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16:15:22'),(14238,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17311,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"126\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17311}','68.53.115.247','2021-05-25 16:15:22'),(14239,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17312,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"432\",\"question_type\":\"Yes_or_No\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17312}','68.53.115.247','2021-05-25 16:15:22'),(14240,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17313,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"10\\/15\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:50 am\",\"created_at\":\"5\\/25\\/2021 11:15:50 am\",\"id\":17313}','68.53.115.247','2021-05-25 16:15:50'),(14241,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17314,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"76\",\"question_type\":\"Short_Answer\",\"text_answer\":\"201906864\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:58 am\",\"created_at\":\"5\\/25\\/2021 11:15:58 am\",\"id\":17314}','68.53.115.247','2021-05-25 16:15:58'),(14242,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17315,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"10\\/15\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:58 am\",\"created_at\":\"5\\/25\\/2021 11:15:58 am\",\"id\":17315}','68.53.115.247','2021-05-25 16:15:58'),(14243,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17316,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"78\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Sara Beauchene\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:58 am\",\"created_at\":\"5\\/25\\/2021 11:15:58 am\",\"id\":17316}','68.53.115.247','2021-05-25 16:15:58'),(14244,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17317,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"79\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Tony Gantenbein\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:58 am\",\"created_at\":\"5\\/25\\/2021 11:15:58 am\",\"id\":17317}','68.53.115.247','2021-05-25 16:15:58'),(14245,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17318,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"80\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Stepping Stones for Living\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:58 am\",\"created_at\":\"5\\/25\\/2021 11:15:58 am\",\"id\":17318}','68.53.115.247','2021-05-25 16:15:58'),(14246,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17319,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"81\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Laura Flynn\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17319}','68.53.115.247','2021-05-25 16:15:59'),(14247,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17320,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"82\",\"question_type\":\"Short_Answer\",\"text_answer\":\"laura.flynn@sslduluth.com\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17320}','68.53.115.247','2021-05-25 16:15:59'),(14248,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17321,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"83\",\"question_type\":\"Short_Answer\",\"text_answer\":\"218-336-6413\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17321}','68.53.115.247','2021-05-25 16:15:59'),(14249,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17322,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Staff Sleeping on Duty\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17322}','68.53.115.247','2021-05-25 16:15:59'),(14250,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17323,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17323}','68.53.115.247','2021-05-25 16:15:59'),(14251,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17324,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-09-19 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17324}','68.53.115.247','2021-05-25 16:15:59'),(14252,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17325,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"On 09\\/19\\/2019, it was reported that AP was found sleeping during their shift when they were to be supervising VA. At this time it is undetermined how long AP was asleep for. No harm came to VA during this time.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17325}','68.53.115.247','2021-05-25 16:15:59'),(14253,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17326,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17326}','68.53.115.247','2021-05-25 16:15:59'),(14254,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17327,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"One staff fell asleep during the day shift.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17327}','68.53.115.247','2021-05-25 16:15:59'),(14255,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17328,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"No\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17328}','68.53.115.247','2021-05-25 16:15:59'),(14256,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17329,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17329}','68.53.115.247','2021-05-25 16:15:59'),(14257,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17330,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17330}','68.53.115.247','2021-05-25 16:15:59'),(14258,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17331,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Staff No Longer Employed\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17331}','68.53.115.247','2021-05-25 16:15:59'),(14259,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17332,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"St. Louis County (Provider-Stepping Stones for Living)\\r\\nNarrative-Staff Sleeping\\r\\n\\r\\nLearning point: One staff fell asleep during the day shift. \\r\\n\\r\\nA DSP was found sleeping during the day shift while supervising two VAs. No harm came to VAs as a result. The staff sleeping was influenced by environmental factors in the home as well as outside factors. \\r\\n\\r\\nOne environmental factor in the home the day of the incident was that there were less people for the DSP to supervise than normal. There is usually an additional person to supervise, as the staffing ratio was 1:3. The third person was at an activity at the time. Due to this, the house was more quiet than usual which allowed for a more relaxed environment that lent itself to rest. For residents of the home, their needs are defined by assessment results and outlined in a Community Services and Support Plan. The level of staffing needed to address these needs is agreed to by provider and lead agency via a rate management worksheet called a 6790. The rates for the services which take into account shared and individual staffing are then entered into and set by the Disability Waiver Rates System (DWRS). \\r\\nAnother environmental factor in the home was the daily program consisted of unstructured home time and TV watching. That day, the house was quiet and there was unstructured TV watching time. Programs or daily schedules for residents are outlined in their CSSP and supported by policies that emphasize and protect personal preference. Personal preference and control over one\\u2019s schedule is a tenant of the federal Home and Community Based Services Rule which governs HCBS providers. Additionally, residential providers are required to carry a 245D license which secures a person\\u2019s right to choose activities they prefer and have a say in their daily schedule. This unstructured time was an additional factor that led to a quiet house in which the staff experienced down time, leading to sleep. \\r\\nOutside factors that contributed to staff sleeping were also present. One outside factor is that the DSP was experiencing homelessness and was exhausted from that life stressor. It is not uncommon for DSPs to experience intermittent homelessness. In the Northeast MN region, there is a lack of affordable housing, housing resources and coordination. The governmental body that oversees housing and distribution of housing resources is Housing and Urban Development. \\r\\nAnother outside factor is the DSP was working extra shifts as the provider had unfilled shifts available. In doing so, the DSP\\u2019s basic needs such as having a roof over his head were met. He picked up extra shifts also because the provider was offering overtime pay. The fact the provider had unfilled shifts is due to the well-known and highly publicized state and national workforce shortage.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17332}','68.53.115.247','2021-05-25 16:15:59'),(14260,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17333,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17333}','68.53.115.247','2021-05-25 16:15:59'),(14261,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17334,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17334}','68.53.115.247','2021-05-25 16:15:59'),(14262,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17335,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17335}','68.53.115.247','2021-05-25 16:15:59'),(14263,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17336,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17336}','68.53.115.247','2021-05-25 16:15:59'),(14264,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17337,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17337}','68.53.115.247','2021-05-25 16:15:59'),(14265,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17338,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17338}','68.53.115.247','2021-05-25 16:15:59'),(14266,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17339,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":\"One environmental factor in the home the day of the incident was that there were less people for the DSP to supervise than normal. There is usually an additional person to supervise, as the staffing ratio was 1:3. The third person was at an activity at the time. Due to this, the house was more quiet than usual which allowed for a more relaxed environment that lent itself to rest. For residents of the home, their needs are defined by assessment results and outlined in a Community Services and Support Plan. The level of staffing needed to address these needs is agreed to by provider and lead agency via a rate management worksheet called a 6790. The rates for the services which take into account shared and individual staffing are then entered into and set by the Disability Waiver Rates System (DWRS). \\r\\nAnother environmental factor in the home was the daily program consisted of unstructured home time and TV watching. That day, the house was quiet and there was unstructured TV watching time. Programs or daily schedules for residents are outlined in their CSSP and supported by policies that emphasize and protect personal preference. Personal preference and control over one\\u2019s schedule is a tenant of the federal Home and Community Based Services Rule which governs HCBS providers. Additionally, residential providers are required to carry a 245D license which secures a person\\u2019s right to choose activities they prefer and have a say in their daily schedule. This unstructured time was an additional factor that led to a quiet house in which the staff experienced down time, leading to sleep.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17339}','68.53.115.247','2021-05-25 16:15:59'),(14267,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17340,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17340}','68.53.115.247','2021-05-25 16:15:59'),(14268,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17341,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":\"Outside factors that contributed to staff sleeping were also present. One outside factor is that the DSP was experiencing homelessness and was exhausted from that life stressor. It is not uncommon for DSPs to experience intermittent homelessness. In the Northeast MN region, there is a lack of affordable housing, housing resources and coordination. The governmental body that oversees housing and distribution of housing resources is Housing and Urban Development. \\r\\nAnother outside factor is the DSP was working extra shifts as the provider had unfilled shifts available. In doing so, the DSP\\u2019s basic needs such as having a roof over his head were met. He picked up extra shifts also because the provider was offering overtime pay. The fact the provider had unfilled shifts is due to the well-known and highly publicized state and national workforce shortage.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17341}','68.53.115.247','2021-05-25 16:15:59'),(14269,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17342,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"105\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17342}','68.53.115.247','2021-05-25 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16:15:59'),(14290,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17363,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"126\",\"question_type\":\"Free_Text\",\"text_answer\":\"Outside factors that contributed to staff sleeping were also present. One outside factor is that the DSP was experiencing homelessness and was exhausted from that life stressor. It is not uncommon for DSPs to experience intermittent homelessness. In the Northeast MN region, there is a lack of affordable housing, housing resources and coordination. The governmental body that oversees housing and distribution of housing resources is Housing and Urban Development. \\r\\nAnother outside factor is the DSP was working extra shifts as the provider had unfilled shifts available. In doing so, the DSP\\u2019s basic needs such as having a roof over his head were met. He picked up extra shifts also because the provider was offering overtime pay. The fact the provider had unfilled shifts is due to the well-known and highly publicized state and national workforce shortage.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17363}','68.53.115.247','2021-05-25 16:15:59'),(14291,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17364,'{\"report_id\":226,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"432\",\"question_type\":\"Yes_or_No\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:59 am\",\"created_at\":\"5\\/25\\/2021 11:15:59 am\",\"id\":17364}','68.53.115.247','2021-05-25 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16:16:35'),(14302,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17375,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Hennepin County\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17375}','68.53.115.247','2021-05-25 16:16:35'),(14303,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17376,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2020-06-29 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17376}','68.53.115.247','2021-05-25 16:16:35'),(14304,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17377,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"On 06\\/29\\/2020 VA packed up his belongings at approximately 6:00 pm and left the home, stating he was going to\\r\\nChicago to visit his sister. VA then proceeded to walk towards the bus stop and waited. Staff followed the bus once VA got on the bus. Staff\\r\\ncontacted Metro Transit Police for assistance, who then intervened. The officer called the Supervisor, who then called in the Community\\r\\nLiving Director (CLD) as well, via phone, to discuss the situation. The CLD explained VA\'s situation and that he is on a commitment and\\r\\nprovisional discharge, and requested assistance in getting the VA back to the residence. The officer informed the CLD and supervisor that\\r\\ndue to VA being their own guardian and not being a danger to himself or others, they could not do anything except encourage VA to go with\\r\\nstaff. The CLD then met VA and staff at the Greyhound Bus Station in Minneapolis a little before 8:00 pm, just as VA was purchasing a bus\\r\\nticket to Chicago. Staff and CLD attempted every approach they could think of to get VA to reconsider leaving the state, but VA still planned\\r\\nto get on the bus. VA reported having connections in Chicago and has a plan, but would not share any further details. VA recently\\r\\npurchased a cell phone, but refused to give staff the phone number to the new phone. The CLD called Fairview Hospital to discuss the\\r\\nsituation, but they also stated \\\"our hands are tied\\\" since VA is his own guardian. Staff remained with VA at the bus station until 1:00 am on\\r\\n06\\/30\\/2020, when VA left on the greyhound bus to Chicago. The CLD filed a missing persons report with the Minneapolis Police\\r\\nDepartment, who stated they would pass this report along to the Chicago Police Department as well. The CLD attempted to contact VA\'s\\r\\nmother, but the mother\'s phone was disconnected. The CLD also attempted to call VA\'s grandmother, who did not answer or respond to\\r\\nthe CLD\'s voicemails.\\r\\nStaff followed all care plans and attempted to redirect VA into not going on the bus, but VA made the choice to leave. VA did not have any\\r\\nmedications packed and is due for an injection on 07\\/08\\/2020. VA is prescribed multiple psychotropic medications, including an injection.\\r\\nVA has a history of attempting to\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17377}','68.53.115.247','2021-05-25 16:16:35'),(14305,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17378,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17378}','68.53.115.247','2021-05-25 16:16:35'),(14306,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17379,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff did not follow person\\u2019s plan that said the person should not have alone time.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17379}','68.53.115.247','2021-05-25 16:16:35'),(14307,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17380,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17380}','68.53.115.247','2021-05-25 16:16:35'),(14308,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17381,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2020-10-06 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17381}','68.53.115.247','2021-05-25 16:16:35'),(14309,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17382,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Two night staff from Bridges were de-briefed.  They relieved two second shift staff who followed the person to the bus station and worked to help attempt to help the person return home.  \\r\\n\\r\\nThe staff worked by relieving each other in the bus station as there was not adequate parking at the bus station so they had to park on the street and one person needed to remain in the car to assure it did not get towed.   They both stated the person would not talk to them and the bus station was very busy.  The person smoked frequently outside the bus station while waiting for departure.   Staff also had one mask to share while switching spots from the car to inside the bus station next to the person.  Staff would use their shirt as a mask while switching.   The person spent most of their time listening to music and ignoring staff.   Staff attempted several times to have a conversation in an effort to persuade the person to return back to the home.   At about 1:00 AM the person departed on the bus and staff returned back to the home.   Staff were in frequent contact with the home manager for guidance. Staff were instructed to remain with the person at the bus station, however, they were instructed that he was his own guardian and could leave.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17382}','68.53.115.247','2021-05-25 16:16:35'),(14310,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17383,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17383}','68.53.115.247','2021-05-25 16:16:35'),(14311,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17384,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"Learning Point:  Staff were unable to redirect a person from departing on a bus to Chicago.  \\r\\n\\r\\nStaff was unable to redirect a person from departing on a bus to Chicago and this was influenced by wanting to go to Chicago to visit their sister. This matter was complicated given the person wouldn\\u2019t communicate with staff present.  All efforts to redirect the person were unsuccessful while exhausting all other safe alternatives. The person was earlier hospitalized regarding mental health and aggression and the staff was hesitant at the moment and didn\\u2019t want to anger the person further. Another contributing factor was that the person received a COVID stimulus check that created the means for the visit to Chicago.    \\r\\n\\r\\nStaff being unable to redirect the person was influenced by the provider ultimately determining the risk was low to take the trip without staff. After many unsuccessful attempts to redirect, the provider reviewed the person\\u2019s risk management plan and it was affirmed. Contributing factors that further influenced the staffs\\u2019 decision to remain at the bus station was the expectation of the lead agency and CSSP was not to follow a person to another state while eloping and assure full communication with all team members and agency staff.\\r\\n\\r\\nAnother influence to the inability to redirect was that staff were hesitant to anger the person. This was further supported by the person having a history of aggressive behavior. The person wouldn\\u2019t communicate with the staff present and they were hesitant to coerce the person too much in their efforts to support him in being safe. Staff also did offer to support this trip at a future date with proper planning to assure health and safety. This moment was further complicated by contacting the hospital who stated there was nothing they or staff could do given the person was his own guardian which further limited staff in their efforts to help him return home.\\r\\n\\r\\nAn additional feature that impacted the support lent to the person was the agency\\u2019s practice of person-centered efforts in trying to find balance of what was important to and for the person while making decisions at that moment. Their operating philosophy supported personal freedoms and choices based on experiences over time.  There is also an overall systemic expectation that providers support experiences, choices, and the person\\u2019s rights.   \\r\\n\\r\\nStaff being unable to redirect was influenced by the provider exhausting all safe alternatives. The person is their own guardian and did have a provisional discharge from the program.  Furthermore, COVID and the Governor\\u2019s stay at home order also influenced the person\\u2019s decision to leave as his routine was limited to low activity. This elopement influenced the agency, team, and staff present to honor the person\\u2019s civil rights which connected directly to their philosophy of protecting his rights which put him in charge of making the decision to leave on the bus.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17384}','68.53.115.247','2021-05-25 16:16:35'),(14312,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17385,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17385}','68.53.115.247','2021-05-25 16:16:35'),(14313,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17386,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17386}','68.53.115.247','2021-05-25 16:16:35'),(14314,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17387,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17387}','68.53.115.247','2021-05-25 16:16:35'),(14315,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17388,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17388}','68.53.115.247','2021-05-25 16:16:35'),(14316,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17389,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17389}','68.53.115.247','2021-05-25 16:16:35'),(14317,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17390,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17390}','68.53.115.247','2021-05-25 16:16:35'),(14318,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17391,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17391}','68.53.115.247','2021-05-25 16:16:35'),(14319,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17392,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17392}','68.53.115.247','2021-05-25 16:16:35'),(14320,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17393,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17393}','68.53.115.247','2021-05-25 16:16:35'),(14321,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17394,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"105\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17394}','68.53.115.247','2021-05-25 16:16:35'),(14322,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17395,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"106\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17395}','68.53.115.247','2021-05-25 16:16:35'),(14323,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17396,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"107\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17396}','68.53.115.247','2021-05-25 16:16:35'),(14324,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17397,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"108\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17397}','68.53.115.247','2021-05-25 16:16:35'),(14325,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17398,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"109\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17398}','68.53.115.247','2021-05-25 16:16:35'),(14326,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17399,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"110\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17399}','68.53.115.247','2021-05-25 16:16:35'),(14327,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17400,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"111\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17400}','68.53.115.247','2021-05-25 16:16:35'),(14328,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17401,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"112\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17401}','68.53.115.247','2021-05-25 16:16:35'),(14329,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17402,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"113\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17402}','68.53.115.247','2021-05-25 16:16:35'),(14330,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17403,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"114\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17403}','68.53.115.247','2021-05-25 16:16:35'),(14331,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17404,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"115\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17404}','68.53.115.247','2021-05-25 16:16:35'),(14332,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17405,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"116\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff was unable to redirect a person from departing on a bus to Chicago and this was influenced by wanting to go to Chicago to visit their sister. This matter was complicated given the person wouldn\\u2019t communicate with staff present.  