{"report_id":237,"form_id":"23","user_id":81,"organization_id":10,"question_id":"98","question_type":"Free_Text","text_answer":"Staff participated in a human factors debriefing, led by a Safety Analyst, on August 27, 2019 at the group home in Richfield where the VA resides.\r\n\r\nThe slow pace of one of the people on the outing impacted the staff persons focus during the outing and he lost sight of one the housemates. The staff placed importance on the safety of the other people in the group when he made the decision to place them in the van while he sought help in locating the missing person. He did not want to lose other people. This decision was further influenced by fact, he was the only staff person on the outing and he had never been to Como Park before so he was not familiar with the park or available resources.","created_by":81,"updated_by":81,"updated_at":"5\/26\/2021 5:33:54 pm","created_at":"5\/26\/2021 5:33:54 pm","id":39003}