INSERT INTO `reports_answer` VALUES (34261,368,22,81,13,319,'Free_Text','A child protection report not being made following the 3-year old being seen in the emergency room and having two head contusions, which the mother could not explain was influenced by the age of the child, as well as location of the injury on the subject child\'s head.  These injuries on a 3-year old can also be explained as a result of normative childhood activities.  Additionally, the severity of the injury did not meet the perceived threshold required for medical personnel to make a child protection report.  Multiple competing priorities were occurring in the emergency room where the child was seen which further impacted the report not being made.  This included the time it takes to make a child protection report, the number of designated people in the emergency department to make child protection reports, as well as, the time the provider spends with a patient is historically shorter in the emergency department versus an appointment with a primary care provider.\r\n\r\nAn additional influence supporting a child protection report not being made was the fact that the subject child was seen at a different hospital and by a provider who was not familiar with the family, making it difficult to understand the child\'s medical history.  Furthermore, in situations like this, it can be difficult to access medical records at the time of the emergency room visit to better understand the child due to the limited amount of time spent in the emergency room.    Lastly, the decision to not make a child protection report was further impacted by the fact that the threshold for mandated reporting can be subjective.',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34262,368,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34263,368,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34264,368,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34265,368,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34266,368,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34267,368,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34268,368,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34269,368,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34270,368,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34271,368,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34272,368,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34273,368,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34274,368,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34275,368,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34276,368,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34277,368,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34278,368,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34279,368,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34280,368,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34281,368,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34282,368,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34283,368,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34284,368,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34285,368,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34286,368,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34287,368,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34288,368,22,81,13,358,'Multiple_Choice','2',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34289,368,22,81,13,359,'Free_Text','The severity of the injury did not meet the perceived threshold required for medical personnel to make a child protection report.\r\nThe decision to not make a child protection report was further impacted by the fact that the threshold for mandated reporting can be subjective, as defined in 626.556 subd. 3.',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34290,368,22,81,13,360,'Multiple_Choice','2',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34291,368,22,81,13,361,'Free_Text','Multiple competing priorities were occurring in the emergency room where the child was seen which further impacted the report not being made.  This included the time it takes to make a child protection report, the number of designated people in the emergency department to make child protection reports, as well as, the time the provider spends with a patient is historically shorter in the emergency department versus an appointment with a primary care provider.',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34292,368,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34293,368,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34294,368,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34295,368,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34296,368,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34297,368,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34298,368,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:32:13','2021-05-26 18:32:13',NULL),(34302,367,22,81,13,291,'Multiple_Choice','Ryan Hartneck',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34303,367,22,81,13,292,'Short_Answer','Aaron Strong',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34304,367,22,81,13,293,'Date','09/09/2016',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34305,367,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34306,367,22,81,13,294,'Multiple_Choice','Fatality',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34307,367,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34308,367,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34309,367,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34310,367,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34311,367,22,81,13,300,'Multiple_Choice','8',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34312,367,22,81,13,301,'Multiple_Choice','Hennepin',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34313,367,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34314,367,22,81,13,303,'Short_Answer','Trinity',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34315,367,22,81,13,304,'Short_Answer','Shelby',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34316,367,22,81,13,305,'Date','08/04/2015',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34317,367,22,81,13,306,'Date','03/24/2016',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34318,367,22,81,13,307,'Date',NULL,1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34319,367,22,81,13,308,'Multiple_Choice','7 Months',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34320,367,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34321,367,22,81,13,310,'Short_Answer','Father',1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34322,367,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34323,367,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34324,367,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:33:12','2021-05-26 18:33:12',NULL),(34325,367,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34326,367,22,81,13,316,'Multiple_Choice','3',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34327,367,22,81,13,317,'Short_Answer','Multidisciplinary team (MDT) or supervisor consult at point of screening was not done as required by policy.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34328,367,22,81,13,318,'Free_Text','It was learned during the debriefing that screening staff were allowed to screen most intakes individually without consultation of a multidisciplinary team or supervisor.  Staff are encouraged to utilize supervisor consultation as needed for screening decisions.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34329,367,22,81,13,319,'Free_Text','Not utilizing consultation with a MDT or supervisor at the point of screening the child protection report was influenced by staff\'s discretionary use for when to use a MDT or supervisor for screening consultation.  The agency\'s procedural adaptation of allowing screeners to discretionarily consult with a MDT or supervisor which deviates from state policy was governed by an overall increase in screening staff\'s workload, affecting staff\'s time to access and utilize a MDT or supervisor for screening consultation.  This increase in staff\'s workload has been impacted by recent changes to the Minnesota Intake, Screening, and Response Path Guidelines resulting from legislative changes following the recommendations made by the Governor\'s Task Force on the Protection of Children.  These changes have expanded intake and screening requirements for local agencies, leading to an increase in intake and screening related tasks. Recent media coverage on high profile child protection cases coupled with the local agency\'s press release on their 24 hour child protection coverage has also generated an increase in the volume of calls received by the local child welfare agency further contributing to an increase in screening staff\'s workloads.  Furthermore, procedural changes made by the agency requiring screening staff to thoroughly document all calls as intakes into SSIS (Social Service Information System) has also added to screening staff\'s workload.  This process has lengthened the time for staff to complete their required tasks, compromising the efficiency of their works as entering all of this information in SSIS is a burdensome process for staff.  This efficiency thoroughness tradeoff has further impacted staff\'s time to seek out a MDT or supervisor for screening consultation when needed. \r\n\r\nAlso influencing the agency\'s procedural adaptation of allowing screeners to discretionarily consult with a MDT or supervisor was the limited availability of supervisors for consultation. Limited supervisory consultation time was impacted by increased workload demands for supervisors that included, only two supervisors being on per shift, the number of staff supervised, and a meeting culture in the agency that affected supervisor\'s availability due to attending multiple meetings per week.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34330,367,22,81,13,320,'Short_Answer','Intake placed in pending status for 22 hours',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34331,367,22,81,13,321,'Free_Text','The intake received on 3/23/2016 was taken by the screener by phone and placed in pending status. Per the supervisor, this is not an uncommon practice (for non-immediate response cases) as screeners often receive high volumes of calls and are given the ability to prioritize those calls based on allegation/circumstances.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34332,367,22,81,13,322,'Free_Text','The worker\'s limited experience with child abuse reports to understand the complexities of screening decisions and inconsistent policy guidance provided by the Minnesota Department of Human Services influenced the intake being placed in pending status for 22 hours.  As a result of the increased volume of child welfare calls received by the agency during this time and the demand to thoroughly complete all intake and screening related tasks staff had less time available to attend training to understand the complexities of child protection screening decisions. Without adequate training, knowledge, and experience to recognize the emergent details within a child protection report, the report may have been seen as a lower priority for the screening staff and thus placed in pending status until consultation with a supervisor or MDT could occur.  The overall increase in volume of child welfare calls also influenced the screening supervisor\'s in making a sacrifice decision for staff to prioritize the completion of workload tasks over attending training.  Furthermore, the high volume of calls taken by screeners reduced the time and opportunity to utilize a MDT or supervisor for consultation further explaining this intake being placed in pending status until consultation with a MDT or supervisor could occur.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34333,367,22,81,13,323,'Short_Answer','Signs of abuse previously identified by child care facility were not reported to child protection.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34334,367,22,81,13,324,'Free_Text','No debriefing took place on this finding.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34335,367,22,81,13,325,'Free_Text','Barriers to reporting signs of child abuse by the child care facility may have been influenced by the fear of retaliation by caregivers of the child which could include caregivers removing their child from the agency.  The decision to not report previous signs of abuse may have been further impacted by an overall distrust of the child protection system, as some child care facilities perceive that nothing is done when they do report child abuse and neglect. Often times the relationship that is developed between caregivers and child care staff influences staff\'s mental model of when to make child protection reports as to not second guess the parent\'s explanation of how injuries occurred, further justifying staff\'s decisions to not report signs of suspected child abuse.  The cumbersome process of calling to report child abuse that includes long waits and calls being held in the que for lengthy periods of time also affects child care agencies not reporting signs of suspected abuse and neglect to the local agency.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34336,367,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34337,367,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34338,367,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34339,367,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34340,367,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34341,367,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34342,367,22,81,13,346,'Multiple_Choice','2',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34343,367,22,81,13,347,'Free_Text','Finding 3: Often times the relationship that is developed between caregivers and child care staff influences staff\'s mental model of when to make child protection reports as to not second guess the parent\'s explanation of how injuries occurred, further justifying staff\'s decisions to not report signs of suspected child abuse.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34344,367,22,81,13,348,'Multiple_Choice','1',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34345,367,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34346,367,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34347,367,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34348,367,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34349,367,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34350,367,22,81,13,354,'Multiple_Choice','2',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34351,367,22,81,13,355,'Free_Text','Finding 3: The decision to not report previous signs of abuse may have been further impacted by an overall distrust of the child protection system, as some child care facilities perceive that nothing is done when they do report child abuse and neglect.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34352,367,22,81,13,356,'Multiple_Choice','3',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34353,367,22,81,13,357,'Free_Text','Finding 2: As a result of the increased volume of child welfare calls received by the agency during this time and the demand to thoroughly complete all intake and screening related tasks staff had less time available to attend training to understand the complexities of child protection screening decisions.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34354,367,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34355,367,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34356,367,22,81,13,358,'Multiple_Choice','2',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34357,367,22,81,13,359,'Free_Text','Finding 2: The worker\'s limited experience with child abuse reports to understand the complexities of screening decisions and inconsistent policy guidance provided by the Minnesota Department of Human Services influenced the intake being placed in pending status for 22 hours.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34358,367,22,81,13,360,'Multiple_Choice','2',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34359,367,22,81,13,361,'Free_Text','Finding 1: The agency\'s procedural adaptation of allowing screeners to discretionarily consult with a MDT or supervisor which deviates from state policy was governed by an overall increase in screening staff\'s workload, affecting staff\'s time to access and utilize a MDT or supervisor for screening consultation.\r\n\r\nFinding 2: The overall increase in volume of child welfare calls also influenced the screening supervisor\'s in making a sacrifice decision for staff to prioritize the completion of workload tasks over attending training.  Furthermore, the high volume of calls taken by screeners reduced the time and opportunity to utilize a MDT or supervisor for consultation further justifying this intake being placed in pending status until consultation with a MDT or supervisor could occur',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34360,367,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34361,367,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34362,367,22,81,13,364,'Multiple_Choice','2',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34363,367,22,81,13,365,'Free_Text','Finding 1: Supervisor availability was impacted by increased workload demands, which includes the number of staff supervised, a meeting culture in the agency, which impacts their availability due to attending multiple meetings per week, and only two supervisors being on per shift.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34364,367,22,81,13,366,'Multiple_Choice','2',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34365,367,22,81,13,367,'Free_Text','Finding 1: The agency\'s procedural adaptation of allowing screeners to discretionarily consult with a MDT or supervisor which deviates from state policy was governed by an overall increase in screening staff\'s workload, affecting staff\'s time to access and utilize a MDT or supervisor for screening consultation.\r\n\r\nFinding 2: The high volume of calls taken by screeners reduced the time and opportunity to utilize a MDT or supervisor for consultation further justifying this intake being placed in pending status until consultation with a MDT or supervisor could occur.',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34366,367,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:33:13','2021-05-26 18:33:13',NULL),(34438,339,22,81,13,291,'Multiple_Choice','Brittany Lochner',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34439,339,22,81,13,292,'Short_Answer','Jennifer Carlson',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34440,339,22,81,13,293,'Date','07/17/2017',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34441,339,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34442,339,22,81,13,294,'Multiple_Choice','Fatality',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34443,339,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34444,339,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34445,339,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34446,339,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34447,339,22,81,13,300,'Multiple_Choice','8',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34448,339,22,81,13,301,'Multiple_Choice','Hennepin',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34449,339,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34450,339,22,81,13,303,'Short_Answer','Nahly',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34451,339,22,81,13,304,'Short_Answer','Ronquillo-Romero',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34452,339,22,81,13,305,'Date','11/12/2005',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34453,339,22,81,13,306,'Date','09/30/2016',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34454,339,22,81,13,307,'Date',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34455,339,22,81,13,308,'Multiple_Choice','10 Years',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34456,339,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34457,339,22,81,13,310,'Short_Answer','Father',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34458,339,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34459,339,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34460,339,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34461,339,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34462,339,22,81,13,316,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34463,339,22,81,13,317,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34464,339,22,81,13,318,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34465,339,22,81,13,319,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34466,339,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34467,339,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34468,339,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34469,339,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34470,339,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34471,339,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34472,339,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34473,339,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34474,339,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34475,339,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34476,339,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34477,339,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34478,339,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34479,339,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:09','2021-05-26 18:35:09',NULL),(34480,339,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34481,339,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34482,339,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34483,339,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34484,339,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34485,339,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34486,339,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34487,339,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34488,339,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34489,339,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34490,339,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34491,339,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34492,339,22,81,13,358,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34493,339,22,81,13,359,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34494,339,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34495,339,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34496,339,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34497,339,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34498,339,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34499,339,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34500,339,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34501,339,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34502,339,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:35:10','2021-05-26 18:35:10',NULL),(34503,338,22,81,13,291,'Multiple_Choice','Ryan Hartneck',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34504,338,22,81,13,292,'Short_Answer','Triage Team',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34505,338,22,81,13,293,'Date','12/11/2017',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34506,338,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34507,338,22,81,13,294,'Multiple_Choice','Near Fatality',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34508,338,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34509,338,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34510,338,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34511,338,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34512,338,22,81,13,300,'Multiple_Choice','9',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34513,338,22,81,13,301,'Multiple_Choice','Ramsey',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34514,338,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34515,338,22,81,13,303,'Short_Answer','Mykel',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34516,338,22,81,13,304,'Short_Answer','Powell',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34517,338,22,81,13,305,'Date','07/16/2017',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34518,338,22,81,13,306,'Date',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34519,338,22,81,13,307,'Date','11/22/2017',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34520,338,22,81,13,308,'Multiple_Choice','4 Months',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34521,338,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34522,338,22,81,13,310,'Short_Answer','Father',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34523,338,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34524,338,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34525,338,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34526,338,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34527,338,22,81,13,316,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34528,338,22,81,13,317,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34529,338,22,81,13,318,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34530,338,22,81,13,319,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34531,338,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34532,338,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34533,338,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34534,338,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34535,338,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34536,338,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34537,338,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34538,338,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34539,338,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34540,338,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34541,338,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34542,338,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34543,338,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34544,338,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34545,338,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34546,338,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34547,338,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34548,338,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34549,338,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34550,338,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34551,338,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34552,338,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:47','2021-05-26 18:35:47',NULL),(34553,338,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34554,338,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34555,338,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34556,338,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34557,338,22,81,13,358,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34558,338,22,81,13,359,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34559,338,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34560,338,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34561,338,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34562,338,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34563,338,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34564,338,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34565,338,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34566,338,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34567,338,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:35:48','2021-05-26 18:35:48',NULL),(34571,340,22,81,13,291,'Multiple_Choice','Brittany Lochner',1,81,81,'2021-05-26 18:36:39','2021-05-26 18:36:39',NULL),(34572,340,22,81,13,292,'Short_Answer','Triage Review',1,81,81,'2021-05-26 18:36:39','2021-05-26 18:36:39',NULL),(34573,340,22,81,13,293,'Date','05/11/2018',1,81,81,'2021-05-26 18:36:39','2021-05-26 18:36:39',NULL),(34574,340,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:36:39','2021-05-26 18:36:39',NULL),(34575,340,22,81,13,294,'Multiple_Choice','Near Fatality',1,81,81,'2021-05-26 18:36:39','2021-05-26 18:36:39',NULL),(34576,340,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:36:39','2021-05-26 18:36:39',NULL),(34577,340,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:36:39','2021-05-26 18:36:39',NULL),(34578,340,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:36:39','2021-05-26 18:36:39',NULL),(34579,340,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:36:39','2021-05-26 18:36:39',NULL),(34580,340,22,81,13,300,'Multiple_Choice','8',1,81,81,'2021-05-26 18:36:39','2021-05-26 18:36:39',NULL),(34581,340,22,81,13,301,'Multiple_Choice','Hennepin',1,81,81,'2021-05-26 18:36:39','2021-05-26 18:36:39',NULL),(34582,340,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34583,340,22,81,13,303,'Short_Answer','Naomi',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34584,340,22,81,13,304,'Short_Answer','Wallace',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34585,340,22,81,13,305,'Date','08/20/2016',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34586,340,22,81,13,306,'Date',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34587,340,22,81,13,307,'Date','03/06/2018',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34588,340,22,81,13,308,'Multiple_Choice','1 Year',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34589,340,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34590,340,22,81,13,310,'Short_Answer','Babysitter',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34591,340,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 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18:36:40','2021-05-26 18:36:40',NULL),(34602,340,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34603,340,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34604,340,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34605,340,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34606,340,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34607,340,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34608,340,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34609,340,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34610,340,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34611,340,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34612,340,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34613,340,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34614,340,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34615,340,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34616,340,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34617,340,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34618,340,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34619,340,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34620,340,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34621,340,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34622,340,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34623,340,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34624,340,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34625,340,22,81,13,358,'Multiple_Choice','0',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34626,340,22,81,13,359,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34627,340,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34628,340,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34629,340,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34630,340,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34631,340,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34632,340,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34633,340,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34634,340,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34635,340,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:36:40','2021-05-26 18:36:40',NULL),(34639,341,22,81,13,291,'Multiple_Choice','Ryan Hartneck',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34640,341,22,81,13,292,'Short_Answer','Triage Team',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34641,341,22,81,13,293,'Date','04/14/2020',1,81,81,'2021-05-26 18:37:28','2021-05-26 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18:37:28',NULL),(34651,341,22,81,13,303,'Short_Answer','Nelson',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34652,341,22,81,13,304,'Short_Answer','Schladetzky',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34653,341,22,81,13,305,'Date','10/24/2011',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34654,341,22,81,13,306,'Date','12/1/2020',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34655,341,22,81,13,307,'Date',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34656,341,22,81,13,308,'Multiple_Choice','8 