All efforts to redirect the person were unsuccessful while exhausting all other safe alternatives. The person was earlier hospitalized regarding mental health and aggression and the staff was hesitant at the moment and didn\\u2019t want to anger the person further. Another contributing factor was that the person received a COVID stimulus check that created the means for the visit to Chicago.    \\r\\n\\r\\nStaff being unable to redirect the person was influenced by the provider ultimately determining the risk was low to take the trip without staff. After many unsuccessful attempts to redirect, the provider reviewed the person\\u2019s risk management plan and it was affirmed. Contributing factors that further influenced the staffs\\u2019 decision to remain at the bus station was the expectation of the lead agency and CSSP was not to follow a person to another state while eloping and assure full communication with all team members and agency staff.\\r\\n\\r\\nAnother influence to the inability to redirect was that staff were hesitant to anger the person. This was further supported by the person having a history of aggressive behavior. The person wouldn\\u2019t communicate with the staff present and they were hesitant to coerce the person too much in their efforts to support him in being safe. Staff also did offer to support this trip at a future date with proper planning to assure health and safety. This moment was further complicated by contacting the hospital who stated there was nothing they or staff could do given the person was his own guardian which further limited staff in their efforts to help him return home.\\r\\n\\r\\nAn additional feature that impacted the support lent to the person was the agency\\u2019s practice of person-centered efforts in trying to find balance of what was important to and for the person while making decisions at that moment. Their operating philosophy supported personal freedoms and choices based on experiences over time.  There is also an overall systemic expectation that providers support experiences, choices, and the person\\u2019s rights.   \\r\\n\\r\\nStaff being unable to redirect was influenced by the provider exhausting all safe alternatives. The person is their own guardian and did have a provisional discharge from the program.  Furthermore, COVID and the Governor\\u2019s stay at home order also influenced the person\\u2019s decision to leave as his routine was limited to low activity. This elopement influenced the agency, team, and staff present to honor the person\\u2019s civil rights which connected directly to their philosophy of protecting his rights which put him in charge of making the decision to leave on the bus.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17405}','68.53.115.247','2021-05-25 16:16:35'),(14333,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17406,'{\"report_id\":227,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"117\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:16:35 am\",\"created_at\":\"5\\/25\\/2021 11:16:35 am\",\"id\":17406}','68.53.115.247','2021-05-25 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16:17:15'),(14356,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17429,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"Peter walked to the store down the road from his home. He was gone for roughly 30 minutes. Peter does not have alone time.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17429}','68.53.115.247','2021-05-25 16:17:15'),(14357,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17430,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17430}','68.53.115.247','2021-05-25 16:17:15'),(14358,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17431,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff did not follow person\\u2019s plan that said the person should not have alone time\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17431}','68.53.115.247','2021-05-25 16:17:15'),(14359,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17432,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17432}','68.53.115.247','2021-05-25 16:17:15'),(14360,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17433,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2020-02-12 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17433}','68.53.115.247','2021-05-25 16:17:15'),(14361,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17434,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff did not follow person\\u2019s plan that said the person should not have alone time\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17434}','68.53.115.247','2021-05-25 16:17:15'),(14362,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17435,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17435}','68.53.115.247','2021-05-25 16:17:15'),(14363,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17436,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff not following the person\\u2019s plan that said they should not have alone time was influenced by the unfamiliarity the staff had at the home as they were transferred to cover appropriate shifts as the provider was short staffed. This required the provider to train the staff quickly to become familiar with the home and the people who lived there. When a staff trains at a new home, they have to read multiple plans for each person who lives in the home. The staff present the day of the incident worked at multiple homes to help fill shifts as the provider was short staffed. Low unemployment rates in the region and the state contributed to low unemployment rates, which in turn contributed the provider being short staffed. Adding to the unfamiliarity the staff had with the home, the person who eloped was difficult to understand and was noted to often test boundaries with staff which made it difficult for staff to understand that the person was not supposed to be alone.\\r\\n\\r\\nThe staff\\u2019s understanding of the difference between alone and community time further influenced the staff not following the person\\u2019s plan.  There was also another person in the home that did not have alone time which was contrary to the house norm which implied that each person had some alone time.  Furthermore, the two staff\\u2019s roles were not clearly communicated to them and the second staff didn\\u2019t counter the support staff\\u2019s understanding and may not have been aware.   The person\\u2019s plan stated they did have 10 minutes of home time alone but no unsupervised time in the community.  This created confusion for the staff who was new working in the home and had to train fast. \\r\\n\\r\\nThe basis for alone time according to the provider can be difficult to manage as staff have to read multiple plans for a person.  There was also pressure due to the staff shortage that is directly tied to regional and statewide staff shortages and overall low unemployment rates.  The CSSP no longer has a line to state whether a person has alone time hence creating confusion and vagueness.  The DWRS further influences the 6790 which connects to provider resources and their need to share a van with multiple locations that support people with disabilities.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17436}','68.53.115.247','2021-05-25 16:17:15'),(14364,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17437,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17437}','68.53.115.247','2021-05-25 16:17:15'),(14365,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17438,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17438}','68.53.115.247','2021-05-25 16:17:15'),(14366,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17439,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17439}','68.53.115.247','2021-05-25 16:17:15'),(14367,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17440,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17440}','68.53.115.247','2021-05-25 16:17:15'),(14368,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17441,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17441}','68.53.115.247','2021-05-25 16:17:15'),(14369,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17442,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17442}','68.53.115.247','2021-05-25 16:17:15'),(14370,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17443,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17443}','68.53.115.247','2021-05-25 16:17:15'),(14371,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17444,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17444}','68.53.115.247','2021-05-25 16:17:15'),(14372,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17445,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff not following the person\\u2019s plan that said they should not have alone time was influenced by the unfamiliarity the staff had at the home as they were transferred to cover appropriate shifts as the provider was short staffed. This required the provider to train the staff quickly to become familiar with the home and the people who lived there. When a staff trains at a new home, they have to read multiple plans for each person who lives in the home. The staff present the day of the incident worked at multiple homes to help fill shifts as the provider was short staffed. The basis for alone time according to the provider can be difficult to manage as staff have to read multiple plans for a person.   The CSSP no longer has a line to state whether a person has alone time hence creating confusion and vagueness.  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This required the provider to train the staff quickly to become familiar with the home and the people who lived there.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17459}','68.53.115.247','2021-05-25 16:17:15'),(14387,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17460,'{\"report_id\":228,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"119\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:17:15 am\",\"created_at\":\"5\\/25\\/2021 11:17:15 am\",\"id\":17460}','68.53.115.247','2021-05-25 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16:18:16'),(14406,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17479,'{\"report_id\":232,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:18:16 am\",\"created_at\":\"5\\/25\\/2021 11:18:16 am\",\"id\":17479}','68.53.115.247','2021-05-25 16:18:16'),(14407,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17480,'{\"report_id\":232,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-03-22 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:18:16 am\",\"created_at\":\"5\\/25\\/2021 11:18:16 am\",\"id\":17480}','68.53.115.247','2021-05-25 16:18:16'),(14408,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17481,'{\"report_id\":232,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff 1 administered the person another roommates\\u2019 medication at 8:15pm on 3\\/22\\/19. Immediately following, Staff 1 notified the facility\'s RN Consultant, the person\'s primary physician, poison control, and the home\'s Associate Director. Poison Control suggested that the person be transported to a local emergency room for treatment. The Staff 1 immediately dialed 9-1-1and activated EMS. EMS arrived and brought the person to St. Mary\'s Medical Center ER in Duluth via Gold Cross Ambulance. VA was brought into an ER room and assessment began. The Associate Director met the person at the hospital. The person was given IV fluids as a precaution. Blood was drawn and x-rays were taken. ER MD planned on transferring person from the ER to a regular room for overnight observation. In the interim, the person had a seizure in the ER and the ER MD\'s plan was changed to have him transferred to an ICU bed for monitoring. The person was moved from the ICU to a regular hospital room on 4 East the next day. The person was discharged from the hospital on 3\\/24 at 1:30pm as he returned to baseline without any adverse effects per Hospitalist.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:18:16 am\",\"created_at\":\"5\\/25\\/2021 11:18:16 am\",\"id\":17481}','68.53.115.247','2021-05-25 16:18:16'),(14409,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17482,'{\"report_id\":232,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:18:16 am\",\"created_at\":\"5\\/25\\/2021 11:18:16 am\",\"id\":17482}','68.53.115.247','2021-05-25 16:18:16'),(14410,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17483,'{\"report_id\":232,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Agency staff administered incorrect medication to a person living in the home.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:18:16 am\",\"created_at\":\"5\\/25\\/2021 11:18:16 am\",\"id\":17483}','68.53.115.247','2021-05-25 16:18:16'),(14411,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17484,'{\"report_id\":232,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:18:16 am\",\"created_at\":\"5\\/25\\/2021 11:18:16 am\",\"id\":17484}','68.53.115.247','2021-05-25 16:18:16'),(14412,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17485,'{\"report_id\":232,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2019-08-01 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:18:16 am\",\"created_at\":\"5\\/25\\/2021 11:18:16 am\",\"id\":17485}','68.53.115.247','2021-05-25 16:18:16'),(14413,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17486,'{\"report_id\":232,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff 1 arrived at work at 2:00pm and described it as a normal day.  The person 1 who received the incorrect medication was picked up by his Mother around 3:00pm and staff was told they would be back at 6:00pm.   Staff 1 stated that the person receives seizure medications and it is important to administer at specific times per doctors\\u2019 orders.   Missing medications or being untimely can trigger seizures.   Evening medication pass is at 7:00pm and as of 7:30pm the person 1 did not arrive home.  Staff 1 stated they felt anxious about not being able to pass medications, however, there is a one hour window on each side of medication passes.   Therefore, medications could be passed between 6:00pm and 8:00pm.   As of 8:30pm, the person 1 did not arrive and staff 2\\u2019s shift ended. Staff 2 asked staff 1 if he could administer all medications to the people who lived there.  Staff 1 agreed and continued to feel anxious given the person was not home and was not able to administer medications.     \\r\\n\\r\\nStaff 1 began the process of a blood check that is routine for person 2 who lives in the home.   Person 2 receives sleep medication (Trazadone 300mg).   Staff 1 described that person 2 needed a lot of time to prepare for his blood check and taking his medications which required significant attention.  Person 2 was watching TV and required a lot of reminders to eventually transition to the kitchen area to take medications.  Staff 1 was eventually at the kitchen table with person 2 and began the blood check. At about 9pm, person 1 arrived home and staff 1 went to lock the medication cabinet that he had left open.  Staff 1 had already prepared person 1 and 2\\u2019s medications.  Staff 1 put both sets of medications on the table in apple sauce and then quickly passed medications to person 1.   Person 1 proceeded to eat a snack while staff 1 was finishing the blood check with person 2.   \\r\\n\\r\\nShortly after the medication was passed, staff 1 realized he gave person 1 the incorrect medication and proceeded to contact the house LPN and director.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:18:16 am\",\"created_at\":\"5\\/25\\/2021 11:18:16 am\",\"id\":17486}','68.53.115.247','2021-05-25 16:18:16'),(14414,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17487,'{\"report_id\":232,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:18:16 am\",\"created_at\":\"5\\/25\\/2021 11:18:16 am\",\"id\":17487}','68.53.115.247','2021-05-25 16:18:16'),(14415,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17488,'{\"report_id\":232,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"Agency staff administering the incorrect medication was influenced by passing medications in apple sauce to two people at the same time. Staff punched out medications for two people from pre-packaged bubble packs at the same time, placed them both in apple sauce but then could not differientiate between the medications in apple sauce.   An additional factor influencing giving the incorrect medication to the person was that the provider had one less staff working than they typically did during medication administration. The provider typically had a 2 staff to 4 person ratio until 8pm, so that two staff would be on during the 6p-8p med administration window. On this day, the person\\u2019s mother kept him out past the medication window, so that when he returned the second staff had left, leaving one staff on to administer the person\\u2019s meds when he arrived. The provider\'s staff ratio and schedule is influenced by the county\\u2019s service agreement with the provider to deliver services. MNCHOICES also influences how the county determines how many staffing hours to include in their service agreement and what medication administration responsibility they assign to the provider.    \\r\\n\\r\\nStaff had further constraints on their attention while assisting another person in the home with a blood check. This was further supported by staff worrying about the adverse effects of not passing seizure medications within the window of the medication protocol.  The pressure to pass timely seizure medications is based on the provider\\u2019s medication protocol. 245D licensing and nursing protocols further complicated the medication protocol which connects to the person\\u2019s physician who established specific times and dosages. Medications for both people were in apple sauce and when the person arrived staff felt pressure to pass medications and did pass the incorrect nighttime medications to the person.  \\r\\n\\r\\nThe DWRS, MNCHOICES assessment, and county service agreement also impacted the staff schedule and further complicated the medication protocol.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:18:16 am\",\"created_at\":\"5\\/25\\/2021 11:18:16 am\",\"id\":17488}','68.53.115.247','2021-05-25 16:18:16'),(14416,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17489,'{\"report_id\":232,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:18:16 am\",\"created_at\":\"5\\/25\\/2021 11:18:16 am\",\"id\":17489}','68.53.115.247','2021-05-25 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VA needed to go to the bathroom. Bathroom was at sight so AP let VA walk\\r\\nto the bathroom by himself. AP observed VA walk in to the bathroom but did not observe VA come out. After about 10 minutes, AP went to\\r\\ncheck the bathroom with Housemate but VA was not there. AP talked to an unknown cleaning lady about contacting the security. AP\\r\\ncontacted security and also called Nurse and Reporter. Nurse contacted Coordinator.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17583}','68.53.115.247','2021-05-25 16:21:08'),(14511,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17584,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17584}','68.53.115.247','2021-05-25 16:21:08'),(14512,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17585,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff did not continuously monitor a public restroom door a person with dementia was using.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17585}','68.53.115.247','2021-05-25 16:21:08'),(14513,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17586,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17586}','68.53.115.247','2021-05-25 16:21:08'),(14514,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17587,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2020-10-13 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17587}','68.53.115.247','2021-05-25 16:21:08'),(14515,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17588,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff drove two housemates to the Eden Prairie mall. The staff and housemates frequent the mall and are very familiar with the area. They parked in the back of the mall parking lot as they prefer the walk into the mall for some exercise. After shopping in the mall they stopped at the food court for lunch. The person who went missing brought his own lunch and after eating needed to use the restroom. This person had never used the restroom at this mall before. Staff stayed with the other person while he walked to the restroom. The restroom sign was in line of sight for the staff and staff saw the person enter the hallway that led to the restroom. There was only one entrance to the restroom area.  \\r\\n\\r\\nWhile the person was using the restroom, the staff reported the other person was experiencing anxiety. Staff is trained in positive behavior approaches and did help the person by talking to them while they used a paper bag to take some deep breaths. After about 10 minutes, staff and the person she was supporting went to the restroom area to check on the person as they did not see him exit. While she was assisting the person, she did have line of sight on the exit to her best knowledge. Staff checked the family and womens restroom, while the other person checked the mens restroom. The person was not present. Staff then spoke with a cleaning attendant and she helped contact the mall security.   \\r\\n\\r\\nMall security searched for the person while the staff and other person searched around the food court. Mall security then asked the staff to remain at the food court and that they would contact the police to assist.  Staff then called the Opportunity Partners nurse as the typical program manager was on vacation.  \\r\\n\\r\\nAt about 12:45 the mall security found the person standing by the staff\\u2019s vehicle. Mall security then reunited the staff with the person.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17588}','68.53.115.247','2021-05-25 16:21:08'),(14516,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17589,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17589}','68.53.115.247','2021-05-25 16:21:08'),(14517,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17590,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff did not continuously monitor a public restroom door a person with dementia was using. This was influenced by staff\\u2019s attention being diverted by both the crowded mall, as it was a busy Saturday at the food court, and assisting another person who was experiencing anxiety. The staff and the two people routinely went to this mall and the one person did not return from the restroom as anticipated.  Staff was within line of sight of the the entrance to the bathroom that only had one exit. The staff did not think using the restroom was a risk and assumed he\\u2019d return safely given they frequent the mall and are familiar. Staff knew there was not a back door behind the restrooms. \\r\\n\\r\\nThe person had only recently been diagnosed with dementia. While the company nurse trained the staff on supporting people with dementia, the staff was not certain what that meant for the person, but did have familiarity with supporting the person. The person also had been grieving the loss  of a long-time friend\\/room mate. Person-Centered practices influenced the decision to adhere to the person\\u2019s routine and community inclusion activities to have lunch at the mall. This situation was further complicated as the definition of the need of support was not synonimous with the agency\\u2019s definition. While the person\\u2019s CSSP required 24\\/7 supervision, it did not require \\u201cdirect line of sight\\u201d supervision in the community. Agencies are given flexibility in determining what level of supervision is required when the CSSP is not specific. Both the provider and case manager noted that \\u201cdirect line of sight\\u201d supervision would require 1:1 staffing, which was not supported in the person\\u2019s CSSP or 6790 rate form. \\r\\n\\r\\n\\r\\nThe providers policies allowed for a 1:2 staffing ratio which is influenced by the county via the 6790 rates form and DHS\\u2019s DWRS system. The person\\u2019s MNCHOICES assessment was not up for renewal for several months which creates more complexity while the person\\u2019s dementia as the condition possibly changes or is not understood over time and new symptoms develop. The provider noted that while many times a person with dementia has a higher staffing level in the community, this person did not yet have a higher staffing level as the person\\u2019s dementia had just recently developed. The provider had not sought out additional staff or funding for the person yet because they weren\\u2019t sure they could add more staff due to the workforce shortage and that the person had not yet had an episode of elopement. The provider noted that staffing levels were typically reactive after incidents rather than proactive to prevent them.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17590}','68.53.115.247','2021-05-25 16:21:08'),(14518,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17591,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17591}','68.53.115.247','2021-05-25 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16:21:08'),(14521,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17594,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17594}','68.53.115.247','2021-05-25 16:21:08'),(14522,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17595,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17595}','68.53.115.247','2021-05-25 16:21:08'),(14523,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17596,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17596}','68.53.115.247','2021-05-25 16:21:08'),(14524,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17597,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":\"This was influenced by staff\\u2019s attention being diverted by both the crowded mall, as it was a busy Saturday at the food court, and assisting another person who was experiencing anxiety.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17597}','68.53.115.247','2021-05-25 16:21:08'),(14525,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17598,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17598}','68.53.115.247','2021-05-25 16:21:08'),(14526,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17599,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17599}','68.53.115.247','2021-05-25 16:21:08'),(14527,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17600,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"105\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17600}','68.53.115.247','2021-05-25 16:21:08'),(14528,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17601,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"106\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17601}','68.53.115.247','2021-05-25 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16:21:08'),(14531,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17604,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"109\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17604}','68.53.115.247','2021-05-25 16:21:08'),(14532,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17605,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"110\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17605}','68.53.115.247','2021-05-25 16:21:08'),(14533,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17606,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"111\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17606}','68.53.115.247','2021-05-25 16:21:08'),(14534,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17607,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"112\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17607}','68.53.115.247','2021-05-25 16:21:08'),(14535,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17608,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"113\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17608}','68.53.115.247','2021-05-25 16:21:08'),(14536,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17609,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"114\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17609}','68.53.115.247','2021-05-25 16:21:08'),(14537,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17610,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"115\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17610}','68.53.115.247','2021-05-25 16:21:08'),(14538,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17611,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"116\",\"question_type\":\"Free_Text\",\"text_answer\":\"This situation was further complicated as the definition of the need of support was not synonymous with the agency\\u2019s definition. While the person\\u2019s CSSP required 24\\/7 supervision, it did not require \\u201cdirect line of sight\\u201d supervision in the community. Agencies are given flexibility in determining what level of supervision is required when the CSSP is not specific. Both the provider and case manager noted that \\u201cdirect line of sight\\u201d supervision would require 1:1 staffing, which was not supported in the person\\u2019s CSSP or 6790 rate form.