower with chair
and arm rests, and adaptive shower hoses.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks in this area.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

2. Areas Difficult to Supervise:

The home features two separate levels in which one person cannot visually see one level when on the
other. Resident bedroom and bathrooms feature doors and locks which cannot be observed when the
doors are closed. Staff can hear residents from all areas of the home and routinely walk around and
access rooms on both levels.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

Page 5 of 7
Last revised: 1/1/2020
 III. ENVIRONMENT and COMMUNITY:
Describe the physical plant in which the program is located. Assess the possible risk of harm and/or abuse to
persons served based on the physical plant. Describe the program’s plan to reduce the risk of harm
and/or abuse to persons served in the assessed area.

1. Neighborhood and Community:

Redwood is located in a residential suburban neighborhood on the border of Apple Valley and
Burnsville. Within walking distance of the home, there are several public parks, a community
center/pool, a lake, a middle and elementary school. There are no immediate stores or restaurants
within the neighborhood, but nearby malls, shopping centers, restaurants, grocery stores, and gas
stations are within a 5-mile radius. The neighborhood exits out to high traffic street that is the main
artery of both downtown Apple Valley and Burnsville.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There is a risk for eloping residents to attempt to self-harm in nearby lake waters, or to be involved with
high density traffic.

Describe the Plan to Reduce the Risk to Persons Served by the Program:
Each resident served has an extensive, individualized behavioral plan which documents comprehensive
protocols for all areas that the individual is at risk for. Staff are oriented to these individual needs and
are trained on specific approaches relevant to each individual’s needs and mental functioning. As the
program is revised and/or updated, staff receive continual training through debriefs, mentoring
sessions, team trainings, and other various forms of competency checks to ensure the resident’s
program is being followed to minimize risk.

2. Grounds and Terrain:

Redwood is situated on a flat open city lot within a residential neighborhood. There are woods and a
lake located less than 1-mile West from the home.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

3. Type of Internal Programming:

The internal programming and support at Redwood is providing coaching and mentoring to the
residents we serve in developing personal responsibility, creating life goals, and raising awareness in
thinking, and regulating emotional responses to life’s stressors. We provide a range of support tailored
to individual residents’ goals (cooking, house cleaning, exercise, community inclusion, grocery shopping,
and transportation). We encourage the residents to create and practice healthy living habits.

Page 6 of 7
Last revised: 1/1/2020
 Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

4. Staffing Pattern:

There is staffing to address each resident’s specific needs. Staff are present and awake 24 hours a day.
There are two overnight awake staff, one overnight asleep, and three to four support staff working
during the morning, day, and evening. The staffing pattern reflects the resident’s daily activities and
behavioral support needs. There are both male and female staff members who work rotating shifts.
There is a leadership team comprised of five directors. They work various shifts and are the on-call and
crisis back-up team.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

Lynn Nauth 1/1/21

Print name of License-Holder Signature of License Holder Date

Page 7 of 7
Last revised: 1/1/2020
 Program Abuse Prevention Plan (PAPP)

Program: Timber Wolf

Program Address: 1981 Timber Wolf Trail North
Eagan, MN 55122
Date plan 1/1/21
Developed/Revised:

The Human Services Licensing Act (HSLA), Minnesota Statutes 245A.65, subdivision 2, governs what is required
in the adult foster care (AFC) and community residential setting (CRS) program abuse prevention plan. License
holders must develop and enforce a written program abuse prevention plan in accordance with the HSLA, and
the Reporting of Maltreatment of Vulnerable Adults Act (VAA), Minnesota Statures 626.557, subdivision 14.

I. POPULATION ASSESSMENT:
Describe the persons the program is planning to serve. Assess the possible risk of harm and/or
abuse to persons served in the assessed area.

1. Age range of persons the program plans to serve:

We provide services to individuals age 11 years and older.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the age of people receiving services?

Any minor(s) receiving services will be supported through staff supervision throughout the home. At no
point will the minor(s) be left unsupervised when they are with other adult housemate(s). All residents
will have their own private bedrooms.

Any property or cash funds declared for safekeeping will be clearly labeled and separated from each
resident’s storage. At no point will any of the residents’ money be combined.

2. Gender of persons the program plans to serve:

We provide services to males.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the gender of people receiving services?

There are no identified risks associated to the residents’ gender.