Years',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34657,341,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34658,341,22,81,13,310,'Short_Answer','Father',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34659,341,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34660,341,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34661,341,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34662,341,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34663,341,22,81,13,316,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34664,341,22,81,13,317,'Short_Answer',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34665,341,22,81,13,318,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34666,341,22,81,13,319,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34667,341,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34668,341,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34669,341,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34670,341,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34671,341,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34672,341,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34673,341,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34674,341,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34675,341,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34676,341,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34677,341,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34678,341,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34679,341,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34680,341,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34681,341,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34682,341,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34683,341,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34684,341,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34685,341,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34686,341,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34687,341,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34688,341,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34689,341,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34690,341,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34691,341,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34692,341,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34693,341,22,81,13,358,'Multiple_Choice','0',1,81,81,'2021-05-26 18:37:28','2021-05-26 18:37:28',NULL),(34694,341,22,81,13,359,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:29','2021-05-26 18:37:29',NULL),(34695,341,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 18:37:29','2021-05-26 18:37:29',NULL),(34696,341,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:29','2021-05-26 18:37:29',NULL),(34697,341,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 18:37:29','2021-05-26 18:37:29',NULL),(34698,341,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:29','2021-05-26 18:37:29',NULL),(34699,341,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 18:37:29','2021-05-26 18:37:29',NULL),(34700,341,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:29','2021-05-26 18:37:29',NULL),(34701,341,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 18:37:29','2021-05-26 18:37:29',NULL),(34702,341,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:37:29','2021-05-26 18:37:29',NULL),(34703,341,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:37:29','2021-05-26 18:37:29',NULL),(34708,342,22,81,13,291,'Multiple_Choice','Ryan Hartneck',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34709,342,22,81,13,292,'Short_Answer','Triage Team',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34710,342,22,81,13,293,'Date','07/10/2019',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34711,342,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34712,342,22,81,13,294,'Multiple_Choice','Near Fatality',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34713,342,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34714,342,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34715,342,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34716,342,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34717,342,22,81,13,300,'Multiple_Choice','8',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34718,342,22,81,13,301,'Multiple_Choice','Hennepin',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34719,342,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34720,342,22,81,13,303,'Short_Answer','Noah',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34721,342,22,81,13,304,'Short_Answer','Pucci-Hoyos',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34722,342,22,81,13,305,'Date','04/01/2019',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34723,342,22,81,13,306,'Date',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34724,342,22,81,13,307,'Date','06/05/2019',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34725,342,22,81,13,308,'Multiple_Choice','2 Months',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34726,342,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34727,342,22,81,13,310,'Short_Answer','Father',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34728,342,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34729,342,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34730,342,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34731,342,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34732,342,22,81,13,316,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34733,342,22,81,13,317,'Short_Answer',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34734,342,22,81,13,318,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34735,342,22,81,13,319,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34736,342,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34737,342,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34738,342,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34739,342,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34740,342,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34741,342,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34742,342,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34743,342,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34744,342,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34745,342,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34746,342,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34747,342,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34748,342,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34749,342,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34750,342,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34751,342,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34752,342,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34753,342,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34754,342,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34755,342,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34756,342,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34757,342,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34758,342,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34759,342,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34760,342,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34761,342,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34762,342,22,81,13,358,'Multiple_Choice','0',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34763,342,22,81,13,359,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34764,342,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34765,342,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34766,342,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34767,342,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34768,342,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34769,342,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34770,342,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34771,342,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34772,342,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:41:20','2021-05-26 18:41:20',NULL),(34844,345,22,81,13,291,'Multiple_Choice','Brittany Lochner',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34845,345,22,81,13,292,'Short_Answer','Triage Team',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34846,345,22,81,13,293,'Date','07/27/2018',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34847,345,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34848,345,22,81,13,294,'Multiple_Choice','Fatality',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34849,345,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34850,345,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34851,345,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34852,345,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34853,345,22,81,13,300,'Multiple_Choice','4',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34854,345,22,81,13,301,'Multiple_Choice','Wright',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34855,345,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34856,345,22,81,13,303,'Short_Answer','Nolan',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34857,345,22,81,13,304,'Short_Answer','Muonio',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34858,345,22,81,13,305,'Date','04/30/2015',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34859,345,22,81,13,306,'Date','06/03/2018',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34860,345,22,81,13,307,'Date',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34861,345,22,81,13,308,'Multiple_Choice','3 Years',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34862,345,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34863,345,22,81,13,310,'Short_Answer','Mother',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34864,345,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34865,345,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34866,345,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34867,345,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34868,345,22,81,13,316,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34869,345,22,81,13,317,'Short_Answer',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34870,345,22,81,13,318,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34871,345,22,81,13,319,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34872,345,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34873,345,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34874,345,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34875,345,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34876,345,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34877,345,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34878,345,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34879,345,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34880,345,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34881,345,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34882,345,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34883,345,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34884,345,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34885,345,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34886,345,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34887,345,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34888,345,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34889,345,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34890,345,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34891,345,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34892,345,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34893,345,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34894,345,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34895,345,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34896,345,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34897,345,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34898,345,22,81,13,358,'Multiple_Choice','2',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34899,345,22,81,13,359,'Free_Text','There is absent, conflicting, or vague guidance regarding maltreatment determinations on inadequate supervision specific to drowning fatalities/near fatalities. It was noted that the determination was made based upon the subject child being unsupervised for a period of 5-30 minutes.  It is unclear where the local agency made the assumption from that if the child was left being unsupervised for a period of 5-30 minutes that this becomes a qualifying criteria for a maltreatment determination.  This is the specific piece that seems vague or absent. It also seems that similar critical incidents have occurred without a maltreatment determination being made.',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34900,345,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34901,345,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34902,345,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34903,345,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34904,345,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34905,345,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34906,345,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34907,345,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34908,345,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:42:47','2021-05-26 18:42:47',NULL),(34912,346,22,81,13,291,'Multiple_Choice','Kelly Knutson',1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34913,346,22,81,13,292,'Short_Answer','Paul Lennander',1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34914,346,22,81,13,293,'Date','01/29/2018',1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34915,346,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34916,346,22,81,13,294,'Multiple_Choice','Near Fatality',1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34917,346,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34918,346,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34919,346,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34920,346,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34921,346,22,81,13,300,'Multiple_Choice','4',1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34922,346,22,81,13,301,'Multiple_Choice','Stearns',1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34923,346,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34924,346,22,81,13,303,'Short_Answer','Owen',1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34925,346,22,81,13,304,'Short_Answer','Ware Podgurski',1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34926,346,22,81,13,305,'Date','08/12/2017',1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34927,346,22,81,13,306,'Date',NULL,1,81,81,'2021-05-26 18:43:33','2021-05-26 18:43:33',NULL),(34928,346,22,81,13,307,'Date','02/18/2018',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34929,346,22,81,13,308,'Multiple_Choice','5 Months',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34930,346,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34931,346,22,81,13,310,'Short_Answer','Father',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34932,346,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34933,346,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34934,346,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34935,346,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34936,346,22,81,13,316,'Multiple_Choice','1',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34937,346,22,81,13,317,'Short_Answer','A child protection report was not made following the previous diagnosis of â€œfailure to thriveâ€.',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34938,346,22,81,13,318,'Free_Text','There was not a debrief that occurred as the learning point was beyond the scope of CP.',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34939,346,22,81,13,319,'Free_Text','A child protection report not being made by the medical provider following a previous diagnosis of â€œfailure to thriveâ€ was influenced by the medical providers experience with child maltreatment.  Contributing to a report not being made was the ambiguity of the threshold and understanding of when and where to report when there is a diagnosis of â€œfailure to thriveâ€.  In cases such as this, barriers can also exist when accessing professional expertise to provide clarity around a â€œfailure to thriveâ€ diagnosis and what diagnosis and treatment rise to the level of a child protection report.  This can also make it difficult for providers to know when to make a child protection report.\r\n\r\nAdditional circumstances, such as the need to preserve the relationship with the family and ensure that the family will follow through with routine medical care can further support a medical provider not making a child protection report in a case like this.  Mom\'s active engagement and consistent follow through with the child\'s routine medical care supported a report not being made.  Furthermore, the mother in this case was already engaged with routine medical care for the child.  \r\n\r\nFurther supporting a report not being made is that there is subjectivity in the definition of â€œfailure to thriveâ€ as well as a variety of diagnoses and treatment for failure to thrive situations. Additionally, the definition of â€œfailure to thriveâ€ under general neglect embedded within the Intake, Screening, and Response Path guidelines can also influence individual\'s understanding of what meets the threshold to report.',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34940,346,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34941,346,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34942,346,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34943,346,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34944,346,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34945,346,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34946,346,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34947,346,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34948,346,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34949,346,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34950,346,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34951,346,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34952,346,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34953,346,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34954,346,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34955,346,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34956,346,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34957,346,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34958,346,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34959,346,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34960,346,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34961,346,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34962,346,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34963,346,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34964,346,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34965,346,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34966,346,22,81,13,358,'Multiple_Choice','2',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34967,346,22,81,13,359,'Free_Text','Contributing to a report not being made was the ambiguity of the threshold and understanding of when and where to report when there is a diagnosis of â€œfailure to thriveâ€. In cases such as this, barriers can also exist when accessing professional expertise to provide clarity around a â€œfailure to thriveâ€ diagnosis and what diagnosis and treatment rise to the level of a child protection report. This can also make it difficult for providers to know when to make a child protection report.\r\n\r\nFurther supporting a report not being made is that there is subjectivity in the definition of â€œfailure to thriveâ€ as well as a variety of diagnoses and treatment for failure to thrive situations. Additionally, the definition of â€œfailure to thriveâ€ under general neglect embedded within the Intake, Screening, and Response Path guidelines can also influence individual\'s understanding of what meets the threshold to report.',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34968,346,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34969,346,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34970,346,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34971,346,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34972,346,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34973,346,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34974,346,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34975,346,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(34976,346,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:43:34','2021-05-26 18:43:34',NULL),(35048,348,22,81,13,291,'Multiple_Choice','Brittany Lochner',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35049,348,22,81,13,292,'Short_Answer','Paul Lennander',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35050,348,22,81,13,293,'Date','07/18/2018',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35051,348,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35052,348,22,81,13,294,'Multiple_Choice','Near Fatality',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35053,348,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35054,348,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35055,348,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35056,348,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35057,348,22,81,13,300,'Multiple_Choice','8',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35058,348,22,81,13,301,'Multiple_Choice','Hennepin',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35059,348,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35060,348,22,81,13,303,'Short_Answer','Princeton',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35061,348,22,81,13,304,'Short_Answer','Johnson',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35062,348,22,81,13,305,'Date','05/12/2018',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35063,348,22,81,13,306,'Date',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35064,348,22,81,13,307,'Date','06/21/2018',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35065,348,22,81,13,308,'Multiple_Choice','<1 Month',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35066,348,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35067,348,22,81,13,310,'Short_Answer','Father',1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35068,348,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35069,348,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35070,348,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35071,348,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35072,348,22,81,13,316,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35073,348,22,81,13,317,'Short_Answer',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35074,348,22,81,13,318,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35075,348,22,81,13,319,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35076,348,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 18:44:56','2021-05-26 18:44:56',NULL),(35077,348,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35078,348,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35079,348,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35080,348,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35081,348,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35082,348,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35083,348,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35084,348,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35085,348,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35086,348,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35087,348,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35088,348,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35089,348,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35090,348,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35091,348,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35092,348,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35093,348,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35094,348,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35095,348,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35096,348,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35097,348,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35098,348,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35099,348,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35100,348,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35101,348,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35102,348,22,81,13,358,'Multiple_Choice','0',1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35103,348,22,81,13,359,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35104,348,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35105,348,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35106,348,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35107,348,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35108,348,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35109,348,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35110,348,22,81,13,366,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35111,348,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35112,348,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:44:57','2021-05-26 18:44:57',NULL),(35116,349,22,81,13,291,'Multiple_Choice','Ryan Hartneck',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35117,349,22,81,13,292,'Short_Answer','Wendy Woessner',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35118,349,22,81,13,293,'Date','06/16/2018',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35119,349,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35120,349,22,81,13,294,'Multiple_Choice','Fatality',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35121,349,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35122,349,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35123,349,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35124,349,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35125,349,22,81,13,300,'Multiple_Choice','9',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35126,349,22,81,13,301,'Multiple_Choice','Ramsey',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35127,349,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35128,349,22,81,13,303,'Short_Answer','Prophecy',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35129,349,22,81,13,304,'Short_Answer','Watley',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35130,349,22,81,13,305,'Date','03/19/2018',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35131,349,22,81,13,306,'Date','04/14/2018',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35132,349,22,81,13,307,'Date',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35133,349,22,81,13,308,'Multiple_Choice','<1 Month',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35134,349,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35135,349,22,81,13,310,'Short_Answer','Mother',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35136,349,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35137,349,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35138,349,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35139,349,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35140,349,22,81,13,316,'Multiple_Choice','2',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35141,349,22,81,13,317,'Short_Answer','Father not added as participant in workgroup',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35142,349,22,81,13,318,'Free_Text','It was learned that the social workers are typically responsible for adding any additional participants that they come across during an assessment or investigation. These situations often arise as a result of minimal information being available at intake and additional information about sibs/parents/relatives coming in during assessment/investigation interviews. At the time of the critical incident, after-hours staff had responded to the report and conducted initial interviews. There was then a transition of the case back to her and she was to conduct the additional interview with the child\'s father as the on-call worker was unable to do so. The worker reported not adding the father to the participants in SSIS was an oversight on her part, however stated that the dad wasn\'t technically living in the apartment, so that may have been part of why she didn\'t add him. She reported that her caseload was heavy at the time due to rotating schedule for assignment of new cases and turnover rates and she often times has to sacrifice some things being done over others to ensure safety for children on her case load. Additionally, she stated that this is not one of those things that would pop up on a data clean-up in SSIS, further supporting why she never caught that the father wasn\'t added.',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35143,349,22,81,13,319,'Free_Text','The father not being added as a participant in the workgroup was influenced by worker transitions within the agency as well as SSIS functionality and workload levels. The critical incident case came into the agency during after-hours. The after-hours process was new for the agency and was in process regarding smoothing out the progression of case duties when cases come in after-hours. As a result of this, the after-hours worker is responsible for completing initial interviews when needed and is also tasked with gathering as much information as available at the time and sharing this information with the worker that takes the case from there. In this case, the father was not able to be interviewed during the after-hours response as he was not a resident of the home. When the case was transferred from the after-hours worker to the assigned investigator, communication gaps existed regarding family information and as a result, it was not relayed that the father was not added as a participant. In addition to this, the investigator that received the case from the after-hours worker was experiencing high caseload levels due to turnover within the agency. This caseload was managed through a rotation schedule for getting cases, which doesn\'t account for cases the worker already has. As a result of this high caseload pressure, the worker was sacrificing some case duties, in this case adding participants, in order to prioritize safety for children on her caseload. \r\nFinally, at completion of a case, there is a case consultation with supervisors. It was reported that the consultations do not pertain to every detail of the case. Supporting this oversight in not adding the father as a participant was the fact that while closing the case in SSIS, there is not a data-cleanup function that pertains to father-related fields, so the worker was not directed to add him. Generally, SSIS is focused on mothers and not fathers.',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35144,349,22,81,13,320,'Short_Answer','Sibling children not placed per agency policy',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35145,349,22,81,13,321,'Free_Text','The worker reported that she initially received this case as a THC positive newborn (family assessment response). She went and completed a face to face with the mother and child and was able to conduct a short, not exhaustive, assessment of safety for the other children, which she identified as safe and healthy. Safe sleep was discussed. When the case came in after the critical incident, it was received by agency after-hours staff, which was just recently added to Ramsey County\'s work tasks as it was previously contracted out. This new process created gaps in communication and transition between workers. Due to a snowstorm, the after-hours staff was unable to make it to the children\'s home. The after-hours worker had questioned the need for removal of the children given their ages, and that LE had not identified a need for removal at the time of the incident, but was told that it was agency policy to remove siblings when a child dies and neglect is suspected.