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17611}','68.53.115.247','2021-05-25 16:21:08'),(14539,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17612,'{\"report_id\":230,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"117\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:21:08 am\",\"created_at\":\"5\\/25\\/2021 11:21:08 am\",\"id\":17612}','68.53.115.247','2021-05-25 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16:22:00'),(14606,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17679,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"81\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Chet Whitmore\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17679}','68.53.115.247','2021-05-25 16:22:00'),(14607,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17680,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"82\",\"question_type\":\"Short_Answer\",\"text_answer\":\"chet.whitmore@thomasalleninc.com\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17680}','68.53.115.247','2021-05-25 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16:22:00'),(14610,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17683,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Hennepin County\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17683}','68.53.115.247','2021-05-25 16:22:00'),(14611,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17684,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-06-27 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17684}','68.53.115.247','2021-05-25 16:22:00'),(14612,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17685,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"On 6\\/27\\/2019 between 8:00am and 9:30am, Staff 1 was driving person in their electronic wheelchair.  Staff 1 ran into door way, and the person\\u2019s leg got caught. The person\\u2019s leg looked swollen, so Reporter told Program Manager to bring VA to an Urgent Care (unknown information.) Reporter notified Guardian, Case Manager (unknown information,) and County Licensor. Urgent Care Physician (unknown information) told Program Manager to bring VA to an ER. Program Manager brought VA to an ER (unknown information,) and VA has a hairline fracture in VAs\' foot (unknown information.) VA was admitted to Hospital (unknown information.) Reporter is waiting to hear back to see what plan of action Hospital plans to take. Reporter will train AP on how to drive VAs\' wheelchair.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17685}','68.53.115.247','2021-05-25 16:22:00'),(14613,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17686,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17686}','68.53.115.247','2021-05-25 16:22:00'),(14614,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17687,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff did not have foot pedals on person\\u2019s wheelchair while driving the person to the restroom.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17687}','68.53.115.247','2021-05-25 16:22:00'),(14615,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17688,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17688}','68.53.115.247','2021-05-25 16:22:00'),(14616,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17689,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2019-09-05 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17689}','68.53.115.247','2021-05-25 16:22:00'),(14617,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17690,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff arrived at 6:00am and described the morning as a typical shift.  Staff took a Benadryl for allergy relief at 5:00am and described that the medication did not make her sleepy.  Staff then assisted the person with their morning routine by helping them use the restroom, bathing, and then going to the kitchen for breakfast.  The person has difficulty swallowing food and requires assistance eating and reminders to swallow twice.  Staff was doing a variety of household tasks and was helping people get ready between 6:00am and 8:00am.  There were three staff on duty that morning. \\r\\n\\r\\nAfter breakfast staff then assisted the person by driving her electric chair from the kitchen to the restroom without foot pedals.  The person does not like their foot pedals on the chair.  The person has a lot of rigidity in her muscles and her legs were sticking out the sides of the chair.  Staff stopped shortly before the doorway to do a task and then proceeded driving the person in their chair.  The person\\u2019s leg broke when their foot got caught on a cupboard door jam.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17690}','68.53.115.247','2021-05-25 16:22:00'),(14618,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17691,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17691}','68.53.115.247','2021-05-25 16:22:00'),(14619,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17692,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"Agency staff not having foot pedals on while driving the person\\u2019s wheelchair was influenced by the staffs\\u2019 divided attention.  Staff could not recall the specific task that divided her attention while being midway through the kitchen. The person had a preference against using foot pedals and communicates their preference by their rigidity and loud vocalizations.  This was further complicated by typical morning routine that resembles the practice of most busy group homes.  Additionally the staff pushing the wheelchair had a number of years of experience working with the person and felt more comfortable pushing the person without foot pedals. Furthermore, there were policies and plans that were conflicting related to wheel chair. The provider had a policy to always use foot pedals with wheelchairs for safety, but had also been pushing person-centered practices to support people they serve to have more control of daily decisions. \\r\\n\\r\\nThe CSSP and risk management plan followed standard wheelchair safety and practice related to the wheelchair manufacturer guidelines.  The general practice for wheel chair use conflicted with the agency\\u2019s practice. Team conversations about how this person wanted to live did not have consistency with the person\\u2019s plan and guidelines related to wheelchair use. 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The provider had a policy to always use foot pedals with wheelchairs for safety, but had also been pushing person-centered practices to support people they serve to have more control of daily decisions. \\r\\n\\r\\nThe general practice for wheel chair use conflicted with the agency\\u2019s practice.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17713}','68.53.115.247','2021-05-25 16:22:00'),(14641,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17714,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"117\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17714}','68.53.115.247','2021-05-25 16:22:00'),(14642,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17715,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"118\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17715}','68.53.115.247','2021-05-25 16:22:00'),(14643,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17716,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"119\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17716}','68.53.115.247','2021-05-25 16:22:00'),(14644,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17717,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"120\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17717}','68.53.115.247','2021-05-25 16:22:00'),(14645,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17718,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"121\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17718}','68.53.115.247','2021-05-25 16:22:00'),(14646,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17719,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"122\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17719}','68.53.115.247','2021-05-25 16:22:00'),(14647,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17720,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"123\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17720}','68.53.115.247','2021-05-25 16:22:00'),(14648,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17721,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"124\",\"question_type\":\"Free_Text\",\"text_answer\":\"Team conversations about how this person wanted to live did not have consistency with the person\\u2019s plan and guidelines related to wheelchair use. There was a practice of the home not to use foot pedals and given the numerous tasks in the morning, staff could not account for everything.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17721}','68.53.115.247','2021-05-25 16:22:00'),(14649,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17722,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"125\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17722}','68.53.115.247','2021-05-25 16:22:00'),(14650,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17723,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"126\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17723}','68.53.115.247','2021-05-25 16:22:00'),(14651,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17724,'{\"report_id\":233,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"432\",\"question_type\":\"Yes_or_No\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:00 am\",\"created_at\":\"5\\/25\\/2021 11:22:00 am\",\"id\":17724}','68.53.115.247','2021-05-25 16:22:00'),(14652,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17725,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"09\\/16\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:26 am\",\"created_at\":\"5\\/25\\/2021 11:22:26 am\",\"id\":17725}','68.53.115.247','2021-05-25 16:22:26'),(14653,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17726,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"76\",\"question_type\":\"Short_Answer\",\"text_answer\":\"201906219\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17726}','68.53.115.247','2021-05-25 16:22:32'),(14654,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17727,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"09\\/16\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17727}','68.53.115.247','2021-05-25 16:22:32'),(14655,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17728,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"78\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Tony Gantenbein\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17728}','68.53.115.247','2021-05-25 16:22:32'),(14656,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17729,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"79\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Jill Tilbury\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17729}','68.53.115.247','2021-05-25 16:22:32'),(14657,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17730,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"80\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Dungarvin - Brooklyn Park\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17730}','68.53.115.247','2021-05-25 16:22:32'),(14658,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17731,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"81\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Heather Golden\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17731}','68.53.115.247','2021-05-25 16:22:32'),(14659,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17732,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"82\",\"question_type\":\"Short_Answer\",\"text_answer\":\"hgolden@dungarvin.com\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17732}','68.53.115.247','2021-05-25 16:22:32'),(14660,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17733,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"83\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17733}','68.53.115.247','2021-05-25 16:22:32'),(14661,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17734,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Elopement\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17734}','68.53.115.247','2021-05-25 16:22:32'),(14662,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17735,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Hennepin County\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17735}','68.53.115.247','2021-05-25 16:22:32'),(14663,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17736,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-08-24 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17736}','68.53.115.247','2021-05-25 16:22:32'),(14664,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17737,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"On 8\\/24\\/2019, VA and AP went to the Minnesota State Fair. An unknown event occurred between 12:30 PM and 5:30 PM wile VA was\\r\\nunsupervised. VA was unsupervised for approximately thirty minutes.\\r\\n\\r\\nReporter found out 8\\/26\\/2019. VA had appointment with Psychologist at 3:30 PM. Behavior Specialist accompanied VA to appointment. VA\\r\\ntold Psychologist \\\"while at the Minnesota State Fair on Saturday, I was alone for about thirty minutes.\\\" VA said AP walked away from VA. VA\\r\\ncould not find AP. AP found VA.\\r\\n\\r\\nReporter asked AP to explain. AP said VA had a rental scooter while at the Minnesota State Fair. VA told AP she was going to the bathroom\\r\\non scooter, and took off. AP could not keep up with scooter and soon lost VA. AP continued to search for VA. Approximately thirty minutes\\r\\nlater AP found VA near a bathroom.\\r\\n\\r\\nReporter noted that VA has a previous history of false reporting.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17737}','68.53.115.247','2021-05-25 16:22:32'),(14665,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17738,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17738}','68.53.115.247','2021-05-25 16:22:32'),(14666,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17739,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff lost sight of a person at the State Fair\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17739}','68.53.115.247','2021-05-25 16:22:32'),(14667,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17740,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17740}','68.53.115.247','2021-05-25 16:22:32'),(14668,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17741,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2019-10-25 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17741}','68.53.115.247','2021-05-25 16:22:32'),(14669,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17742,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Collaborative Safety \\u2013 Systems Mapping \\r\\nCase Summary\\r\\nOctober 14, 2019\\r\\nHennepin County\\r\\n\\r\\n\\r\\nLearning Point #1: Staff lost sight of a person at the State Fair.\\r\\n\\r\\nLearning Point #2: Staff brought his son along on this community outing. \\r\\n\\r\\nIncident report description\\r\\n\\u2022\\tIncident date: 8\\/24\\/2019, between 12:30 PM and 5:30 PM\\r\\n\\u2022\\tReport date: 8\\/27\\/2019 4:11PM\\r\\n\\r\\nStaff and person went to the Minnesota State Fair on a Saturday afternoon. During this outing, the person was unsupervised for approximately thirty minutes. The person had a rental scooter and took off on it to go to use the bathroom. The staff could not keep up with the scooter and lost sight of the person. Approximately 30 minutes later, staff found the person near the bathroom. \\r\\n\\r\\nTwo days later, the reporter found out about the incident during an appointment between the person and a Psychologist when the person told the Psychologist \\\"while at the Minnesota State Fair on Saturday, I was alone for about thirty minutes.\\\" \\r\\n\\r\\nDebriefing information for learning Point #1, October 25, 2019\\r\\n\\r\\nStaff participated in a human factors debriefing, led by a Safety Analyst, on October 25, 2019.\\r\\n\\r\\nUpon arrival at the State Fair, the person rented an electric mobility scooter for people with disabilities. The staff brought his 10 year old son along to the event. The staff\\u2019s attention was influenced by the person\\u2019s behavior as they began walking into the Fair, when the person said she wanted to go to the beer garden and drink beer. This action triggered the staff to wonder if this was a good idea. \\r\\n\\r\\nShortly after arriving, the staff and his son sat down to eat some food while the person used the scooter to go and browse at a souvenir stand within eyesight. The crowd at the Fair impacted the staff\\u2019s focus when he lost sight of the person on the scooter during the outing. Staff reported he was not distracted by his son\\u2019s presence. \\r\\n\\r\\nDebriefing information for learning Point #2, October 25, 2019\\r\\n\\r\\nDuring the debriefing session for Learning Point #1, Staff shared he brought his son along to the outing after the VA told him she thought it was fine. He explained it was a last minute decision because of issues around child care coverage.\\r\\n\\r\\nResult of Incident\\r\\nStaff reported going to the beer garden to search for the person. She was not there, so he called her on her cell phone. She answered his call, but could not tell staff exactly where she was. This phone call went on for about 30 minutes until staff located the person.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17742}','68.53.115.247','2021-05-25 16:22:32'),(14670,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17743,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17743}','68.53.115.247','2021-05-25 16:22:32'),(14671,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17744,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"The crowd size, unfamiliarity with the State Fair and the person, impacted staff losing sight of the individual. When the staff lost sight of the person, his attention was divided between his 10-year-old son and the person. Staff brought their son along on the outing because the person offered for him to come along. The person likely offered because if staff was unable to work the person would be unable to go to the fair as the person overheard a conversation the staff had about his son not having childcare on the day of the Fair. The provider was experiencing a staff shortage and would not have been able to find another staff to go to the fair with the person. \\r\\n\\r\\nAnother contributing factor to losing sight of the person was that staff did not perceive a risk of losing the person because there was no elopement history. Therefore, staff felt comfortable bringing their son. Staff also knew the person\\u2019s high level abilities to be independent and capabilities to navigate the scooter, which further supported their decision to have divided attention between the person and their son.  The provider has a policy that allows staff to use judgment\\/interpretation of the Coordinated Services & Support Plan (CSSP) as long as staff is attentive to the persons needs without direct line of sight. The provider allows this room for staff judgment because it gives staff the space and ability to support each person as they need and choose. \\r\\n\\r\\nThe Case Manager approved the decision not to require a line of sight on the person while out in the community. The person\\u2019s history of challenging behaviors influenced the Guardian\\u2019s directive to the Case Manager not to include any alone time in the CSSP and the Case Manager\'s decision to include a 1:1 staffing ratio on public outings in the CSSP. This requirement was an influence on how the provider selected staff for the outing. An industry wide staffing shortage impacted the providers\\u2019 ability to hire and retain part-time, intermittent, 1:1 activities staff. The HCBS Rule on Community Inclusion and Person Centered Planning and Person Centered Thinking influenced the Case Manager and provider roles to meet these standards when staffing for outings in the community.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17744}','68.53.115.247','2021-05-25 16:22:32'),(14672,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17745,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17745}','68.53.115.247','2021-05-25 16:22:32'),(14673,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17746,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17746}','68.53.115.247','2021-05-25 16:22:32'),(14674,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17747,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17747}','68.53.115.247','2021-05-25 16:22:32'),(14675,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17748,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17748}','68.53.115.247','2021-05-25 16:22:32'),(14676,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17749,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17749}','68.53.115.247','2021-05-25 16:22:32'),(14677,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17750,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17750}','68.53.115.247','2021-05-25 16:22:32'),(14678,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17751,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":\"The crowd size, unfamiliarity with the State Fair and the person, impacted staff losing sight of the individual. When the staff lost sight of the person, his attention was divided between his 10-year-old son and the person. \\r\\n\\r\\nAnother contributing factor to losing sight of the person was that staff did not perceive a risk of losing the person because there was no elopement history. Therefore, staff felt comfortable bringing their son. Staff also knew the person\\u2019s high level abilities to be independent and capabilities to navigate the scooter, which further supported their decision to have divided attention between the person and their son.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17751}','68.53.115.247','2021-05-25 16:22:32'),(14679,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17752,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17752}','68.53.115.247','2021-05-25 16:22:32'),(14680,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17753,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":\"The provider was experiencing a staff shortage and would not have been able to find another staff to go to the fair with the person.  \\r\\n\\r\\nAn industry wide staffing shortage impacted the providers\\u2019 ability to hire and retain part-time, intermittent, 1:1 activities staff. The HCBS Rule on Community Inclusion and Person Centered Planning and Person Centered Thinking influenced the Case Manager and provider roles to meet these standards when staffing for outings in the community.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17753}','68.53.115.247','2021-05-25 16:22:32'),(14681,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17754,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"105\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17754}','68.53.115.247','2021-05-25 16:22:32'),(14682,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17755,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"106\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17755}','68.53.115.247','2021-05-25 16:22:32'),(14683,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17756,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"107\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17756}','68.53.115.247','2021-05-25 16:22:32'),(14684,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17757,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"108\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17757}','68.53.115.247','2021-05-25 16:22:32'),(14685,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17758,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"109\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17758}','68.53.115.247','2021-05-25 16:22:32'),(14686,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17759,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"110\",\"question_type\":\"Free_Text\",\"text_answer\":\"The Case Manager approved the decision not to require a line of sight on the person while out in the community. The person\\u2019s history of challenging behaviors influenced the Guardian\\u2019s directive to the Case Manager not to include any alone time in the CSSP and the Case Manager\'s decision to include a 1:1 staffing ratio on public outings in the CSSP. This requirement was an influence on how the provider selected staff for the outing .\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17759}','68.53.115.247','2021-05-25 16:22:32'),(14687,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17760,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"111\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17760}','68.53.115.247','2021-05-25 16:22:32'),(14688,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17761,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"112\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17761}','68.53.115.247','2021-05-25 16:22:32'),(14689,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17762,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"113\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17762}','68.53.115.247','2021-05-25 16:22:32'),(14690,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17763,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"114\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17763}','68.53.115.247','2021-05-25 16:22:32'),(14691,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17764,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"115\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17764}','68.53.115.247','2021-05-25 16:22:32'),(14692,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17765,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"116\",\"question_type\":\"Free_Text\",\"text_answer\":\"The provider has a policy that allows staff to use judgment\\/interpretation of the Coordinated Services & Support Plan (CSSP) as long as staff is attentive to the persons needs without direct line of sight. The provider allows this room for staff judgment because it gives staff the space and ability to support each person as they need and choose.