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Summary Report Incident Investigative Report

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									MUI Training

   Incidents adversely affecting
        health and safety.
        OAC 5123:2-17-02
                Objectives:
   Provide new and/or current staff/providers with an
    awareness of the importance incident reporting
   Create awareness about abuse and neglect so staff can
    identify and report information
   Educate staff on types of Unusual Incidents and
    MUI’s
   Educate staff/providers on the procedures and
    process of reporting incidents
   Educate staff/providers of roles and responsibilities
    of providers, support administrators, and
    investigative agent
              The Rule:
   Establishes the requirements for
    managing incidents adversely
    affecting health or safety.

   Implements a continuous quality
    improvement process in order to
    prevent or reduce the risk of harm to
    individuals.
              The Rule:
   The Purpose is to establish a system to:
     Report

     Investigate

     Review

     Remedy

     Analyze
An Unusual incident (UI)
is:
   An event or occurrence involving an eligible
    individual that is not consistent with routine
    operations, policies and procedures, or the
    care or individual service plan of the
    individual, but is not an MUI .
   Unusual incidents directly relate to and are
    written about the individual receiving
    services that the incident happens to. Reports
    are about the victim, not the perpetrator
               UI’s include
             but are not limited to:


   Minor Injuries
   Behavioral Episode
   Self-Medication Errors
   A-typical Behavior
Minor Injuries
   lacerations, scrapes, contusions or
   discolorations of known origin, minor burns,
    rash, minor
   recreational/work related injuries, falls; peer-
    to-peer incidents that are not MUIs;
   overnight relocation of an individual due to
    fire, natural disaster, or mechanical failure;
   any injury to an individual that is not an MUI.
Behavioral episode

   a physical or verbal outburst of an
    eligible individual that does not require
    physical intervention.
Self-medication errors

   an individual who administers their own
    medication (as outlined in their ISP)
    fails to administer the medication as
    prescribed (with no adverse effects).
Atypical behavior

   an occurrence where an eligible
    individual displays behavior that is
    unusual or displays a typical behavior
    increasingly which causes concern for
    health and safety.
    A Major Unusual Incident
           (MUI) is:
   The alleged, suspected or actual occurrence of an
    incident when there is reason to believe the health or
    safety of an individual may be adversely affected.
   Or when an individual may be placed at a reasonable
    risk of harm.
   If such individual is receiving services through the
    DCBDD service system or will be receiving such
    services as a result of the incident.
   Major Unusual incidents directly relate to and are
    written about the individual receiving services that
    the incident happens to. Reports are about the
    victim, not the perpetrator
         MUI’s include:
   Abuse
   Attempted suicide
   Death
   Exploitation
   Failure to report
   Known injury
   Law enforcement
   Medical emergency
   Misappropriation
         MUI’s include:
   Missing individual
   Neglect
   Peer-to-Peer acts
   Prohibited sexual relations
   Rights code violation
   Unapproved behavior support
   Unknown injury
   Unscheduled hospitalization
PROTOCOL MUI’s
   Require 4 hour notification to DCBDD
   Require immediate Notification to Law
    Enforcement or Children Services in
    cases of suspected child abuse (up to
    age 21 for DCBDD Eligible individuals).
   Require immediate notification to Law
    Enforcement for criminal cases.
         Failure to report:
   When a person has reason to believe
    that an individual has suffered or faces
    substantial risk of suffering from any
    wound, injury, disability, or condition of
    such a nature as to indicate abuse or
    neglect. Including misappropriation.
           Failure to report:
   And that person does not immediately
    report the incident to:
       Law enforcement
       Children Services
       The DCBDD


   The Omission of the reporting is itself the
    MUI and must be reported immediately.
                        Abuse:
   Physical:
       use of physical force
       That can be expected to or does result in
        physical or serious physical harm.
       Including but not limited to:
            Hitting
            Slapping
            Pushing
            Throwing objects at an individual
                    Abuse:
   Sexual Abuse:
       Unlawful sexual conduct or sexual contact


   Verbal Abuse:
       Purposefully using words or gestures to
        threaten, coerce, intimidate, harass, or
        humiliate an individual
            Misappropriation:

   Depriving, defrauding, or
    otherwise obtaining the
    real or personal property
    of an individual by any
    means prohibited by the
    Ohio Revised Code.