Page 1 of 7
Last revised: 10/1/2020
3. Describe the range of mental functioning of persons the program plans to serve:

We serve individuals with histories of RAD, Autism, down syndrome, severe MR, mild intellectual
disability, sensory integration disorder, mild-moderate bilateral hearing loss, polycythemia.

What specific measure has the program take to minimize the risk of abuse to people as related to the
mental functioning of people receiving services?

Tools, medications, chemicals, flammable/ignitable objects, and sharp objects are stored in locked areas
that are inaccessible to all current residents without supervision. Each resident served has an
individualized plan which documents comprehensive protocols for all areas that the individual is at risk
for. Staff are oriented to these individual needs and are trained on specific approaches relevant to each
individual’s needs and mental functioning. As the program is revised and/or updated, staff receive
continual training through debriefs, mentoring sessions, team trainings, and other various forms of
competency checks to ensure the resident’s program is being followed to minimize risk.

GraceLyn Group has a Relational Leader Certification Program which all staff participates in on some
level. The following are the main components of the program: 60-100 hrs. of annual training; 1:1 and
group coaching and mentoring sessions; participation in master classes annually on the topics of
Diversity and Inclusion, 15 Laws of Growth, Relationship Approach, Intentional Living, and Becoming A
Person of Influence. The certification program equips staff to support the residents from a person
centered, principle based and positive relationship approach.

Staff are present 24 hours a day at the ratio each individual has been assigned. There is one awake staff,
and one asleep staff during the overnight hours. The number of staff present at any given time depends
on the individual needs and how many residents at home during the day and evening. GraceLyn utilizes
an on-call protocol to maintain staffing ratios, and to provide additional support in crisis or emergency
situations.

4. Describe the range of physical and emotional health of persons the program plans to serve:

Residents have limited communication skills, sensory integration disorder, partial hearing loss, struggles
significantly with fine motor skills, self-injurious behaviors. Mild-moderate bilateral hearing loss,
polycythemia.

What specific measure has the program take to minimize the risk of abuse to people as related to the
physical and emotional health of people receiving services served?

Tools, medications, chemicals, flammable/ignitable objects, and sharp objects are stored in locked areas
that are inaccessible to all current residents without supervision Each resident served has an
individualized plan which documents comprehensive protocols for all areas that the individual is at risk
for. Staff are oriented to these individual needs and are trained on specific approaches relevant to each
individual’s needs and mental functioning. As the program is revised and/or updated, staff receive
Page 2 of 7
Last revised: 10/1/2020
 continual training through debriefs, mentoring sessions, team trainings, and other various forms of
competency checks to ensure the resident’s program is being followed to minimize risk.

GraceLyn Group has a Relational Leader Certification Program which all staff participates in on some
level. The following are the main components of the program: 60-100 hrs. of annual training; 1:1 and
group coaching and mentoring sessions; participation in master classes annually on the topics of
Diversity and Inclusion, 15 Laws of Growth, Relationship Approach, Intentional Living, and Becoming A
Person of Influence. The certification program equips staff to support the residents from a person
centered, principle based and positive relationship approach.

Staff are present 24 hours a day at the ratio each individual has been assigned. There is one awake staff,
and one asleep staff during the overnight hours. The number of staff present at any given time depends
on the individual needs and how many residents at home during the day and evening. GraceLyn utilizes
an on-call protocol to maintain staffing ratios, and to provide additional support in crisis or emergency
situations.

5. Describe the range of adaptive/maladaptive behavior(s) of persons the program plans to serve:

We serve individuals with a range of maladaptive behaviors. These include physical aggression towards
others/property destruction/indecent exposure of genitalia/verbal abuse/self-harm.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the adaptive/maladaptive behavior(s) of the people receiving services served?

Residents are oriented to and guided in taking safety measures (going into personal bedrooms or other
locked rooms) when another resident is posing a possible risk to safety. The physical environment has
been modified and adapted, reducing the need for physical intervention and risk of personal injury.
Staff are trained in physical intervention strategies, positive behavior support strategies, emergency use
of manual restraint, and to each individual’s adaptive/maladaptive behaviors. Tools, medications,
chemicals, flammable/ignitable objects, and sharp objects are stored in locked areas that are
inaccessible to the residents without supervision. Each resident served has an individualize plan which
documents comprehensive protocols for all areas that the individual is at risk for.