\r\n\r\nAfter the attempt to place the children in shelter was hampered by an April snowstorm, there was no further conversation regarding the need to remove the children. The worker provided risk and safety assessments regarding the sibling children during subsequent home visits and did not identify the need to remove. The worker stated she looks at removal of children on a case-to-case basis, however believed it to be typical of other staff to remove other children after a child death and then figure out next steps after that. The worker was unsure if policy existed around placement of remaining children when a child death occurs.',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35146,349,22,81,13,322,'Free_Text','The sibling children to the subject child not being placed after the critical incident was influenced by agency procedures, having multiple workers on the case and Law Enforcement\'s (LE) response to the incident. When the case came in after the critical incident, it was received by agency after-hours staff, which was just recently added to the agency\'s work tasks as it was previously contracted out. This new process created gaps in communication during transitions between after-hour workers and subsequently-assigned FA/FI workers. Due to a snowstorm, the after-hours staff was unable to make it to the children\'s home during the after-hours response. The after-hours worker had questioned the need for removal of the children at the time given their ages, and also because LE had not identified a need for removal at the time of the incident. The case was then assigned to an agency staff that was working with the family in a family assessment workgroup at the time and that worker subsequently conducted in-home face to face contact with the family and identified the children as safe. In situations such as this, after a home visit and assessment that children are safe, manager overrides may occur. \r\nRegarding policy within the agency concerning removal of children after a child death suspected due to neglect, it was identified that the policy was not â€œtransferred wellâ€ to staff and thus, the worker had no knowledge of the policy. Without this knowledge, the worker assessed the need for removal on a case-to-case basis. In this case, the worker provided risk and safety assessments regarding the sibling children during subsequent home visits and did not identify the need to remove.',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35147,349,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35148,349,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35149,349,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35150,349,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35151,349,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35152,349,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35153,349,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35154,349,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35155,349,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35156,349,22,81,13,346,'Multiple_Choice','2',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35157,349,22,81,13,347,'Free_Text','Learning Point 2:\r\nThe after-hours worker had questioned the need for removal of the children at the time given their ages, and also because LE had not identified a need for removal at the time of the incident.',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35158,349,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35159,349,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35160,349,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35161,349,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35162,349,22,81,13,352,'Multiple_Choice','2',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35163,349,22,81,13,353,'Free_Text','Learning Point 1: \r\nWhile closing the case in SSIS, there is not a data-cleanup function that pertains to father-related fields, so the worker was not directed to add him. Generally, SSIS is focused on mothers and not fathers.',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35164,349,22,81,13,354,'Multiple_Choice','3',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35165,349,22,81,13,355,'Free_Text','Learning Point 1:\r\nWhen the case was transferred from the after-hours worker to the assigned investigator, communication gaps existed regarding family information and as a result, it was not relayed that the father was not added as a participant.',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35166,349,22,81,13,356,'Multiple_Choice','2',1,81,81,'2021-05-26 18:45:55','2021-05-26 18:45:55',NULL),(35167,349,22,81,13,357,'Free_Text','Learning Point 2:\r\nRegarding policy within the agency concerning removal of children after a child death suspected due to neglect, it was identified that the policy was not â€œtransferred wellâ€ to staff and thus, the worker had no knowledge of the policy.',1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35168,349,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35169,349,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35170,349,22,81,13,358,'Multiple_Choice','2',1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35171,349,22,81,13,359,'Free_Text','Learning Point 1:\r\nThe after-hours process was new for the agency and was in process regarding smoothing out the progression of case duties when cases come in after-hours.\r\n\r\nLearning Point 2:\r\nWhen the case came in after the critical incident, it was received by agency after-hours staff, which was just recently added to the agency\'s work tasks as it was previously contracted out. This new process created gaps in communication during transitions between after-hour workers and subsequently-assigned FA/FI workers.',1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35172,349,22,81,13,360,'Multiple_Choice','2',1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35173,349,22,81,13,361,'Free_Text','Learning Point 1:\r\nThe investigator that received the case from the after-hours worker was experiencing high caseload levels due to turnover within the agency. This caseload was managed through a rotation schedule for getting cases, which doesn\'t account for cases the worker already has. As a result of this high caseload pressure, the worker was sacrificing some case duties, in this case adding participants, in order to prioritize safety for children on her caseload.',1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35174,349,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35175,349,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35176,349,22,81,13,364,'Multiple_Choice','1',1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35177,349,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35178,349,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35179,349,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35180,349,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:45:56','2021-05-26 18:45:56',NULL),(35252,365,22,81,13,291,'Multiple_Choice','Ryan Hartneck',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35253,365,22,81,13,292,'Short_Answer','JoLynn Sundstrom',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35254,365,22,81,13,293,'Date','03/13/2017',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35255,365,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35256,365,22,81,13,294,'Multiple_Choice','Fatality',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35257,365,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35258,365,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35259,365,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35260,365,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35261,365,22,81,13,300,'Multiple_Choice','4',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35262,365,22,81,13,301,'Multiple_Choice','Stearns',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35263,365,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35264,365,22,81,13,303,'Short_Answer','Syncere',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35265,365,22,81,13,304,'Short_Answer','Moore',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35266,365,22,81,13,305,'Date','10/15/2015',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35267,365,22,81,13,306,'Date','03/09/2016',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35268,365,22,81,13,307,'Date',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35269,365,22,81,13,308,'Multiple_Choice','5 Months',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35270,365,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35271,365,22,81,13,310,'Short_Answer','Mother',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35272,365,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35273,365,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35274,365,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35275,365,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35276,365,22,81,13,316,'Multiple_Choice','2',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35277,365,22,81,13,317,'Short_Answer','1.	Face to face contact with alleged offender never occurred',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35278,365,22,81,13,318,'Free_Text','The child protection investigator participated in the debriefing and shared the following information.\r\n\r\nAfter receiving intake of the child\'s fatality, the CP worker contacted LE to coordinate the investigation. CP worker indicated that at that time, he was asked to hold off on interviewing the child\'s mother. Due to the child\'s cousin\'s being present at the time of the child\'s death, the CP worker reached out to a neighboring Human Services Agency to connect with a worker that was working with that family. Safety of those children were assessed and ensured by that agency. In regards to coordination between CP and LE, the worker indicated that outside of this case, it usually occurs. The worker went on to state that there were multiple LE investigators on the case as there was a LE investigator that had established a relationship with the child\'s mother in the past and they were coordinating this between themselves. \r\n\r\nThe worker indicated that delays in finding maltreatment on the case was partially due to the inability to obtain the ME report. When LE obtained the report, he was informed by them that they were unsure if they could share the report with CP. The worker never made contact with the mother, however used the LE interview with her to complete his investigation. To his knowledge, LE had one interview with her and never made contact with her thereafter. It is believed that she left the state.',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35279,365,22,81,13,319,'Free_Text','Face to face contact not occurring with the alleged offender was influenced by state statute 626.556 Subd. 10 (b)(5), and Admin Rule 9560.0220 Subp. 4 which allows the local agency to defer to law enforcement on making contact with an alleged offender during an open criminal investigation. As a result of this, the local agency honored law enforcement\'s request to delay the interview and face to face contact with the alleged offender in this case as to not interfere with the current criminal investigation.  \r\nFurthermore, the multiple tasks required by law enforcement during an investigation contributed to a lengthy investigation that delayed when law enforcement allowed the local agency to proceed with making face to face contact with the alleged offender. At the time the agency was allowed to make contact with the alleged offender, the offender was no longer available as a result of moving out of state; however, the agency made multiple attempts to contact the alleged offender prior to learning of their move out of state. \r\nAdditional contributing factors that further impacted the agency\'s decision to delay contact with the alleged offender included the local agency not being involved in law enforcement\'s multidisciplinary team (MDT) regarding the planning of this investigation. Local agencies are not typically part of law enforcement MDT\'s. Non-normative practices between the local agency and law enforcement further supported the alleged offender not being seen. Normative practice in these investigations would include coordination in conducting a joint interview and ongoing communication throughout the investigation.',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35280,365,22,81,13,320,'Short_Answer','2.	Previous concerns of the condition of the child\'s home not reported to child protection',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35281,365,22,81,13,321,'Free_Text','No debriefing took place on this Learning Point.',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35282,365,22,81,13,322,'Free_Text','The decision to not report the condition of the child\'s home was influenced by the public health worker\'s experience of child protection reports not being screened in after a report is made.  Further supporting the decision to not report the condition of the child\'s home was the public health worker\'s interpretation of state statute that governs mandated reporting for suspected child abuse and neglect. She did not believe that the conditions met the threshold to report. The public health worker\'s understanding of state statute was influenced by the subjective statutory language within 626.556 Subd. 3(a) that states â€œHas reason to believeâ€ a child is being neglected and/or abused.\r\n\r\nThe public health worker\'s interpretation of state statute was impacted by their awareness of where to access available trainings within the agency. Quality and consistency of these trainings also varied, further supporting her reason to not seek them out. Per state statute, local agencies are responsible for providing mandated reporter training within their agency; however, multiple competing priorities, such as the need to get day-to-day work done to serve clients and to fulfill their job duties can make this statutory requirement burdensome for the local agency.',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35283,365,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35284,365,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35285,365,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35286,365,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35287,365,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35288,365,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35289,365,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35290,365,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35291,365,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35292,365,22,81,13,346,'Multiple_Choice','3',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35293,365,22,81,13,347,'Free_Text','Learning Point #2: Further supporting the decision to not report the condition of the child\'s home was the public health worker\'s interpretation of state statute that governs mandated reporting for suspected child abuse and neglect. She did not believe that the conditions met the threshold to report.',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35294,365,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35295,365,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35296,365,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35297,365,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35298,365,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35299,365,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35300,365,22,81,13,354,'Multiple_Choice','2',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35301,365,22,81,13,355,'Free_Text','Learning Point #1: Additional contributing factors that further impacted the agency\'s decision to delay contact with the alleged offender included the local agency not being involved in law enforcement\'s multidisciplinary team (MDT) regarding the planning of this investigation.',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35302,365,22,81,13,356,'Multiple_Choice','1',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35303,365,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35304,365,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35305,365,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35306,365,22,81,13,358,'Multiple_Choice','3',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35307,365,22,81,13,359,'Free_Text','Learning Point #1: Face to face contact not occurring with the alleged offender was influenced by state statute 626.556 Subd. 10 (b)(5), and Admin Rule 9560.0220 Subp. 4 which allows the local agency to defer to law enforcement on making contact with an alleged offender during an open criminal investigation.\r\n\r\nLearning Point #2: The public health worker\'s understanding of state statute was influenced by the subjective statutory language within 626.556 Subd. 3(a) that states â€œHas reason to believeâ€ a child is being neglected and/or abused.',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35308,365,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35309,365,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35310,365,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35311,365,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35312,365,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35313,365,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35314,365,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35315,365,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35316,365,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:51:07','2021-05-26 18:51:07',NULL),(35320,364,22,81,13,291,'Multiple_Choice','Ryan Hartneck',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35321,364,22,81,13,292,'Short_Answer','Triage Team',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35322,364,22,81,13,293,'Date','01/11/2019',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35323,364,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35324,364,22,81,13,294,'Multiple_Choice','Fatality',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35325,364,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35326,364,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35327,364,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35328,364,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35329,364,22,81,13,300,'Multiple_Choice','8',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35330,364,22,81,13,301,'Multiple_Choice','Hennepin',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35331,364,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35332,364,22,81,13,303,'Short_Answer','Sylas',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35333,364,22,81,13,304,'Short_Answer','Farnsworth',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35334,364,22,81,13,305,'Date','08/31/2018',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35335,364,22,81,13,306,'Date','10/30/2018',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35336,364,22,81,13,307,'Date',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35337,364,22,81,13,308,'Multiple_Choice','2 Months',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35338,364,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35339,364,22,81,13,310,'Short_Answer','Father',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35340,364,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35341,364,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35342,364,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35343,364,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35344,364,22,81,13,316,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35345,364,22,81,13,317,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35346,364,22,81,13,318,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35347,364,22,81,13,319,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35348,364,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35349,364,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35350,364,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35351,364,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35352,364,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35353,364,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35354,364,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35355,364,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35356,364,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35357,364,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35358,364,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35359,364,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35360,364,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35361,364,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35362,364,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35363,364,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35364,364,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35365,364,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35366,364,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35367,364,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35368,364,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35369,364,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35370,364,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35371,364,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35372,364,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35373,364,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35374,364,22,81,13,358,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35375,364,22,81,13,359,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35376,364,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35377,364,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35378,364,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35379,364,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35380,364,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35381,364,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35382,364,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35383,364,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35384,364,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:51:47','2021-05-26 18:51:47',NULL),(35457,351,22,81,13,291,'Multiple_Choice','Kristine Frick',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35458,351,22,81,13,292,'Short_Answer','Lynn Shafer',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35459,351,22,81,13,293,'Date','09/21/2016',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35460,351,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35461,351,22,81,13,294,'Multiple_Choice','Near Fatality',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35462,351,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35463,351,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35464,351,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35465,351,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35466,351,22,81,13,300,'Multiple_Choice','8',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35467,351,22,81,13,301,'Multiple_Choice','Hennepin',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35468,351,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35469,351,22,81,13,303,'Short_Answer','Rainy',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35470,351,22,81,13,304,'Short_Answer','Darden',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35471,351,22,81,13,305,'Date','09/17/2016',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35472,351,22,81,13,306,'Date',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35473,351,22,81,13,307,'Date','09/17/2016',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35474,351,22,81,13,308,'Multiple_Choice','<1 Month',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35475,351,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35476,351,22,81,13,310,'Short_Answer','Mother',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35477,351,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35478,351,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35479,351,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35480,351,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35481,351,22,81,13,316,'Multiple_Choice','1',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35482,351,22,81,13,317,'Short_Answer','CP Intake was not made for allegation of neglect (failure to protect from serious endangerment) to subject child\'s half-brother by Aunt\'s former husband in the 3/30/15 -CP Family Assessment.',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35483,351,22,81,13,318,'Free_Text','Information obtained during the Debrief regarding Learning Point:\r\nâ€¢	Family dynamics are convoluted and intertwined coupled by SSIS database challenges \r\nâ€¢	Complexity of family dynamics impacted how to document in SSIS, along with two family assessments overlapping.  \r\nâ€¢	CP Intake sets up the participants and victim children in SSIS\r\no	CP intake came in around 4pm on Friday (03/27). The CP intake was entered into SSIS and screened in for family assessment on Monday (03/30). \r\nâ€¢	Knowledge of complex social services history for subject child\'s half-brother was limited by accessibility of intakes and workgroups as all of them do not appear in the â€˜associated workgroups feature\' of SSIS.  \r\no	Not associated because documented under the legal guardian, which was the subject child\'s half-brother\'s deceased grandmother \r\no	MNCIS was used, MGA Court Records online did not exist in 2015\r\no	Process of accessing court documents for subject child\'s half-brother entailed calling the clerk, who could sometimes find requested information, but sometimes could not. \r\nâ€¢	Belief about family assessments being less severe allegations and lower safety risk, a softer approach, and perceived to be voluntary work with families, similar to PSOP cases. \r\nâ€¢	Because maltreatment determinations are not made for family assessments, attention was on providing services to the family, especially legal permanency for the subject child\'s half-brother through guardianship with his Aunt.\r\nâ€¢	This family assessment was lower priority on workers caseload due to the nature of the allegations, perception of family assessment being voluntary, and that there was a family assessment workgroup open with the subject child\'s half-brother already (opened on March 4), where the professional was already providing services regarding legal permanency. \r\nâ€¢	The subject child\'s half-brother was included as a participant on the FA, therefore the he would qualify for CP Family Assessment - Case Management. \r\nâ€¢	Guidance on how to add victim child and/or allegation to a victim child in an already open FA/FI had changed around March 2015, it did not make sense to the professional to make a new CP report for allegation of neglect (failure to protect from serious endangerment) to subject child\'s half-brother by Aunt\'s former husband. \r\no	Time and attention to the new guidance about how to document in SSIS was not priority for the professional because the goal was to work with the family to address needs and provide services. \r\no	The professional believed the Aunt was following through with expectations in regard to establishing legal permanency for the subject child\'s half-brother. \r\no	It did not make sense to make a CP intake because it would have been documented under the deceased grandmother\'s name and the professional would have to duplicate documentation between the workgroups. This would have been time intensive and hard for the professional to track. \r\no	The workaround met the goal of getting the child and family the services they needed, and did not require the worker to document in two separate family assessment workgroups.\r\nï‚§	Less confusing since would have had to document under the deceased grandmother in SSIS\r\no	The SSIS technicality was not priority. \r\nï‚§	Mondays were especially stressful for assessment workers/investigators, because the intake backlog from Friday late afternoon and over the weekend was entered and distributed amongst the assessment/investigation units for assignment to assessment workers/investigators.\r\nï‚§	There was a significant amount of family assessments/investigations backlogged and ready to be assigned as well. There were not enough assessment workers/investigators available to work the influx number of cases being screened in. \r\nï‚§	The time to juggle notes back and forth in SSIS for companion cases would not have been productive given the totality of the circumstances.',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35484,351,22,81,13,319,'Free_Text','SCIR Narrative - Hennepin County\r\nLP: CP intake was not made for allegation of neglect (failure to protect from serious endangerment) to subject child\'s half-brother by Aunt\'s former husband in the 3/30/2015 CP Family Assessment.\r\nIn March 2015, resource constraints existed for the local agency. The local agency was overwhelmed with reports being made to the child protection (CP) system, resulting in an influx of CP intake reports, approximately 400, backlogged and waiting to be screened. Family assessment (FA) and investigations also had a backlog of cases pending assignment to staff. While triaging priority for case assignment from the backlogs, the agency concurrently experienced production pressure to meet data metrics for the amount of reports receiving FA response. Local agencies were not only motivated to comply and meet a certain percentage rate conveyed by the state, but also to produce a successful percentage rate, as the results of the agency\'s success was published in a formal report, released by the state for all local agencies to see the results, intensifying the pressure for the local agency to meet this demand. \r\nStaying aware of new DHS guidance changes and having the time to comprehend how to implement them, was a duty that staff were not always able to stay up-to-date on.  The amount changes being made to state guidance, stemming from the Governor\'s Task Force recommendations, along with high caseload sizes, there was not time to learn the new technical guidance. Trying to meet timelines for cases backlogged in the intake/screening and assessment/investigation units was prioritized and the main focus of the agency.\r\nStaff were faced with a goal conflict, to work the case in accordance to local agency normative practice and expected family assessment response best practice guidance (engagement with children and families to meet their needs), versus following the DHS technical requirement to document a new CP Intake for new allegations. Knowing that documenting the CP Intake would contribute to the backlog and not change the course of work with the family influenced the local agency\'s decision to prioritize family engagement over the documentation requirement.  Additionally, there was a belief about neglect being viewed as a less severe allegation.  The belief was that safety risk was lower than other allegations and neglect reports commonly were assigned FA response. This notion combined with the fact that less attention was paid to the allegation details and identifying victim children in family assessment cases, since maltreatment determinations are not made in family assessment response, supported decision not to make a new CP report as well. Instead staff prioritized engagement, assessing safety, risk, needs and recommending services for the family. Ultimately, the documentation requirement is/was not aligned with the work the staff were conducting with the family in an already open family assessment workgroup (opened on 03/04/2015) and the child was able to continue receiving CP Case Management (field services).\r\nWhen staff received a new case assignment, they took the report at face value, trusting how the allegations and victim children were identified and documented in the CP intake by the CP intake worker. A procedural adaptation was made to not document the allegation of neglect under the deceased grandmother\'s name in a new CP intake in SSIS in order to cope with production pressure and efficiently manage worker caseload. Additionally, the staff believed the Aunt would follow through and complete establishing legal custody for the child. Making a new CP report for the neglect allegation (labelling the intake and workgroup under the maternal grandmother\'s name in SSIS), did not align with the trajectory of work being completed with the family at the time. There was not a feature in SSIS available to link workgroups when they are labelled under different names, and duplicating documentation of same information in separate workgroups in SSIS was time intensive for staff. This enhanced the agency\'s decision to make the procedural adaptation.',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35485,351,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35486,351,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35487,351,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35488,351,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35489,351,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35490,351,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35491,351,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35492,351,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35493,351,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35494,351,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35495,351,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35496,351,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35497,351,22,81,13,346,'Multiple_Choice','3',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35498,351,22,81,13,347,'Free_Text','Local agency belief about allegation of neglect and FA response being less severe. Additionally, there was a belief about neglect being viewed as a less severe allegation. The belief was that safety risk was lower than other allegations and neglect reports commonly were assigned FA response. This notion combined with the fact that less attention was paid to the allegation details and identifying victim children in family assessment cases, since maltreatment determinations are not made in family assessment response, supported decision not to make a new CP report as well.',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35499,351,22,81,13,348,'Multiple_Choice','3',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35500,351,22,81,13,349,'Free_Text','The local agency was overwhelmed with reports being made to the child protection (CP) system, resulting in an influx of CP intake reports, approximately 400, backlogged and waiting to be screened.',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35501,351,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35502,351,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35503,351,22,81,13,352,'Multiple_Choice','3',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35504,351,22,81,13,353,'Free_Text','Ultimately, the documentation requirement is/was not aligned with the work the staff were conducting with the family in an already open family assessment workgroup (opened on 03/04/2015) and the child was able to continue receiving CP Case Management (field services).',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35505,351,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35506,351,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35507,351,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35508,351,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35509,351,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35510,351,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35511,351,22,81,13,358,'Multiple_Choice','3',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35512,351,22,81,13,359,'Free_Text','-Staying aware of new DHS guidance changes and having the time to comprehend how to implement them, was a duty that staff were not always able to stay up-to-date on.  