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17765}','68.53.115.247','2021-05-25 16:22:32'),(14693,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17766,'{\"report_id\":234,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"117\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:22:32 am\",\"created_at\":\"5\\/25\\/2021 11:22:32 am\",\"id\":17766}','68.53.115.247','2021-05-25 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Inc.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17832}','68.53.115.247','2021-05-25 16:23:33'),(14760,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17833,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"81\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Gordon Clark\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17833}','68.53.115.247','2021-05-25 16:23:33'),(14761,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17834,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"82\",\"question_type\":\"Short_Answer\",\"text_answer\":\"gordonc@marytinc.com\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17834}','68.53.115.247','2021-05-25 16:23:33'),(14762,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17835,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"83\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17835}','68.53.115.247','2021-05-25 16:23:33'),(14763,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17836,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Elopement\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17836}','68.53.115.247','2021-05-25 16:23:33'),(14764,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17837,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Hennepin County\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17837}','68.53.115.247','2021-05-25 16:23:33'),(14765,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17838,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-06-01 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17838}','68.53.115.247','2021-05-25 16:23:33'),(14766,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17839,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff brought four housemates to the Como Park Zoo on a summer Saturday afternoon. After spending some time walking around the crowed zoo looking at animals, one person wandered away from the group. Staff was not sure what to do so he brought the other guys back to the van, leaving the windows down, to keep them together. He went back to look for the missing person with the help of zoo staff.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17839}','68.53.115.247','2021-05-25 16:23:33'),(14767,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17840,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17840}','68.53.115.247','2021-05-25 16:23:33'),(14768,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17841,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff lost sight of person at Como Zoo\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17841}','68.53.115.247','2021-05-25 16:23:33'),(14769,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17842,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17842}','68.53.115.247','2021-05-25 16:23:33'),(14770,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17843,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2019-08-27 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17843}','68.53.115.247','2021-05-25 16:23:33'),(14771,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17844,'{\"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\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17844}','68.53.115.247','2021-05-25 16:23:33'),(14772,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17845,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17845}','68.53.115.247','2021-05-25 16:23:33'),(14773,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17846,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"Losing sight of a person was influenced by staff being distracted while holding the hand of a slow walker in the group and watching their footing. This was further influenced by the crowded zoo and the varying needs of each of the four people in the group. Also this was the staffs first time at Como Park Zoo and he was unfamiliar with the park and available resources. He wanted to do an activity the group enjoyed and was not afraid to take risks by going to a new place for an outing. It was known that the people living in the home enjoyed seeing animals, and considering that Como Zoo was a free activity, this outing was selected. The staff\\u2019s willingness to take risk was likely impacted by the disability advocacy community\\u2019s emphasis on allowing people with disabilities the dignity of risk. \\r\\nAdditional factors that influenced the Como Park outing and staff decision making were the community inclusion goals developed by the provider. These goals are outlined in the CSP\\/CSSP for each person in the group based on the MN Choices Assessment and the Person Centered\\/Informed Choice protocols. \\r\\n\\r\\nThe staffing pattern on the day of the outing to Como Zoo was impacted by the provider\\u2019s budget and the hours allocated to the home during the negotiation process facilitated by DHS Form 6790. This process is impacted by the individual needs of each person in the home, assessed by MnCHOICES and developed into each person\\u2019s Coordinated Services and Support Plan. The hours and rate are further impacted by the Disability Waiver Rate System created by the Minnesota Legislature. \\r\\n\\r\\nThe staff training established in 245D statute and the Positive Supports Rule influenced the provider required training to prepare staff for community based outings and discretion for decision making. Staff demonstrated competency in this area when he was able to describe the clothing worn by the missing person and share \\u201cthe book\\u201d with details about the person.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17846}','68.53.115.247','2021-05-25 16:23:33'),(14774,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17847,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17847}','68.53.115.247','2021-05-25 16:23:33'),(14775,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17848,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17848}','68.53.115.247','2021-05-25 16:23:33'),(14776,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17849,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17849}','68.53.115.247','2021-05-25 16:23:33'),(14777,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17850,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17850}','68.53.115.247','2021-05-25 16:23:33'),(14778,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17851,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17851}','68.53.115.247','2021-05-25 16:23:33'),(14779,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17852,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17852}','68.53.115.247','2021-05-25 16:23:33'),(14780,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17853,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":\"Losing sight of a person was influenced by staff being distracted while holding the hand of a slow walker in the group and watching their footing. This was further influenced by the crowded zoo and the varying needs of each of the four people in the group.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17853}','68.53.115.247','2021-05-25 16:23:33'),(14781,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17854,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17854}','68.53.115.247','2021-05-25 16:23:33'),(14782,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17855,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":\"The staffing pattern on the day of the outing to Como Zoo was impacted by the provider\\u2019s budget and the hours allocated to the home during the negotiation process facilitated by DHS Form 6790. This process is impacted by the individual needs of each person in the home, assessed by MnCHOICES and developed into each person\\u2019s Coordinated Services and Support Plan. The hours and rate are further impacted by the Disability Waiver Rate System created by the Minnesota Legislature.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17855}','68.53.115.247','2021-05-25 16:23:33'),(14783,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17856,'{\"report_id\":237,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"105\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:23:33 am\",\"created_at\":\"5\\/25\\/2021 11:23:33 am\",\"id\":17856}','68.53.115.247','2021-05-25 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The setting was a family foster home with owner\\/operator on-site and no other residents.   The provider was newly licensed for 2 residents and this was the first individual that was placed in her home.   The individual was in his grandparents\\u2019 care prior to this AFC.  The individual is his own guardian.  \\r\\nPrior to the placement the provider had communicated with the individual\\u2019s grandparents and CADI case manager.  The provider was told that the individual was in special education in school and A few weeks after the placement the provider was given a file with additional information on the individual.  The file included police reports indicating the individual had been in physical fights.  After the placement the provider also learned that the individual had a history of stealing money, cigarettes and specifically an incident when he stole credit cards from his grandparents.   The provider also learned that he was expelled from Cloquet High School due to his behaviors and transferred to the Merit Creek Academy.  The provider stated that in conversations with the individual\\u2019s grandparents they stated that he was easily influenced by his friends.  \\r\\nThe provider stated while the individual was residing with her he would swear at her and try to physically intimidate her.  The provider noted that the individual never physically assaulted her.  The provider noted that the individual spent much of his time in his bedroom playing video games.  He ate the majority of this meals in his room alone.   Prior to COVID19, the individual was in therapy twice a week for depression and anger issues.  This moved to telehealth and soon ended all together.  The individual was also with Choice Unlimited for employment after he graduated school, but did not want to continue to work on employment.\\r\\nDue to the individual constantly isolating himself and physically intimidating behaviors the provider decided to issue a 60 day termination notice. The case manager was aware of the concerns and supported the individual moving.  The individual was not initially supportive of the move, but was excited to move once he toured the new facility.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:47:28 am\",\"created_at\":\"5\\/25\\/2021 11:47:28 am\",\"id\":17896}','68.53.115.247','2021-05-25 16:47:28'),(14831,'SNNwGL2wcdotN927fMCX92PpgHSvQNWECfP1J8zG',81,'reports_answer','create',17897,'{\"report_id\":188,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:47:28 am\",\"created_at\":\"5\\/25\\/2021 11:47:28 am\",\"id\":17897}','68.53.115.247','2021-05-25 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21:57:11'),(14921,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17940,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Blue Earth County\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17940}','68.53.115.247','2021-05-25 21:57:11'),(14922,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17941,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-07-20 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17941}','68.53.115.247','2021-05-25 21:57:11'),(14923,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17942,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"on 7\\/20\\/19 It had been reported to On-call that a scheduled 2 medication had 2 tablets gone missing. Staff reported this to On-call right away in the AM. DCC complained about staff on the Overnight not being awake when he was attempting to wake them up for a PRN. Staff administered an Acetaminophen to DCC at 5:00am. It is suspected that the staff on the overnight were asleep not supervising DCC and after administering the medication DCC reported the staff went back to the couch to sleep after he took his PRN. Staff may have not locked up the office and DCC may have gotten the keys from the key lockbox by breaking into it to get the schedule 2 medication. DCC has in the past requested multiple times from staff stating he has not gotten this medication. DCC has had a problem with medication seeking.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17942}','68.53.115.247','2021-05-25 21:57:11'),(14924,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17943,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17943}','68.53.115.247','2021-05-25 21:57:11'),(14925,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17944,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff did not count medications per provider policy\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17944}','68.53.115.247','2021-05-25 21:57:11'),(14926,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17945,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17945}','68.53.115.247','2021-05-25 21:57:11'),(14927,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17946,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2019-09-13 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17946}','68.53.115.247','2021-05-25 21:57:11'),(14928,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17947,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff 1 worked a double shift (working at other homes within agency) prior to arriving at 11pm and then came to work the overnight shift at the location of the incident.  Staff 2 stated this was the first shift of the day for them.  The provider\\u2019s shift are from 11p-7am; 7am-3pm; 3pm-11pm.  Both staff were float staff for several homes throughout the agency, however they had worked in this home prior to the event.  Staff 1 worked for the provider for over a year and Staff 2 had worked for the provider since February.  Each of the staff works approximately 40-48 hours per week.  Provider has a policy for a 2:4 staffing ratio at the home and both staff remain awake.  \\r\\n\\r\\nProvider\\u2019s policy is to go into the office and count medications upon arriving for a shift.  While in the office they are to also read the daily log notes on the people supported in the home.  The 11pm staff arrived for their shift, neither staff person had reviewed the notes from the previous shift or counted the medications.  This had been the pattern that staff did not typically check meds and\\/or notes when they arrived to the home because the norm was the individuals were awake and needed support.  The staff started interacting with the individuals in the home because many of them were awake on this evening and required the staff\\u2019s attention. Individual 1 typically was not awake and in the common area of the home, however they were on this evening.  \\r\\n\\r\\nIndividual 2 (with alone time) from the residence called and stated he needed a ride home.  Staff 1 left to go get individual 2.  Staff 1 did not take the office keys with them when they left the home.  Staff 1 did not know if the office was locked at this time.  \\r\\n\\r\\n\\r\\nWhen both staff arrive Individual 1 was typically in their room and this night the individual was awake more during the night and was talking to Staff 2 about videos games and film animation.  Individual 1 has no alone time.  Individual 1 is very planful, smart, he works at a department store, likes animation or playing videos games, funny, jokester, and typically calm.  \\r\\n\\r\\nAt 5am Individual 1 came to Staff 1 for a PRN and staff was watching YouTube videos.  The office is locked at all times per policy from the provider and staff carry the keys on a lanyard (on their person at all times).  One set of keys per two staff.  If keys are locked inside of the office there is another set in a lockbox (with a key code to get in).  Once in the office, the medications are set up per person in a \\u201cfile cabinet like\\u2019 with another set of keys required to get into the medications.  When staff 1 went into the office for the medications the office and the medications were all locked.  Staff 1 gave individual 1 medications and went back to watching youtube from 5am-6am.  Staff 1 was unable recall if they had fallen asleep.   Staff 1 was very tired due to the length of time they had worked during their shift and the previous two shifts at another home.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17947}','68.53.115.247','2021-05-25 21:57:11'),(14929,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17948,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17948}','68.53.115.247','2021-05-25 21:57:11'),(14930,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17949,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff did not count meds per provider policy was influenced by numerous factors.  The norm is to interact with the awake individuals and on this day there was someone awake which is impacted by staff wanting to support the individual based off of the plan of care created by the team and further influenced by societal norms to engage with others and implementing person centered culture mandated by DHS and CMS.  An additional factor was Individual 2 being in the community and needed transportation home. Staff 1 left the home to pick up Individual 2, thus leaving staff 2 alone with an awake Individual 1 who requires a 24-plan of care supported by norms to interact with others and person centered practices.  One element was there was no staff overlap upon both staff arriving to the home which resulted in staff prioritizing interaction with the individuals over counting medications.  The set wages and benefits which was indicative of the care plan therefore influenced by norms to interact with others and person centered practices.   \\r\\n\\r\\nThe final factor was both staff thought Individual 1 had no history of medication seeking supported by their staff not knowing the individual plan for medications due to being trained in several homes with several individuals\\u2019 plans to follow and also being fatigued because the staff had to work overtime prior to this shift.  The agency being shorted staffed is complicated to the set wages and benefits, low unemployment, thus constraining the college employees (seasonal) and this is byproduct of DWRS which was put in place by the legislature.  Contributing factors that further supported the provider\\u2019s policy for the work of the direct care staff 1 and 2 was the nurse\\u2019s license in providing some position to the policy.  Overall the nurse\\u2019s license is regulated by legislation and statute.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17949}','68.53.115.247','2021-05-25 21:57:11'),(14931,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17950,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17950}','68.53.115.247','2021-05-25 21:57:11'),(14932,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17951,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17951}','68.53.115.247','2021-05-25 21:57:11'),(14933,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17952,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17952}','68.53.115.247','2021-05-25 21:57:11'),(14934,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17953,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17953}','68.53.115.247','2021-05-25 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21:57:11'),(14941,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17960,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"106\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17960}','68.53.115.247','2021-05-25 21:57:11'),(14942,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17961,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"107\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17961}','68.53.115.247','2021-05-25 21:57:11'),(14943,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17962,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"108\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17962}','68.53.115.247','2021-05-25 21:57:11'),(14944,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17963,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"109\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17963}','68.53.115.247','2021-05-25 21:57:11'),(14945,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17964,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"110\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17964}','68.53.115.247','2021-05-25 21:57:11'),(14946,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17965,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"111\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17965}','68.53.115.247','2021-05-25 21:57:11'),(14947,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17966,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"112\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17966}','68.53.115.247','2021-05-25 21:57:11'),(14948,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17967,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"113\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17967}','68.53.115.247','2021-05-25 21:57:11'),(14949,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17968,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"114\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17968}','68.53.115.247','2021-05-25 21:57:11'),(14950,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17969,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"115\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17969}','68.53.115.247','2021-05-25 21:57:11'),(14951,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17970,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"116\",\"question_type\":\"Free_Text\",\"text_answer\":\"The norm is to interact with the awake individuals and on this day there was someone awake which is impacted by staff wanting to support the individual based off of the plan of care created by the team and further influenced by societal norms to engage with others and implementing person centered culture mandated by DHS and CMS.  \\r\\n\\r\\nOne element was there was no staff overlap upon both staff arriving to the home which resulted in staff prioritizing interaction with the individuals over counting medications.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17970}','68.53.115.247','2021-05-25 21:57:11'),(14952,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17971,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"117\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17971}','68.53.115.247','2021-05-25 21:57:11'),(14953,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17972,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"118\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17972}','68.53.115.247','2021-05-25 21:57:11'),(14954,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17973,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"119\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17973}','68.53.115.247','2021-05-25 21:57:11'),(14955,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17974,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"120\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17974}','68.53.115.247','2021-05-25 21:57:11'),(14956,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17975,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"121\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17975}','68.53.115.247','2021-05-25 21:57:11'),(14957,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17976,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"122\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17976}','68.53.115.247','2021-05-25 21:57:11'),(14958,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17977,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"123\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17977}','68.53.115.247','2021-05-25 21:57:11'),(14959,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17978,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"124\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17978}','68.53.115.247','2021-05-25 21:57:11'),(14960,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17979,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"125\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17979}','68.53.115.247','2021-05-25 21:57:11'),(14961,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17980,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"126\",\"question_type\":\"Free_Text\",\"text_answer\":\"The final factor was both staff thought Individual 1 had no history of medication seeking supported by their staff not knowing the individual plan for medications due to being trained in several homes with several individuals\\u2019 plans to follow and also being fatigued because the staff had to work overtime prior to this shift.