GraceLyn Group has a Relational Leader Certification Program which all staff participates in on some
level. The following are the main components of the program: 60-100 hrs. of annual training; 1:1 and
group coaching and mentoring sessions; participation in master classes annually on the topics of
Diversity and Inclusion, 15 Laws of Growth, Relationship Approach, Intentional Living, and Becoming A
Person of Influence. The certification program equips staff to support the residents from a person
centered, principle based and positive relationship approach.

Staff are present 24 hours a day at the ratio each individual has been assigned. There is one awake staff,
and one asleep staff during the overnight hours. The number of staff present at any given time depends
on the individual needs and how many residents at home during the day and evening. GraceLyn utilizes
Page 3 of 7
Last revised: 10/1/2020
 an on-call protocol to maintain staffing ratios, and to provide additional support in crisis or emergency
situations.

6. Describe the need for specialized programs of care for persons the program plans to serve:

ASL (American Sign Language), and visual aids for things like daily activity schedules.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the need for specialized programs of care for people receiving services?

All staff members will receive training in ASL.

7. Describe the need for specific staff training to meet individual service needs:

All staff are provided training on their responsibilities to address each person’s physical and emotional
health as outlined in his Individual Abuse Prevention Plan, CSSP, and CSSP Addendum.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the need for specific staff training designed to meet individual service needs?

Staff are trained and certified in Medication Administration, First Aid, and CPR, Physical Intervention
strategies/techniques and positive behavior supports.

There is no need for additional specific staff training to meet individual needs. The core foundation of
support at Timber Wolf is providing daily structure, coaching and mentoring to the residents we serve in
developing personal responsibility, creating life goals, and raising awareness in thinking, and regulating
emotional responses to life’s stressors. This specific staff training is continuous to create and sustain a
positive and growth-oriented program, which reduces the potential of abuse/harm.

8. Describe any knowledge of previous abuse that is relevant to minimizing the risk of abuse to people
receiving services:

There are no specific instances of previous abuse that are known at this time.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the knowledge of previous abuse?

To protect the safety and well-being of the vulnerabilities of the residents, GraceLyn Group and its staff
adheres to all mandated reporting requirements within the vulnerable adult and maltreatment of minor
reporting policies. In addition, staff will be trained to support any specific risk of abuse assessed in an
individual’s program documentation.

Page 4 of 7
Last revised: 10/1/2020
 II. PHYSICAL PLANT ASSESSMENT:
Describe the physical plant in which the program is located. Assess the possible risk of harm and/or abuse to
persons served based on the physical plant. Describe the program’s plan to reduce the risk of harm
and/or abuse to persons served in the assessed area.

1. Describe the condition and design of the facility as it relates to safety for the people receiving
services:

Timber Wolf is a single-family home built in the 1980’s. It is a large split entry with bedrooms on both
levels. There will be a few designated rooms for staff access only, but common areas, bathrooms,
kitchen and bedrooms are open for common use. for There are three bathrooms in the home. The home
is in good condition and is situated on a large lot. There is an attached garage, and backyard deck
coming from the main floor down to a concrete patio.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the condition and design of the facility in terms of safety for people receiving services?

Extensive interior remodeling has been completed to provide reinforcements to structural property.
These revisions help keep residents and staff safe during behavioral interventions and minimize
property damage. These modifications include solid core doors, protective shiplap covering on walls,
bolted down common area furniture, toilets that do not overflow with tank top locks, and recessed LED
lighting. As a safety precaution for elopement behaviors, door alarms have been installed on all exit
windows and entry doors.

2. Describe any areas of the facility that are difficult to supervise:

The split entry has two levels separated by a stairway. You cannot visually see one level when on the
other. Staff can hear residents from all areas of the home and routinely walk around and access rooms
on both levels.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the areas of the facility that are difficult to supervise?

There are no risks identified with the layout of the facility. Staff will be trained to maintain visual contact
with residents when providing services. Other areas that store dangerous items will not be accessible by
residents

Page 5 of 7
Last revised: 10/1/2020
 III. ENVIRONMENT and COMMUNITY:
Describe the physical plant in which the program is located. Assess the possible risk of harm and/or
abuse to persons served based on the physical plant. Describe the program’s plan to reduce the risk of
harm and/or abuse to persons served in the assessed area.

1. Describe the location of the facility including information about the neighborhood and community in
which the facility is located:

Timber Wolf is located in a suburban neighborhood located in Eagan, Minnesota. There are public parks
and transportation within walking distance.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the location of the facility, including factors about the neighborhood and community?