The amount changes being made to state guidance, stemming from the Governor\'s Task Force recommendations, along with high caseload sizes, there was not time to learn the new technical guidance. Trying to meet timelines for cases backlogged in the intake/screening and assessment/investigation units was prioritized and the main focus of the agency.\r\n\r\n-Staff were faced with a goal conflict, to work the case in accordance to local agency normative practice and expected family assessment response best practice guidance (engagement with children and families to meet their needs), versus following the DHS technical requirement to document a new CP Intake for new allegations.\r\n\r\n-Ultimately, the documentation requirement is/was not aligned with the work the staff were conducting with the family in an already open family assessment workgroup (opened on 03/04/2015) and the child was able to continue receiving CP Case Management (field services).',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35513,351,22,81,13,360,'Multiple_Choice','3',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35514,351,22,81,13,361,'Free_Text','While triaging priority for case assignment from the backlogs, the agency concurrently experienced production pressure to meet data metrics for the amount of reports receiving FA response. Local agencies were not only motivated to comply and meet a certain percentage rate conveyed by the state, but also to produce a successful percentage rate, as the results of the agency’s success was published in a formal report, released by the state for all local agencies to see the results, intensifying the pressure for the local agency to meet this demand. The amount changes being made to state guidance, stemming from the Governors Task Force recommendations, along with high caseload sizes, there was not time to learn the new technical guidance Knowing that documenting the CP Intake would contribute to the backlog and not change the course of work with the family influenced the local agency’s decision to prioritize family engagement over the documentation requirement.',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35515,351,22,81,13,362,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35516,351,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35517,351,22,81,13,364,'Multiple_Choice','1',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35518,351,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35519,351,22,81,13,366,'Multiple_Choice','3',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35520,351,22,81,13,367,'Free_Text','A procedural adaptation was made to not document the allegation of neglect under the deceased grandmother\'s name in a new CP intake in SSIS in order to cope with production pressure and efficiently manage worker caseload. Additionally, the staff believed the Aunt would follow through and complete establishing legal custody for the child. Making a new CP report for the neglect allegation (labelling the intake and workgroup under the maternal grandmother\'s name in SSIS), did not align with the trajectory of work being completed with the family at the time. There was not a feature in SSIS available to link workgroups when they are labelled under different names, and duplicating documentation of same information in separate workgroups in SSIS was time intensive for staff. This enhanced the agency\'s decision to make the procedural adaptation.',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35521,351,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:53:31','2021-05-26 18:53:31',NULL),(35525,352,22,81,13,291,'Multiple_Choice','Ryan Hartneck',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35526,352,22,81,13,292,'Short_Answer','Jenny Anderson',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35527,352,22,81,13,293,'Date','04/04/2018',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35528,352,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35529,352,22,81,13,294,'Multiple_Choice','Near Fatality',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35530,352,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35531,352,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35532,352,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35533,352,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35534,352,22,81,13,300,'Multiple_Choice','3',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35535,352,22,81,13,301,'Multiple_Choice','Morrison',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35536,352,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35537,352,22,81,13,303,'Short_Answer','Reese',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35538,352,22,81,13,304,'Short_Answer','St Martin',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35539,352,22,81,13,305,'Date','12/09/2016',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35540,352,22,81,13,306,'Date',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35541,352,22,81,13,307,'Date','12/20/2017',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35542,352,22,81,13,308,'Multiple_Choice','1 Year',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35543,352,22,81,13,309,'Multiple_Choice','2',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35544,352,22,81,13,310,'Short_Answer','Mother',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35545,352,22,81,13,311,'Short_Answer','Father',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35546,352,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35547,352,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35548,352,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35549,352,22,81,13,316,'Multiple_Choice','1',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35550,352,22,81,13,317,'Short_Answer','CP Intake not screened-in though it met screen-in criteria (Neglect â€“ chronic and severe use of alcohol/controlled substances)',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35551,352,22,81,13,318,'Free_Text','N/A - mapped after mapping team identified the learning point.',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35552,352,22,81,13,319,'Free_Text','The intake not being screened-in when it met screen-in criteria was influenced by the agency\'s knowledge of the family, the information contained in the report and law enforcement\'s (LE) response to the report. The agency had had previous intakes and workgroups with the family and was aware of the family\'s dynamics. Due to this, the agency questioned the motives and credibility of the reporter as there had been a history of reports made by both parents against the other. Additionally, there was a considerable amount of time (months) between when the alleged incident occurred and when it was actually reported to child services. Utilizing county attorney\'s input, coupled with DHS\'s ambiguity on consideration of reporting timeframes, the agency identified the report as non-current maltreatment and subsequently screened-out the report. \r\nDHS also emphasized coordination with LE when possible. As a result of this coordination, it is common for the agency to rely on interactions between LE and the families to assist in making screening decisions. LE did not identify concerns for safety for the children, further supporting the agency to not identify the need to screen-in this case and intervene.',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35553,352,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35554,352,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35555,352,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35556,352,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35557,352,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35558,352,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35559,352,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35560,352,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35561,352,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35562,352,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35563,352,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35564,352,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35565,352,22,81,13,346,'Multiple_Choice','2',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35566,352,22,81,13,347,'Free_Text','The agency had had previous intakes and workgroups with the family and was aware of the family\'s dynamics. Due to this, the agency questioned the motives and credibility of the reporter as there had been a history of reports made by both parents against the other.\r\n\r\nDHS also emphasized coordination with LE when possible. As a result of this coordination, it is common for the agency to rely on interactions between LE and the families to assist in making screening decisions. LE did not identify concerns for safety for the children, further supporting the agency to not identify the need to screen-in this case and intervene.',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35567,352,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35568,352,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35569,352,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35570,352,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35571,352,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35572,352,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35573,352,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35574,352,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35575,352,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35576,352,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35577,352,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35578,352,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35579,352,22,81,13,358,'Multiple_Choice','2',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35580,352,22,81,13,359,'Free_Text','Additionally, there was a considerable amount of time (months) between when the alleged incident occurred and when it was actually reported to child services. Utilizing county attorney\'s input, coupled with DHS\'s ambiguity on consideration of reporting timeframes, the agency identified the report as non-current maltreatment and subsequently screened-out the report.',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35581,352,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35582,352,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35583,352,22,81,13,362,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35584,352,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35585,352,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35586,352,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35587,352,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35588,352,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35589,352,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:54:12','2021-05-26 18:54:12',NULL),(35593,353,22,81,13,291,'Multiple_Choice','Brittany Lochner',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35594,353,22,81,13,292,'Short_Answer','Jenny Anderson',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35595,353,22,81,13,293,'Date','02/14/2017',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35596,353,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35597,353,22,81,13,294,'Multiple_Choice','Fatality',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35598,353,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35599,353,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35600,353,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35601,353,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35602,353,22,81,13,300,'Multiple_Choice','3',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35603,353,22,81,13,301,'Multiple_Choice','Crow Wing',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35604,353,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35605,353,22,81,13,303,'Short_Answer','Riley',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35606,353,22,81,13,304,'Short_Answer','Peterson',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35607,353,22,81,13,305,'Date','10/11/2016',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35608,353,22,81,13,306,'Date','11/21/2016',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35609,353,22,81,13,307,'Date',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35610,353,22,81,13,308,'Multiple_Choice','<1 Month',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35611,353,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35612,353,22,81,13,310,'Short_Answer','Father',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35613,353,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35614,353,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35615,353,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35616,353,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35617,353,22,81,13,316,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35618,353,22,81,13,317,'Short_Answer',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35619,353,22,81,13,318,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35620,353,22,81,13,319,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35621,353,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35622,353,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35623,353,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35624,353,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35625,353,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35626,353,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35627,353,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35628,353,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35629,353,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35630,353,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35631,353,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35632,353,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35633,353,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35634,353,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35635,353,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35636,353,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 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18:55:00','2021-05-26 18:55:00',NULL),(35647,353,22,81,13,358,'Multiple_Choice','0',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35648,353,22,81,13,359,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35649,353,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35650,353,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35651,353,22,81,13,362,'Multiple_Choice',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35652,353,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35653,353,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35654,353,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35655,353,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35656,353,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35657,353,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 18:55:00','2021-05-26 18:55:00',NULL),(35661,354,22,81,13,291,'Multiple_Choice','Brittany Lochner',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35662,354,22,81,13,292,'Short_Answer','Triage review',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35663,354,22,81,13,293,'Date','07/02/2019',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35664,354,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35665,354,22,81,13,294,'Multiple_Choice','Fatality',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35666,354,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35667,354,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35668,354,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35669,354,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35670,354,22,81,13,300,'Multiple_Choice','9',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35671,354,22,81,13,301,'Multiple_Choice','Ramsey',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35672,354,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35673,354,22,81,13,303,'Short_Answer','Riley',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35674,354,22,81,13,304,'Short_Answer','Taylor',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35675,354,22,81,13,305,'Date','08/21/2014',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35676,354,22,81,13,306,'Date','05/04/2019',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35677,354,22,81,13,307,'Date',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35678,354,22,81,13,308,'Multiple_Choice','4 Years',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35679,354,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35680,354,22,81,13,310,'Short_Answer','Father',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35681,354,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35682,354,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35683,354,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35684,354,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35685,354,22,81,13,316,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 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19:04:46','2021-05-26 19:04:46',NULL),(35696,354,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35697,354,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35698,354,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35699,354,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35700,354,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35701,354,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35702,354,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35703,354,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35704,354,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 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19:04:46','2021-05-26 19:04:46',NULL),(35715,354,22,81,13,358,'Multiple_Choice','0',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35716,354,22,81,13,359,'Free_Text',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35717,354,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35718,354,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35719,354,22,81,13,362,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35720,354,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35721,354,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35722,354,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35723,354,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35724,354,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35725,354,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 19:04:46','2021-05-26 19:04:46',NULL),(35729,355,22,81,13,291,'Multiple_Choice','Kristine Frick',1,81,81,'2021-05-26 19:05:34','2021-05-26 19:05:34',NULL),(35730,355,22,81,13,292,'Short_Answer','JoLynn Sundstrom',1,81,81,'2021-05-26 19:05:34','2021-05-26 19:05:34',NULL),(35731,355,22,81,13,293,'Date','03/04/2017',1,81,81,'2021-05-26 19:05:34','2021-05-26 19:05:34',NULL),(35732,355,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 19:05:34','2021-05-26 19:05:34',NULL),(35733,355,22,81,13,294,'Multiple_Choice','Near Fatality',1,81,81,'2021-05-26 19:05:34','2021-05-26 19:05:34',NULL),(35734,355,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 19:05:34','2021-05-26 19:05:34',NULL),(35735,355,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:05:34','2021-05-26 19:05:34',NULL),(35736,355,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35737,355,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35738,355,22,81,13,300,'Multiple_Choice','7',1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35739,355,22,81,13,301,'Multiple_Choice','Dakota',1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35740,355,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35741,355,22,81,13,303,'Short_Answer','Riley',1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35742,355,22,81,13,304,'Short_Answer','Vititoe',1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35743,355,22,81,13,305,'Date','01/04/2015',1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35744,355,22,81,13,306,'Date',NULL,1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35745,355,22,81,13,307,'Date','02/13/2017',1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35746,355,22,81,13,308,'Multiple_Choice','2 Years',1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35747,355,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35748,355,22,81,13,310,'Short_Answer','Mother\'s boyfriend',1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35749,355,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35750,355,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35751,355,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35752,355,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35753,355,22,81,13,316,'Multiple_Choice','1',1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35754,355,22,81,13,317,'Short_Answer','While conducting a family assessment for neglect (inadequate supervision), additional signs of suspected abuse/neglect were noted to the 2 year old sibling child and a Child Protection report did not occur.',1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35755,355,22,81,13,318,'Free_Text','Debrief informationâ€“ Local Rationality - Knowledge factors, strategic factors, and attentional dynamics\r\nThe worker received this family assessment assignment on a Friday, and felt the family assessment went as good as it could have. The worker works a four 10 hour shift (Tuesday-Friday) every week, with Monday off.  The worker\'s perception is that this was a routine assessment in that after assignment, he/she cross reported the case to law enforcement as Family Assessment workers always do per local agency norm. Law enforcement combines their investigative/assessment efforts with the worker depending on the allegation type, and/or if there is extensive historical law enforcement contacts with a given family, and/or if there are other safety risks posed to the worker. The worker noted the working relationship between his/herself and LE is good.\r\nThe worker did not anticipate LE would want to attend the home visit/initial face to face contact for this case as it was for neglect â€“ inadequate supervision to 9 and 6 year olds.  Law enforcement did not join the FA worker for the initial contact with the family. There is a mutual understanding between this experienced (30 years) Family Assessment worker and local law enforcement. If the worker does not hear from Llaw enforcement after he/she makes the cross report, the worker moves forward without them - making meeting timelines a top priority. In some situations the worker will check in with them after making initial face to face upon their request to report any concerns. The worker noted an advantage of having experience working with local law enforcement as she knows the types of situations they typically want to jointly assess/investigate.   \r\nThe worker noted there is a 5 day expectation to meet face to face timelines for family assessments, but prefers to reach out by noon each day to schedule a time to meet with caregivers for each new report she receives. This worker prefers to make face to face contact as soon as possible for each report. This worker was able to connect with the mother and scheduled a time to meet at the home the afternoon of the same day the report was received. The worker noted the mother was not guarded, she was cooperative, answered her call and scheduled with her for the same day. The mother allowed her to come into the home, speak to the children, and observe the 2 year old\'s body without resisting the worker\'s request to do so. From the worker\'s years of experience, the mother was forthcoming with information and appeared genuine in her responses. The worker credits comforting approach of using a telephone call to present his/herself in a cordial manner when setting up a time to meet with the caregiver as being most helpful in gathering trustworthy information from caregivers.\r\nThe worker observed marks and bruises to the 2 year old and asked the mother about all of them.  There was a Â½-inch scratch on his forehead and a 2-inch scratch mark on his back, which Mother said that he got it from his dad\'s when he was there on January 20th / 21st and that he fell out of a high chair.  Mother didn\'t really know how he fell out, but he had the scratch mark when he returned to her care on the 21st.  The 2 year old also had a huge egg on his head. Father told the babysitter, that the subject child fell out of the high chair and his back fell onto a metal dry crate. Father told the mother that he fell out of the high chair. Mother is not going to allow the child to go to his father\'s home anymore because of this incident with the high chair.  \r\nThere was a quarter-sized bruise on the right side of his forehead and 1-inch scratch mark on the right side of his face. Mother did not know how he got those marks.  Subject child also had a quarter-sized and dime-sized bruise on the left side of his face.  Mother said that he got the dime-sized bruise on Tuesday or Wednesday when her live-in boyfriend gave the subject child a bath and he hit the soap dispenser when he kept trying to stand up in the bath.  \r\nSibling sister reported the subject child had fallen down the steps on Wednesday (two days prior) at supper time.  Sibling brother reported subject child â€œhead buttsâ€ his sibling brother.    \r\nAs part of the safety assessment, the worker took photos of the marks and bruises observed on the 2 year old and uploaded them to the agency\'s electronic file system. Other professionals who have rights to the electronic file system can access the photos, and other â€œhard fileâ€ documents stored on the electronic file system. The agency does not have paper copied of â€œhard filesâ€. The worker noted it is not always the practice norm to take photos of scratches/bruises.  He/she explained in this case, the scratches/bruises raised concern that he/she wanted to have them documented and saved for the safety assessment.   \r\nWhen considering the potential of possible abuse/neglect during an open family assessment, if the worker believes the level of injury meets criteria for a making a new allegation/CP report, the worker can consult with peers, his/her supervisor and/or the intake.  The worker will most often use supervisor consult first, and of it is then believed that potential for abuse/neglect meets criteria to make a CP report, the supervisor and worker will decide with intake if a new allegation warrants a new report. The worker did not feel the injuries warranted making a new Child Protection Report after asking the mother and siblings about the 2 year olds scratches/bruises. \r\nAlthough the worker noted caseload size depends on many variables, the timing of this Family Assessment came at a time when caseload sizes typically increase between February â€“ April.  Yet, the worker indicated caseload size always feels manageable to him/her. There are 13 staff who take Family Assessment type cases. During these busier months of February â€“ April it is not uncommon for FA workers to receive 8-12 new cases a month. \r\nWhen the allegation of physical abuse for the 2 year old child came into Child Protection during the open Family Assessment, this had the most significant impact on his/her work.  The Family Assessment work with the family ended sooner than the 45 day timeframe, since the investigation into the near fatal injury to the 2 year old took precedence. The worker consulted with his/her supervisor and completed dictating her contacts for the case so the dictations could be sent in for transcription.   \r\nContact with non-custodial parents who do not reside in the same home as the child is guided by a County Attorney\'s Office protocol.  The protocol recommends the family assessment worker make contact with the alleged perpetrator, and non-custodial parents of identified victim children in the family assessment because they have the right to know about allegations. There is an exception for some domestic violence situations, but in this case the mother was compliant with providing the names and contact information about all the children\'s fathers. \r\nIt is important to note that the 2 year old child observed to have scratches and bruises was not an alleged victim of the Family Assessment allegation of neglectâ€“ inadequate supervision.',1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35756,355,22,81,13,319,'Free_Text','A Child protection family assessment response to the family\'s home was conducted regarding allegations of neglect (inadequate supervision) involving the two older children. Staff focused attention on the older children and the neglect allegation during the initial face to face home visit.  The staff also focused attention on assessing immediate threats to safety and risk of maltreatment to  all the children during the initial contact with the family. During the initial safety and risk assessment, the staff observed and documented the marks and bruises on the 2 year old. The staff also took photos of the injuries and uploaded them to the case file as part of the staff\'s ongoing safety and risk assessments under the open family assessment. The older children and mother provided explanations of how the two year old child received the injuries, which were perceived by the staff as being accidental in nature, and as not occurring in the mother\'s home. The staff perceived the mother\'s demeanor to be nonâ€defensive and willing to engage with the worker\'s requests. The mother\'s protective capacities were assessed and determined to be protective, as the mother verbalized a safety plan regarding the two year old sibling child. The mother was deemed to be a safe caregiver with no immediate danger or safety risk present in her home following the initial face to face home visit. The totality of the information learned in real time by the staff, influenced the staff to not make a child protection report regarding the 2 year olds injuries.\r\nThe staff\'s many years of experience working in child welfare, along with, interpretation of statute and exercising ethical professional judgement about when mandated reporting is required, influenced the staff to not make a new report. Guided  MN statute 626.556 Reporting of Maltreatment of Minors definitions of â€˜Accidental\', â€˜Neglect\', â€˜Physical Abuse\', and â€˜Threatened Injury\', along with 626.556 Subd. 3 â€˜Persons mandated to report; persons voluntarily report\', contributed to the staff\'s interpretation of the threshold to report or not report.. Knowledge factors accessed and available to the staff at the time influenced the staff\'s perception regarding not meeting the statutory definitions; the staff did not have â€œa reason to believeâ€ that the 2 year old was a new victim, as that the marks/bruises on the 2 year old child were not perceived as being a result of suspected maltreatment based on the explanations provided by the mother and older children corroborating statements about the marks/bruises\' accidental nature.\r\nFurthermore, obtaining knowledge by using proven engagement strategies from experience, including not having law enforcement present during the initial face to face home visit, was the staff\'s priority using the family assessment approach. The staff\'s ability to gather credible information in order to assess safety and risk, in addition to the family\'s strengths and needs, was perceived as more successful when law enforcement was not present, and shaped the staff\'s mental model around credibility of the information the staff learned at the time. \r\n	Assessing initial safety and risk without law enforcement present in this case enabled the staff to remain involved with the family, and to operate under the presumption that continued monitoring of safety and risk would occur, as the mother was compliant and was willing to cooperate with the staff\'s requests during the initial home visit. The staff also prioritized using the least invasive approach and least restrictive intervention with the family, which also contributed to the staff\'s decision not to make a new CP report. The staff did not believe there was a need to control for an immediate safety threat, as the marks/bruises observed on the 2 year old child did not meet the burden of proof as defined in state statute at that moment in time.  The staff considered needing more time to understand the full extent of the circumstances, and that future work with the family would expose any potential safety and risk to the children while the staff continued work under the open family assessment.',1,81,81,'2021-05-26 19:05:35','2021-05-26 19:05:35',NULL),(35757,355,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35758,355,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35759,355,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35760,355,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35761,355,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35762,355,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35763,355,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35764,355,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35765,355,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35766,355,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35767,355,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35768,355,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35769,355,22,81,13,346,'Multiple_Choice','3',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35770,355,22,81,13,347,'Free_Text','1.) The staff\'s decision not to make a new report after observation of marks/bruises on the 2 year old child was influenced by the staff\'s many years of experience working FA response cases, and the staff\'s perception that the marks/bruises did not rise to the level of making a new CP report . \r\n\r\n2.) Guided by the staff\'s interpretation of 626.556 Reporting of Maltreatment of Minors definitions of â€˜Accidental\', â€˜Neglect\', â€˜Physical Abuse\', and â€˜Threatened Injury\', along with 626.556 Subd. 3 â€˜Persons mandated to report; persons voluntarily report\', contributed to the staff\'s interpretation of the threshold to report or not report.  