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17980}','68.53.115.247','2021-05-25 21:57:11'),(14962,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17981,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"432\",\"question_type\":\"Yes_or_No\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:11 pm\",\"created_at\":\"5\\/25\\/2021 4:57:11 pm\",\"id\":17981}','68.53.115.247','2021-05-25 21:57:11'),(14963,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17982,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"09\\/13\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:57:46 pm\",\"created_at\":\"5\\/25\\/2021 4:57:46 pm\",\"id\":17982}','68.53.115.247','2021-05-25 21:57:46'),(14964,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17983,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"76\",\"question_type\":\"Short_Answer\",\"text_answer\":\"201905316\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17983}','68.53.115.247','2021-05-25 21:58:11'),(14965,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17984,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"08\\/15\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17984}','68.53.115.247','2021-05-25 21:58:11'),(14966,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17985,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"78\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Jill Tilbury\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17985}','68.53.115.247','2021-05-25 21:58:11'),(14967,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17986,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"79\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Charles Young\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17986}','68.53.115.247','2021-05-25 21:58:11'),(14968,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17987,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"80\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Progressive Living Inc\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17987}','68.53.115.247','2021-05-25 21:58:11'),(14969,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17988,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"81\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17988}','68.53.115.247','2021-05-25 21:58:11'),(14970,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17989,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"82\",\"question_type\":\"Short_Answer\",\"text_answer\":\"nicole.s@progressivelivinginc.net\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17989}','68.53.115.247','2021-05-25 21:58:11'),(14971,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17990,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"83\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17990}','68.53.115.247','2021-05-25 21:58:11'),(14972,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17991,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Medication Error\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17991}','68.53.115.247','2021-05-25 21:58:11'),(14973,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17992,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Blue Earth County\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17992}','68.53.115.247','2021-05-25 21:58:11'),(14974,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17993,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-07-20 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17993}','68.53.115.247','2021-05-25 21:58:11'),(14975,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17994,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"on 7\\/20\\/19 It had been reported to On-call that a scheduled 2 medication had 2 tablets gone missing. Staff reported this to On-call right away in the AM. DCC complained about staff on the Overnight not being awake when he was attempting to wake them up for a PRN. Staff administered an Acetaminophen to DCC at 5:00am. It is suspected that the staff on the overnight were asleep not supervising DCC and after administering the medication DCC reported the staff went back to the couch to sleep after he took his PRN. Staff may have not locked up the office and DCC may have gotten the keys from the key lockbox by breaking into it to get the schedule 2 medication. DCC has in the past requested multiple times from staff stating he has not gotten this medication. DCC has had a problem with medication seeking.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17994}','68.53.115.247','2021-05-25 21:58:11'),(14976,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17995,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17995}','68.53.115.247','2021-05-25 21:58:11'),(14977,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17996,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff did not count medications per provider policy\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17996}','68.53.115.247','2021-05-25 21:58:11'),(14978,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17997,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17997}','68.53.115.247','2021-05-25 21:58:11'),(14979,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17998,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"09\\/13\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17998}','68.53.115.247','2021-05-25 21:58:11'),(14980,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',17999,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff 1 worked a double shift (working at other homes within agency) prior to arriving at 11pm and then came to work the overnight shift at the location of the incident.  Staff 2 stated this was the first shift of the day for them.  The provider\\u2019s shift are from 11p-7am; 7am-3pm; 3pm-11pm.  Both staff were float staff for several homes throughout the agency, however they had worked in this home prior to the event.  Staff 1 worked for the provider for over a year and Staff 2 had worked for the provider since February.  Each of the staff works approximately 40-48 hours per week.  Provider has a policy for a 2:4 staffing ratio at the home and both staff remain awake.  \\r\\n\\r\\nProvider\\u2019s policy is to go into the office and count medications upon arriving for a shift.  While in the office they are to also read the daily log notes on the people supported in the home.  The 11pm staff arrived for their shift, neither staff person had reviewed the notes from the previous shift or counted the medications.  This had been the pattern that staff did not typically check meds and\\/or notes when they arrived to the home because the norm was the individuals were awake and needed support.  The staff started interacting with the individuals in the home because many of them were awake on this evening and required the staff\\u2019s attention. Individual 1 typically was not awake and in the common area of the home, however they were on this evening.  \\r\\n\\r\\nIndividual 2 (with alone time) from the residence called and stated he needed a ride home.  Staff 1 left to go get individual 2.  Staff 1 did not take the office keys with them when they left the home.  Staff 1 did not know if the office was locked at this time.  \\r\\n\\r\\n\\r\\nWhen both staff arrive Individual 1 was typically in their room and this night the individual was awake more during the night and was talking to Staff 2 about videos games and film animation.  Individual 1 has no alone time.  Individual 1 is very planful, smart, he works at a department store, likes animation or playing videos games, funny, jokester, and typically calm.  \\r\\n\\r\\nAt 5am Individual 1 came to Staff 1 for a PRN and staff was watching YouTube videos.  The office is locked at all times per policy from the provider and staff carry the keys on a lanyard (on their person at all times).  One set of keys per two staff.  If keys are locked inside of the office there is another set in a lockbox (with a key code to get in).  Once in the office, the medications are set up per person in a \\u201cfile cabinet like\\u2019 with another set of keys required to get into the medications.  When staff 1 went into the office for the medications the office and the medications were all locked.  Staff 1 gave individual 1 medications and went back to watching youtube from 5am-6am.  Staff 1 was unable recall if they had fallen asleep.   Staff 1 was very tired due to the length of time they had worked during their shift and the previous two shifts at another home.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":17999}','68.53.115.247','2021-05-25 21:58:11'),(14981,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18000,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":18000}','68.53.115.247','2021-05-25 21:58:11'),(14982,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18001,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff did not count meds per provider policy was influenced by numerous factors.  The norm is to interact with the awake individuals and on this day there was someone awake which is impacted by staff wanting to support the individual based off of the plan of care created by the team and further influenced by societal norms to engage with others and implementing person centered culture mandated by DHS and CMS.  An additional factor was Individual 2 being in the community and needed transportation home. Staff 1 left the home to pick up Individual 2, thus leaving staff 2 alone with an awake Individual 1 who requires a 24-plan of care supported by norms to interact with others and person centered practices.  One element was there was no staff overlap upon both staff arriving to the home which resulted in staff prioritizing interaction with the individuals over counting medications.  The set wages and benefits which was indicative of the care plan therefore influenced by norms to interact with others and person centered practices.   \\r\\n\\r\\nThe final factor was both staff thought Individual 1 had no history of medication seeking supported by their staff not knowing the individual plan for medications due to being trained in several homes with several individuals\\u2019 plans to follow and also being fatigued because the staff had to work overtime prior to this shift.  The agency being shorted staffed is complicated to the set wages and benefits, low unemployment, thus constraining the college employees (seasonal) and this is byproduct of DWRS which was put in place by the legislature.  Contributing factors that further supported the provider\\u2019s policy for the work of the direct care staff 1 and 2 was the nurse\\u2019s license in providing some position to the policy.  Overall the nurse\\u2019s license is regulated by legislation and statute.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":18001}','68.53.115.247','2021-05-25 21:58:11'),(14983,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18002,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":18002}','68.53.115.247','2021-05-25 21:58:11'),(14984,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18003,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":18003}','68.53.115.247','2021-05-25 21:58:11'),(14985,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18004,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":18004}','68.53.115.247','2021-05-25 21:58:11'),(14986,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18005,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":18005}','68.53.115.247','2021-05-25 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21:58:11'),(15003,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18022,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"116\",\"question_type\":\"Free_Text\",\"text_answer\":\"The norm is to interact with the awake individuals and on this day there was someone awake which is impacted by staff wanting to support the individual based off of the plan of care created by the team and further influenced by societal norms to engage with others and implementing person centered culture mandated by DHS and CMS.  \\r\\n\\r\\nOne element was there was no staff overlap upon both staff arriving to the home which resulted in staff prioritizing interaction with the individuals over counting medications.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":18022}','68.53.115.247','2021-05-25 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21:58:11'),(15012,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18031,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"125\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":18031}','68.53.115.247','2021-05-25 21:58:11'),(15013,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18032,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"126\",\"question_type\":\"Free_Text\",\"text_answer\":\"The final factor was both staff thought Individual 1 had no history of medication seeking supported by their staff not knowing the individual plan for medications due to being trained in several homes with several individuals\\u2019 plans to follow and also being fatigued because the staff had to work overtime prior to this shift.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":18032}','68.53.115.247','2021-05-25 21:58:11'),(15014,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18033,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"432\",\"question_type\":\"Yes_or_No\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:11 pm\",\"created_at\":\"5\\/25\\/2021 4:58:11 pm\",\"id\":18033}','68.53.115.247','2021-05-25 21:58:11'),(15015,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18034,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"76\",\"question_type\":\"Short_Answer\",\"text_answer\":\"201905316\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18034}','68.53.115.247','2021-05-25 21:58:16'),(15016,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18035,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"08\\/15\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18035}','68.53.115.247','2021-05-25 21:58:16'),(15017,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18036,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"78\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Jill Tilbury\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18036}','68.53.115.247','2021-05-25 21:58:16'),(15018,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18037,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"79\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Charles Young\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18037}','68.53.115.247','2021-05-25 21:58:16'),(15019,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18038,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"80\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Progressive Living Inc\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18038}','68.53.115.247','2021-05-25 21:58:16'),(15020,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18039,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"81\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18039}','68.53.115.247','2021-05-25 21:58:16'),(15021,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18040,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"82\",\"question_type\":\"Short_Answer\",\"text_answer\":\"nicole.s@progressivelivinginc.net\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18040}','68.53.115.247','2021-05-25 21:58:16'),(15022,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18041,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"83\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18041}','68.53.115.247','2021-05-25 21:58:16'),(15023,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18042,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Medication Error\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18042}','68.53.115.247','2021-05-25 21:58:16'),(15024,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18043,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Blue Earth County\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18043}','68.53.115.247','2021-05-25 21:58:16'),(15025,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18044,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-07-20 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18044}','68.53.115.247','2021-05-25 21:58:16'),(15026,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18045,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"on 7\\/20\\/19 It had been reported to On-call that a scheduled 2 medication had 2 tablets gone missing. Staff reported this to On-call right away in the AM. DCC complained about staff on the Overnight not being awake when he was attempting to wake them up for a PRN. Staff administered an Acetaminophen to DCC at 5:00am. It is suspected that the staff on the overnight were asleep not supervising DCC and after administering the medication DCC reported the staff went back to the couch to sleep after he took his PRN. Staff may have not locked up the office and DCC may have gotten the keys from the key lockbox by breaking into it to get the schedule 2 medication. DCC has in the past requested multiple times from staff stating he has not gotten this medication. DCC has had a problem with medication seeking.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18045}','68.53.115.247','2021-05-25 21:58:16'),(15027,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18046,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18046}','68.53.115.247','2021-05-25 21:58:16'),(15028,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18047,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff did not count medications per provider policy\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18047}','68.53.115.247','2021-05-25 21:58:16'),(15029,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18048,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18048}','68.53.115.247','2021-05-25 21:58:16'),(15030,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18049,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"09\\/13\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18049}','68.53.115.247','2021-05-25 21:58:16'),(15031,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18050,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff 1 worked a double shift (working at other homes within agency) prior to arriving at 11pm and then came to work the overnight shift at the location of the incident.  Staff 2 stated this was the first shift of the day for them.  The provider\\u2019s shift are from 11p-7am; 7am-3pm; 3pm-11pm.  Both staff were float staff for several homes throughout the agency, however they had worked in this home prior to the event.  Staff 1 worked for the provider for over a year and Staff 2 had worked for the provider since February.  Each of the staff works approximately 40-48 hours per week.  Provider has a policy for a 2:4 staffing ratio at the home and both staff remain awake.  \\r\\n\\r\\nProvider\\u2019s policy is to go into the office and count medications upon arriving for a shift.  While in the office they are to also read the daily log notes on the people supported in the home.  The 11pm staff arrived for their shift, neither staff person had reviewed the notes from the previous shift or counted the medications.  This had been the pattern that staff did not typically check meds and\\/or notes when they arrived to the home because the norm was the individuals were awake and needed support.  The staff started interacting with the individuals in the home because many of them were awake on this evening and required the staff\\u2019s attention. Individual 1 typically was not awake and in the common area of the home, however they were on this evening.  \\r\\n\\r\\nIndividual 2 (with alone time) from the residence called and stated he needed a ride home.  Staff 1 left to go get individual 2.  Staff 1 did not take the office keys with them when they left the home.  Staff 1 did not know if the office was locked at this time.  \\r\\n\\r\\n\\r\\nWhen both staff arrive Individual 1 was typically in their room and this night the individual was awake more during the night and was talking to Staff 2 about videos games and film animation.  Individual 1 has no alone time.  Individual 1 is very planful, smart, he works at a department store, likes animation or playing videos games, funny, jokester, and typically calm.  \\r\\n\\r\\nAt 5am Individual 1 came to Staff 1 for a PRN and staff was watching YouTube videos.  The office is locked at all times per policy from the provider and staff carry the keys on a lanyard (on their person at all times).  One set of keys per two staff.  If keys are locked inside of the office there is another set in a lockbox (with a key code to get in).  Once in the office, the medications are set up per person in a \\u201cfile cabinet like\\u2019 with another set of keys required to get into the medications.  When staff 1 went into the office for the medications the office and the medications were all locked.  Staff 1 gave individual 1 medications and went back to watching youtube from 5am-6am.  Staff 1 was unable recall if they had fallen asleep.   Staff 1 was very tired due to the length of time they had worked during their shift and the previous two shifts at another home.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18050}','68.53.115.247','2021-05-25 21:58:16'),(15032,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18051,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18051}','68.53.115.247','2021-05-25 21:58:16'),(15033,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18052,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff did not count meds per provider policy was influenced by numerous factors.  The norm is to interact with the awake individuals and on this day there was someone awake which is impacted by staff wanting to support the individual based off of the plan of care created by the team and further influenced by societal norms to engage with others and implementing person centered culture mandated by DHS and CMS.  An additional factor was Individual 2 being in the community and needed transportation home. Staff 1 left the home to pick up Individual 2, thus leaving staff 2 alone with an awake Individual 1 who requires a 24-plan of care supported by norms to interact with others and person centered practices.  One element was there was no staff overlap upon both staff arriving to the home which resulted in staff prioritizing interaction with the individuals over counting medications.  The set wages and benefits which was indicative of the care plan therefore influenced by norms to interact with others and person centered practices.   \\r\\n\\r\\nThe final factor was both staff thought Individual 1 had no history of medication seeking supported by their staff not knowing the individual plan for medications due to being trained in several homes with several individuals\\u2019 plans to follow and also being fatigued because the staff had to work overtime prior to this shift.  The agency being shorted staffed is complicated to the set wages and benefits, low unemployment, thus constraining the college employees (seasonal) and this is byproduct of DWRS which was put in place by the legislature.  Contributing factors that further supported the provider\\u2019s policy for the work of the direct care staff 1 and 2 was the nurse\\u2019s license in providing some position to the policy.  Overall the nurse\\u2019s license is regulated by legislation and statute.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18052}','68.53.115.247','2021-05-25 21:58:16'),(15034,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18053,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18053}','68.53.115.247','2021-05-25 21:58:16'),(15035,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18054,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18054}','68.53.115.247','2021-05-25 21:58:16'),(15036,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18055,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18055}','68.53.115.247','2021-05-25 21:58:16'),(15037,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18056,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18056}','68.53.115.247','2021-05-25 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21:58:16'),(15044,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18063,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"106\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18063}','68.53.115.247','2021-05-25 21:58:16'),(15045,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18064,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"107\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18064}','68.53.115.247','2021-05-25 21:58:16'),(15046,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18065,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"108\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18065}','68.53.115.247','2021-05-25 21:58:16'),(15047,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18066,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"109\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18066}','68.53.115.247','2021-05-25 21:58:16'),(15048,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18067,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"110\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18067}','68.53.115.247','2021-05-25 21:58:16'),(15049,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18068,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"111\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18068}','68.53.115.247','2021-05-25 21:58:16'),(15050,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18069,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"112\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18069}','68.53.115.247','2021-05-25 21:58:16'),(15051,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18070,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"113\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18070}','68.53.115.247','2021-05-25 21:58:16'),(15052,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18071,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"114\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18071}','68.53.115.247','2021-05-25 21:58:16'),(15053,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18072,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"115\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18072}','68.53.115.247','2021-05-25 21:58:16'),(15054,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18073,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"116\",\"question_type\":\"Free_Text\",\"text_answer\":\"The norm is to interact with the awake individuals and on this day there was someone awake which is impacted by staff wanting to support the individual based off of the plan of care created by the team and further influenced by societal norms to engage with others and implementing person centered culture mandated by DHS and CMS.  \\r\\n\\r\\nOne element was there was no staff overlap upon both staff arriving to the home which resulted in staff prioritizing interaction with the individuals over counting medications.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18073}','68.53.115.247','2021-05-25 21:58:16'),(15055,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18074,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"117\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18074}','68.53.115.247','2021-05-25 21:58:16'),(15056,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18075,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"118\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18075}','68.53.115.247','2021-05-25 21:58:16'),(15057,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18076,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"119\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18076}','68.53.115.247','2021-05-25 21:58:16'),(15058,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18077,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"120\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18077}','68.53.115.247','2021-05-25 21:58:16'),(15059,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18078,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"121\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18078}','68.53.115.247','2021-05-25 21:58:16'),(15060,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18079,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"122\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18079}','68.53.115.247','2021-05-25 21:58:16'),(15061,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18080,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"123\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18080}','68.53.115.247','2021-05-25 21:58:16'),(15062,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18081,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"124\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18081}','68.53.115.247','2021-05-25 21:58:16'),(15063,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18082,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"125\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18082}','68.53.115.247','2021-05-25 21:58:16'),(15064,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18083,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"126\",\"question_type\":\"Free_Text\",\"text_answer\":\"The final factor was both staff thought Individual 1 had no history of medication seeking supported by their staff not knowing the individual plan for medications due to being trained in several homes with several individuals\\u2019 plans to follow and also being fatigued because the staff had to work overtime prior to this shift.