There are no risks associated with the neighborhood and community that the facility is located in. Staff
will be trained to know the local neighborhood layout, common amenities, and land markers.

2. Describe the type of grounds and terrain that surround the facility:

Timber Wolf is situated on a flat lot within a residential neighborhood. The lawns in the front and back
are sodded. Rock and garden landscaping are done throughout the lot. The home is surrounded by other
neighboring homes and residential streets.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the type of grounds and terrain that surround the facility?

Landscaping provides as a visual deterrence away from busy streets and other potential hazards. There
are no other identified risks associated with the grounds or terrain of the facility.

3. Describe the type of internal programming provided at the program:

The internal programming and support at Timber Wolf are providing structure for daily routines,
coaching and mentoring to the residents we serve in developing personal responsibility, creating life
goals, and raising awareness in thinking, and regulating emotional responses to life’s stressors.

What specific measures has the program taken to minimize the risk of abuse to people through the
type of internal programming provided at the program?

GraceLyn Group provides a range of support tailored to individual residents’ goals (cooking, house
cleaning, exercise, community inclusion, job development/training, and transportation). We encourage
the residents to create and practice healthy living habits.

Page 6 of 7
Last revised: 10/1/2020
4. Describe the program’s staffing pattern:

There is staffing to address each resident’s specific needs. Staff are present and awake 24 hours a day.
There is one awake overnight and one asleep staff during overnight hours. Three to four support staff
work during the day and evening.

What specific measures has the program taken to minimize the risk of abuse to people through the
program’s staffing pattern?

The staffing pattern reflects the resident’s daily activities and behavioral support needs. There are both
male and female employees who work rotating shifts. There is a leadership team comprised of five
directors. They work various shifts and are the on-call and crisis back-up team.

Lynn Nauth 1/1/21

Print name of License-Holder Signature of License Holder Date

Page 7 of 7
Last revised: 10/1/2020
 Program Abuse Prevention Plan (PAPP)

Program: Valley High

Program Address: 503 Valley High Road
Burnsville, MN 55337
Date plan 3/4/21
Developed/Revised: Revised 6/21/22, 7/11/22

The Human Services Licensing Act (HSLA), Minnesota Statutes 245A.65, subdivision 2, governs what is required
in the adult foster care (AFC) and community residential setting (CRS) program abuse prevention plan. License
holders must develop and enforce a written program abuse prevention plan in accordance with the HSLA, and
the Reporting of Maltreatment of Vulnerable Adults Act (VAA), Minnesota Statures 626.557, subdivision 14.

I. POPULATION ASSESSMENT:
Describe the persons the program is planning to serve. Assess the possible risk of harm and/or
abuse to persons served in the assessed area.

1. Age range of persons the program plans to serve:

The program serves individuals age 17 and older.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the age of people receiving services?

There are no identified risks associated to the resident’s age.

2. Gender of persons the program plans to serve:

We provide services to males.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the gender of people receiving services?

There are no identified risks associated to the residents’ gender.

3. Describe the range of mental functioning of persons the program plans to serve:

Diagnoses include mild DD, autism, anxiety disorder, impulse control disorder, and PTSD. The mental
functioning of the resident is considerably impaired in many areas of their social, and behavioral
skillsets.

Page 1 of 7
Last revised: 10/1/2020
 What specific measure has the program take to minimize the risk of abuse to people as related to the
mental functioning of people receiving services?

Tools, medications, chemicals, flammable/ignitable objects, and sharp objects are stored in locked areas
that are inaccessible to all current residents without supervision. Each resident served has an
individualized plan which documents comprehensive protocols for all areas that the individual is at risk
for. Staff are oriented to these individual needs and are trained on specific approaches relevant to each
individual’s needs and mental functioning. As the program is revised and/or updated, staff receive
continual training through debriefs, mentoring sessions, team trainings, and other various forms of
competency checks to ensure the resident’s program is being followed to minimize risk.

GraceLyn Group’s model of training is equipping staff through attending Masterclasses on developing
core character, becoming a person of positive influence, assertive behavior, personal responsibility,
having faith in others and other relationship focused topics. Staff also participate in mentoring meetings
to learn and be supported in applying the knowledge acquired int he masterclasses. This is in addition to
the required training related to our licenses.