   It is a felony to steal even
    one penny!
           Exploitation:

   The unlawful or improper act of using
    an individual’s resources for monetary
    or personal benefit, profit, or gain.
                   Neglect:
   When there is a duty to do so, failing to
    provide an individual with:
       Treatment
       Care
       Goods
       Supervision
       Services necessary to maintain the health
        or safety of the individual.
                Neglect:
   Consideration must be given to whether
    there is reasonable risk to health and
    safety.
   Neglect includes patient endangerment
    which means an MR/DD caretaker has
    created a substantial risk to the health
    or safety of an individual.
          Peer to Peer Acts:
   Act committed by one individual against
    another when there is:
       Physical abuse with intent to harm
       Verbal abuse with intent to intimidate, harass, or
        humiliate
       Any Sexual abuse
       Any Exploitation
       Intentional misappropriation of property of
        significant value – determined by ODMRDD to be
        about $10.00
          Prohibited Sexual
             Relations:
   An MR/DD employee engaging in consensual
    sexual conduct or having consensual sexual
    contact with an individual who is not the
    employee’s spouse, and for whom the MR/DD
    employee was employed or under contract to
    provide care at the time of the incident and
    includes persons in the employee’s
    supervisory chain of command.
      Rights Code Violation:
   Any violation of the rights enumerated
    in section 5123.62 of the Revised Code
    that creates a reasonable risk of harm to
    the health or safety of an individual.
NON PROTOCOL MUI
   Required to report the same day
   Required to implement immediate plan
    of correction to ensure health and
    safety.
    Attempted Suicide & Death:
   Attempted Suicide:               Death:
       A physical attempt by            The death of an
        an individual that                individual
        results in emergency
        room treatment, in-
        patient observation, or
        hospital admission.
    Injury from a known
            cause:
Is not considered   Requires
as possible abuse   immobilization
or neglect
Requires casting   Requires 5+
                   sutures or
                   equivalent
Is a 2nd or 3rd    Includes dental
degree burn        injuries
Any injury that prohibits the
individual from participating in
       Law Enforcement:
   Any incident that
    results in the
    individual being
    charged,
    incarcerated, or
    arrested.
Medical Emergency:
            An incident where
             emergency medical
             intervention is
             required to save an
             individual’s life:
                Heimlich maneuver
                CPR
                IV fluid for
                 dehydration
      Missing Individual:
   An incident that is not considered neglect and
    the individual cannot be located for a period
    of time longer than specified in the Individual
    Service Plan (ISP)
   And the individual cannot be located after
    actions specified in the ISP
   And the individual cannot be located in a
    search of the immediate surrounding area
   Or the circumstances indicate that the
    individual may be in immediate jeopardy
   Or Law enforcement has been called to assist
    in the search
      Unapproved Behavior
           Support:
   The use of any aversive strategy or
    intervention implemented without
    approval by the human rights
    committee or behavior support
    committee or without informed
    consent.
        Unknown Injury:
   An injury of an unknown cause that is
    not considered possible abuse or neglect
    and that requires treatment that only a
    physician, physician’s assistant, or
    nurse practitioner can provide.
              Unscheduled
             Hospitalization:
   Any hospital admission that
    is not that is not scheduled
    unless the hospital
    admission is due to a
    condition that is specified in
    the ISP or nursing care plan
    indicating the specific
    symptoms and criteria that
    require hospitalization.
        (D)(1) Any Person with MRDD
        Not Served
   Report possible Abuse including
    Misappropriation or Neglect
   To local law enforcement and the county
    board
              OR
   Public Children’s Service Agency and county
    board
   Entry page on ITS
Reporting MUI’s on Person
served
   Abuse, Neglect, Exploitation,
    Misappropriation, Death, Prohibited Sexual
    Relations, and Failure to Report
   Regardless of where the incident occurred
   Follow all rule requirements
   Remaining categories (All other MUI’s) when:
       Incident occurs in program operated by the
        county board
                       OR
       When the individual is being served by a licensed
        or certified provider
       Follow all requirements
(D)(3) Upon Identification or Notification
of MUI, Provider or County Board Shall:
   Take immediate actions to protect all at
    risk individuals which shall include:
          Immediate or ongoing medical attention as
           appropriate
          Remove employee from direct contact until
           determined unnecessary
          Other measures as necessary
   The Department shall resolve any
    disagreements
(E) Alleged Criminal Acts