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18083}','68.53.115.247','2021-05-25 21:58:16'),(15065,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18084,'{\"report_id\":198,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"432\",\"question_type\":\"Yes_or_No\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:16 pm\",\"created_at\":\"5\\/25\\/2021 4:58:16 pm\",\"id\":18084}','68.53.115.247','2021-05-25 21:58:16'),(15066,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18085,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"12\\/17\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:33 pm\",\"created_at\":\"5\\/25\\/2021 4:58:33 pm\",\"id\":18085}','68.53.115.247','2021-05-25 21:58:33'),(15067,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports','update',186,'{\"id\":186,\"form_id\":\"23\",\"user_id\":\"81\",\"question_id\":null,\"organization_id\":\"10\",\"tab_id\":null,\"question_type\":null,\"text_answer\":\"{\\\"Short_Answer__76\\\":\\\"Care Manager\\\",\\\"Date__77\\\":\\\"12\\\\\\/17\\\\\\/2019\\\",\\\"Multiple_Choice__78\\\":\\\"Charles Young\\\",\\\"Multiple_Choice__79\\\":\\\"Kristie Pittman\\\",\\\"Short_Answer__80\\\":\\\"Harry Meyering\\\",\\\"Short_Answer__81\\\":\\\"Emily Britz \\\\\\/ Tana Helleksen\\\",\\\"Short_Answer__82\\\":\\\"ebritz \\\\\\/ thelleksen \\\\\\/@harrymeyeringcenter.org\\\",\\\"Multiple_Choice__84\\\":\\\"Termination of Services\\\",\\\"Multiple_Choice__85\\\":\\\"Blue Earth County\\\",\\\"Multiple_Choice__96\\\":\\\"2\\\",\\\"Short_Answer__91\\\":\\\"Person\'s services were terminated due to challenging behavior\\\",\\\"True_or_False__94\\\":\\\"Yes\\\",\\\"Free_Text__98\\\":\\\"Yes\\\",\\\"Free_Text__100\\\":\\\"Influencing why the ICF\\\\\\/DD provider terminated this person\\\\u2019s services due to challenging behavior was that the person was posing a safety risk to others in the home. The other 3 individuals in the home were considered to be more vulnerable to abuse due to their lower functioning levels, and so the person posed a greater risk to them. The provider had to balance their responsibility to protect the health and safety of three people in the home with their responsibility to meet the needs of the person whose services they terminated. The guardians of the other 3 individuals had an expectation that the provider would keep them safe, and due to their higher vulnerability the guardians expressed their concern often in this instance. Another impact to the provider\\\\u2019s responsibility for people\\\\u2019s health and safety include county case managers assigning this function to providers via the CSSP. Unique to ICF\\\\\\/DDs is that they are licensed by both the Department of Human Services and the Minnesota Department of Health. Both Departments require providers to protect the health and safety of the people they serve. Minnesota Statutes 245D outlines the requirements for providers enforced by DHS while MDH relies on other statutory requirements in Minnesota statutes 144 and Rule. A unique requirement enforced by MDH is that ICF\\\\\\/DDs are expected to protect the people they serve from \\\\u201cimmediate jeopardy\\\\u201d. The provider in this instance noted that many times in the past they had been asked after a critical incident how they were going to protect the people they served from \\\\u201cimmediate jeopardy\\\\u201d in the future, so this mandate shaped the perception of the provider\\\\u2019s managers and supervisors whenever a health and safety concern arose and placed pressure on them to prioritize their response in a way that would satisfy MDH reviewers. The provider in this instance noted that terminating the person\\\\u2019s services was part of their response as to how they would respond to MDH\\\\u2019s questioning of how they were protecting the health and safety of the other people in the home. Between the requirements of DHS and MDH as well as the expectations of the guardians and case managers, the provider felt a strong need to act in this situation and felt that termination was the only way they could keep the majority of the people in the home safe. \\\\r\\\\nThe provider noted that the team had explored the possibility of implementing rights restrictions with the individual, but the team determined they wouldn\\\\u2019t be possible due to the requirements of 245D surrounding rights restrictions, or wouldn\\\\u2019t be sufficient to meet the safety needs of the person and others in the home. Due to the ineffectiveness of a rights restriction, the provider felt they had few options to address the person\\\\u2019s challenging behavior. \\\\r\\\\nAnother influence as to why the provider terminated a person\\\\u2019s services due to challenging behavior was that the person\\\\u2019s challenging behavior did not dissipate as expected after the person moved to the home. While it was known prior to intake that the person sometimes exhibited challenging behavior, there was an assumption by the team that this environment would likely help decrease the triggers that impacted the challenging behavior in the past. \\\\r\\\\nA number of factors were identified that  person\\\\u2019s challenging behavior not dissipating. For one, the provider noted that the staff at the site were trained more on meeting the medical needs of the other people in the home than de-escalating challenging behavior. While Minnesota Statutes 245D and the Positive Supports Rule (9544) required the provider to ensure their staff had training and were competent on positive support strategies, de-escalation techniques and the use of restrictive interventions, because the other people in the home didn\\\\u2019t exhibit challenging behavior, the focus of their training was centered more on medical needs than \\\\u2018behavioral needs\\\\u2019. The provider also noted that the staff felt a fear to administer pro re nata (PRN) medication to the person during mental health episodes due to the stigma of providing medication at these times and the training and reporting requirements of the Positive Supports Rule. The Positive Supports Rule (MN Rule 9544) requires providers to report the use of PRN medications when administered in a behavioral situation, and there was a belief among staff that the use of PRNs in this manner were not ok because they required reporting. \\\\r\\\\nThe provider \\\\u2013 and the person\\\\u2019s team - expected the person\\\\u2019s challenging behavior to dissipate after intake not only because they thought the environment would suit the person, but they assumed that a behavior support plan would positively effect change and decrease the person\\\\u2019s interfering behavior and that other external services would be able to assist with challenging episodes. Unfortunately, upon arrival the provider found there was a lack of external behavior services in their area and that they had a lack of information about what mental health services were available. Additionally, the person\\\\u2019s case manager \\\\u2013 who would typically be expected to also help find needed services \\\\u2013 was very busy and unable to devote much time to the person\\\\u2019s case. A number of influences as to why case managers would be busy were identified \\\\u2013 between high case load and recent federal and state initiatives changing services. MnCHOICES, HCBS rule and person-centered planning initiatives were all noted as positive changes, but changes that took a lot of time away from case managers to learn and meet the new requirements. This program was located in southern Minnesota, and the team noted that this region in particular has a scarcity of mental health resources. The provider and the team did find a neuropsych practitioner that was willing to work with the person, but unfortunately they were too far away and the drive was too long. This made it hard to make regular meetings and implement the neuropsych\\\\u2019s recommendations. Additionally, the provider was able to bring the person to a nearby hospital during challenging episodes, but noted that any interventions offered by the hospital unfortunately were ineffective.\\\\r\\\\nAlong with the lack of mental health resources, the provider also noted there was a lack of behavioral resources available to the person. Some practitioners had recommended that the person be admitted to an inpatient facility where they could try a \\\\u201cmed holiday\\\\u201d \\\\u2013 taking the person off all their meds and slowly re-introducing medication to determine their effectiveness. The provider could only find 1 program in the state that offered \\\\u201cmed holidays\\\\u201d, and that program had only 9 beds and waiting list of 25 people. The mapping team noted that the Jensen Settlement, which limited community base intensive services and the interventions they could use, influenced the lack of behavioral services like this one. \\\\r\\\\nWithout interventions that met the needs of the person, coupled with the lack of training of the staff, the provider noted their staff were stressed at the site. They often times engaged in power struggles with the individual and spent time trying to keep the other 3 residents safe. The provider did note that one option they wanted to explore before terminating the person\\\\u2019s services was to find out if they could obtain 1 on 1 staffing for the individual, but didn\\\\u2019t know who to ask or where to start. ICF\\\\\\/DD rates have many regulations and oftentimes hard to navigate they noted. The provider noted that the ability to obtain reimbursement beyond the facility\\\\u2019s establish rate was a mystifying process.\\\",\\\"Yes_or_No__128\\\":\\\"Yes\\\",\\\"Free_Text__130\\\":\\\"Influencing why this person was placed in what was seen as an atypical placement was that the person had never stayed at an ICF\\\\\\/DD before and the other people in the home were seen as having more medical needs than behavioral challenges. Despite these differences, the team, including the case manager, guardian and the provider thought this could be a good fit for the person because they could have more attention from staff and the person wouldn\\\\u2019t see the other roommates as a \\\\u2018threat\\\\u2019. \\\\r\\\\nAnother factor into this placement was that the provider had an open ICFs\\\\\\/DD bed. The fact it was an ICF\\\\\\/DD bed was one of the reasons why the bed was open. The providers in the room noted that there isn\\\\u2019t much interest in ICF\\\\\\/DD beds any more. Regionally, statewide and nationally, ICF or other institutional placements are seen as undesirable and passed over for foster care or other community-based settings. A number of factors have influenced this opinion about ICFs\\\\\\/DDs, including; public sentiment shifting away from institutions and large settings; the HCBS settings rule which has required systems to move towards community settings; the Minnesota Olmstead Plan which reflects the Supreme Court\\\\u2019s 1999 Olmstead ruling determining people should be served in the \\\\u201cmost integrated setting\\\\u201d, and; the Jensen Settlement Agreement which resulted in both Minnesota\\\\u2019s Olmstead Plan and the closure of some institutional services.\\\\r\\\\nAnother factor as to why this person was placed in an atypical placement was that the provider was willing to take a risk by accepting someone who didn\\\\u2019t fit the typical profile for this home. They were willing to take a risk because they did have an open ICF\\\\\\/DD bed that needed to be filled and hadn\\\\u2019t had much interest from other people in. The provider was also willing to take a risk because they determined the person could do well at the site.  This determination impacted the placement and was impacted by a number of factors. While the other people in the home didn\\\\u2019t have similar needs as this person, the team thought this might work well in this case. The other five people in the home had higher Activities of Daily Living (ADL) needs than this person so it was thought the person wouldn\\\\u2019t add much to the staff\\\\u2019s workload in this area. The five people also exhibited challenging behavior that was more easily redirected and managed by staff, so it was thought the house wouldn\\\\u2019t be overwhelming for staff to manage challenging behavior in the home as a whole. Additionally, it seemed to the provider that the person\\\\u2019s challenging behavior appeared manageable. This was due to a number of influences such as the case manager reporting there weren\\\\u2019t major recent behavioral concerns and the paperwork received from the person\\\\u2019s previous provider before intake. Beyond the concerns around the person\\\\u2019s challenging behavior, the paperwork from the previous provider supported the new provider\\\\u2019s assessment that the person could do well at this site. The person\\\\u2019s psychiatrist also weighed in and supported this particular placement, contributing to this assessment.\\\\r\\\\nAlong with the provider being willing to take a risk by accepting the person\\\\u2019s placement in this atypical setting was that both the case manager and the person\\\\u2019s guardian were willing to take a risk by placing the person in a home that didn\\\\u2019t fit the \\\\u2018typical\\\\u2019 profile. The person had failed at multiple community-based settings before so they both reported being interested in trying something different. Their options were likely limited too because this region has a lack of residential placement beds, which is also the trend statewide. This lack of residential beds is seen as influenced by a statewide moratorium on foster care beds as well as a moratorium on ICF\\\\\\/DD beds. The providers in the room also noted that the current statewide workforce shortage prohibits them from opening new programs as well as influences the closure of other residential sites. Without staff, programs cannot open or even stay open as providers can\\\\u2019t meet the supervision needs of the people living there.\\\",\\\"Multiple_Choice__101\\\":\\\"2\\\",\\\"Free_Text__102\\\":\\\"Unique to ICF\\\\\\/DDs is that they are licensed by both the Department of Human Services and the Minnesota Department of Health. Both Departments require providers to protect the health and safety of the people they serve. Minnesota Statutes 245D outlines the requirements for providers enforced by DHS while MDH relies on other statutory requirements in Minnesota statutes 144 and Rule. A unique requirement enforced by MDH is that ICF\\\\\\/DDs are expected to protect the people they serve from \\\\u201cimmediate jeopardy\\\\u201d. The provider in this instance noted that many times in the past they had been asked after a critical incident how they were going to protect the people they served from \\\\u201cimmediate jeopardy\\\\u201d in the future, so this mandate shaped the perception of the provider\\\\u2019s managers and supervisors whenever a health and safety concern arose and placed pressure on them to prioritize their response in a way that would satisfy MDH reviewers. The provider in this instance noted that terminating the person\\\\u2019s services was part of their response as to how they would respond to MDH\\\\u2019s questioning of how they were protecting the health and safety of the other people in the home. Between the requirements of DHS and MDH as well as the expectations of the guardians and case managers, the provider felt a strong need to act in this situation and felt that termination was the only way they could keep the majority of the people in the home safe.\\\",\\\"Multiple_Choice__109\\\":\\\"2\\\",\\\"Free_Text__110\\\":\\\"The provider \\\\u2013 and the person\\\\u2019s team - expected the person\\\\u2019s challenging behavior to dissipate after intake not only because they thought the environment would suit the person, but they assumed that a behavior support plan would positively effect change and decrease the person\\\\u2019s interfering behavior and that other external services would be able to assist with challenging episodes. Unfortunately, upon arrival the provider found there was a lack of external behavior services in their area and that they had a lack of information about what mental health services were available. Additionally, the person\\\\u2019s case manager \\\\u2013 who would typically be expected to also help find needed services \\\\u2013 was very busy and unable to devote much time to the person\\\\u2019s case. A number of influences as to why case managers would be busy were identified \\\\u2013 between high case load and recent federal and state initiatives changing services.\\\",\\\"Multiple_Choice__115\\\":\\\"3\\\",\\\"Free_Text__116\\\":\\\"Influencing why the ICF\\\\\\/DD provider terminated this person\\\\u2019s services due to challenging behavior was that the person was posing a safety risk to others in the home. The other 3 individuals in the home were considered to be more vulnerable to abuse due to their lower functioning levels, and so the person posed a greater risk to them. The provider had to balance their responsibility to protect the health and safety of three people in the home with their responsibility to meet the needs of the person whose services they terminated.\\\",\\\"Multiple_Choice__119\\\":\\\"3\\\",\\\"Free_Text__120\\\":\\\"The provider \\\\u2013 and the person\\\\u2019s team - expected the person\\\\u2019s challenging behavior to dissipate after intake not only because they thought the environment would suit the person, but they assumed that a behavior support plan would positively effect change and decrease the person\\\\u2019s interfering behavior and that other external services would be able to assist with challenging episodes. Unfortunately, upon arrival the provider found there was a lack of external behavior services in their area and that they had a lack of information about what mental health services were available. \\\\r\\\\nAlong with the lack of mental health resources, the provider also noted there was a lack of behavioral resources available to the person. Some practitioners had recommended that the person be admitted to an inpatient facility where they could try a \\\\u201cmed holiday\\\\u201d \\\\u2013 taking the person off all their meds and slowly re-introducing medication to determine their effectiveness. The provider could only find 1 program in the state that offered \\\\u201cmed holidays\\\\u201d, and that program had only 9 beds and waiting list of 25 people. The mapping team noted that the Jensen Settlement, which limited community base intensive services and the interventions they could use, influenced the lack of behavioral services like this one. \\\\r\\\\n\\\\r\\\\nAnother factor as to why this person was placed in an atypical placement was that the provider was willing to take a risk by accepting someone who didn\\\\u2019t fit the typical profile for this home. They were willing to take a risk because they did have an open ICF\\\\\\/DD bed that needed to be filled and hadn\\\\u2019t had much interest from other people in\\\\r\\\\n\\\\r\\\\nAlong with the provider being willing to take a risk by accepting the person\\\\u2019s placement in this atypical setting was that both the case manager and the person\\\\u2019s guardian were willing to take a risk by placing the person in a home that didn\\\\u2019t fit the \\\\u2018typical\\\\u2019 profile. The person had failed at multiple community-based settings before so they both reported being interested in trying something different. Their options were likely limited too because this region has a lack of residential placement beds, which is also the trend statewide. This lack of residential beds is seen as influenced by a statewide moratorium on foster care beds as well as a moratorium on ICF\\\\\\/DD beds. The providers in the room also noted that the current statewide workforce shortage prohibits them from opening new programs as well as influences the closure of other residential sites. Without staff, programs cannot open or even stay open as providers can\\\\u2019t meet the supervision needs of the people living there.\\\",\\\"Multiple_Choice__125\\\":\\\"2\\\",\\\"Free_Text__126\\\":\\\"Without interventions that met the needs of the person, coupled with the lack of training of the staff, the provider noted their staff were stressed at the site. They often times engaged in power struggles with the individual and spent time trying to keep the other 3 residents safe\\\",\\\"Yes_or_No__432\\\":\\\"Yes\\\"}\",\"mcq_answer\":null,\"other_answer\":\"0\",\"status\":\"1\",\"created_by\":\"81\",\"updated_by\":81,\"created_at\":\"5\\/25\\/2021 1:14:26 am\",\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"deleted_at\":null,\"report_name\":\"CY_Harry Meyering-BEC-2019-11\"}','68.53.115.247','2021-05-25 21:58:34'),(15068,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18086,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"76\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Care Manager\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18086}','68.53.115.247','2021-05-25 21:58:34'),(15069,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18087,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"12\\/17\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18087}','68.53.115.247','2021-05-25 21:58:34'),(15070,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18088,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"78\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Charles Young\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18088}','68.53.115.247','2021-05-25 21:58:34'),(15071,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18089,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"79\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Kristie Pittman\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18089}','68.53.115.247','2021-05-25 21:58:34'),(15072,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18090,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"80\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Harry Meyering\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18090}','68.53.115.247','2021-05-25 21:58:34'),(15073,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18091,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"81\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Emily Britz \\/ Tana Helleksen\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18091}','68.53.115.247','2021-05-25 21:58:34'),(15074,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18092,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"82\",\"question_type\":\"Short_Answer\",\"text_answer\":\"ebritz \\/ thelleksen \\/@harrymeyeringcenter.org\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18092}','68.53.115.247','2021-05-25 21:58:34'),(15075,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18093,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"83\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18093}','68.53.115.247','2021-05-25 21:58:34'),(15076,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18094,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Termination of Services\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18094}','68.53.115.247','2021-05-25 21:58:34'),(15077,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18095,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Blue Earth County\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18095}','68.53.115.247','2021-05-25 21:58:34'),(15078,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18096,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18096}','68.53.115.247','2021-05-25 21:58:34'),(15079,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18097,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18097}','68.53.115.247','2021-05-25 21:58:34'),(15080,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18098,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18098}','68.53.115.247','2021-05-25 21:58:34'),(15081,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18099,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Person\'s services were terminated due to challenging behavior\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18099}','68.53.115.247','2021-05-25 21:58:34'),(15082,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18100,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18100}','68.53.115.247','2021-05-25 21:58:34'),(15083,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18101,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18101}','68.53.115.247','2021-05-25 21:58:34'),(15084,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18102,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18102}','68.53.115.247','2021-05-25 21:58:34'),(15085,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18103,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18103}','68.53.115.247','2021-05-25 21:58:34'),(15086,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18104,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"Influencing why the ICF\\/DD provider terminated this person\\u2019s services due to challenging behavior was that the person was posing a safety risk to others in the home. The other 3 individuals in the home were considered to be more vulnerable to abuse due to their lower functioning levels, and so the person posed a greater risk to them. The provider had to balance their responsibility to protect the health and safety of three people in the home with their responsibility to meet the needs of the person whose services they terminated. The guardians of the other 3 individuals had an expectation that the provider would keep them safe, and due to their higher vulnerability the guardians expressed their concern often in this instance. Another impact to the provider\\u2019s responsibility for people\\u2019s health and safety include county case managers assigning this function to providers via the CSSP. Unique to ICF\\/DDs is that they are licensed by both the Department of Human Services and the Minnesota Department of Health. Both Departments require providers to protect the health and safety of the people they serve. Minnesota Statutes 245D outlines the requirements for providers enforced by DHS while MDH relies on other statutory requirements in Minnesota statutes 144 and Rule. A unique requirement enforced by MDH is that ICF\\/DDs are expected to protect the people they serve from \\u201cimmediate jeopardy\\u201d. The provider in this instance noted that many times in the past they had been asked after a critical incident how they were going to protect the people they served from \\u201cimmediate jeopardy\\u201d in the future, so this mandate shaped the perception of the provider\\u2019s managers and supervisors whenever a health and safety concern arose and placed pressure on them to prioritize their response in a way that would satisfy MDH reviewers. The provider in this instance noted that terminating the person\\u2019s services was part of their response as to how they would respond to MDH\\u2019s questioning of how they were protecting the health and safety of the other people in the home. Between the requirements of DHS and MDH as well as the expectations of the guardians and case managers, the provider felt a strong need to act in this situation and felt that termination was the only way they could keep the majority of the people in the home safe. \\r\\nThe provider noted that the team had explored the possibility of implementing rights restrictions with the individual, but the team determined they wouldn\\u2019t be possible due to the requirements of 245D surrounding rights restrictions, or wouldn\\u2019t be sufficient to meet the safety needs of the person and others in the home. Due to the ineffectiveness of a rights restriction, the provider felt they had few options to address the person\\u2019s challenging behavior. \\r\\nAnother influence as to why the provider terminated a person\\u2019s services due to challenging behavior was that the person\\u2019s challenging behavior did not dissipate as expected after the person moved to the home. While it was known prior to intake that the person sometimes exhibited challenging behavior, there was an assumption by the team that this environment would likely help decrease the triggers that impacted the challenging behavior in the past. \\r\\nA number of factors were identified that  person\\u2019s challenging behavior not dissipating. For one, the provider noted that the staff at the site were trained more on meeting the medical needs of the other people in the home than de-escalating challenging behavior. While Minnesota Statutes 245D and the Positive Supports Rule (9544) required the provider to ensure their staff had training and were competent on positive support strategies, de-escalation techniques and the use of restrictive interventions, because the other people in the home didn\\u2019t exhibit challenging behavior, the focus of their training was centered more on medical needs than \\u2018behavioral needs\\u2019. The provider also noted that the staff felt a fear to administer pro re nata (PRN) medication to the person during mental health episodes due to the stigma of providing medication at these times and the training and reporting requirements of the Positive Supports Rule. The Positive Supports Rule (MN Rule 9544) requires providers to report the use of PRN medications when administered in a behavioral situation, and there was a belief among staff that the use of PRNs in this manner were not ok because they required reporting. \\r\\nThe provider \\u2013 and the person\\u2019s team - expected the person\\u2019s challenging behavior to dissipate after intake not only because they thought the environment would suit the person, but they assumed that a behavior support plan would positively effect change and decrease the person\\u2019s interfering behavior and that other external services would be able to assist with challenging episodes. Unfortunately, upon arrival the provider found there was a lack of external behavior services in their area and that they had a lack of information about what mental health services were available. Additionally, the person\\u2019s case manager \\u2013 who would typically be expected to also help find needed services \\u2013 was very busy and unable to devote much time to the person\\u2019s case. A number of influences as to why case managers would be busy were identified \\u2013 between high case load and recent federal and state initiatives changing services. MnCHOICES, HCBS rule and person-centered planning initiatives were all noted as positive changes, but changes that took a lot of time away from case managers to learn and meet the new requirements. This program was located in southern Minnesota, and the team noted that this region in particular has a scarcity of mental health resources. The provider and the team did find a neuropsych practitioner that was willing to work with the person, but unfortunately they were too far away and the drive was too long. This made it hard to make regular meetings and implement the neuropsych\\u2019s recommendations. Additionally, the provider was able to bring the person to a nearby hospital during challenging episodes, but noted that any interventions offered by the hospital unfortunately were ineffective.