Staff are present 24 hours a day at the ratio each individual has been assigned. The number of staff
present at any given time depends on the individual needs and how many residents at home during the
day and evening. GraceLyn utilizes an on-call protocol to maintain staffing ratios, and to provide
additional support in crisis or emergency situations.

4. Describe the range of physical and emotional health of persons the program plans to serve:

Resident has no known history of physical or sensory limitations and is in good physical health. There is a
history of food and environmental allergies. Resident does not self-regulate with emotions, and often
engages in aggression when agitated or anxious. Resident generally neglects self-care of physical and
emotional health, but when follows staff prompts for care when in a stable mood.

What specific measure has the program take to minimize the risk of abuse to people as related to the
physical and emotional health of people receiving services served?

Tools, medications, chemicals, flammable/ignitable objects, and sharp objects are stored in locked areas
that are inaccessible to all current residents without supervision Each resident served has an
individualized plan which documents comprehensive protocols for all areas that the individual is at risk
for. Staff are oriented to these individual needs and are trained on specific approaches relevant to each
individual’s needs and mental functioning. As the program is revised and/or updated, staff receive
continual training through debriefs, mentoring sessions, team trainings, and other various forms of
competency checks to ensure the resident’s program is being followed to minimize risk.

GraceLyn Group’s model of training is equipping staff through attending Masterclasses on developing
core character, becoming a person of positive influence, assertive behavior, personal responsibility,
having faith in others and other relationship focused topics. Staff also participate in mentoring meetings
Page 2 of 7
Last revised: 10/1/2020
 to learn and be supported in applying the knowledge acquired int he masterclasses. This is in addition to
the required training related to our licenses.

Staff are present 24 hours a day at the ratio each individual has been assigned. The number of staff
present at any given time depends on the individual needs and how many residents at home during the
day and evening. GraceLyn utilizes an on-call protocol to maintain staffing ratios, and to provide
additional support in crisis or emergency situations.

5. Describe the range of adaptive/maladaptive behavior(s) of persons the program plans to serve:

Resident follows staff prompts, and proactive interventions using verbal redirection. When agitated or
anxious, behaviors include verbal aggression, physical aggression (hitting, grabbing, choking, tackling),
and elopement.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the adaptive/maladaptive behavior(s) of the people receiving services served?

Residents are oriented to and guided in taking safety measures (going into personal bedrooms or other
locked rooms) when another resident is posing a possible risk to safety. The physical environment has
been modified and adapted, reducing the need for physical intervention and risk of personal injury.
Staff are trained in physical intervention strategies, positive behavior support strategies, emergency use
of manual restraint, and to each individual’s adaptive/maladaptive behaviors. Tools, medications,
chemicals, flammable/ignitable objects, and sharp objects are stored in locked areas that are
inaccessible to the residents without supervision. Each resident served has an individualize plan which
documents comprehensive protocols for all areas that the individual is at risk for.

GraceLyn Group’s model of training is equipping staff through attending Masterclasses on developing
core character, becoming a person of positive influence, assertive behavior, personal responsibility,
having faith in others and other relationship focused topics. Staff also participate in mentoring meetings
to learn and be supported in applying the knowledge acquired int he masterclasses. This is in addition to
the required training related to our licenses.

Staff are present 24 hours a day at the ratio each individual has been assigned. The number of staff
present at any given time depends on the individual needs and how many residents at home during the
day and evening. GraceLyn utilizes an on-call protocol to maintain staffing ratios, and to provide
additional support in crisis or emergency situations.

6. Describe the need for specialized programs of care for persons the program plans to serve:

There is no need for any specialized programs of care at this time.

Page 3 of 7
Last revised: 10/1/2020
 What specific measures has the program taken to minimize the risk of abuse to people as related to
the need for specialized programs of care for people receiving services?

N/A

7. Describe the need for specific staff training to meet individual service needs:

All staff are provided training on their responsibilities to address each person’s physical and emotional
health as outlined in his Individual Abuse Prevention Plan, CSSP, and CSSP Addendum.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the need for specific staff training designed to meet individual service needs?

Staff are trained and certified in Medication Administration, First Aid, and CPR, Physical Intervention
strategies/techniques and positive behavior supports.

There is no need for additional specific staff training to meet individual needs. The core foundation of
support is providing daily structure, coaching and mentoring to the residents we serve in developing
personal responsibility, creating life goals, and raising awareness in thinking, and regulating emotional
responses to life’s stressors. This specific staff training is continuous to create and sustain a positive and
growth-oriented program, which reduces the potential of abuse/harm.