   Immediate reporting to law enforcement

   Allegations of Abuse including
    Misappropriation and Neglect which may
    constitute a criminal act

   The county board ensures notification has
    been made
(F) Abused or Neglected
Children
   Allegations of Abuse or Neglect per Ohio
    Revised Code 2151.03 and 2151.031

   Under the age of 21

   Report to local public children’s agency

   The county board shall ensure reports have
    been made
(D)(5) Immediate to 4 Hour
Reporting
   Provider or county board as a provider
   Using county board identified system for
    MUIs
   Report incidents or allegations of:
          Abuse
          Neglect
          Exploitation
          Misappropriation
          Suspicious or accidental death
          Media inquiries
(D)(10)

   County board shall have a system available
    24-7 to receive and respond to reports.

   MUI notification numbers:
       During business hours (8am–4:30pm M-F)
        (740) 368-5801 ext. 303
       After hours (4:30pm-8am), weekends, and
        holidays: (740) 272-2812
(G)(1) Notifications Upon
Awareness of an Incident
   To be made by provider or county board as a
    provider
   Made the same day
   Include immediate actions taken

       Guardian, advocate, or person identified
       SSA for individual
       Licensed or certified residential provider
       Staff or family in the home
(G)(2)-(4)
   Notifications or effort to notify shall be
    documented
   The county board ensure notifications have
    been made
   Do not notify the PPI, PPI’s spouse, or
    significant other
   Not needed if the report came from person to
    be notified or in the case of death where the
    family is already aware
(D)(4) County Board Upon
Notification Shall:
   Ensure reasonable measures are
    appropriate

   Determine if additional measures are
    needed
(D)(6) Submit Written Incident Report by
3:00 p.m. the Next Working Day
   Agency providers, individual providers, and
    county boards as providers
   Department prescribed format: DCBDD IRF is
    included in training packet
   Fax #: (740) 368-5807
    Attn: MUI Investigative Agent (Craig Hill)
   Find out appropriate SA fax number
   DCBDD IA and SA must have report by 3pm
    the next working day – do not use postal
    service or inter-office mail; if fax is not
    available, hand delivery is suggested
(G)(5) Notification to Providers When
PPI Works for Multiple Providers

   The Department makes these
   Alleged crimes
   The other provider determines if steps are
    needed to ensure health and safety
   Notification of case disposition
   Providers, county boards, developmental
    centers to notify the Department if the PPI
    works elsewhere in the system
(K)(1) Written Procedure Implemented for
Internal MUI Review

   County boards and agency providers

   Include responsibility for reasonable
    steps to prevent
(K)(2) Development of
Preventive Measures
   Team including county board and provider
   Address causes and contributing factors
   Determine reasonable steps
   Plans of Prevention/Correction are due in
    their entirety, 21 days from the date the IDF
    was mailed
   In circumstances of few supports –
    implement what is reasonably possible.
   (H) General Investigation
    Requirements
(H)(1)

   All MUIs require an investigation
    meeting the requirements in Appendix
    A or B

   Certified investigative agents shall
    conduct the investigations
(H)(2)
   The county board shall have at least one
   investigative agent. The county board may
   contract with a person or a government
   entity.
   Must be certified
   Must receive annual Department-approved
    training
(H)(5)
   Agency Provider may conduct HR
    investigations from which information except
    for interviews may be used
   The investigative agent shall conduct all
    interviews for MUIs unless Law enforcement
    or Children’s services is investigating
   May obtain assistance with interviewing an
    individual
(H)(6)
   Commence an investigation immediately but
    no later than 24 hours for:

          Abuse, Neglect, Exploitation, or Misappropriation
          Rights Code
          Suspicious or Accidental Death
          Prohibited Sexual Relations
          One determined by the county board
(H)(7)

   For other MUIs – Commence no later
    than 3 working days after identification
    or notification.