\\r\\nAlong with the lack of mental health resources, the provider also noted there was a lack of behavioral resources available to the person. Some practitioners had recommended that the person be admitted to an inpatient facility where they could try a \\u201cmed holiday\\u201d \\u2013 taking the person off all their meds and slowly re-introducing medication to determine their effectiveness. The provider could only find 1 program in the state that offered \\u201cmed holidays\\u201d, and that program had only 9 beds and waiting list of 25 people. The mapping team noted that the Jensen Settlement, which limited community base intensive services and the interventions they could use, influenced the lack of behavioral services like this one. \\r\\nWithout interventions that met the needs of the person, coupled with the lack of training of the staff, the provider noted their staff were stressed at the site. They often times engaged in power struggles with the individual and spent time trying to keep the other 3 residents safe. The provider did note that one option they wanted to explore before terminating the person\\u2019s services was to find out if they could obtain 1 on 1 staffing for the individual, but didn\\u2019t know who to ask or where to start. ICF\\/DD rates have many regulations and oftentimes hard to navigate they noted. The provider noted that the ability to obtain reimbursement beyond the facility\\u2019s establish rate was a mystifying process.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18104}','68.53.115.247','2021-05-25 21:58:34'),(15087,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18105,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18105}','68.53.115.247','2021-05-25 21:58:34'),(15088,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18106,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"128\",\"question_type\":\"Yes_or_No\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18106}','68.53.115.247','2021-05-25 21:58:34'),(15089,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18107,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18107}','68.53.115.247','2021-05-25 21:58:34'),(15090,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18108,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":\"Influencing why this person was placed in what was seen as an atypical placement was that the person had never stayed at an ICF\\/DD before and the other people in the home were seen as having more medical needs than behavioral challenges. Despite these differences, the team, including the case manager, guardian and the provider thought this could be a good fit for the person because they could have more attention from staff and the person wouldn\\u2019t see the other roommates as a \\u2018threat\\u2019. \\r\\nAnother factor into this placement was that the provider had an open ICFs\\/DD bed. The fact it was an ICF\\/DD bed was one of the reasons why the bed was open. The providers in the room noted that there isn\\u2019t much interest in ICF\\/DD beds any more. Regionally, statewide and nationally, ICF or other institutional placements are seen as undesirable and passed over for foster care or other community-based settings. A number of factors have influenced this opinion about ICFs\\/DDs, including; public sentiment shifting away from institutions and large settings; the HCBS settings rule which has required systems to move towards community settings; the Minnesota Olmstead Plan which reflects the Supreme Court\\u2019s 1999 Olmstead ruling determining people should be served in the \\u201cmost integrated setting\\u201d, and; the Jensen Settlement Agreement which resulted in both Minnesota\\u2019s Olmstead Plan and the closure of some institutional services.\\r\\nAnother factor as to why this person was placed in an atypical placement was that the provider was willing to take a risk by accepting someone who didn\\u2019t fit the typical profile for this home. They were willing to take a risk because they did have an open ICF\\/DD bed that needed to be filled and hadn\\u2019t had much interest from other people in. The provider was also willing to take a risk because they determined the person could do well at the site.  This determination impacted the placement and was impacted by a number of factors. While the other people in the home didn\\u2019t have similar needs as this person, the team thought this might work well in this case. The other five people in the home had higher Activities of Daily Living (ADL) needs than this person so it was thought the person wouldn\\u2019t add much to the staff\\u2019s workload in this area. The five people also exhibited challenging behavior that was more easily redirected and managed by staff, so it was thought the house wouldn\\u2019t be overwhelming for staff to manage challenging behavior in the home as a whole. Additionally, it seemed to the provider that the person\\u2019s challenging behavior appeared manageable. This was due to a number of influences such as the case manager reporting there weren\\u2019t major recent behavioral concerns and the paperwork received from the person\\u2019s previous provider before intake. Beyond the concerns around the person\\u2019s challenging behavior, the paperwork from the previous provider supported the new provider\\u2019s assessment that the person could do well at this site. The person\\u2019s psychiatrist also weighed in and supported this particular placement, contributing to this assessment.\\r\\nAlong with the provider being willing to take a risk by accepting the person\\u2019s placement in this atypical setting was that both the case manager and the person\\u2019s guardian were willing to take a risk by placing the person in a home that didn\\u2019t fit the \\u2018typical\\u2019 profile. The person had failed at multiple community-based settings before so they both reported being interested in trying something different. Their options were likely limited too because this region has a lack of residential placement beds, which is also the trend statewide. This lack of residential beds is seen as influenced by a statewide moratorium on foster care beds as well as a moratorium on ICF\\/DD beds. The providers in the room also noted that the current statewide workforce shortage prohibits them from opening new programs as well as influences the closure of other residential sites. Without staff, programs cannot open or even stay open as providers can\\u2019t meet the supervision needs of the people living there.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18108}','68.53.115.247','2021-05-25 21:58:34'),(15091,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18109,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18109}','68.53.115.247','2021-05-25 21:58:34'),(15092,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18110,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18110}','68.53.115.247','2021-05-25 21:58:34'),(15093,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18111,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18111}','68.53.115.247','2021-05-25 21:58:34'),(15094,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18112,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":\"Unique to ICF\\/DDs is that they are licensed by both the Department of Human Services and the Minnesota Department of Health. Both Departments require providers to protect the health and safety of the people they serve. Minnesota Statutes 245D outlines the requirements for providers enforced by DHS while MDH relies on other statutory requirements in Minnesota statutes 144 and Rule. A unique requirement enforced by MDH is that ICF\\/DDs are expected to protect the people they serve from \\u201cimmediate jeopardy\\u201d. The provider in this instance noted that many times in the past they had been asked after a critical incident how they were going to protect the people they served from \\u201cimmediate jeopardy\\u201d in the future, so this mandate shaped the perception of the provider\\u2019s managers and supervisors whenever a health and safety concern arose and placed pressure on them to prioritize their response in a way that would satisfy MDH reviewers. The provider in this instance noted that terminating the person\\u2019s services was part of their response as to how they would respond to MDH\\u2019s questioning of how they were protecting the health and safety of the other people in the home. Between the requirements of DHS and MDH as well as the expectations of the guardians and case managers, the provider felt a strong need to act in this situation and felt that termination was the only way they could keep the majority of the people in the home safe.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18112}','68.53.115.247','2021-05-25 21:58:34'),(15095,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18113,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18113}','68.53.115.247','2021-05-25 21:58:34'),(15096,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18114,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18114}','68.53.115.247','2021-05-25 21:58:34'),(15097,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18115,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"105\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18115}','68.53.115.247','2021-05-25 21:58:34'),(15098,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18116,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"106\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18116}','68.53.115.247','2021-05-25 21:58:34'),(15099,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18117,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"107\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18117}','68.53.115.247','2021-05-25 21:58:34'),(15100,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18118,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"108\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18118}','68.53.115.247','2021-05-25 21:58:34'),(15101,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18119,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"109\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18119}','68.53.115.247','2021-05-25 21:58:34'),(15102,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18120,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"110\",\"question_type\":\"Free_Text\",\"text_answer\":\"The provider \\u2013 and the person\\u2019s team - expected the person\\u2019s challenging behavior to dissipate after intake not only because they thought the environment would suit the person, but they assumed that a behavior support plan would positively effect change and decrease the person\\u2019s interfering behavior and that other external services would be able to assist with challenging episodes. Unfortunately, upon arrival the provider found there was a lack of external behavior services in their area and that they had a lack of information about what mental health services were available. Additionally, the person\\u2019s case manager \\u2013 who would typically be expected to also help find needed services \\u2013 was very busy and unable to devote much time to the person\\u2019s case. A number of influences as to why case managers would be busy were identified \\u2013 between high case load and recent federal and state initiatives changing services.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18120}','68.53.115.247','2021-05-25 21:58:34'),(15103,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18121,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"111\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18121}','68.53.115.247','2021-05-25 21:58:34'),(15104,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18122,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"112\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18122}','68.53.115.247','2021-05-25 21:58:34'),(15105,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18123,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"113\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18123}','68.53.115.247','2021-05-25 21:58:34'),(15106,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18124,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"114\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18124}','68.53.115.247','2021-05-25 21:58:34'),(15107,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18125,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"115\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18125}','68.53.115.247','2021-05-25 21:58:34'),(15108,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18126,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"116\",\"question_type\":\"Free_Text\",\"text_answer\":\"Influencing why the ICF\\/DD provider terminated this person\\u2019s services due to challenging behavior was that the person was posing a safety risk to others in the home. The other 3 individuals in the home were considered to be more vulnerable to abuse due to their lower functioning levels, and so the person posed a greater risk to them. The provider had to balance their responsibility to protect the health and safety of three people in the home with their responsibility to meet the needs of the person whose services they terminated.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18126}','68.53.115.247','2021-05-25 21:58:34'),(15109,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18127,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"117\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18127}','68.53.115.247','2021-05-25 21:58:34'),(15110,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18128,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"118\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18128}','68.53.115.247','2021-05-25 21:58:34'),(15111,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18129,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"119\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18129}','68.53.115.247','2021-05-25 21:58:34'),(15112,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18130,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"120\",\"question_type\":\"Free_Text\",\"text_answer\":\"The provider \\u2013 and the person\\u2019s team - expected the person\\u2019s challenging behavior to dissipate after intake not only because they thought the environment would suit the person, but they assumed that a behavior support plan would positively effect change and decrease the person\\u2019s interfering behavior and that other external services would be able to assist with challenging episodes. Unfortunately, upon arrival the provider found there was a lack of external behavior services in their area and that they had a lack of information about what mental health services were available. \\r\\nAlong with the lack of mental health resources, the provider also noted there was a lack of behavioral resources available to the person. Some practitioners had recommended that the person be admitted to an inpatient facility where they could try a \\u201cmed holiday\\u201d \\u2013 taking the person off all their meds and slowly re-introducing medication to determine their effectiveness. The provider could only find 1 program in the state that offered \\u201cmed holidays\\u201d, and that program had only 9 beds and waiting list of 25 people. The mapping team noted that the Jensen Settlement, which limited community base intensive services and the interventions they could use, influenced the lack of behavioral services like this one. \\r\\n\\r\\nAnother factor as to why this person was placed in an atypical placement was that the provider was willing to take a risk by accepting someone who didn\\u2019t fit the typical profile for this home. They were willing to take a risk because they did have an open ICF\\/DD bed that needed to be filled and hadn\\u2019t had much interest from other people in\\r\\n\\r\\nAlong with the provider being willing to take a risk by accepting the person\\u2019s placement in this atypical setting was that both the case manager and the person\\u2019s guardian were willing to take a risk by placing the person in a home that didn\\u2019t fit the \\u2018typical\\u2019 profile. The person had failed at multiple community-based settings before so they both reported being interested in trying something different. Their options were likely limited too because this region has a lack of residential placement beds, which is also the trend statewide. This lack of residential beds is seen as influenced by a statewide moratorium on foster care beds as well as a moratorium on ICF\\/DD beds. The providers in the room also noted that the current statewide workforce shortage prohibits them from opening new programs as well as influences the closure of other residential sites. Without staff, programs cannot open or even stay open as providers can\\u2019t meet the supervision needs of the people living there.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18130}','68.53.115.247','2021-05-25 21:58:34'),(15113,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18131,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"121\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18131}','68.53.115.247','2021-05-25 21:58:34'),(15114,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18132,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"122\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18132}','68.53.115.247','2021-05-25 21:58:34'),(15115,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18133,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"123\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18133}','68.53.115.247','2021-05-25 21:58:34'),(15116,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18134,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"124\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18134}','68.53.115.247','2021-05-25 21:58:34'),(15117,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18135,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"125\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:34 pm\",\"created_at\":\"5\\/25\\/2021 4:58:34 pm\",\"id\":18135}','68.53.115.247','2021-05-25 21:58:34'),(15118,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18136,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"126\",\"question_type\":\"Free_Text\",\"text_answer\":\"Without interventions that met the needs of the person, coupled with the lack of training of the staff, the provider noted their staff were stressed at the site. They often times engaged in power struggles with the individual and spent time trying to keep the other 3 residents safe\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:35 pm\",\"created_at\":\"5\\/25\\/2021 4:58:35 pm\",\"id\":18136}','68.53.115.247','2021-05-25 21:58:35'),(15119,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18137,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"432\",\"question_type\":\"Yes_or_No\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:35 pm\",\"created_at\":\"5\\/25\\/2021 4:58:35 pm\",\"id\":18137}','68.53.115.247','2021-05-25 21:58:35'),(15120,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18138,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"12\\/16\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:39 pm\",\"created_at\":\"5\\/25\\/2021 4:58:39 pm\",\"id\":18138}','68.53.115.247','2021-05-25 21:58:39'),(15121,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports','update',186,'{\"id\":186,\"form_id\":\"23\",\"user_id\":\"81\",\"question_id\":null,\"organization_id\":\"10\",\"tab_id\":null,\"question_type\":null,\"text_answer\":\"{\\\"Short_Answer__76\\\":\\\"Care Manager\\\",\\\"Date__77\\\":\\\"12\\\\\\/16\\\\\\/2019\\\",\\\"Multiple_Choice__78\\\":\\\"Charles Young\\\",\\\"Multiple_Choice__79\\\":\\\"Kristie Pittman\\\",\\\"Short_Answer__80\\\":\\\"Harry Meyering\\\",\\\"Short_Answer__81\\\":\\\"Emily Britz \\\\\\/ Tana Helleksen\\\",\\\"Short_Answer__82\\\":\\\"ebritz \\\\\\/ thelleksen \\\\\\/@harrymeyeringcenter.org\\\",\\\"Multiple_Choice__84\\\":\\\"Termination of Services\\\",\\\"Multiple_Choice__85\\\":\\\"Blue Earth County\\\",\\\"Multiple_Choice__96\\\":\\\"2\\\",\\\"Short_Answer__91\\\":\\\"Person\'s services were terminated due to challenging behavior\\\",\\\"True_or_False__94\\\":\\\"Yes\\\",\\\"Free_Text__98\\\":\\\"Yes\\\",\\\"Free_Text__100\\\":\\\"Influencing why the ICF\\\\\\/DD provider terminated this person\\\\u2019s services due to challenging behavior was that the person was posing a safety risk to others in the home. The other 3 individuals in the home were considered to be more vulnerable to abuse due to their lower functioning levels, and so the person posed a greater risk to them. The provider had to balance their responsibility to protect the health and safety of three people in the home with their responsibility to meet the needs of the person whose services they terminated. The guardians of the other 3 individuals had an expectation that the provider would keep them safe, and due to their higher vulnerability the guardians expressed their concern often in this instance. Another impact to the provider\\\\u2019s responsibility for people\\\\u2019s health and safety include county case managers assigning this function to providers via the CSSP. Unique to ICF\\\\\\/DDs is that they are licensed by both the Department of Human Services and the Minnesota Department of Health. Both Departments require providers to protect the health and safety of the people they serve. Minnesota Statutes 245D outlines the requirements for providers enforced by DHS while MDH relies on other statutory requirements in Minnesota statutes 144 and Rule. A unique requirement enforced by MDH is that ICF\\\\\\/DDs are expected to protect the people they serve from \\\\u201cimmediate jeopardy\\\\u201d. The provider in this instance noted that many times in the past they had been asked after a critical incident how they were going to protect the people they served from \\\\u201cimmediate jeopardy\\\\u201d in the future, so this mandate shaped the perception of the provider\\\\u2019s managers and supervisors whenever a health and safety concern arose and placed pressure on them to prioritize their response in a way that would satisfy MDH reviewers. The provider in this instance noted that terminating the person\\\\u2019s services was part of their response as to how they would respond to MDH\\\\u2019s questioning of how they were protecting the health and safety of the other people in the home. Between the requirements of DHS and MDH as well as the expectations of the guardians and case managers, the provider felt a strong need to act in this situation and felt that termination was the only way they could keep the majority of the people in the home safe. \\\\r\\\\nThe provider noted that the team had explored the possibility of implementing rights restrictions with the individual, but the team determined they wouldn\\\\u2019t be possible due to the requirements of 245D surrounding rights restrictions, or wouldn\\\\u2019t be sufficient to meet the safety needs of the person and others in the home. Due to the ineffectiveness of a rights restriction, the provider felt they had few options to address the person\\\\u2019s challenging behavior. \\\\r\\\\nAnother influence as to why the provider terminated a person\\\\u2019s services due to challenging behavior was that the person\\\\u2019s challenging behavior did not dissipate as expected after the person moved to the home. While it was known prior to intake that the person sometimes exhibited challenging behavior, there was an assumption by the team that this environment would likely help decrease the triggers that impacted the challenging behavior in the past. \\\\r\\\\nA number of factors were identified that  person\\\\u2019s challenging behavior not dissipating. For one, the provider noted that the staff at the site were trained more on meeting the medical needs of the other people in the home than de-escalating challenging behavior. While Minnesota Statutes 245D and the Positive Supports Rule (9544) required the provider to ensure their staff had training and were competent on positive support strategies, de-escalation techniques and the use of restrictive interventions, because the other people in the home didn\\\\u2019t exhibit challenging behavior, the focus of their training was centered more on medical needs than \\\\u2018behavioral needs\\\\u2019. The provider also noted that the staff felt a fear to administer pro re nata (PRN) medication to the person during mental health episodes due to the stigma of providing medication at these times and the training and reporting requirements of the Positive Supports Rule. The Positive Supports Rule (MN Rule 9544) requires providers to report the use of PRN medications when administered in a behavioral situation, and there was a belief among staff that the use of PRNs in this manner were not ok because they required reporting. \\\\r\\\\nThe provider \\\\u2013 and the person\\\\u2019s team - expected the person\\\\u2019s challenging behavior to dissipate after intake not only because they thought the environment would suit the person, but they assumed that a behavior support plan would positively effect change and decrease the person\\\\u2019s interfering behavior and that other external services would be able to assist with challenging episodes. Unfortunately, upon arrival the provider found there was a lack of external behavior services in their area and that they had a lack of information about what mental health services were available. Additionally, the person\\\\u2019s case manager \\\\u2013 who would typically be expected to also help find needed services \\\\u2013 was very busy and unable to devote much time to the person\\\\u2019s case. A number of influences as to why case managers would be busy were identified \\\\u2013 between high case load and recent federal and state initiatives changing services. MnCHOICES, HCBS rule and person-centered planning initiatives were all noted as positive changes, but changes that took a lot of time away from case managers to learn and meet the new requirements. This program was located in southern Minnesota, and the team noted that this region in particular has a scarcity of mental health resources. The provider and the team did find a neuropsych practitioner that was willing to work with the person, but unfortunately they were too far away and the drive was too long. This made it hard to make regular meetings and implement the neuropsych\\\\u2019s recommendations. Additionally, the provider was able to bring the person to a nearby hospital during challenging episodes, but noted that any interventions offered by the hospital unfortunately were ineffective.