8. Describe any knowledge of previous abuse that is relevant to minimizing the risk of abuse to people
receiving services:

There are no specific instances of previous abuse that are known at this time.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the knowledge of previous abuse?

To protect the safety and well-being of the vulnerabilities of the residents, GraceLyn Group and its staff
adheres to all mandated reporting requirements within the vulnerable adult and maltreatment of minor
reporting policies. In addition, staff will be trained to support any specific risk of abuse assessed in an
individual’s program documentation.

Page 4 of 7
Last revised: 10/1/2020
 II. PHYSICAL PLANT ASSESSMENT:
Describe the physical plant in which the program is located. Assess the possible risk of harm and/or abuse to
persons served based on the physical plant. Describe the program’s plan to reduce the risk of harm
and/or abuse to persons served in the assessed area.

1. Describe the condition and design of the facility as it relates to safety for the people receiving
services:

The site is a one story single family residential home situated in the community near downtown
Burnsville. The home was built in 1985 and features 4 bedrooms, 2.5 bathrooms, 2,248 finished square
footage, and an attached garage. The home has a wooded, private backyard. The four-season porch has
a secured doorway with no attached deck or patio.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the condition and design of the facility in terms of safety for people receiving services?

As a precaution for elopement, auditory alarms have been installed on all entry/exit doors and windows
within the home. The interior has been minimally modified to include solid core doors with locks for the
bedrooms and staff areas. The doors leading out from the four-season porch have been secured with
new door hardware. The key for accessing this door will be used only by staff in emergency situations.

2. Describe any areas of the facility that are difficult to supervise:

The basement of the home is separated by a door. You cannot visually see one level when on the other.
Staff can hear the resident from all areas of the home and routinely walk around and access rooms on
both levels.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the areas of the facility that are difficult to supervise?

There are no risks identified with the layout of the facility. Staff will be trained to maintain visual contact
with residents when providing services. Other areas that store dangerous items will not be accessible by
residents

Page 5 of 7
Last revised: 10/1/2020
 III. ENVIRONMENT and COMMUNITY:
Describe the physical plant in which the program is located. Assess the possible risk of harm and/or
abuse to persons served based on the physical plant. Describe the program’s plan to reduce the risk of
harm and/or abuse to persons served in the assessed area.

1. Describe the location of the facility including information about the neighborhood and community in
which the facility is located:

The home is located in a suburban neighborhood in Burnsville, Minnesota. There are public parks and
transportation within walking distance. The downtown area is nearby which features restaurants, police
station, and shopping centers.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the location of the facility, including factors about the neighborhood and community?

There are no risks associated with the neighborhood and community that the facility is located in. Staff
will be trained to know the local neighborhood layout, common amenities, and land markers.

2. Describe the type of grounds and terrain that surround the facility:

The home sits on elevated terrain that slopes downward towards the backyard which is wooded and
fenced. The home has a very small front yard, and a driveway that leads out to the street.

What specific measures has the program taken to minimize the risk of abuse to people as related to
the type of grounds and terrain that surround the facility?

N/A

3. Describe the type of internal programming provided at the program:

The internal programming and support at Timber Wolf are providing structure for daily routines,
coaching and mentoring to the residents we serve in developing personal responsibility, creating life
goals, and raising awareness in thinking, and regulating emotional responses to life’s stressors.

What specific measures has the program taken to minimize the risk of abuse to people through the
type of internal programming provided at the program?

GraceLyn Group provides a range of support tailored to individual residents’ goals (cooking, house
cleaning, exercise, community inclusion, job development/training, and transportation). We encourage
the residents to create and practice healthy living habits.

Page 6 of 7
Last revised: 10/1/2020
4. Describe the program’s staffing pattern:

There is staffing to address each resident’s specific needs. Staff are present and awake 24 hours a day.

What specific measures has the program taken to minimize the risk of abuse to people through the
program’s staffing pattern?

The staffing pattern reflects the resident’s daily activities and behavioral support needs. There are both
male and female employees who work rotating shifts. There is a leadership team comprised of Program
and Senior Directors. They work various shifts and are the on-call and crisis back-up team.