The staff\'s many years of experience working in child welfare, along with exercising ethical professional judgement about when mandated reporting is required influenced the staff to not make a new report. The staff did not have a reason to believe new allegations and/or a new victim child existed based on the information known at the time.  \r\n3.)The family assessment response to the family\'s home was regarding allegations of neglect (inadequate supervision) involving the two older children, which the staff focused attention on during the initial face to face. The staff also focused attention on assessing immediate safety and future risk of maltreatment of all the children during the initial contact with the family. The staff observed and documented the marks and bruises on the 2 year old. The staff also took photos of the injuries and uploaded them to the case file as part of the staff\'s ongoing safety and risk assessments under the open family assessment.',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35771,355,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35772,355,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35773,355,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35774,355,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35775,355,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35776,355,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35777,355,22,81,13,354,'Multiple_Choice','1',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35778,355,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35779,355,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35780,355,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35781,355,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35782,355,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35783,355,22,81,13,358,'Multiple_Choice','3',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35784,355,22,81,13,359,'Free_Text','1.) Staff worked to balance FA engagement approach with the family and meeting the FA response timeline within 5 days. Scheduling the initial contact with the children and family was top priority for the staff, as best family assessment guidance requires staff to schedule with caregivers prior to making an unexpected home visit. The staff\'s mental model shaped by past experience woking family assessments is to complete scheduling home visits for new reports as soon as possible in order to meet the pressure of 5 day initial face to face timeline.\r\n\r\n2.)Guided by the staff\'s interpretation of 626.556 Reporting of Maltreatment of Minors definitions of â€˜Accidental\', â€˜Neglect\', â€˜Physical Abuse\', and â€˜Threatened Injury\', along with 626.556 Subd. 3 â€˜Persons mandated to report; persons voluntarily report\', contributed to the staff\'s interpretation of the threshold to report or not report.  The staff\'s many years of experience working in child welfare, along with exercising ethical professional judgement about when mandated reporting is required influenced the staff to not make a new report. The staff did not have a reason to believe new allegations and/or a new victim child existed based on the information known at the time.',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35785,355,22,81,13,360,'Multiple_Choice','1',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35786,355,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35787,355,22,81,13,362,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35788,355,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35789,355,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35790,355,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35791,355,22,81,13,366,'Multiple_Choice','3',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35792,355,22,81,13,367,'Free_Text','Using engagement strategies to access the family and build working relationships in order to assess the family\'s strengths and needs, without law enforcement present, was a successful practice that enabled the staff to remain involved with the family to continue monitoring for risk to safety using least restrictive intervention.  The staff prioritized using the family assessment engagement protocol with the mother by calling the mother first to schedule a time that worked to meet and avoiding the need to make an unexpected home visit to meet the 5 day face to face timeline. Scheduling initial face to face home visits for newly assigned reports -as soon as possible- was a practice norm that the staff had developed to balance best FA practice while also successfully meeting the day response timeline. Furthermore, the staff was able to schedule and meet with the family in the same day, which was a Friday, and the staff also had the following Monday off work.  The staff cross reported the report to law enforcement, and responded under the presumption that law enforcement would not join in the initial face to face for an allegation of neglect, and to facilitate best engagement for a working relationship with the client.',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35793,355,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 19:05:36','2021-05-26 19:05:36',NULL),(35797,356,22,81,13,291,'Multiple_Choice','Kristine Frick',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35798,356,22,81,13,292,'Short_Answer','Meg Carriveau',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35799,356,22,81,13,293,'Date','10/25/2017',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35800,356,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35801,356,22,81,13,294,'Multiple_Choice','Fatality',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35802,356,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35803,356,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35804,356,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35805,356,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35806,356,22,81,13,300,'Multiple_Choice','8',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35807,356,22,81,13,301,'Multiple_Choice','Hennepin',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35808,356,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35809,356,22,81,13,303,'Short_Answer','Robert',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35810,356,22,81,13,304,'Short_Answer','McClendon Jr.',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35811,356,22,81,13,305,'Date','01/13/2017',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35812,356,22,81,13,306,'Date','05/17/2017',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35813,356,22,81,13,307,'Date',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35814,356,22,81,13,308,'Multiple_Choice','4 Months',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35815,356,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35816,356,22,81,13,310,'Short_Answer','Father',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35817,356,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35818,356,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35819,356,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35820,356,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35821,356,22,81,13,316,'Multiple_Choice','4',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35822,356,22,81,13,317,'Short_Answer','No Documentation of interview being offered with the alleged father in the CP FA',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35823,356,22,81,13,318,'Free_Text','The father was upset about CP involvement and controlling.  The mother informed the worker that the father was aware of the worker\'s request to meet on 1/18.  The worker\'s contact information was provided to the mother to give to the father, and the mother advised she would give the card to him, but he would decide if he wanted to contact the worker or not. The worker recalled the father to be involved, but controlling.  The mother indicated the alleged father signed recognition of parentage and the birth certificate for the subject child. Typical practice when a father is willing to engage with the worker, is for the worker to encourage him to meet so the worker can explain how to establish his rights as the father.',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35824,356,22,81,13,319,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35825,356,22,81,13,320,'Short_Answer','Child Protection Family Assessment case used face to face contacts from prior Child welfare case.',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35826,356,22,81,13,321,'Free_Text','Case was open as child welfare assessment on 12/20/2016 for prenatal exposure concerns to unborn child. CW assessment was reassigned to new worker on 01/17/2017 due to previous worker out on extended leave.  (Previous worker had made face to face contact with mother in December).  Worker uses an engagement approach during the child welfare assessment prior to baby\'s birth to build rapport and offer services for the mother. Also gather\'s names of relatives for future reference if needed. Worker did not identify risk to any sibling children and did not note significant history for the mother or father. \r\n\r\nChild was born on 01/13/2017. Face to face observation of the subject child and interview with the mother occurred. PSOP services were discussed on 1/18.  \r\nMultiple attempts to reach hospital social worker occurred on 1/18, 1/26, and 1/30. On 1/30, reached the hospital social worker, and learned the mother tested positive for THC, no other illicit drugs. Worker make new CP report when learned mother tested positive for THC. \r\n1/30/2017 â€“ Family Assessment opened and case notes for face to face contacts were documented from previous work with the mother and observation of the child on 1/18 face to face during the child welfare assessment. Meconium for subject child was not screened. Hospital did not make new report to Child Protection about the birth of the baby and the mother testing positive for THC at time of child\'s birth. The CW Assessment completed and closed on 2/21/2017. \r\n\r\nIt is common practice for an open child welfare assessment for prenatal exposure to close and open as a family assessment at time of child\'s birth (depending on results of mother and newborns tox screens). For this case the mother tested positive for THC and child\'s meconium was not tested, so opening family assessment is common procedure, noting that the hospital hadn\'t reported either. The mother was cooperative, and was aware of the expectations from the child welfare assessment. It made sense to the worker to use the previous contacts given the flow of the already opened CW Assessment and opening of the FA assessment.',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35827,356,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35828,356,22,81,13,323,'Short_Answer','Documentation of numerous attempts made, and a significant amount of time spent, accessing medical record from the local hospital.',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35829,356,22,81,13,324,'Free_Text','The decision to determine maltreatment, (or not), was dependent on context included within a specific medical record regarding a doctor appointment day prior to child\'s death.   \r\n\r\nIt was learned that it took multiple contacts and a lot of persistence to receive the medical record needed. Investigations writes request via County Letterhead, including the statute which allows them access to medical records during an open CP investigation. The amount of time spent trying to access the records is somewhat how operations typically go between the hospital and child protection investigations, but this particular case it created significant concern due to the amount of time spent waiting on getting the information needed. The ME report typically takes 2-3 months to receive for child death cases and this occurred for this investigation.\r\n\r\nThe medical records department follows a strict procedure of releasing only exact date and clinic location where care received for an individual.  The information requested is included on County Letterhead, with the Statute allowing investigations access to the child\'s records. A release of information is not needed, but if specific date or location is not known where child received medical care, the information will not be included just by providing a child\'s name. It is not possible to request all records without including dates, so if there was a discrepancy in exact date, or an exact location where care was received, this becomes problematic. Ultimately, the decision to find maltreatment was delayed due to amount of time it took to obtain access to the specific medical record that was needed to inform preponderance of evidence to use in determining maltreatment.\r\nTimeline: \r\n9/6/2017 -Consult occurred with upper management about next steps for the investigation and if preponderance of evidence met or not met. Need medical records to understand context of parents\' awareness and education of risk to their infant.\r\n9/7/2017- Requested medical records\r\n9/12/2017 -Follow up call to medical records department. Request for records is being processed. Medical records department cannot fax medical records due to protected health information. They can mail them when ready. \r\n9/12/2017 â€“ Collateral hospital social worker contact informs about a different clinic and resident provider who saw the subject child. Social worker could not release the record, but shared verbally the context of what education and directives were given to the caregivers by the doctor.  \r\n10/2/2017 -Follow up call to medical records department. Medical records included 600+ pages of medical records information and were mailed on 9/21/2017. \r\n10/6/2017 â€“ Receipt of 600+ pages of medical records information; Consultation with supervisor regarding medical documentation not including needed medical note from doctor appointment. New request sent back to medical records department at local hospital. \r\n10/13/2017 â€“ Worker walk to local hospital and hand delivered a written request for medical note for subject child\'s doctor appointment that took place at the specific location on the specific date. The records personnel reported they do not provide documentation in hand, but was able to print off the medical notes and provided to the worker. Department was waiting on the medical notes from doctor appointment to determine whether to make maltreatment finding or not. It was dependent on what was included in the context of the medical appointment note.',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35830,356,22,81,13,325,'Free_Text','Debrief only/ No Map/ Mapping team decision to score this area of learning using the systems analysis tool.',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35831,356,22,81,13,326,'Short_Answer','Case referred to PSOP case management rather than family assessment case management',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35832,356,22,81,13,327,'Free_Text','Consult with CP Supervisor determined to close the family assessment and make a referral to PSOP. Cases that involve just THC, most likely won\'t open to field, and they may or may not open to PSOP.  \r\nThere was an internal protocol to follow about making the PSOP referral at that time which the worker completed. PSOP was a contracted service through a community agency.',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35833,356,22,81,13,328,'Free_Text','Debrief only/ No Map/ Mapping team decide to score this area of learning using the systems analysis tool.',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35834,356,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35835,356,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35836,356,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35837,356,22,81,13,346,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35838,356,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35839,356,22,81,13,348,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35840,356,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35841,356,22,81,13,350,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35842,356,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35843,356,22,81,13,352,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35844,356,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35845,356,22,81,13,354,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35846,356,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35847,356,22,81,13,356,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35848,356,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35849,356,22,81,13,368,'Multiple_Choice','2',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35850,356,22,81,13,369,'Free_Text','LP3: Documentation of numerous attempts and a significant amount of time being spent to access medical records from the local hospital, which delayed a decision about maltreatment. \r\nIt took CP worker multiple contacts and a lot of persistence to receive the medical record needed.  Investigations writes request via County Letterhead, included in the context of the Letter is the statute which allows them access to medical records during an open CP investigation. The amount of time that was spent trying to access the records was somewhat typical, but it does not support the work CP is trying to achieve, especially for this particular case, the time spent trying to obtain the medical records created a barrier, and caused delay in CP investigator being able to make a maltreatment determination. A significant amount of time was spent waiting on getting the information needed. The hospital\'s medical records department follows a strict procedure of releasing only exact date and clinic location where care received for an individual. The information requested is included on County Letterhead, with the Statute allowing investigations access to the child\'s records. A release of information is not needed, But if specific date or location is not known where child received medical care, the information will not be included just by providing a child\'s name. It is not possible to request all records without including dates, so if there was a discrepancy in exact date, or an exact location where care was received, this becomes problematic. Ultimately, the decision to find maltreatment was delayed due to amount of time it took to obtain access to the specific medical records needed to inform preponderance of evidence.',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35851,356,22,81,13,358,'Multiple_Choice','2',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35852,356,22,81,13,359,'Free_Text','Unsafe sleep critical incident. Maltreatment determined for Neglect - Inadequate supervision to subject child by the alleged father.',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35853,356,22,81,13,360,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35854,356,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35855,356,22,81,13,362,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35856,356,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35857,356,22,81,13,364,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35858,356,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35859,356,22,81,13,366,'Multiple_Choice',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35860,356,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35861,356,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 19:06:15','2021-05-26 19:06:15',NULL),(35865,357,22,81,13,291,'Multiple_Choice','Brittany Lochner',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35866,357,22,81,13,292,'Short_Answer','Jess VanKuyk',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35867,357,22,81,13,293,'Date','09/01/2019',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35868,357,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35869,357,22,81,13,294,'Multiple_Choice','Fatality',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35870,357,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35871,357,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35872,357,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35873,357,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35874,357,22,81,13,300,'Multiple_Choice','9',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35875,357,22,81,13,301,'Multiple_Choice','Ramsey',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35876,357,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35877,357,22,81,13,303,'Short_Answer','Marietta',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35878,357,22,81,13,304,'Short_Answer','Rudolph',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35879,357,22,81,13,305,'Date','05/28/2018',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35880,357,22,81,13,306,'Date','12/18/2018',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35881,357,22,81,13,307,'Date',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35882,357,22,81,13,308,'Multiple_Choice','6 Months',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35883,357,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35884,357,22,81,13,310,'Short_Answer','Father',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35885,357,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35886,357,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35887,357,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35888,357,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35889,357,22,81,13,316,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35890,357,22,81,13,317,'Short_Answer',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35891,357,22,81,13,318,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35892,357,22,81,13,319,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35893,357,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35894,357,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35895,357,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35896,357,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35897,357,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35898,357,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35899,357,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35900,357,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35901,357,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35902,357,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35903,357,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35904,357,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35905,357,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35906,357,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35907,357,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35908,357,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35909,357,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35910,357,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35911,357,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35912,357,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35913,357,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35914,357,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35915,357,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35916,357,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35917,357,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35918,357,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35919,357,22,81,13,358,'Multiple_Choice','0',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35920,357,22,81,13,359,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35921,357,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35922,357,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35923,357,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 20:16:59','2021-05-26 20:16:59',NULL),(35924,357,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:00','2021-05-26 20:17:00',NULL),(35925,357,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 20:17:00','2021-05-26 20:17:00',NULL),(35926,357,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:00','2021-05-26 20:17:00',NULL),(35927,357,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 20:17:00','2021-05-26 20:17:00',NULL),(35928,357,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:00','2021-05-26 20:17:00',NULL),(35929,357,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 20:17:00','2021-05-26 20:17:00',NULL),(35933,358,22,81,13,291,'Multiple_Choice','Ryan Hartneck',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35934,358,22,81,13,292,'Short_Answer','Triage Team',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35935,358,22,81,13,293,'Date','05/07/2018',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35936,358,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35937,358,22,81,13,294,'Multiple_Choice','Near Fatality',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35938,358,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35939,358,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35940,358,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35941,358,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35942,358,22,81,13,300,'Multiple_Choice','6',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35943,358,22,81,13,301,'Multiple_Choice','Rice',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35944,358,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35945,358,22,81,13,303,'Short_Answer','Safwan',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35946,358,22,81,13,304,'Short_Answer','Ali',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35947,358,22,81,13,305,'Date','03/04/2014',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35948,358,22,81,13,306,'Date',NULL,1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35949,358,22,81,13,307,'Date','03/06/2018',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35950,358,22,81,13,308,'Multiple_Choice','4 Years',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35951,358,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35952,358,22,81,13,310,'Short_Answer','Friend/Neighbor',1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35953,358,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35954,358,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35955,358,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35956,358,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 20:17:49','2021-05-26 20:17:49',NULL),(35957,358,22,81,13,316,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35958,358,22,81,13,317,'Short_Answer',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35959,358,22,81,13,318,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35960,358,22,81,13,319,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35961,358,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35962,358,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35963,358,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35964,358,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35965,358,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35966,358,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35967,358,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35968,358,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35969,358,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35970,358,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35971,358,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35972,358,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35973,358,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35974,358,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35975,358,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35976,358,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35977,358,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35978,358,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35979,358,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 20:17:50','2021-05-26 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20:17:50','2021-05-26 20:17:50',NULL),(35990,358,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35991,358,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35992,358,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35993,358,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35994,358,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35995,358,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35996,358,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(35997,358,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 20:17:50','2021-05-26 20:17:50',NULL),(36001,360,22,81,13,291,'Multiple_Choice','Ryan Hartneck',1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36002,360,22,81,13,292,'Short_Answer','Tracy Nielsen',1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36003,360,22,81,13,293,'Date','06/26/2019',1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36004,360,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36005,360,22,81,13,294,'Multiple_Choice','Fatality',1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36006,360,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36007,360,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36008,360,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36009,360,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36010,360,22,81,13,300,'Multiple_Choice','4',1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36011,360,22,81,13,301,'Multiple_Choice','Sherburne',1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36012,360,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36013,360,22,81,13,303,'Short_Answer','Spencer',1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36014,360,22,81,13,304,'Short_Answer','Parker',1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36015,360,22,81,13,305,'Date','04/08/2018',1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36016,360,22,81,13,306,'Date','04/15/2019',1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36017,360,22,81,13,307,'Date',NULL,1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36018,360,22,81,13,308,'Multiple_Choice','1 Year',1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36019,360,22,81,13,309,'Multiple_Choice','1',1,81,81,'2021-05-26 20:19:02','2021-05-26 20:19:02',NULL),(36020,360,22,81,13,310,'Short_Answer','Father',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36021,360,22,81,13,311,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36022,360,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36023,360,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36024,360,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36025,360,22,81,13,316,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36026,360,22,81,13,317,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36027,360,22,81,13,318,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36028,360,22,81,13,319,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36029,360,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36030,360,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36031,360,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36032,360,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36033,360,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36034,360,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36035,360,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36036,360,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36037,360,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36038,360,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36039,360,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36040,360,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36041,360,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36042,360,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36043,360,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36044,360,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36045,360,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36046,360,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36047,360,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36048,360,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36049,360,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36050,360,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36051,360,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36052,360,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36053,360,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36054,360,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36055,360,22,81,13,358,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36056,360,22,81,13,359,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36057,360,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36058,360,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36059,360,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36060,360,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36061,360,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36062,360,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36063,360,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36064,360,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36065,360,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 20:19:03','2021-05-26 20:19:03',NULL),(36069,361,22,81,13,291,'Multiple_Choice','Ryan Hartneck',1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36070,361,22,81,13,292,'Short_Answer','Jennifer Carlson',1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36071,361,22,81,13,293,'Date','12/18/2017',1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36072,361,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36073,361,22,81,13,294,'Multiple_Choice','Fatality',1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36074,361,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36075,361,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36076,361,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36077,361,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36078,361,22,81,13,300,'Multiple_Choice','8',1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36079,361,22,81,13,301,'Multiple_Choice','Hennepin',1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36080,361,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36081,361,22,81,13,303,'Short_Answer','Staci',1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36082,361,22,81,13,304,'Short_Answer','Bowdry',1,81,81,'2021-05-26 20:19:41','2021-05-26 20:19:41',NULL),(36083,361,22,81,13,305,'Date','12/02/2017',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36084,361,22,81,13,306,'Date','12/18/2017',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36085,361,22,81,13,307,'Date',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36086,361,22,81,13,308,'Multiple_Choice','<1 Month',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36087,361,22,81,13,309,'Multiple_Choice','2',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36088,361,22,81,13,310,'Short_Answer','Mother',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36089,361,22,81,13,311,'Short_Answer','Father',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36090,361,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36091,361,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36092,361,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36093,361,22,81,13,316,'Multiple_Choice','1',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36094,361,22,81,13,317,'Short_Answer','Information in case record documents that maltreatment was determined, however no maltreatment determination was made',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36095,361,22,81,13,318,'Free_Text','Debriefed worker indicated that this was the first case that she had ever worked on her own. She had recently moved from the Induction Unit to the Assessment Unit and had shadowed a fellow worker for 1-2 months prior to working a case solo (she previously worked in probation). She reported that in the Induction Unit, the training is focused on Field case work (case management) and does not train on how to complete assessments/investigations. She reported that this was the only case she had on her caseload at that time and that there was sufficient information to find maltreatment determinations on the child\'s father and uncle. Maltreatment determinations are always staffed with supervisors and both the worker and the supervisor agreed that the determinations were appropriate; additionally stating that supervision is â€œalways available.