\\\\r\\\\nAlong with the lack of mental health resources, the provider also noted there was a lack of behavioral resources available to the person. Some practitioners had recommended that the person be admitted to an inpatient facility where they could try a \\\\u201cmed holiday\\\\u201d \\\\u2013 taking the person off all their meds and slowly re-introducing medication to determine their effectiveness. The provider could only find 1 program in the state that offered \\\\u201cmed holidays\\\\u201d, and that program had only 9 beds and waiting list of 25 people. The mapping team noted that the Jensen Settlement, which limited community base intensive services and the interventions they could use, influenced the lack of behavioral services like this one. \\\\r\\\\nWithout interventions that met the needs of the person, coupled with the lack of training of the staff, the provider noted their staff were stressed at the site. They often times engaged in power struggles with the individual and spent time trying to keep the other 3 residents safe. The provider did note that one option they wanted to explore before terminating the person\\\\u2019s services was to find out if they could obtain 1 on 1 staffing for the individual, but didn\\\\u2019t know who to ask or where to start. ICF\\\\\\/DD rates have many regulations and oftentimes hard to navigate they noted. The provider noted that the ability to obtain reimbursement beyond the facility\\\\u2019s establish rate was a mystifying process.\\\",\\\"Yes_or_No__128\\\":\\\"Yes\\\",\\\"Free_Text__130\\\":\\\"Influencing why this person was placed in what was seen as an atypical placement was that the person had never stayed at an ICF\\\\\\/DD before and the other people in the home were seen as having more medical needs than behavioral challenges. Despite these differences, the team, including the case manager, guardian and the provider thought this could be a good fit for the person because they could have more attention from staff and the person wouldn\\\\u2019t see the other roommates as a \\\\u2018threat\\\\u2019. \\\\r\\\\nAnother factor into this placement was that the provider had an open ICFs\\\\\\/DD bed. The fact it was an ICF\\\\\\/DD bed was one of the reasons why the bed was open. The providers in the room noted that there isn\\\\u2019t much interest in ICF\\\\\\/DD beds any more. Regionally, statewide and nationally, ICF or other institutional placements are seen as undesirable and passed over for foster care or other community-based settings. A number of factors have influenced this opinion about ICFs\\\\\\/DDs, including; public sentiment shifting away from institutions and large settings; the HCBS settings rule which has required systems to move towards community settings; the Minnesota Olmstead Plan which reflects the Supreme Court\\\\u2019s 1999 Olmstead ruling determining people should be served in the \\\\u201cmost integrated setting\\\\u201d, and; the Jensen Settlement Agreement which resulted in both Minnesota\\\\u2019s Olmstead Plan and the closure of some institutional services.\\\\r\\\\nAnother factor as to why this person was placed in an atypical placement was that the provider was willing to take a risk by accepting someone who didn\\\\u2019t fit the typical profile for this home. They were willing to take a risk because they did have an open ICF\\\\\\/DD bed that needed to be filled and hadn\\\\u2019t had much interest from other people in. The provider was also willing to take a risk because they determined the person could do well at the site.  This determination impacted the placement and was impacted by a number of factors. While the other people in the home didn\\\\u2019t have similar needs as this person, the team thought this might work well in this case. The other five people in the home had higher Activities of Daily Living (ADL) needs than this person so it was thought the person wouldn\\\\u2019t add much to the staff\\\\u2019s workload in this area. The five people also exhibited challenging behavior that was more easily redirected and managed by staff, so it was thought the house wouldn\\\\u2019t be overwhelming for staff to manage challenging behavior in the home as a whole. Additionally, it seemed to the provider that the person\\\\u2019s challenging behavior appeared manageable. This was due to a number of influences such as the case manager reporting there weren\\\\u2019t major recent behavioral concerns and the paperwork received from the person\\\\u2019s previous provider before intake. Beyond the concerns around the person\\\\u2019s challenging behavior, the paperwork from the previous provider supported the new provider\\\\u2019s assessment that the person could do well at this site. The person\\\\u2019s psychiatrist also weighed in and supported this particular placement, contributing to this assessment.\\\\r\\\\nAlong with the provider being willing to take a risk by accepting the person\\\\u2019s placement in this atypical setting was that both the case manager and the person\\\\u2019s guardian were willing to take a risk by placing the person in a home that didn\\\\u2019t fit the \\\\u2018typical\\\\u2019 profile. The person had failed at multiple community-based settings before so they both reported being interested in trying something different. Their options were likely limited too because this region has a lack of residential placement beds, which is also the trend statewide. This lack of residential beds is seen as influenced by a statewide moratorium on foster care beds as well as a moratorium on ICF\\\\\\/DD beds. The providers in the room also noted that the current statewide workforce shortage prohibits them from opening new programs as well as influences the closure of other residential sites. Without staff, programs cannot open or even stay open as providers can\\\\u2019t meet the supervision needs of the people living there.\\\",\\\"Multiple_Choice__101\\\":\\\"2\\\",\\\"Free_Text__102\\\":\\\"Unique to ICF\\\\\\/DDs is that they are licensed by both the Department of Human Services and the Minnesota Department of Health. Both Departments require providers to protect the health and safety of the people they serve. Minnesota Statutes 245D outlines the requirements for providers enforced by DHS while MDH relies on other statutory requirements in Minnesota statutes 144 and Rule. A unique requirement enforced by MDH is that ICF\\\\\\/DDs are expected to protect the people they serve from \\\\u201cimmediate jeopardy\\\\u201d. The provider in this instance noted that many times in the past they had been asked after a critical incident how they were going to protect the people they served from \\\\u201cimmediate jeopardy\\\\u201d in the future, so this mandate shaped the perception of the provider\\\\u2019s managers and supervisors whenever a health and safety concern arose and placed pressure on them to prioritize their response in a way that would satisfy MDH reviewers. The provider in this instance noted that terminating the person\\\\u2019s services was part of their response as to how they would respond to MDH\\\\u2019s questioning of how they were protecting the health and safety of the other people in the home. Between the requirements of DHS and MDH as well as the expectations of the guardians and case managers, the provider felt a strong need to act in this situation and felt that termination was the only way they could keep the majority of the people in the home safe.\\\",\\\"Multiple_Choice__109\\\":\\\"2\\\",\\\"Free_Text__110\\\":\\\"The provider \\\\u2013 and the person\\\\u2019s team - expected the person\\\\u2019s challenging behavior to dissipate after intake not only because they thought the environment would suit the person, but they assumed that a behavior support plan would positively effect change and decrease the person\\\\u2019s interfering behavior and that other external services would be able to assist with challenging episodes. Unfortunately, upon arrival the provider found there was a lack of external behavior services in their area and that they had a lack of information about what mental health services were available. Additionally, the person\\\\u2019s case manager \\\\u2013 who would typically be expected to also help find needed services \\\\u2013 was very busy and unable to devote much time to the person\\\\u2019s case. A number of influences as to why case managers would be busy were identified \\\\u2013 between high case load and recent federal and state initiatives changing services.\\\",\\\"Multiple_Choice__115\\\":\\\"3\\\",\\\"Free_Text__116\\\":\\\"Influencing why the ICF\\\\\\/DD provider terminated this person\\\\u2019s services due to challenging behavior was that the person was posing a safety risk to others in the home. The other 3 individuals in the home were considered to be more vulnerable to abuse due to their lower functioning levels, and so the person posed a greater risk to them. The provider had to balance their responsibility to protect the health and safety of three people in the home with their responsibility to meet the needs of the person whose services they terminated.\\\",\\\"Multiple_Choice__119\\\":\\\"3\\\",\\\"Free_Text__120\\\":\\\"The provider \\\\u2013 and the person\\\\u2019s team - expected the person\\\\u2019s challenging behavior to dissipate after intake not only because they thought the environment would suit the person, but they assumed that a behavior support plan would positively effect change and decrease the person\\\\u2019s interfering behavior and that other external services would be able to assist with challenging episodes. Unfortunately, upon arrival the provider found there was a lack of external behavior services in their area and that they had a lack of information about what mental health services were available. \\\\r\\\\nAlong with the lack of mental health resources, the provider also noted there was a lack of behavioral resources available to the person. Some practitioners had recommended that the person be admitted to an inpatient facility where they could try a \\\\u201cmed holiday\\\\u201d \\\\u2013 taking the person off all their meds and slowly re-introducing medication to determine their effectiveness. The provider could only find 1 program in the state that offered \\\\u201cmed holidays\\\\u201d, and that program had only 9 beds and waiting list of 25 people. The mapping team noted that the Jensen Settlement, which limited community base intensive services and the interventions they could use, influenced the lack of behavioral services like this one. \\\\r\\\\n\\\\r\\\\nAnother factor as to why this person was placed in an atypical placement was that the provider was willing to take a risk by accepting someone who didn\\\\u2019t fit the typical profile for this home. They were willing to take a risk because they did have an open ICF\\\\\\/DD bed that needed to be filled and hadn\\\\u2019t had much interest from other people in\\\\r\\\\n\\\\r\\\\nAlong with the provider being willing to take a risk by accepting the person\\\\u2019s placement in this atypical setting was that both the case manager and the person\\\\u2019s guardian were willing to take a risk by placing the person in a home that didn\\\\u2019t fit the \\\\u2018typical\\\\u2019 profile. The person had failed at multiple community-based settings before so they both reported being interested in trying something different. Their options were likely limited too because this region has a lack of residential placement beds, which is also the trend statewide. This lack of residential beds is seen as influenced by a statewide moratorium on foster care beds as well as a moratorium on ICF\\\\\\/DD beds. The providers in the room also noted that the current statewide workforce shortage prohibits them from opening new programs as well as influences the closure of other residential sites. Without staff, programs cannot open or even stay open as providers can\\\\u2019t meet the supervision needs of the people living there.\\\",\\\"Multiple_Choice__125\\\":\\\"2\\\",\\\"Free_Text__126\\\":\\\"Without interventions that met the needs of the person, coupled with the lack of training of the staff, the provider noted their staff were stressed at the site. They often times engaged in power struggles with the individual and spent time trying to keep the other 3 residents safe\\\",\\\"Yes_or_No__432\\\":\\\"Yes\\\"}\",\"mcq_answer\":null,\"other_answer\":\"0\",\"status\":\"1\",\"created_by\":\"81\",\"updated_by\":81,\"created_at\":\"5\\/25\\/2021 1:14:26 am\",\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"deleted_at\":null,\"report_name\":\"CY_Harry Meyering-BEC-2019-11\"}','68.53.115.247','2021-05-25 21:58:40'),(15122,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18139,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"76\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Care Manager\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18139}','68.53.115.247','2021-05-25 21:58:40'),(15123,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18140,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"12\\/16\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18140}','68.53.115.247','2021-05-25 21:58:40'),(15124,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18141,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"78\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Charles Young\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18141}','68.53.115.247','2021-05-25 21:58:40'),(15125,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18142,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"79\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Kristie Pittman\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18142}','68.53.115.247','2021-05-25 21:58:40'),(15126,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18143,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"80\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Harry Meyering\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18143}','68.53.115.247','2021-05-25 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21:58:40'),(15129,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18146,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"83\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18146}','68.53.115.247','2021-05-25 21:58:40'),(15130,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18147,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Termination of Services\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18147}','68.53.115.247','2021-05-25 21:58:40'),(15131,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18148,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Blue Earth County\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18148}','68.53.115.247','2021-05-25 21:58:40'),(15132,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18149,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18149}','68.53.115.247','2021-05-25 21:58:40'),(15133,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18150,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18150}','68.53.115.247','2021-05-25 21:58:40'),(15134,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18151,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18151}','68.53.115.247','2021-05-25 21:58:40'),(15135,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18152,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Person\'s services were terminated due to challenging behavior\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18152}','68.53.115.247','2021-05-25 21:58:40'),(15136,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18153,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18153}','68.53.115.247','2021-05-25 21:58:40'),(15137,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18154,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18154}','68.53.115.247','2021-05-25 21:58:40'),(15138,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18155,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18155}','68.53.115.247','2021-05-25 21:58:40'),(15139,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18156,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18156}','68.53.115.247','2021-05-25 21:58:40'),(15140,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18157,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"Influencing why the ICF\\/DD provider terminated this person\\u2019s services due to challenging behavior was that the person was posing a safety risk to others in the home. The other 3 individuals in the home were considered to be more vulnerable to abuse due to their lower functioning levels, and so the person posed a greater risk to them. The provider had to balance their responsibility to protect the health and safety of three people in the home with their responsibility to meet the needs of the person whose services they terminated. The guardians of the other 3 individuals had an expectation that the provider would keep them safe, and due to their higher vulnerability the guardians expressed their concern often in this instance. Another impact to the provider\\u2019s responsibility for people\\u2019s health and safety include county case managers assigning this function to providers via the CSSP. Unique to ICF\\/DDs is that they are licensed by both the Department of Human Services and the Minnesota Department of Health. Both Departments require providers to protect the health and safety of the people they serve. Minnesota Statutes 245D outlines the requirements for providers enforced by DHS while MDH relies on other statutory requirements in Minnesota statutes 144 and Rule. A unique requirement enforced by MDH is that ICF\\/DDs are expected to protect the people they serve from \\u201cimmediate jeopardy\\u201d. The provider in this instance noted that many times in the past they had been asked after a critical incident how they were going to protect the people they served from \\u201cimmediate jeopardy\\u201d in the future, so this mandate shaped the perception of the provider\\u2019s managers and supervisors whenever a health and safety concern arose and placed pressure on them to prioritize their response in a way that would satisfy MDH reviewers. The provider in this instance noted that terminating the person\\u2019s services was part of their response as to how they would respond to MDH\\u2019s questioning of how they were protecting the health and safety of the other people in the home. Between the requirements of DHS and MDH as well as the expectations of the guardians and case managers, the provider felt a strong need to act in this situation and felt that termination was the only way they could keep the majority of the people in the home safe. \\r\\nThe provider noted that the team had explored the possibility of implementing rights restrictions with the individual, but the team determined they wouldn\\u2019t be possible due to the requirements of 245D surrounding rights restrictions, or wouldn\\u2019t be sufficient to meet the safety needs of the person and others in the home. Due to the ineffectiveness of a rights restriction, the provider felt they had few options to address the person\\u2019s challenging behavior. \\r\\nAnother influence as to why the provider terminated a person\\u2019s services due to challenging behavior was that the person\\u2019s challenging behavior did not dissipate as expected after the person moved to the home. While it was known prior to intake that the person sometimes exhibited challenging behavior, there was an assumption by the team that this environment would likely help decrease the triggers that impacted the challenging behavior in the past. \\r\\nA number of factors were identified that  person\\u2019s challenging behavior not dissipating. For one, the provider noted that the staff at the site were trained more on meeting the medical needs of the other people in the home than de-escalating challenging behavior. While Minnesota Statutes 245D and the Positive Supports Rule (9544) required the provider to ensure their staff had training and were competent on positive support strategies, de-escalation techniques and the use of restrictive interventions, because the other people in the home didn\\u2019t exhibit challenging behavior, the focus of their training was centered more on medical needs than \\u2018behavioral needs\\u2019. The provider also noted that the staff felt a fear to administer pro re nata (PRN) medication to the person during mental health episodes due to the stigma of providing medication at these times and the training and reporting requirements of the Positive Supports Rule. The Positive Supports Rule (MN Rule 9544) requires providers to report the use of PRN medications when administered in a behavioral situation, and there was a belief among staff that the use of PRNs in this manner were not ok because they required reporting. \\r\\nThe provider \\u2013 and the person\\u2019s team - expected the person\\u2019s challenging behavior to dissipate after intake not only because they thought the environment would suit the person, but they assumed that a behavior support plan would positively effect change and decrease the person\\u2019s interfering behavior and that other external services would be able to assist with challenging episodes. Unfortunately, upon arrival the provider found there was a lack of external behavior services in their area and that they had a lack of information about what mental health services were available. Additionally, the person\\u2019s case manager \\u2013 who would typically be expected to also help find needed services \\u2013 was very busy and unable to devote much time to the person\\u2019s case. A number of influences as to why case managers would be busy were identified \\u2013 between high case load and recent federal and state initiatives changing services. MnCHOICES, HCBS rule and person-centered planning initiatives were all noted as positive changes, but changes that took a lot of time away from case managers to learn and meet the new requirements. This program was located in southern Minnesota, and the team noted that this region in particular has a scarcity of mental health resources. The provider and the team did find a neuropsych practitioner that was willing to work with the person, but unfortunately they were too far away and the drive was too long. This made it hard to make regular meetings and implement the neuropsych\\u2019s recommendations. Additionally, the provider was able to bring the person to a nearby hospital during challenging episodes, but noted that any interventions offered by the hospital unfortunately were ineffective.\\r\\nAlong with the lack of mental health resources, the provider also noted there was a lack of behavioral resources available to the person. Some practitioners had recommended that the person be admitted to an inpatient facility where they could try a \\u201cmed holiday\\u201d \\u2013 taking the person off all their meds and slowly re-introducing medication to determine their effectiveness. The provider could only find 1 program in the state that offered \\u201cmed holidays\\u201d, and that program had only 9 beds and waiting list of 25 people. The mapping team noted that the Jensen Settlement, which limited community base intensive services and the interventions they could use, influenced the lack of behavioral services like this one. \\r\\nWithout interventions that met the needs of the person, coupled with the lack of training of the staff, the provider noted their staff were stressed at the site. They often times engaged in power struggles with the individual and spent time trying to keep the other 3 residents safe. The provider did note that one option they wanted to explore before terminating the person\\u2019s services was to find out if they could obtain 1 on 1 staffing for the individual, but didn\\u2019t know who to ask or where to start. ICF\\/DD rates have many regulations and oftentimes hard to navigate they noted. The provider noted that the ability to obtain reimbursement beyond the facility\\u2019s establish rate was a mystifying process.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18157}','68.53.115.247','2021-05-25 21:58:40'),(15141,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18158,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18158}','68.53.115.247','2021-05-25 21:58:40'),(15142,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18159,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"128\",\"question_type\":\"Yes_or_No\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18159}','68.53.115.247','2021-05-25 21:58:40'),(15143,'IkWGXP6lPFImvc9heWKBYqDkEYJQFTh6kFAFqlj9',81,'reports_answer','create',18160,'{\"report_id\":186,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 4:58:40 pm\",\"created_at\":\"5\\/25\\/2021 4:58:40 pm\",\"id\":18160}','68.53.115.247','2021-05-25 21:58:40');