Lynn Nauth 7/11/22

Print name of License-Holder Signature of License Holder Date

Page 7 of 7
Last revised: 10/1/2020
 Program Abuse Prevention Plan (PAPP)

Program: Aspen
Program Address: 1008 Aspen Drive
Burnsville, MN, 55337
Date plan 10/28/21
Developed/Revised:

The Human Services Licensing Act (HSLA), Minnesota Statutes 245A.65, subdivision 2, governs what is required
in the adult foster care (AFC) and community residential setting (CRS) program abuse prevention plan. License
holders must develop and enforce a written program abuse prevention plan in accordance with the HSLA, and
the Reporting of Maltreatment of Vulnerable Adults Act (VAA), Minnesota Statures 626.557, subdivision 14.

I. POPULATION ASSESSMENT:
Describe the persons the program is planning to serve. Assess the possible risk of harm and/or
abuse to persons served in the assessed area.

1. Age: We serve individuals age 18 years and older.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no identified risks due to the age of the residents.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

2. Gender: Male

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no identified risks due to the gender of the residents.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

3. Mental Functioning:
We have a history of providing services to individuals with mild to moderate DD, Autism, and Anxiety
Disorder. The cognitive emotional and behavioral responses of some of the residents are impaired and
immature relative to their ages.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
Aggressive behaviors in the form of physical abuse, self abuse, property destruction, elopement and
verbal abuse can occur when the residents are experiencing life’s challenges and stressors.

Page 1 of 6
Last revised: 1/1/2020
 Describe the Plan to Reduce the Risk to Persons Served by the Program:
Tools, chemicals, and sharp knives are stored in locked areas. Staff are available to discuss and supervise
the usage of any of the restricted items that a resident requests (for cooking, cleaning, etc). After use of
the item, staff would return the item and safely secure it into locked storage. Staff are oriented to each
individual’s abuse prevention plan, CSSP, CSSP Addendum, and trained on specific approaches relevant
to each individual’s needs and mental functioning.

GraceLyn Group has a Relational Leader Certification Program which all staff participates in on some
level. The certification program equips staff to support the residents from a relational, principle based
approach. Staff are present 24 hours a day. The number of staff present at any given time depends on
the individual needs and how many residents at home during the day and evening. There is an on-call
and crisis back up structure in place.

4. Physical and Emotional Health:

Aspen serves individuals who may have a variety of emotional health support needs. These range from
mild to moderate DD, Autism, and Anxiety Disorder. Aspen serves individuals who are ambulatory and
can navigate stairs.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
Aggressive behaviors in the form of physical abuse, self abuse, property destruction, elopement and
verbal abuse can occur when the residents are experiencing life’s challenges and stressors.

Describe the Plan to Reduce the Risk to Persons Served by the Program:
All staff are provided training on their responsibilities to address each person’s physical and emotional
health as outlined in his Individual Abuse Prevention Plan, CSSP, and CSSP Addendum. Staff are trained
and certified in Medication Administration, First Aid, and CPR. Staff are trained in Physical Intervention
strategies and techniques and positive behavior supports.

GraceLyn Group has a Relational Leader Certification Program which all staff participates in on some
level. The certification program equips staff to support the residents from a relational, principle based
approach. Staff are present 24 hours a day. The number of staff present at any given time depends on
the individual needs and how many residents at home during the day and evening. There is an on-call
and crisis back up structure in place.

5. Behaviors:
We serve individuals with a range of adaptive and maladaptive behaviors (mild to severe physical
aggression and property damage, mild self injurious behaviors, sexual inappropriateness, mild to severe
verbal abuse, elopement) requiring low to high level of support needs. The program can serve up to two
individuals.

Page 2 of 6
Last revised: 1/1/2020
 Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
Aggressive behaviors in the form of physical abuse, self abuse, property destruction, elopement and
verbal abuse can occur when the residents are experiencing life’s challenges and stressors.

Describe the Plan to Reduce the Risk to Persons Served by the Program:
Residents are oriented to and guided in taking safety measures (going into personal bedrooms or other
locked rooms) when another resident is posing a possible risk to safety. Staff are trained in physical
intervention strategies, positive behavior support strategies, emergency use of manual restraint, and to
each individual’s adaptive/maladaptive behaviors.

GraceLyn Group has a Relational Leader Certification Program which all staff participates in on some
level. The certification program equips staff to support the residents from a relational, principle based
approach. Staff are present 24 hours a day. The number of staff present at any given time depends on
the individual needs and how many residents at home during the day and evening. There is an on-call
and crisis back up structure in place.