â€ The worker went on to share that while her intentions were to click â€œyesâ€ in SSIS to indicate maltreatment was found, she clicked â€œnoâ€ instead. As a result of clicking â€œnoâ€, SSIS generated a Notice of Determination (NOD) letter that stated that maltreatment did not occur. When this document is generated by the SSIS system, the only thing a worker must do is put in the allegation detail and the final letter is created. She indicated that these letters do not have a redundancy that the FA letters do, as they have you click additional times to specify whether ongoing services for the family are indicated.',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36096,361,22,81,13,319,'Free_Text','The agency documenting that maltreatment was determined however no formal maltreatment determination being made was influenced by multiple systemic contributions. These included the worker being new to the position, supervisor availability, external pressure and accessibility to training. The agency was experiencing high ongoing worker caseloads and subsequently, high worker turnover due to work demands. This turnover and available openings in field unit influenced the agency to make field-related case work a priority in the Induction Unit (training unit for new staff). As a result of this emphasis, Induction Unit staff did not receive specialized training on how to conduct investigations. This was the worker\'s first solo investigation case after leaving the Induction Unit. The worker also hadn\'t completed Foundations Training where a more comprehensive training on completing investigations occurs. Circumstances around the time of the Governor\'s Task force influenced long waitlist for Foundations Training. Not being able to attend Foundation Training as a result of the waitlist further impacted the worker\'s unfamiliarity with the investigations process. \r\n\r\nOnce investigations are completed, there was a process in the agency where cases needed to be reviewed by supervisors to ensure the case was completed accurately. This process was delayed as supervisors also had competing demands. They were balancing meetings and committee attendance with supervision and consultation for staff. This resulted in less time for supervisors to engage in case compliance/oversight.\r\n\r\nDuring this time, the Governor\'s Task Force had recently made many recommendations regarding CW (child welfare) practice in the State. These recommendations, including new intake screening guidelines, resulted in more cases being screened in and additional media attention and community group scrutiny on the CW system. This, coupled with the Federal CFSR and subsequent PIP\'s, put pressure on managers and supervisors to implement change. This pressure was then overtly put on the worker completing the investigation to be more efficient.\r\n\r\nWith the agency staff being new to the CW system, the worker had minimal familiarity with the SSIS system and had only one day of training on the use of SSIS. The unfamiliarity with the system led to the staff making the assumption that she had clicked â€œyesâ€ that maltreatment was determined.  The worker shared that her intentions were to click â€œyesâ€ in SSIS to indicate maltreatment was found; however, she clicked â€œnoâ€ instead. As a result of clicking â€œnoâ€, SSIS generated a Notice of Determination (NOD) letter that stated that maltreatment did not occur. When this document is generated by the SSIS system, the only thing a worker must do is put in the allegation detail and the final letter is created.',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36097,361,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36098,361,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36099,361,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36100,361,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36101,361,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36102,361,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36103,361,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36104,361,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36105,361,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36106,361,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36107,361,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36108,361,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36109,361,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36110,361,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36111,361,22,81,13,348,'Multiple_Choice','2',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36112,361,22,81,13,349,'Free_Text','The agency was experiencing high ongoing worker caseloads and subsequently, high worker turnover due to work demands.',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36113,361,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36114,361,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36115,361,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36116,361,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36117,361,22,81,13,354,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36118,361,22,81,13,355,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36119,361,22,81,13,356,'Multiple_Choice','3',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36120,361,22,81,13,357,'Free_Text','This turnover and available openings in field unit influenced the agency to make field-related case work a priority in the Induction Unit (training unit for new staff). As a result of this emphasis, Induction Unit staff did not receive specialized training on how to conduct investigations. \r\n\r\nThe worker also hadn\'t completed Foundations Training where a more comprehensive training on completing investigations occurs. \r\n\r\nNot being able to attend Foundation Training as a result of the waitlist further impacted the worker\'s unfamiliarity with the investigations process. \r\n\r\nWith the agency staff being new to the CW system, the worker had minimal familiarity with the SSIS system and had only one day of training on the use of SSIS. The unfamiliarity with the system led to the staff making the assumption that she had clicked â€œyesâ€ that maltreatment was determined.',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36121,361,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36122,361,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36123,361,22,81,13,358,'Multiple_Choice','1',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36124,361,22,81,13,359,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36125,361,22,81,13,360,'Multiple_Choice','2',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36126,361,22,81,13,361,'Free_Text','Once investigations are completed, there was a process in the agency where cases needed to be reviewed by supervisors to ensure the case was completed accurately. This process was delayed as supervisors also had competing demands. They were balancing meetings and committee attendance with supervision and consultation for staff. This resulted in less time for supervisors to engage in case compliance/oversight.\r\n\r\nThis, coupled with the Federal CFSR and subsequent PIP\'s, put pressure on managers and supervisors to implement change. This pressure was then overtly put on the worker completing the investigation to be more efficient.',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36127,361,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36128,361,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36129,361,22,81,13,364,'Multiple_Choice','2',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36130,361,22,81,13,365,'Free_Text','Once investigations are completed, there was a process in the agency where cases needed to be reviewed by supervisors to ensure the case was completed accurately. This process was delayed as supervisors also had competing demands. They were balancing meetings and committee attendance with supervision and consultation for staff. This resulted in less time for supervisors to engage in case compliance/oversight.',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36131,361,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36132,361,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36133,361,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 20:19:42','2021-05-26 20:19:42',NULL),(36137,362,22,81,13,291,'Multiple_Choice','Brittany Lochner',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36138,362,22,81,13,292,'Short_Answer','Tracy Nielson',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36139,362,22,81,13,293,'Date','08/02/2016',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36140,362,22,81,13,342,'Date',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36141,362,22,81,13,294,'Multiple_Choice','Near Fatality',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36142,362,22,81,13,295,'Yes_or_No','No',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36143,362,22,81,13,296,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36144,362,22,81,13,297,'Short_Answer',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36145,362,22,81,13,299,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36146,362,22,81,13,300,'Multiple_Choice','6',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36147,362,22,81,13,301,'Multiple_Choice','Goodhue',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36148,362,22,81,13,302,'Short_Answer',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36149,362,22,81,13,303,'Short_Answer','Sunni',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36150,362,22,81,13,304,'Short_Answer','Betzold',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36151,362,22,81,13,305,'Date','06/20/2015',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36152,362,22,81,13,306,'Date',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36153,362,22,81,13,307,'Date','05/20/2016',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36154,362,22,81,13,308,'Multiple_Choice','10 Months',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36155,362,22,81,13,309,'Multiple_Choice','2',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36156,362,22,81,13,310,'Short_Answer','Mother',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36157,362,22,81,13,311,'Short_Answer','Father',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36158,362,22,81,13,312,'Short_Answer',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36159,362,22,81,13,313,'Short_Answer',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36160,362,22,81,13,314,'Short_Answer',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36161,362,22,81,13,316,'Multiple_Choice',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36162,362,22,81,13,317,'Short_Answer',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36163,362,22,81,13,318,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36164,362,22,81,13,319,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36165,362,22,81,13,320,'Short_Answer',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36166,362,22,81,13,321,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36167,362,22,81,13,322,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36168,362,22,81,13,323,'Short_Answer',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36169,362,22,81,13,324,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36170,362,22,81,13,325,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36171,362,22,81,13,326,'Short_Answer',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36172,362,22,81,13,327,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36173,362,22,81,13,328,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36174,362,22,81,13,343,'Short_Answer',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36175,362,22,81,13,344,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36176,362,22,81,13,345,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36177,362,22,81,13,346,'Multiple_Choice','0',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36178,362,22,81,13,347,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36179,362,22,81,13,348,'Multiple_Choice','0',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36180,362,22,81,13,349,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36181,362,22,81,13,350,'Multiple_Choice','0',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36182,362,22,81,13,351,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36183,362,22,81,13,352,'Multiple_Choice','0',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36184,362,22,81,13,353,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36185,362,22,81,13,354,'Multiple_Choice','2',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36186,362,22,81,13,355,'Free_Text','The hospital reported the near fatality to the local agency 5 days after the incident occurred.  The report being made 5 days after the incident occurred impacted the agency\'s ability to ensure immediate safety of the subject child and the surviving siblings.',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36187,362,22,81,13,356,'Multiple_Choice','0',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36188,362,22,81,13,357,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36189,362,22,81,13,368,'Multiple_Choice','0',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36190,362,22,81,13,369,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36191,362,22,81,13,358,'Multiple_Choice','0',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36192,362,22,81,13,359,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36193,362,22,81,13,360,'Multiple_Choice','0',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36194,362,22,81,13,361,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36195,362,22,81,13,362,'Multiple_Choice','0',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36196,362,22,81,13,363,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36197,362,22,81,13,364,'Multiple_Choice','0',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36198,362,22,81,13,365,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36199,362,22,81,13,366,'Multiple_Choice','0',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36200,362,22,81,13,367,'Free_Text',NULL,1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(36201,362,22,81,13,370,'Yes_or_No','Yes',1,81,81,'2021-05-26 20:20:21','2021-05-26 20:20:21',NULL),(39505,191,23,81,10,76,'Short_Answer','201903632',1,NULL,NULL,NULL,NULL,NULL),(39506,191,23,81,10,77,'Date','2019-06-19',1,NULL,NULL,NULL,NULL,NULL),(39507,191,23,81,10,78,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(39508,191,23,81,10,79,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(39509,191,23,81,10,80,'Short_Answer','REM Arrowhead',1,NULL,NULL,NULL,NULL,NULL),(39510,191,23,81,10,81,'Short_Answer','Corey Labissoniere',1,NULL,NULL,NULL,NULL,NULL),(39511,191,23,81,10,82,'Short_Answer','Corey.LaBissoniere@thementornetwork.com',1,NULL,NULL,NULL,NULL,NULL),(39512,191,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39513,191,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(39514,191,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(39515,191,23,81,10,86,'Date','2019-05-18',1,NULL,NULL,NULL,NULL,NULL),(39516,191,23,81,10,87,'Free_Text','It was reported that the program provided inadequate staffing levels per individuals plan.  Individual eloped from the program and is currently in the hospital for mental health reasons.',1,NULL,NULL,NULL,NULL,NULL),(39517,191,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39518,191,23,81,10,91,'Short_Answer','Individual left the home via the bathroom without staff knowledge.',1,NULL,NULL,NULL,NULL,NULL),(39519,191,23,81,10,94,'True_or_False','No',1,NULL,NULL,NULL,NULL,NULL),(39520,191,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39521,191,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39522,191,23,81,10,99,'Multiple_Choice','Staff No Longer Employed',1,NULL,NULL,NULL,NULL,NULL),(39523,191,23,81,10,100,'Free_Text','The individual eloping from the home was influenced by the staff’s belief that the individual was bathing and that the individual was able to be in the bathroom without supervision. The individual had eloped previously, but had developed new tactics including letting the water run in the bathroom (giving the illusion of bathing/showering) and eloping out the bathroom window. The absence of rights restriction and societal norms regarding privacy also influenced staff’s decision not to provide direct supervision while the individual was using the bathroom. The individual was quickly adapting her behaviors to attempt elopement in ways that staff hadn’t experienced before.  The individual’s support team (guardian, case manager, etc.) also had varying views on what the individual’s needs were. Staff’s confusion around these new behaviors, the support team’s varying views and the ability to communicate with each other in real time were influencing the individual’s support plan not being updated to reflect the person’s updated safety considerations.  \r\n\r\nPer the individual’s support plan, 1:1 supervision was required. The regulatory agencies definition of 1:1 staffing is not clear and is left at the interpretation of the provider and may be outlined in the support plan. Staff has access to the support plan(s); however, they are not clear and concise. The support plan is influenced by a chain of processes and requirements: Coordinated Service and Support Plans created by the case managers are influenced by MN Choices Assessment of a person’s needs, which then impact the service hours negotiated between the lead agency and provider using DHS Form-6790. The 6790 approval process is directly influenced by the Disability Waiver Rate System (DWRS), which was created by the Minnesota legislature and implemented by the Minnesota Department of Human Services. DWRS is set in statute and is a calculator that produces a service rate based on the hours of staffing needed by the person and provided by the provider. The DWRS is additionally impacted by HCBS Medicaid Waiver requirements enforced nationally by the Centers for Medicare and Medicaid Services (CMS).  ',1,NULL,NULL,NULL,NULL,NULL),(39524,191,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39525,191,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39526,191,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39527,191,23,81,10,130,'Free_Text',' ',1,NULL,NULL,NULL,NULL,NULL),(39528,191,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39529,191,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39530,191,23,81,10,101,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39531,191,23,81,10,102,'Free_Text','The individual eloping from the home was influenced by the staff’s belief that the individual was bathing and that the individual was able to be in the bathroom without supervision.  The individual had eloped previously, but had developed new tactics including letting the water run in the bathroom (giving the illusion of bathing/showering) and eloping out the bathroom window.  The absence of rights restriction and societal norms regarding privacy also influenced staff’s decision not to provide direct supervision while the individual was using the bathroom.',1,NULL,NULL,NULL,NULL,NULL),(39532,191,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39533,191,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39534,191,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39535,191,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39536,191,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39537,191,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39538,191,23,81,10,109,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39539,191,23,81,10,110,'Free_Text','The individual’s support team (guardian, case manager, etc.) also had varying views on what the individual’s needs were. Staff’s confusion around these new behaviors, the support team’s varying views and the ability to communicate with each other in real time were influencing the individual’s support plan not being updated to reflect the person’s updated safety considerations.  ',1,NULL,NULL,NULL,NULL,NULL),(39540,191,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39541,191,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39542,191,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39543,191,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39544,191,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39545,191,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39546,191,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39547,191,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39548,191,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39549,191,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39550,191,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39551,191,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39552,191,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39553,191,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39554,191,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39555,191,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39556,191,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39557,192,23,81,10,76,'Short_Answer','DV_Rural Living Enivronment-SLC-2020-06',1,NULL,NULL,NULL,NULL,NULL),(39558,192,23,81,10,77,'Date','2020-07-10',1,NULL,NULL,NULL,NULL,NULL),(39559,192,23,81,10,78,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(39560,192,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39561,192,23,81,10,80,'Short_Answer','Rural Living Environment',1,NULL,NULL,NULL,NULL,NULL),(39562,192,23,81,10,81,'Short_Answer','Leanne Negley',1,NULL,NULL,NULL,NULL,NULL),(39563,192,23,81,10,82,'Short_Answer','lnegley@rurallivingmn.com',1,NULL,NULL,NULL,NULL,NULL),(39564,192,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39565,192,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(39566,192,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(39567,192,23,81,10,86,'Date','2019-04-23',1,NULL,NULL,NULL,NULL,NULL),(39568,192,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39569,192,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39570,192,23,81,10,91,'Short_Answer','Person was given a 60-day service termination',1,NULL,NULL,NULL,NULL,NULL),(39571,192,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39572,192,23,81,10,97,'Date','2020-08-11',1,NULL,NULL,NULL,NULL,NULL),(39573,192,23,81,10,98,'Free_Text','The individual was living in a large 4000 sq. ft. adult foster care home in rural northern MN.  The individual has been served by this provider for approximately 10 years and was living in this particular home for the past 4 + years.   The individual’s mother is her legal guardian.  The AFC was home to two other females at the time the termination notice was issued.  The individual is diagnosed with Prader-Willi syndrome and has some challenging behaviors associated with her diagnosis.  These behaviors kept the provider cautious about adding additional people in the home even though there was capacity to do so.  The provider stated that recently the individual was given a new medication and her behaviors had improved.  Staff indicated that the provider was discussing a more individualized living arrangement for the individual, which would have included a larger area of the home designated to the individual.  \r\n\r\nWhen concerns for COVID19 arose in March, the provider sent out letters to the guardians of the people they serve to see if the guardians wanted to provide direct care for their respective program participants.  The individual’s mother responded and indicated that she wanted to provide care for her daughter.  The original plan was that this arrangement would last for two weeks.  The provider asked if the individual could return to the program and the individual’s mother wasn’t comfortable with her returning at that time.  The individual’s mother had previously worked for the provider.  In an effort to continue to support the individual the provider did the following: retrained the mother, employed her as a direct support staff for the individual, provided groceries and medications to the mother’s home, and provided an iPad so the individual could remain connected to others served by the provider as well as her mother being able to use the device for documentation.  The provider also provided remote support via Zoom meetings 2 hours a day, Monday through Friday.  County waiver case manager and supervisor were consulted about the alternative arrangement in response to the pandemic and they explained to the provider that they were not in support of this.  They had not been consulted until after the plan was in place.  The agency advised the provider to issue a termination notice if individual did not return to the program.  Mother and individual were notified of this recommendation and chose not to have the individual return to the program.  Mother and individual understood the termination was coming and agreed with it.  \r\n\r\nStaff reported that the provider’s management team was involved with the termination notice and issued the termination in accordance with policy/rules.  No previous terminations were noted.   \r\n',1,NULL,NULL,NULL,NULL,NULL),(39574,192,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39575,192,23,81,10,100,'Free_Text','The person being given a 60-day service termination was influenced by the individual’s legal guardian/mother deciding to not have the person return to the program after she was not comfortable with safety in the Adult Foster Care (AFC) setting during the COVID-19 pandemic and elected to provide care to the individual for a two week period. The service provider sent a letter to the individual’s mother that gave the guardian the option to provide care for two weeks to the individual in lieu of being in the AFC.  The two week timeline was based on the maximum time limit that a provider could bill for (under the guise of a “camping trip”) and continue to hold the individual’s bed. The uncertainties of the pandemic influenced the provider to develop a creative plan to continue to support the individual in her mother’s home.  This plan included the provider having the mother become an employee to formally provide direct support to the individual.  This was influenced by the mother previously being a provider for the agency as well as what was deemed to be important to the individual.  The uncertainties of the pandemic again made timelines unclear for how long this arrangement would be appropriate.  The provider then reached out to the County to discuss the alternative plan that was currently in place.  The county couldn’t approve this alternative service delivery.  The individual’s mother was made aware of this but was still comfortable with the individual to return to an AFC setting and decided to continue to have the individual reside with her.   Based on the mother’s decision, the provider not being able to sustain the current plan and the County stance on the alternative plan the person was given a 60-day termination notice.  \r\nThe County’s inability to support the alternative plan was influenced by the plan’s language not matching service definitions for the service the provider was authorized to provide.  The provider was delivering residential Supported Living Services (SLS) which by regulations cannot be provided remotely.  Additionally parents cannot provide SLS in their own home and these rules were not flexible enough to accommodate the individual’s specific situation.\r\nThe provider’s decision to issue a service termination was additionally impacted by a  fiscal constraints.  Providers are unable to bill for long-term empty beds. The inability to bill is based on the Disability Waiver Rate System (DWRS) which already factors in absences in the daily rate but not the ability to bill for days away.  This billing constraint is impacted by CMS regulations which only allows one method of billing for absences.  This billing constraint is also impacted by the Minnesota State Legislature which chose this method of billing for absences. \r\nThe uncertainties surrounding the pandemic were influenced by ongoing changes to requirements and timelines that were demonstrated by ongoing changes in the Governor’s orders.\r\n',1,NULL,NULL,NULL,NULL,NULL),(39576,192,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39577,192,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39578,192,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39579,192,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39580,192,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39581,192,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39582,192,23,81,10,101,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39583,192,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39584,192,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39585,192,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39586,192,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39587,192,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39588,192,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39589,192,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39590,192,23,81,10,109,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39591,192,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39592,192,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39593,192,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39594,192,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39595,192,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39596,192,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39597,192,23,81,10,116,'Free_Text','The County’s inability to support the alternative plan was influenced by the plan’s language not matching service definitions for the service the provider was authorized to provide.  The provider was delivering residential Supported Living Services (SLS) which by regulations cannot be provided remotely.  Additionally parents cannot provide SLS in their own home and these rules were not flexible enough to accommodate the individual’s specific situation.\r\nThe provider’s decision to issue a service termination was additionally impacted by a  fiscal constraints.  