Provider Rule Training

1. Provider Rule Training Effective7/1/07

2. 2007 Trends • Neglect • Not following Supervision Plan • Left Alone at Home • Sleeping • Left in Vehicle • Physical Abuse • Punched • Slapped • Pushed • Grabbed • Sexual Abuse • Peer – Sexual Contact about 65% of the time • Misappropriation • Credit Cards • Utilities • Cell Phone Expenses • Lack of Agency/Co. Bd. Oversight • Home Manager – All Control > No oversight • Verbal Abuse • Harsh Abusive Language • Not Reported – Tolerated by Other Staff

3. Incident Reporting (M)(1) Each agency provider shall develop and implement a policy/procedure that: (a) Identifies what is to be reported as a UI (b) Requires anyone who becomes aware of a UI to report to the person designated by the provider who can initiate proper action (c) Requires written report no later than 24 hours after the incident occurred (d) Requires appropriate actions be taken to protect the health/safety of any at-risk individual.

4. Agency Provider and County Board as provider report to County Board MUI or IA Section

5. County Board IA/MUI contact reviews all potential incidents and determines yes or no

6. Immediate Actions to protect the individual and other individuals from harm

7. Reporting Timeframes • Immediate for potential Abuse/Neglect/Exploitation or Misappropriation, Peer-to-Peer, and all Deaths • Others to County Board IA by next working day

8. Incident Reporting Form • Who – What – Where – How - When – Why • Detail • Timeframes

9. MUI Means… • Alleged, suspected or actual occurrence • Reason to believe a person is at risk of harm based on facts present not opinion • Receiving services or will be as a result of incident

10. Physical Abuse • Physical force • Reasonably be expected to result in harm Examples: Hitting, slapping, pushing, dragging or throwing an object when the allegation indicates that it could reasonably result in harm

11. Sexual Abuse • Unlawful sexual contact • Unlawful sexual conduct • Public indecency, voyeurism, importuning, etc.

12. Verbal Abuse • Purposeful use of words or gestures • Threaten, coerce, intimidate, harass, humiliate

13. Attempted Suicide • Physical attempt that: • Results in ER treatment or • Inpatient observation or • Hospital admission

14. Death • All deaths of individuals served

15. Exploitation Unlawful or improper act Using individual Individual’s resources for personal benefit, profit, or gain

16. Failure to Report (Criminal) 5123.61(C) • Person has reason to believe • Individual suffered or faces a substantial risk of suffering • Any wound, injury, disability or condition to reasonably indicate Abuse or Neglect (including Misappropriation) • Did not immediately report or cause reports to be made to law enforcement or a county board

17. Failure to Report (Registry) • MR/DD employee unreasonably failed to report Abuse or Neglect pursuant to 5123.61(C) • Knew or should have known • Failure would result in a substantial risk of harm

18. Known Injury • Known cause • Not Abuse or Neglect • Requires: • Immobilization or casting • Five or more sutures or equivalent • 2nd or 3rd degree burns • Dental injuries • Injury that prohibits participation in daily routine tasks for more than 2 consecutive days

19. Unknown Injury • Unknown cause • Not considered possible Abuse or Neglect • Requires treatment that only a physician, physician assistant, or nurse practitioner can provide

20. Law Enforcement Individual is: charged (C) incarcerated (I) arrested (A)

21. Medical Emergency Emergency medical intervention required to save one’s life includes Heimlich Maneuver, CPR, and IV for dehydration, etc.

22. Misappropriation • With intent • Deprive, defraud, or otherwise obtain real or personal property • As prohibited in Ohio Revised Code 2911 and 2913

23. Missing Individual • Has been reviewed for neglect • Not located per ISP and actions identified in plan and in search of immediate surrounding area OR • Circumstances indicate immediate jeopardy OR • Law enforcement was called to assist

24. Neglect • When you have a duty and you • Fail to provide treatment, care, goods, supervision or services • That result in a reasonable risk of harm

25. Peer-to-Peer Acts • One individual against another • Physical Abuse with intent to harm • Verbal Abuse with intent to threaten, coerce, intimidate, harass or humiliate • Any Sexual Abuse • Any Exploitation • Any intentional Misappropriation of significant value

26. Prohibited Sexual Relations • MR/DD employee • Consensual sexual conduct or contact • With an individual who is not their spouse • Employed or under contract to provide care to the individual at the time of the incident • Anyone in the MR/DD employee’s supervisory chain of command

27. Rights Code Violation • Any violation of rights listed in Ohio Revised Code 5123.62 and it creates a reasonable risk of harm

28. Unapproved Behavior Support • Any adverse strategy or intervention • Implemented without approval by committee and guardian or without informed consent

29. Unscheduled Hospitalization • Hospital admission that is not scheduled Unless • Due to condition specified in ISP or nursing care plan • Specific symptoms and criteria must be listed that lead to hospitalization

30. Event not consistent with routine operation, policy and procedure, or care or plan for the individual Includes but not limited to: Medication errors Falls Peer-to-peer that are not MUIs Overnight relocation Injury that is not an MUI Refusal to take meds Unusual Incident

31. (L) Analysis of MUI Trends and Patterns

32. (L)(1) MUI Analysis for Trends and Patterns Two Times Per Year • Quarterly trends and patterns are to be completed by all agency providers and county board as providers • The county board shall review all agency providers for quarterly trends and patterns

33. (L)(1) MUI Analysis for Trends and Patterns Two Times Per Year • The semi-annual review shall be cumulative for the first two quarters and include an in-depth analysis • The annual review shall be inclusive for the year and include an in-depth analysis

34. (L)(1) County Board’s Analysis and Follow-Up • Each review shall take preventive measures to address trends and patterns • All reviews and analysis are to be completed within 30 days following the end of the quarter

35. (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

36. (M) Unusual Incident Requirements

37. (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

38. (M)(5) Unusual Incidents are Reviewed at Least Monthly • Who – agency providers and county board as a provider • Appropriate preventive measures • Trends and patterns identified and addressed

39. (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

40. (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

41. (M)(10) Trends and Patterns of Unusual Incidents Addressed in the ISP • Who – agency provider and county board as a provider

42. TRAINING MUI Rule training is required for all county, state, and provider personnel.

43. (P)(1) Training on Identification and Reporting Requirements Who: All agency providers and county boards. When: Prior to unsupervised contact and no later than 30 calendar days after employment and annually thereafter (calendar year). Includes review of health/safety Alerts issued since the last training.

44. (P)(2) Individual Provider Training on Identification and Reporting • Based accordingly to certification requirements • Annually, based on certification date • Includes review of Alerts issued since the previous year’s training

45. Thank You