   Decision based upon:
       Initial information received
       Consistent with health and safety of at risk
        persons
(H)(10)
   When an agency provider conducts an
    internal review of an incident, (HR
    investigation) and an MUI has been filed

   The results of the review including
    statements and documents go to the county
    board within 14 calendar days of awareness
    of the incident
(H)(11)

   All MR/DD employees shall cooperate
    with any administrative investigation

   Providers and the county board shall
    respond to information within
    timeframes requested
(H)(12)
   The investigative agent submits the
    report of investigation for closure in ITS
    within 30 working days.

   Extensions may be granted by
    ODMR/DD based on established criteria.
(I)(1) Dept directed investigations
   The Department shall conduct the MUI
    investigation when the allegation is against:
       Superintendent of a county board or
        developmental center
       Executive Director or equivalent of a Counsel of
        Government
       Management employee who reports to the
        Superintendent or Executive Director
       An investigative agent
       An SSA
       An MUI contact for a county board
       A current member of a county board
(I)(1) Continued
   Known relationship with A-G when it may
    present a conflict of interest or the
    appearance of a conflict of interest
   County board employee who is alleged to be
    responsible for individual’s death, has
    committed sexual abuse, engaged in
    prohibited sexual activity, or committed
    physical abuse or neglect resulting in
    emergency room treatment or hospitalization.
(J)(1)(2)
   Those receiving written notice:
       Individual or individual’s guardian or
        advocate
       Licensed or certified provider and provider
        at the time of the incident
       SSA or person selected to coordinate
        services
       Not to family in case of death unless
        requested
(J)(3)
   Written summary not provided to PPI,
    PPI’s spouse, or significant other

   A reasonable attempt to notify the PPI
    of disposition shall be made no later
    than 5 working days following case
    closure
(J)(5)
   Findings may be disputed by:
       Individual or individual’s guardian, or
        individual’s advocate
       Provider
            Process:
                 Submit letter of dispute and supporting documents
                  to the County Board Superintendent within 15 days
                  of receipt of the written summary.
                 To Director if investigation was conducted by
                  ODMR/DD
(J)(6)
   The superintendent shall consider
    information received and issue a
    determination in 30 calendar days

   Actions consistent with the
    determination shall be taken
(J)(7)
   The final finding of the county board
    may be disputed with the Director

   Findings and documentation contesting
    findings to the Director within 15
    calendar days

   Decision in 30 calendar days
(K)(7) Closure Criteria
   Reasonable measures to ensure the health
    and safety of at risk individuals
   Thorough investigation per Appendix A and
    Appendix B
   Team collaboration on preventive measures
    to address causes and contributing factors
   Preventive measures have been implemented
   Additional action taken if a trend
   All rule requirements have been met
(K)(8)

   The county board notifies provider that
    case is closed within 5 working days.
(L)(1) MUI Analysis for Trends and
Patterns Two Times Per Year
   County boards and agency providers

   July 31st for the first 6 months

   January 31st for the entire year
(L)(2) County Board’s Analysis
and Follow-Up
   For county board operated programs,
    workshops, school, transportation

   For individual providers

   Sent to the Department by August 31st
    and February 28th
(L)(3) Agency Provider
Analysis and Follow-Up
   For all programs in the county

   Sent by August 31st and February 28th
    to the county board

   Kept on file and made available upon
    request to the Department
(L)(4)

   The county board and Department shall
    review to ensure issues have been reasonably
    addressed to prevent reoccurrence.
   The county board and Department shall
    review to ensure issues have been reasonably
    addressed to prevent reoccurrence.
(L)(5)