Providers are unable to bill for long-term empty beds. The inability to bill is based on the Disability Waiver Rate System (DWRS) which already factors in absences in the daily rate but not the ability to bill for days away.  This billing constraint is impacted by CMS regulations which only allows one method of billing for absences.  This billing constraint is also impacted by the Minnesota State Legislature which chose this method of billing for absences. \r\nThe uncertainties surrounding the pandemic were influenced by ongoing changes to requirements and timelines that were demonstrated by ongoing changes in the Governor’s orders.',1,NULL,NULL,NULL,NULL,NULL),(39598,192,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39599,192,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39600,192,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39601,192,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39602,192,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39603,192,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39604,192,23,81,10,123,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39605,192,23,81,10,124,'Free_Text','The person being given a 60-day service termination was influenced by the individual’s legal guardian/mother deciding to not have the person return to the program after she was not comfortable with safety in the Adult Foster Care (AFC) setting during the COVID-19 pandemic and elected to provide care to the individual for a two week period. The service provider sent a letter to the individual’s mother that gave the guardian the option to provide care for two weeks to the individual in lieu of being in the AFC.  The two week timeline was based on the maximum time limit that a provider could bill for (under the guise of a “camping trip”) and continue to hold the individual’s bed. The uncertainties of the pandemic influenced the provider to develop a creative plan to continue to support the individual in her mother’s home.  This plan included the provider having the mother become an employee to formally provide direct support to the individual.  This was influenced by the mother previously being a provider for the agency as well as what was deemed to be important to the individual.  The uncertainties of the pandemic again made timelines unclear for how long this arrangement would be appropriate.  The provider then reached out to the County to discuss the alternative plan that was currently in place.  The county couldn’t approve this alternative service delivery.  The individual’s mother was made aware of this but was still comfortable with the individual to return to an AFC setting and decided to continue to have the individual reside with her.   Based on the mother’s decision, the provider not being able to sustain the current plan and the County stance on the alternative plan the person was given a 60-day termination notice.  ',1,NULL,NULL,NULL,NULL,NULL),(39606,192,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39607,192,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39608,192,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39609,193,23,81,10,76,'Short_Answer','A954660000',1,NULL,NULL,NULL,NULL,NULL),(39610,193,23,81,10,77,'Date','2019-10-15',1,NULL,NULL,NULL,NULL,NULL),(39611,193,23,81,10,78,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(39612,193,23,81,10,79,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(39613,193,23,81,10,80,'Short_Answer','Stepping Stones for Living',1,NULL,NULL,NULL,NULL,NULL),(39614,193,23,81,10,81,'Short_Answer','Laura Flynn',1,NULL,NULL,NULL,NULL,NULL),(39615,193,23,81,10,82,'Short_Answer','laura.flynn@sslduluth.com',1,NULL,NULL,NULL,NULL,NULL),(39616,193,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39617,193,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(39618,193,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(39619,193,23,81,10,86,'Date','2019-08-24',1,NULL,NULL,NULL,NULL,NULL),(39620,193,23,81,10,87,'Free_Text','Tracy was outside the patio smoking. A few minutes later, the staff didn\'t see Tracy outside anymore and he hadn\'t seen him come inside the house. Staff searched the house and then went outside to look down the street, but could not locate Tracy.\r\n\r\nStaff called the on-call supervisor, who told staff to call 911 to report a missing person. After doing so, the police officer called the house to talk with the staff and then the officer came to the house to gather more information. Staff was instructed to update the officer if Tracy returned home. Close to 1 pm, Tracy came back to the house and the staff asked him where he went. Tracy told staff that he took a cab went to the mall. Tracy was carrying pop, chips, and cookies that he had bought at the mall. He then sat down in the dining room and ate his food.',1,NULL,NULL,NULL,NULL,NULL),(39621,193,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39622,193,23,81,10,91,'Short_Answer','Staff did not observe the individual leave the home',1,NULL,NULL,NULL,NULL,NULL),(39623,193,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39624,193,23,81,10,97,'Date','2019-12-09',1,NULL,NULL,NULL,NULL,NULL),(39625,193,23,81,10,98,'Free_Text','The day of the incident the staff person(SP) was supervising the individual who eloped as well as 3 other residents.   SP doesn’t work at this home regularly.  The individual was outside smoking and told staff that he was going to walk to a convenience store located nearby the home.  SP advised the individual to take a “walkie talkie” with him.   SP was cleaning the bathroom and never directly observed the individual leave the residence or confirm whether he took the walkie talkie with him.  The SP stated that there is a plan in place that supports this individual going to the convenience store unsupervised, with a walkie talkie for a period of 30 minutes.  Approximately 30 minutes later he noticed the individual had not returned to the home.  SP noted that the individual had not taken the walkie talkie with him.  SP stated there is protocol in place when the individual doesn’t return after 30 minutes.  Following protocol, the SP called the agency’s crisis staff.  The convenience store was contacted and they informed staff that the individual had not been to the store.  SP was advised to call 911 and did.  Shortly after the 911 call was placed, the individual returned to the home via taxi cab.  The individual disclosed that he took a cab to get McDonald’s and went to the mall.  The individual had recently received money from a renter’s rebate.  The individual manages their own spending money and the day of the incident he had $400(est.)in cash in his possession.  The agency has assisted the individual to go to other places besides the local convenience store.  On the day of the incident SP stated that the individual did not express a desire to go anywhere else.  ',1,NULL,NULL,NULL,NULL,NULL),(39626,193,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39627,193,23,81,10,100,'Free_Text','Staff was preoccupied, cleaning the bathroom during the time the individual left the home.  From the bathroom the staff did not have a vantage point to see the patio area where the individual was smoking prior to leaving the home.  The staff cleaning the bathroom was influenced by the provider assigning staff multiple duties such as cleaning, cooking, etc. Staff cleans the home as the home is required to be safe and sanitary which is also part of the licensing requirements through Minnesota Statutes, 245D.  The staffing ratio at the time of the incident also influenced the staff performing multiple duties.  There was a 1:4 ratio with no other staff on duty, so staff was supporting the four individuals as well as completing other support related tasks such as cleaning. \r\n\r\nOther contributing factors to staff cleaning in an area where they were unable to observe the individual was that staff had no concerns that the individual would leave without confirming with staff and taking the walkie talkie. The individual frequently smoked outside without leaving, in particular, the individual had not previously left the house without telling this staff person. The individual mentioned they might go to the convenience store and staff asked him to take a walkie talkie with, which also influenced staff’s comfortability in cleaning the bathroom as the staff assumed he would take the walkie talkie if he left. The Staff\'s perception that the individual would follow alone time protocol was supported  by the individual’s plan which allowed him to go for a 30 minute walk without staff supervision.   This unsupervised time is driven from the CSSP which allows for unsupervised time and individual’s team developing specific parameters around unsupervised time.  The individual is his own guardian  which directly impacted the development of the CSSP and specific parameters around unsupervised time.   Per the individual’s 6790, they were not allocated one-on-one supervision which has a reciprocal relationship with  the person’s CSSP.  The 6790 is a tool created by DHS to implement the Disability Waiver Rate Setting statutes, created by the Minnesota Legislature, which provides a calculation for the person’s service rates based on  the staff ratios required of the provider. The ratios and rates in a 6790 are negotiated between the provider and the case manager based on the needs for supervision a person has in their CSSP and the provider’s assessment of the staff a person needs as well as the staff they have available. \r\n\r\nThe individual being outside prior to elopement was also influenced by a provider rule of no smoking in the home.  This rule was created to comply with the Minnesota Clean Air Act, which legislatively prohibits smoking in many public places. The rule is reinforced by DHS not allowing smoking in a licensed facility.  Society in general is aware of concerns for smoking in homes.  These concerns influenced DHS provider rules along and the Minnesota Clean Indoor Act.\r\n',1,NULL,NULL,NULL,NULL,NULL),(39628,193,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39629,193,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39630,193,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39631,193,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39632,193,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39633,193,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39634,193,23,81,10,101,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39635,193,23,81,10,102,'Free_Text','Staff was preoccupied, cleaning the bathroom during the time the individual left the home. From the bathroom the staff did not have a vantage point to see the patio area where the individual was smoking prior to leaving the home.  The staff cleaning the bathroom was influenced by the provider assigning staff multiple duties such as cleaning, cooking, etc. Staff cleans the home as the home is required to be safe and sanitary which is also part of the licensing requirements through Minnesota Statutes, 245D.  The staffing ratio at the time of the incident also influenced the staff performing multiple duties.  There was a 1:4 ratio with no other staff on duty, so staff was supporting the four individuals as well as completing other support related tasks such as cleaning. \r\n\r\nOther contributing factors to staff cleaning in an area where they were unable to observe the individual was that staff had no concerns that the individual would leave without confirming with staff and taking the walkie talkie. The individual frequently smoked outside without leaving, in particular, the individual had not previously left the house without telling this staff person. The individual mentioned they might go to the convenience store and staff asked him to take a walkie talkie with, which also influenced staff’s comfortability in cleaning the bathroom as the staff assumed he would take the walkie talkie if he left. The Staff\'s perception that the individual would follow alone time protocol was supported  by the individual’s plan which allowed him to go for a 30 minute walk without staff supervision. \r\n',1,NULL,NULL,NULL,NULL,NULL),(39636,193,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39637,193,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39638,193,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39639,193,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39640,193,23,81,10,107,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39641,193,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39642,193,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39643,193,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39644,193,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39645,193,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39646,193,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39647,193,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39648,193,23,81,10,115,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39649,193,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39650,193,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39651,193,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39652,193,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39653,193,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39654,193,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39655,193,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39656,193,23,81,10,123,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39657,193,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39658,193,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39659,193,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39660,193,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39661,194,23,81,10,76,'Short_Answer','DV_Taylor SLS-SLC-2021-04',1,NULL,NULL,NULL,NULL,NULL),(39662,194,23,81,10,77,'Date','2021-04-28',1,NULL,NULL,NULL,NULL,NULL),(39663,194,23,81,10,78,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(39664,194,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39665,194,23,81,10,80,'Short_Answer','Taylor SLS',1,NULL,NULL,NULL,NULL,NULL),(39666,194,23,81,10,81,'Short_Answer','Jenifer Forneris',1,NULL,NULL,NULL,NULL,NULL),(39667,194,23,81,10,82,'Short_Answer','jenforneris.basswood@yahoo.com',1,NULL,NULL,NULL,NULL,NULL),(39668,194,23,81,10,83,'Short_Answer','218-591-2612',1,NULL,NULL,NULL,NULL,NULL),(39669,194,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(39670,194,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(39671,194,23,81,10,86,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39672,194,23,81,10,87,'Free_Text','\"We, at Taylor SLS, Inc., had always hoped that the Basswood House would be person\'s forever home. We understand that over the course of one\'s life now and challenging obstacles may arise, and while we take great pride in successfully navigating those challenges, we have come to the realization that we do not have the resources available to us to assist him in managing his moggies while providing him (and his housemates) with the best possible quality of life he (and they) deserve in the comfort of a home. In addition to the increased behavioral health \r\nconcerns that have arisen, we feel that he has been negatively affected by the COVID-19 pandemic, the shutdown of Stepping Stones for Living, and the decreased ability to access his community. All of these circumstances have in turn caused a tremendous increase in his obsessive and aggressive behaviors. As you are aware, Taylor SLS, Inc. has taken numerous steps to avoid the need for terminating services. We have worked on behavior modification programming, sought out additional behavioral health specialists, and received services from the Minnesota Department of Human Services Community Support Services, both in the form of temporary crisis placement and in receiving training for Taylor SLS, Inc. staff. Additionally, we have made attempts to increase staffing in order to provide additional support to him in his home. Unfortunately, our efforts to provide him with the support he needs have been unsuccessful. We feel it is in his best interest that we terminate services so that he can find a home that can meet his needs. Until the date of his discharge from Taylor SLS, Inc. we will continue to provide services, which will include working with the appropriate county agencies to develop a plan to provide for his continuity of care. \"',1,NULL,NULL,NULL,NULL,NULL),(39673,194,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39674,194,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39675,194,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(39676,194,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39677,194,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39678,194,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39679,194,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39680,194,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39681,194,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39682,194,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39683,194,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39684,194,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39685,194,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39686,194,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39687,194,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39688,194,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39689,194,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39690,194,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39691,194,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39692,194,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39693,194,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39694,194,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39695,194,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39696,194,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39697,194,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39698,194,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39699,194,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39700,194,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39701,194,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39702,194,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39703,194,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39704,194,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39705,194,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39706,194,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39707,194,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39708,194,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39709,194,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39710,194,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39711,194,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39712,194,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39713,195,23,81,10,76,'Short_Answer','JT_Beacon-HC-2021-03',1,NULL,NULL,NULL,NULL,NULL),(39714,195,23,81,10,77,'Date','2021-03-30',1,NULL,NULL,NULL,NULL,NULL),(39715,195,23,81,10,78,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(39716,195,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39717,195,23,81,10,80,'Short_Answer','Beacon Specialized Living',1,NULL,NULL,NULL,NULL,NULL),(39718,195,23,81,10,81,'Short_Answer','Barbara Turner',1,NULL,NULL,NULL,NULL,NULL),(39719,195,23,81,10,82,'Short_Answer','bturner@beaconspecialized.org',1,NULL,NULL,NULL,NULL,NULL),(39720,195,23,81,10,83,'Short_Answer','651-451-2889',1,NULL,NULL,NULL,NULL,NULL),(39721,195,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(39722,195,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(39723,195,23,81,10,86,'Date','2021-02-18',1,NULL,NULL,NULL,NULL,NULL),(39724,195,23,81,10,87,'Free_Text','Concerns reported about the VA\'s continued elopement from the facility and missing/refusing his weekly Risperdal injections. In latest incident, VA eloped 2/18 and is still missing at time of assessment. The VA is his own guardian and can come/go from the facility as he wishes. Beacon recently acquired the facility and is making changes to staffing/supervision in the home as well as meeting with the VA\'s team. See investigator notes. ',1,NULL,NULL,NULL,NULL,NULL),(39725,195,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39726,195,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39727,195,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(39728,195,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39729,195,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39730,195,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39731,195,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39732,195,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39733,195,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39734,195,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39735,195,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39736,195,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39737,195,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39738,195,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39739,195,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39740,195,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39741,195,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39742,195,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39743,195,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39744,195,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39745,195,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39746,195,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39747,195,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39748,195,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39749,195,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39750,195,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39751,195,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39752,195,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39753,195,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39754,195,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39755,195,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39756,195,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39757,195,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39758,195,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39759,195,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39760,195,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39761,195,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39762,195,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39763,195,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39764,195,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39765,196,23,81,10,76,'Short_Answer','201901929',1,NULL,NULL,NULL,NULL,NULL),(39766,196,23,81,10,77,'Date','2019-05-22',1,NULL,NULL,NULL,NULL,NULL),(39767,196,23,81,10,78,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(39768,196,23,81,10,79,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(39769,196,23,81,10,80,'Short_Answer','MRCI',1,NULL,NULL,NULL,NULL,NULL),(39770,196,23,81,10,81,'Short_Answer','Cathy Groebner',1,NULL,NULL,NULL,NULL,NULL),(39771,196,23,81,10,82,'Short_Answer','cgroebner@mymrci.org',1,NULL,NULL,NULL,NULL,NULL),(39772,196,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39773,196,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(39774,196,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(39775,196,23,81,10,86,'Date','2019-03-19',1,NULL,NULL,NULL,NULL,NULL),(39776,196,23,81,10,87,'Free_Text','Wednesday March 13, 2019 at approximately 1:40pm, staff 1 noticed VA leave the Department 123 work area. Staff 1 stepped outside the room and saw VA going into the women’s bathroom located off of the production floor nearest to Department 123.  Staff 1 checked on VA at about 1:45pm and saw that VA was in the handicap stall with their green jacket off.  Staff 1 asked if VA was OK and they replied “yeah” and also asked if VA needed anything and they said “no”.  Staff 1 then went back to that same bathroom to assist another individual at approximately 1:50pm and VA was still in the same stall.  Staff 1 went back to the room at about 1:55pm.  It should be noted that the VA had been diagnosed with a mild UTI on Sunday 3/10/19 and was sent home early on Monday 3/11/19 due to them not feeling well.  VA also came in late on Tuesday, 3/12/19.  \r\n\r\nVA has eloped in the past, VA takes her lunch box with her.  Because of that, VA is required to leave the lunch box in the Team Leader’s office.  At approximately 2:00pm, staff 1 notice VA’s lunch box was still in the office.  Support Specialist Staff 2 went to that same bathroom that VA was in approximately 2:05pm and that VA was no longer in the bathroom.  A bus drive for the day program was driving the buss back to the program and notice someone in a green jacket standing in the street on Map Drive around 2pm.  There are no sidewalks on Map Drive.  Staff recognized the person as the VA and immediately called her supervisor at the program. And drove back to where the VA was walking.  It was reported that two “good Samaritans” pulled over and stopped the VA on the sidewalk along stadium drive, which is the road that connects with Map Drive, and started walking with her back to the program until the staff arrived.  \r\n\r\nAt 2:07 the Supervisor received a phone call from the transportation supervisor stating VA was found walking on the sidewalk along Stadium Drive and was being walked back to the program’s building.  The program supervisor ran outside and saw VA with about four other program staff walking with VA.  The supervisor walked alongside VA all the way back to the office and the VA waited in the office until was time for VA to board the bus to go home.  While the office, VA was ask if VA thought what happened was safe and the VA said, “No”. The VA was asked why it wasn’t and safe and the response was “I could get hurt”. Supervisor asked VA if it will ever happen again and VA shook their head “no”. Supervisor walked VA to the bus and fastened seatbelt and sat patiently until the bus departed.  ',1,NULL,NULL,NULL,NULL,NULL),(39777,196,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39778,196,23,81,10,91,'Short_Answer','Staff didn’t continuously monitor the person in bathroom and the person eloped without being seen',1,NULL,NULL,NULL,NULL,NULL),(39779,196,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39780,196,23,81,10,97,'Date','2019-07-10',1,NULL,NULL,NULL,NULL,NULL),(39781,196,23,81,10,98,'Free_Text','VA has worked at the employment program for 10 years and the staff interviewed reported they have worked with her for most of that time.  Over this 10 years the VA lived with an aunt, then in an adult foster care setting (near her employment program) and at the time of the incident was living in an apartment.  \r\n\r\nVA enjoyed coloring/crafts, being outside, working, having attention and encouragement from staff.  VA enjoyed food (lunch at work and wouldn’t necessarily heat up a meal that typically would be a meal to heat up).\r\n\r\nVA has a staffing ratio at the employment program of a 1:3, most individuals there have 1:6 or 1:7.  At home VA had a 2:1 staffing ratio.  The 2:1 at home was higher because VA was more physically aggressive at home than at work.  Less aggression towards male staff-staff interviewed stated VA has less male staff at residence than at the employment program.  \r\n\r\nThe employment program has 200 individuals in their facility and approximately 45 in the area where VA works.  The day of the event there was 7-8 staff in the area for all of those individuals being served.  \r\n\r\nThe elopement protocol at the employment program was for the staff to have eyes on VA, except in the bathroom and just do 5 minute checks.  Keep the lunch and duffle bag in the supervisor’s office.  VA would have no antecedents prior to elopements or other incidents of maladaptive behavior (this day was no different.  The team agreed to this plan including the guardians (parents).\r\n\r\nVA works at the employment program Monday-Friday from 9am-3pm and typically VA shows signs of being done with work at around 2pm.  The day of the incident the VA had arrive late or had not been ready when the bus arrived to pick her up.  This was a common occurrence.  \r\n\r\nWhen at work the VA was a great worker completing piece work on the work floor.  That day there was not a lot of work available and the group had been doing other craft activities (VA enjoyed).  It is believed that VA had a possible UTI infection and VA had a history of GERD/esophagus issues (causing her to vomit and cause pain), however VA could not verbalize their needs all of the time.  Verbal skills were limited.  Over the time VA worked at the employment program they were able to get her to improve her verbal skills by encouraging VA to use her words.  If she were sick and she was about to vomit VA would attempt to express this to the employment staff and sometimes ask them for a Tums.  \r\n\r\nThe VA did not take the duffle bag or lunch when the elopement occurred which typically the VA would not have left the building without either of the bags.  The VA never was able to explain the reason for elopement, however the staff believe there is a Kwik Trip nearby that was the direction VA was headed and her previous residence was near the employment program.  VA did things with no antecedents and would do things for attention.  The staff believe potentially VA was not feeling well and potentially wanted to go outside because VA really enjoyed being outside.  Staff went outside after receiving phone call from transportation company and got the VA from the Good Samaritan that was walking with VA.  ',1,NULL,NULL,NULL,NULL,NULL),(39782,196,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39783,196,23,81,10,100,'Free_Text','The staff not continuously monitoring the person in the bathroom was impacted by the staff adapting the person’s supervision protocol to allow for privacy in the bathroom.  It is the providers practice to allow all of the individual’s privacy in the restroom as this is influenced by societal norms.  The other factors contributing to adapt the protocol the day of the event was the individual was not feeling well, typically towards the end of the day this individual participates in work less (the time of incident was at the end of the work day), and there is a history of the person taking a long time in the restroom.  Further influencing the person’s ability to elope without staff noticing was the staff did not see the historical antecedent the person would display before eloping because in this case the individual eloped without taking their lunch bag out of the staff’s office.  Additionally, during this event there were multiple staff checking on the individual since in this setting there is not a specific staff assigned to one individual person working.  This process is the norm for the department as it is shaped by the support plan stating the need for a 1:3 staffing ratio. Thus the ratio allows the county to manage the budget allocation they are given by the state and federal allocations which is determined through the legislation.  Overall legislation determines the rates that are set which then is strengthened by MNCHOICES to determine the needs are met, thus to create the staffing patterns for the provider in the support plan. ',1,NULL,NULL,NULL,NULL,NULL),(39784,196,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39785,196,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39786,196,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39787,196,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39788,196,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39789,196,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39790,196,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39791,196,23,81,10,102,'Free_Text','The other factors contributing to adapt the protocol the day of the event was the individual was not feeling well, typically towards the end of the day this individual participates in work less (the time of incident was at the end of the work day), and there is a history of the person taking a long time in the restroom.  Further influencing the person’s ability to elope without staff noticing was the staff did not see the historical antecedent the person would display before eloping because in this case the individual eloped without taking their lunch bag out of the staff’s office.  ',1,NULL,NULL,NULL,NULL,NULL),(39792,196,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39793,196,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39794,196,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39795,196,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39796,196,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39797,196,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39798,196,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39799,196,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39800,196,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39801,196,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39802,196,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39803,196,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39804,196,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39805,196,23,81,10,116,'Free_Text','The staff not continuously monitoring the person in the bathroom was impacted by the staff adapting the person’s supervision protocol to allow for privacy in the bathroom.  \r\n\r\nAdditionally, during this event there were multiple staff checking on the individual since in this setting there is not a specific staff assigned to one individual person working.  