{"report_id":213,"form_id":"23","user_id":81,"organization_id":10,"question_id":"98","question_type":"Free_Text","text_answer":"Debriefing 1 \r\nThe home was created in 2007 and licensed for 3 beds. Referrals were in from other counties; however, at the same time 2 MSOCS homes were being closed in the county and St. Louis County needed those beds. Host county concurrence from St. Louis County was denied on the 3 out of county individuals. Administration felt that they were forced into taking the three people who eventually moved in. All three had 1:1 staffing ratios when they came in. Even at that time, staff felt that the one individual should have been a 2:1; however, this was not approved by the county. He would bite himself, bite others, hit things which often resulted in daily restraints. He was on a Rule 40 program that created a plan for these restraints. Through the years adjustments were made to the home, attempting to reinforce walls, replacing toilets, industrial sheetrock, etc. \r\n\r\nIn 2017, one of the individuals in the home passed away. The home then went from 3 licensed beds to 2 licensed beds, subsequently only now having 2 staff members in the home where prior to 2017 there were 3. Through the next few years, the individual\u2019s behaviors continued to be present but with the loss of the one staff member, it made it more difficult to intervene. This even resulted in a 60 day termination notice being issued in April 2018; however, no alternative housing option was ever found so the individual never did move from the home .The county was approached about developing a specialized home for the one individual; however, due to banding, which is when rates are locked only allowing incremental increases, they were told this couldn\u2019t happen. In 2019, the banding was frozen so there was no slight increase they saw on their rate. They realize they could have put in 2:1 staffing, but they would have \u201cate the cost\u201d for this as they would not be reimbursed for the extra staffing. \r\nThrough the years, the individual worked with one staff member who he tended to do better with. This was helpful in having to bring the individual places because they would try to schedule it with the one staff member. However, the staff member resigned in the fall of 2019. With the staff member\u2019s departure, it appeared that the individual\u2019s behaviors started to increase. They attempted various things, some even being quite non-conventional such as getting \u201cgay man pheromones\u201d. At the time of the notice, 911 was called 2 days in a row. They eventually brought him to the Duluth ER where once there, he was restrained by 8 hospital staff.\r\n\r\nWhen asked about other impacts of the situation they found themselves in, the quality of employees was quickly brought up. There continues to be a staffing shortage and it is difficult to find staff, let alone finding staff with any experience or other qualifications. There is also a concern that our state is missing a part of the continuum of care, specifically that there is little to no institutional care option that would allow individuals a longer period of stabilization. \r\n\r\nDebriefing 2 \r\nStaff members were at a point where they were no longer being effective in managing the individual\u2019s behaviors. He went to the annual assessment meeting and saw the extremely high number of PRN\u2019s being given. He realized they were using that as a means to control and \u201cif we\u2019re doing that something is wrong.\u201d In further looking at this, he discovered that the documentation wasn\u2019t always consistent depending on what staff member was documenting. Many behaviors were not being reported in the documentation or if they were, it wasn\u2019t consistent amongst staff on how they were recorded. He felt that they weren\u2019t training staff right. It was difficult to get staff to recognize what they were seeing. The house manager did not experience the same behaviors as the other staff; therefore, what he was reporting was not consistent with what staff experienced. The individual tended to treat certain staff differently, being particularly worse for women.\r\n\r\nAbout three years ago, the number of injuries that staff were sustaining started to rise consistently. Many workman\u2019s comp claims, particularly with concerns about staff being bit. It came down to the realization that they did not have the right house for him and the concerns for staff\u2019s safety. He felt strongly that staff did not fail the individual but rather the individual needed different suppor","created_by":81,"updated_by":81,"updated_at":"5\/26\/2021 4:46:01 pm","created_at":"5\/26\/2021 4:46:01 pm","id":37705}