   County board ensures trends and
    patterns are included and addressed in
    the ISP.
(L)(8)(9)(10) Meet Twice a
Year
   September for the first six months – March
    for the year
   Aggregate data sent to participants by the
    county board ten days prior to the meeting
   Record and distribute minutes and make
    available upon request
   The Department ensure follow-up actions are
    implemented
MUI Reporting, Investigation,
Follow-up, and Closure
Day      Date      Action                       Provider   IA       ODMRDD
Thurs    1/11/07   Becomes aware of                X
                   possible physical abuse
Thurs    1/11/07   Takes immediate action to       X
                   ensure health and safety
Thurs    1/11/07   Notifies law enforcement        X
                   or CPS immediately
Thurs    1/11/07   Notifies DCBDD within 4         X
                   hours
Friday   1/12/07   Initiates investigation                      X
                   within 24 hours
Friday   1/12/07   Ensures notifications have                   X
                   been made
Friday   1/12/07   Sends required IRF form         X
                   to DCBDD by 3pm. This is
                   considered DCBDD’s
                   discovery date
Mon      1/15/07   IA places the incident on                    X
                   ITS by 3pm
MUI Reporting, Investigation,
Follow-up, and Closure
Day      Date      Action                       Provider   IA       ODMRDD
Tues     1/16/07   IA interviews victim                         X
                   within 3 working days
Thurs    1/25/07   Agency provider HR report       X
                   sent to IA within 14
                   calendar days
Friday   2/23/07   Final report placed in ITS                   X
                   within 30 working days
Friday   2/23/07   Closure within 30 working                    X
                   days
Wed      2/28/07   ODMRDD reviews and                                 X
                   closes case within 3
                   working days
Friday   3/2/07    IA sends out written                         X
                   summary within 5
                   calendar days after
                   recommended for closure
Wed      3/7/07    IA provides disposition to                   X
                   PPI within 5 working days
   (M) Unusual Incident Requirements
    and Service Exceptions
(M)(1) Implement a Policy and
Procedure
   Each agency provider and county board
    as a provider
   Identifies what is to be reported
   Anyone who becomes aware – report to
    designated person
   No later than 24 hours
   Appropriate actions to protect health
    and safety
(M)(2) Trained and
Knowledgeable Staff
   Agency provider and county board as a
    provider must be trained on specific
    agency policy and procedure
   Individual provider – Initial and annual
    training on DCBDD policy and
    procedure
(M)(3)Unusual Incident
Notification
   If the incident occurs at a county board
    operated or contracted site, the county
    board or contracted entity notifies:
       the licensed provider,
       staff, or family at the individual’s home
   Same day notification
(M)(4)
   Individual providers make reports to the
       person designated by the county board on the
        same day as discovery
   The county board designates a person to log
    the incidents – DCBDD designates the
    Support Administrator
   Rule does not specify report must be written;
    suggested best practice –write and maintain
    IRFs
(M)(5) Unusual Incidents are
Reviewed at Least Monthly
   Who – agency providers and county
    board as a provider
       Support Administrator performing required
        tasks for individual providers are
        considered “county board as a provider”
   Appropriate preventive measures
   Trends and patterns identified and
    addressed
(M)(6)
   Unusual incident reports,
    documentation of trends and patterns,
    and corrective action made available to
    the county board and Department upon
    request.
(M)(7) Maintain a Log of
Unusual Incidents
   Who – agency providers and county
    board as a provider
   Name of individual
   Brief description of incident
   Any injuries
   Time/date/location
   Preventive measures
(M)(8) County Board Review of
Representative Sampling of Logs
   Monthly
   Provider logs, individual logs, and county
    board as a provider
   Ensure none are MUIs
   Ensure trends and patterns have been
    identified and addressed
   Provide to Department to review upon
    request
(M)(9) Department Review of
Representative Sampling of Logs
   Monthly
   County board as a provider logs
   Submit to Department upon request
   Ensure none are MUIs
   Ensure trends and patterns have been
    identified and addressed
(M)(10) Trends and Patterns of Unusual
Incidents Addressed in the ISP
   Who – agency provider and county board as
    a provider
   Rule does not specify SA, but it is logical to
    make the connection as it pertains to ISP
    development
   SA for individual provider
   Team - UI’s and MUI’s should be addressed
    by the team prior to and during ISP
    development

								
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