6. Need for Specialized Programs:

We have not identified any need for additional specialized programs of care at Aspen in addition to what
has been addressed above or indicated in each person’s Individual Abuse Prevention Plan, CSSP, and
CSSP Addendum.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks in this area.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

7. Specific Staff Training for Individual Needs:

All staff are provided training on their responsibilities to address each person’s physical and emotional
health as outlined in his Individual Abuse Prevention Plan, ISSA, CSSP, and CSSP Addendum. Staff are
trained and certified in Medication Administration, First Aid, and CPR, Physical Intervention
strategies/techniques and positive behavior supports. Additional training topics include Autism, and
Mental Health Training. The core foundation of support at Aspen is providing coaching and mentoring to
the residents we serve in developing personal responsibility, creating life goals, and raising awareness in
thinking, and regulating emotional responses to life’s stressors. This specific staff training is continuous
to create and sustain a positive and growth-oriented program, which reduces the potential of
abuse/harm.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks in this area.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

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8. Knowledge of Previous Abuse:
Sexual, Financial

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
Resident may seek others to sexually and/or financially abuse. Resident is also at risk for being abused
sexually and/or financially by others.

Describe the Plan to Reduce the Risk to Persons Served by the Program:

Staff are oriented to each individual’s abuse prevention plan, CSSP, CSSP Addendum, and trained on
specific approaches relevant to each individual’s needs and mental functioning. These approaches and
processes are in effect to minimize the known areas of risk. Any resident involved in any suspected acts
of maltreatment, abuse, or neglect are immediately reported as mandated in GraceLyn’s Vulnerable
Adult, and Maltreatment of Minors Reporting policies.

II. PHYSICAL PLANT ASSESSMENT:

Describe the physical plant in which the program is located. Assess the possible risk of harm and/or abuse to
persons served based on the physical plant. Describe the program’s plan to reduce the risk of harm
and/or abuse to persons served in the assessed area.

1. Condition and Design of the Physical Plant:

Aspen is a single-family rambler built in the 1967. The home is in good condition, with a spacious floor
plan. The home features 3 bedrooms, 2 bathrooms, a full kitchen, an office, 2 large common spaces, a
large storage room, and a 4 season porch which was added in 1990. The lower level has a walkout to a
grassy backyard.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks in this area.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

2. Areas Difficult to Supervise:

All areas of the home are easily accessible. Staff can hear residents from all areas of the home and
routinely walk around and access rooms on both levels.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

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 III. ENVIRONMENT and COMMUNITY:
Describe the physical plant in which the program is located. Assess the possible risk of harm and/or abuse to
persons served based on the physical plant. Describe the program’s plan to reduce the risk of harm
and/or abuse to persons served in the assessed area.

1. Neighborhood and Community:

Aspen is in a residential neighborhood located in Burnsville, MN. There are several parks within walking
distance, and nearby businesses and access to freeways are within a short driving proximity.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

2. Grounds and Terrain:

Aspen is situated on an irregular wooded lot of .27 acres. The home is located on a city lot in a
residential community. The terrain in front of the home is flat, with a gentle slope to the backyard.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

3. Type of Internal Programming:

The internal programming and support at Aspen are providing coaching and mentoring to the residents
we serve in developing personal responsibility, creating life goals, and raising awareness in thinking, and
regulating emotional responses to life’s stressors. We provide a range of support tailored to individual
residents’ goals (cooking, house cleaning, exercise, community inclusion, job development/training, and
transportation). We encourage the residents to create and practice healthy living habits.

Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

4. Staffing Pattern:

There is staffing to address each resident’s specific needs. Staff are present and awake 24 hours a day.
There is one awake overnight staff and one to two support staff working during the day and evening.
The staffing pattern reflects the resident’s daily activities and behavioral support needs. There are both
male and female employees who work rotating shifts. There is a leadership that work various shifts and
are the on-call and crisis back-up team.
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 Describe Any Possible Risks – if there are not risks in this area please state that there is no risk:
There are no risks.

Describe the Plan to Reduce the Risk to Persons Served by the Program: N/A

Lynn Nauth 10/31/21

Print name of License-Holder Signature of License Holder Date

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Mee#ng/Coaching/Mentoring/Debrief/Master Class/Training
Signature Sheet

Training Date:

* [Link] Purpose: Read and sign off on GraceLyn Group Program Abuse

[Link] Plans for:

Aspen
Koinonia
Redwood
Timber Wolf
Valley High

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