This process is the norm for the department as it is shaped by the support plan stating the need for a 1:3 staffing ratio.',1,NULL,NULL,NULL,NULL,NULL),(39806,196,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39807,196,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39808,196,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39809,196,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39810,196,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39811,196,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39812,196,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39813,196,23,81,10,124,'Free_Text','The staff not continuously monitoring the person in the bathroom was impacted by the staff adapting the person’s supervision protocol to allow for privacy in the bathroom.  ',1,NULL,NULL,NULL,NULL,NULL),(39814,196,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39815,196,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39816,196,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39817,197,23,81,10,76,'Short_Answer','JT_Mary T-HC-2020-07',1,NULL,NULL,NULL,NULL,NULL),(39818,197,23,81,10,77,'Date','2020-07-28',1,NULL,NULL,NULL,NULL,NULL),(39819,197,23,81,10,78,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(39820,197,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39821,197,23,81,10,80,'Short_Answer','Mary T',1,NULL,NULL,NULL,NULL,NULL),(39822,197,23,81,10,81,'Short_Answer','Brent Krocak',1,NULL,NULL,NULL,NULL,NULL),(39823,197,23,81,10,82,'Short_Answer','brentk@marytinc.com',1,NULL,NULL,NULL,NULL,NULL),(39824,197,23,81,10,83,'Short_Answer','763-274-8463',1,NULL,NULL,NULL,NULL,NULL),(39825,197,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(39826,197,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(39827,197,23,81,10,86,'Date','2020-06-18',1,NULL,NULL,NULL,NULL,NULL),(39828,197,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39829,197,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39830,197,23,81,10,91,'Short_Answer','Staff assisted the person to leave for an overnight with people they had concerns about',1,NULL,NULL,NULL,NULL,NULL),(39831,197,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39832,197,23,81,10,97,'Date','2020-10-13',1,NULL,NULL,NULL,NULL,NULL),(39833,197,23,81,10,98,'Free_Text','Staff #1: This staff has worked with this person for quite some time and this person has lived with this provider for over 14 years.  The staff informed during the debriefing she is the Manager and did not find out about what had happened until the Monday after this person left the residence on Saturday.  This Manager had received a phone call about that this person had left because she has the ability to do so, although this person had been asked not to due to COVID and the provider’s policy was no visitors were allowed in the staff, even family.  The staff stated it was reported to her that this person had asked to get ready, her aunt and uncle were coming to get her for a visit, and she was going to go.  The staff reported to this Manager they did not feel comfortable, however they could not make her stay in the home and the aunt and uncle came to get her and assisted her in the process, as she is non-ambulatory.  The staff stated they did not know she had family in Duluth and did not know she was going when she had left the house on Friday before the weekend.  Staff reported they called the known uncle and asked who these people in Duluth were and if they indeed were family members and the known uncle reported they were not family.  The person had misinformed the staff working who allowed her to go.  The Manager also stated staff reported to her they did not feel comfortable allowing her to go, aside from COVID, because they did not appear to be family, however this person seemed to be happy when the individuals came to pick her up.  It was reported to the Manager the staff had taken pictures of the car and the license plate number and the people as they were leaving the home on Saturday.  The Manager drove to Duluth to pick up the individual at the hospital as she had been transported there via ambulance after sitting in the restaurant informing the server she needed help via her iPad.  The individual had given her check card to the people who had picked her up and they had financially exploited her when they took her to Duluth.  \r\n\r\nStaff #2\r\n\r\nStaff had arrived to work at 8am on Saturday after picking up this extra shift (at the time this was his first month working for this provider).  This staff was informed by the overnight staff and the lead staff that this person was to get ready, that she was leaving, and the staff would need to help her get ready as well as pack her things for the weekend.  This staff person has had difficulties working this individual in the past as she calls this staff person names and is verbally aggressive through her iPad to the staff person.  Due to the person being non-ambulatory, it is the house policy to reposition her every two hours.  On this day the staff was going to change her brief and get her ready to leave for the day, she would not turn off her iPad prior to the changing to occur.  The staff wanted to be respectful and it is HIPAA policies as well as house policy to turn off the video when the staff are assisting.  Staff stated the person they would assist when she turned off her iPad so staff left the room and came back.  The person still would not turn off the iPad and began to call the staff names.  This staff gave 30 minutes this time and the person still had not gotten off the iPad and continued to call him names and verbal aggressions.  The staff person had asked Manager previously how to handle these matters and was aware of what was happening and continued to try to work with this person so they would not call staff names and how staff could assist better.  The staff went into the person’s room a third time and covered the iPad with a pillow during the dressing and changing process and continued to assist her with getting ready to be picked up for the day.  When the people arrived to pick up this person staff did not allow them into the house due to COVID and the new policies for no visitors.  The visitors assisted the person into the car with her and her wheelchair.  The staff did not say anything about it to anyone else as the lead staff had informed him what to do and the overnight staff had provided instructions on this was what was planned for this person’s day.  \r\n',1,NULL,NULL,NULL,NULL,NULL),(39834,197,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39835,197,23,81,10,100,'Free_Text','A factor into why staff assisted the person to leave for an overnight with people they had concerns about was that the person wanted to leave with the people (claiming to be family). The person she left with claimed to be the person’s uncle, which the person herself confirmed and she appeared to trust him. There was a perception that since the person was a family member, visiting with the person would be less risky than if the person was unrelated. The lead staff at the home also determined this trip was important to the person. The provider agency trusted the lead staff in this home and had been working to implement a person-centered philosophy which prioritized weighing supporting things that were important to the people they served over what was important for them. This philosophy was impacted by the statewide emphasis placed on supported decision making and person-centered thinking, the latter of which was supported by provider requirements in the provider’s licensing statute, Minnesota Statutes 245D. The provider had worked with this person for 14 years, so the relationship with the person influenced the provider to make supporting the person’s own decisions even stronger.  Influencing the lead staff to determine the trip was important to supporting the person was that it appeared that assisting the person to have a safe trip seemed to mitigate risk versus allowing the person to leave without assistance. The person appeared to be determined to go, and without help from the provider, it seemed more likely issues might arise. Mitigating risk is a priority for all HCBS providers for a number of reasons: Case managers assign this priority to providers in Coordinated Service and Support Plan, Minnesota Statutes 245D requires providers to ensure the health, safety and well-being of the people they serve, and providers could be liable to lawsuits, investigations or insurance claims if a person they serve is harmed. If someone is harmed while in the care of a provider, that provider could be found in violation of the Vulnerable Adult Act and additional penalties may be brought upon a provider by the Department of Human Services. \r\nAnother was that the provider felt they did not have a choice but to assist her in leaving. The person was their own guardian and had the power to make many choices independently.  Additionally, the person had attempted to leave with this person in the past, and the provider determined they would weigh what was important to the person over what was important for the person. This decision was impacted by the provider’s person-centered philosophy, which in turn was impacted by statewide emphasis on supported decision-making and person-centered thinking. This emphasis came from a number of sources including advocacy organizations and DHS, which released best practice guidance on both and enforced person-centered planning requirements governing providers in Minnesota Statutes Chapter 245D. The provider’s concerns about the person leaving with the person did not seem to outweigh the provider’s desire to empower and support the person.   \r\nAn additional influence into why the staff assisted the person to leave an overnight with people they had concerns about was that the staff wanted to empower the person during this time since they had attempted to leave with this person in the past. Although the provider had a practice in place to not allow people to take overnights at the time due to the threat of COVID-19 and MDH guidance on COVID-19 for residential programs, the provider determined they would weigh what was important to over what was important for the person. The provider’s person-centered philosophy, influenced by the statewide emphasis on supported decision making and person-centered thinking influenced this decision by the provider. Additionally, the provider staff determined the concerns they had about the person leaving weren’t enough to take restrictive actions and weigh safety over the person’s own choice. Implementing restrictions on a person’s rights could create the liability of providers being incompliant with the conditions of Minnesota Statutes, Chapter 245D enforced by the Department of Human Services.\r\n',1,NULL,NULL,NULL,NULL,NULL),(39836,197,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39837,197,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39838,197,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39839,197,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39840,197,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39841,197,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39842,197,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39843,197,23,81,10,102,'Free_Text','A factor into why staff assisted the person to leave for an overnight with people they had concerns about was that the person wanted to leave with the people (claiming to be family). The person she left with claimed to be the person’s uncle, which the person herself confirmed and she appeared to trust him. There was a perception that since the person was a family member, visiting with the person would be less risky than if the person was unrelated. \r\n\r\nMore??\r\n',1,NULL,NULL,NULL,NULL,NULL),(39844,197,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39845,197,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39846,197,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39847,197,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39848,197,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39849,197,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39850,197,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39851,197,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39852,197,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39853,197,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39854,197,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39855,197,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39856,197,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39857,197,23,81,10,116,'Free_Text','A factor into why staff assisted the person to leave for an overnight with people they had concerns about was that the person wanted to leave with the people (claiming to be family). The person she left with claimed to be the person’s uncle, which the person herself confirmed and she appeared to trust him. There was a perception that since the person was a family member, visiting with the person would be less risky than if the person was unrelated. The lead staff at the home also determined this trip was important to the person. The provider agency trusted the lead staff in this home and had been working to implement a person-centered philosophy which prioritized weighing supporting things that were important to the people they served over what was important for them. This philosophy was impacted by the statewide emphasis placed on supported decision making and person-centered thinking, the latter of which was supported by provider requirements in the provider’s licensing statute, Minnesota Statutes 245D. The provider had worked with this person for 14 years, so the relationship with the person influenced the provider to make supporting the person’s own decisions even stronger.  Influencing the lead staff to determine the trip was important to supporting the person was that it appeared that assisting the person to have a safe trip seemed to mitigate risk versus allowing the person to leave without assistance. The person appeared to be determined to go, and without help from the provider, it seemed more likely issues might arise. Mitigating risk is a priority for all HCBS providers for a number of reasons: Case managers assign this priority to providers in Coordinated Service and Support Plan, Minnesota Statutes 245D requires providers to ensure the health, safety and well-being of the people they serve, and providers could be liable to lawsuits, investigations or insurance claims if a person they serve is harmed. If someone is harmed while in the care of a provider, that provider could be found in violation of the Vulnerable Adult Act and additional penalties may be brought upon a provider by the Department of Human Services. \r\n\r\nAnother was that the provider felt they did not have a choice but to assist her in leaving. The person was their own guardian and had the power to make many choices independently.  Additionally, the person had attempted to leave with this person in the past, and the provider determined they would weigh what was important to the person over what was important for the person. This decision was impacted by the provider’s person-centered philosophy, which in turn was impacted by statewide emphasis on supported decision-making and person-centered thinking. This emphasis came from a number of sources including advocacy organizations and DHS, which released best practice guidance on both and enforced person-centered planning requirements governing providers in Minnesota Statutes Chapter 245D. The provider’s concerns about the person leaving with the person did not seem to outweigh the provider’s desire to empower and support the person.   \r\nAn additional influence into why the staff assisted the person to leave an overnight with people they had concerns about was that the staff wanted to empower the person during this time since they had attempted to leave with this person in the past. Although the provider had a practice in place to not allow people to take overnights at the time due to the threat of COVID-19 and MDH guidance on COVID-19 for residential programs, the provider determined they would weigh what was important to over what was important for the person. The provider’s person-centered philosophy, influenced by the statewide emphasis on supported decision making and person-centered thinking influenced this decision by the provider. Additionally, the provider staff determined the concerns they had about the person leaving weren’t enough to take restrictive actions and weigh safety over the person’s own choice. Implementing restrictions on a person’s rights could create the liability of providers being incompliant with the conditions of Minnesota Statutes, Chapter 245D enforced by the Department of Human Services.\r\n',1,NULL,NULL,NULL,NULL,NULL),(39858,197,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39859,197,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39860,197,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39861,197,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39862,197,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39863,197,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39864,197,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39865,197,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39866,197,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39867,197,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39868,197,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39869,198,23,81,10,76,'Short_Answer','201905316',1,NULL,NULL,NULL,NULL,NULL),(39870,198,23,81,10,77,'Date','2019-08-15',1,NULL,NULL,NULL,NULL,NULL),(39871,198,23,81,10,78,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(39872,198,23,81,10,79,'Multiple_Choice','Charles Young',1,NULL,NULL,NULL,NULL,NULL),(39873,198,23,81,10,80,'Short_Answer','Progressive Living Inc',1,NULL,NULL,NULL,NULL,NULL),(39874,198,23,81,10,81,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39875,198,23,81,10,82,'Short_Answer','nicole.s@progressivelivinginc.net',1,NULL,NULL,NULL,NULL,NULL),(39876,198,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39877,198,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(39878,198,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(39879,198,23,81,10,86,'Date','2019-07-20',1,NULL,NULL,NULL,NULL,NULL),(39880,198,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(39881,198,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39882,198,23,81,10,91,'Short_Answer','Staff did not count medications per provider policy',1,NULL,NULL,NULL,NULL,NULL),(39883,198,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39884,198,23,81,10,97,'Date','2019-09-13',1,NULL,NULL,NULL,NULL,NULL),(39885,198,23,81,10,98,'Free_Text','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’s 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’s 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’s 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 “file cabinet like’ 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.  \r\n',1,NULL,NULL,NULL,NULL,NULL),(39886,198,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39887,198,23,81,10,100,'Free_Text','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’ 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’s policy for the work of the direct care staff 1 and 2 was the nurse’s license in providing some position to the policy.  Overall the nurse’s license is regulated by legislation and statute.   ',1,NULL,NULL,NULL,NULL,NULL),(39888,198,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39889,198,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39890,198,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39891,198,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39892,198,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39893,198,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39894,198,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39895,198,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39896,198,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39897,198,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39898,198,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39899,198,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39900,198,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39901,198,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39902,198,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39903,198,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39904,198,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39905,198,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39906,198,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39907,198,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39908,198,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39909,198,23,81,10,116,'Free_Text','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.  ',1,NULL,NULL,NULL,NULL,NULL),(39910,198,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39911,198,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39912,198,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39913,198,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39914,198,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39915,198,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39916,198,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39917,198,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39918,198,23,81,10,125,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39919,198,23,81,10,126,'Free_Text','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’ plans to follow and also being fatigued because the staff had to work overtime prior to this shift.  ',1,NULL,NULL,NULL,NULL,NULL),(39920,198,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39921,199,23,81,10,76,'Short_Answer','JT_REM Hennepin-HC-2020-11',1,NULL,NULL,NULL,NULL,NULL),(39922,199,23,81,10,77,'Date','2020-11-24',1,NULL,NULL,NULL,NULL,NULL),(39923,199,23,81,10,78,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(39924,199,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39925,199,23,81,10,80,'Short_Answer','REM Hennepin',1,NULL,NULL,NULL,NULL,NULL),(39926,199,23,81,10,81,'Short_Answer','Devin Nelson',1,NULL,NULL,NULL,NULL,NULL),(39927,199,23,81,10,82,'Short_Answer','devin.nelson@thementornetwork.com',1,NULL,NULL,NULL,NULL,NULL),(39928,199,23,81,10,83,'Short_Answer','507-233-4410',1,NULL,NULL,NULL,NULL,NULL),(39929,199,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(39930,199,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(39931,199,23,81,10,86,'Date','2020-08-06',1,NULL,NULL,NULL,NULL,NULL),(39932,199,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39933,199,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39934,199,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39935,199,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(39936,199,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39937,199,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39938,199,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39939,199,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39940,199,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39941,199,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39942,199,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39943,199,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39944,199,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39945,199,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39946,199,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39947,199,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39948,199,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39949,199,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39950,199,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39951,199,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39952,199,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39953,199,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39954,199,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39955,199,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39956,199,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39957,199,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39958,199,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39959,199,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39960,199,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39961,199,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39962,199,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39963,199,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39964,199,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39965,199,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39966,199,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39967,199,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39968,199,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39969,199,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39970,199,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39971,199,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39972,199,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39973,200,23,81,10,76,'Short_Answer','201906882',1,NULL,NULL,NULL,NULL,NULL),(39974,200,23,81,10,77,'Date','2019-10-15',1,NULL,NULL,NULL,NULL,NULL),(39975,200,23,81,10,78,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(39976,200,23,81,10,79,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(39977,200,23,81,10,80,'Short_Answer','Wingspan Life Resources',1,NULL,NULL,NULL,NULL,NULL),(39978,200,23,81,10,81,'Short_Answer','Therese Davis',1,NULL,NULL,NULL,NULL,NULL),(39979,200,23,81,10,82,'Short_Answer','tdavis@wingspanlife.org',1,NULL,NULL,NULL,NULL,NULL),(39980,200,23,81,10,83,'Short_Answer','651-242-5840',1,NULL,NULL,NULL,NULL,NULL),(39981,200,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(39982,200,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(39983,200,23,81,10,86,'Date','2019-08-30',1,NULL,NULL,NULL,NULL,NULL),(39984,200,23,81,10,87,'Free_Text','VA was taken to the doctor and AP received a written script to increase one of the insulin medications (Tuejeo) by 2 units.\r\nOrder was given on 08/29/2019.\r\n\r\nAP is suppose to transcribe the right medication on the med sheet but instead he documented a referral for the appointment and\r\ndocumented the increase on the to visit note and informed staff. The med sheet was never updated and Staff are suppose to follow the\r\nmed sheet.\r\n\r\nThere was a couple days where VA did give the right dosage because AP gave it to her himself. Nurse discovered this on Thursday Morning 09/19/2019 and informed Reporter of the mistake.',1,NULL,NULL,NULL,NULL,NULL),(39985,200,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39986,200,23,81,10,91,'Short_Answer','Medication Error over an Extended Period of Time',1,NULL,NULL,NULL,NULL,NULL),(39987,200,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39988,200,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39989,200,23,81,10,98,'Free_Text','The VA has had Type 1 diabetes since they were 6 years old and now is 44 years old.  The VA lives in an adult foster care setting for the past seven years with three other individuals.  The VA enjoys walking the dog, going to work 5 days a week, and being active in the community.  \r\n\r\nThe VA has a protocol that all staff are trained on and due to this regimen it is difficult to have any fill in staff cover shifts at the adult foster care home.  The VA completes the blood sugar checks without assistance from staff with an Accuchek machine.  The machine then tells the staff how much insulin is required at that time depending on how many carbs the VA is going to eat at that meal time for both medications.  The VA gets novolox 4x/day and the tuojeo 1x/day at dinner.   The protocol goes onto say if the numbers are within this range give this much insulin and if they are within this much give this amount.  The VA takes two different types of insulin along with several other medications. This protocol is listed on the computer within the MAR system that the provider utilizes to document medications and communications amongst the staff.   \r\n\r\nThe staff will then “dial up” the insulin for the VA and they will give themselves the insulin injections.  The insulin medications are not labeled with the amount of units that are to be given due to the variances based off of the blood sugar numbers and the amount of carbs that are about to be eaten by the VA.  The VA is aware of the regimen and understands the necessity to take her insulin each day. \r\n\r\nThe VA is unable to feel the effects of having blood sugar numbers out of the normal range (80-120) and their numbers will reach as high as 300-400 without any signs (dizzy, light headed, sweaty, etc.).  The VA understands when their numbers are high if they exercise they can reduce the numbers.  The VA had a checkup with their doctor regarding the blood sugar being high, although the staff will educate the VA on proper eating choices and the VA exercises frequently.  The doctor stated the Tuojeo needed to go from 15 units to 17 units at dinner time.  The supervisor of the house had taken the VA to the appointment and came home and documented this in the MAR and in the staff notes of the change and had given the VA the change in medications when giving the medication that evening.  The supervisor gave the other staff the information to follow.  \r\n\r\nThe nurse found the error in the medications after different staff had worked and not just the supervisor and the staff that was informed on 8/29/19 after the VA went to the doctor appointment.  The supervisor had been doing compliance checks once a week of the medications, however did not see it because the medications and the MAR don’t match because they never have matched because of the variances in the medication that is given based off what the numbers are and how many carbs are being eaten.  There are many moving parts to giving the insulin medications while the staff also must follow the protocol.  The staff typically give the medication after the supervisor has left for the day as well due to the supervisor working from 9a-5pm and the VA gets this medication at dinner time.   \r\n',1,NULL,NULL,NULL,NULL,NULL),(39990,200,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39991,200,23,81,10,100,'Free_Text','Staff not providing the correct medication dosage to an individual was influenced by the staff being unware of the increase in the medication dosage. A contributing factor to the unawareness of the increase was that information was not communicated to the staff in the transition time because there is not enough time available to read the health progress notes.  The short amount of staff transition time is impacted by the provider not building transition time into the staff schedules due to contributing factors of the weather, the staff’s second job, and the labor laws.  The other influencer is the CSSP and the 6790 does not allow the ability of the rate system to pay the provider more to have staff overlap on the shift change.  Another contributor of the staff not being able to communicate during the transition is there are several documentation points for communication for each individual living in the home thus requirements set for by licensing 245D.  \r\n\r\nStaff giving the incorrect dosage was also influenced by the documentation was not completed in the Medical Administration Record (MAR). At this home, it was the supervisor’s role to update medication changes in the MAR.  The individual’s medication administration had complexities to giving the medications that were not relayed in the MAR as the individual was to receive two different types of insulin and staff relied on the previous MAR to provide the medication.  The influence of the MAR not being updated is the provider experiencing frequent lapses in internet connectivity (which occurred frequently at the residence) and the MAR is an electronic document, thus the documentation is in two places and not reviewed by all staff.  The supervisor had relied on the protocol for the med changes that is given by the physician, which has an outside influence of the pharmaceutical laws that informs the physician on how to write the protocols.  \r\n\r\nA final influence to staff giving the incorrect dosage was that they were using an “old” prescription because the physician did not change the prescription with the pharmacy.  ',1,NULL,NULL,NULL,NULL,NULL),(39992,200,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39993,200,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39994,200,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39995,200,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39996,200,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39997,200,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39998,200,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39999,200,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40000,200,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40001,200,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40002,200,23,81,10,105,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40003,200,23,81,10,106,'Free_Text','A contributing factor to the unawareness of the increase was that information was not communicated to the staff in the transition time because there is not enough time available to read the health progress notes.  ',1,NULL,NULL,NULL,NULL,NULL),(40004,200,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40005,200,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40006,200,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40007,200,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40008,200,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40009,200,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40010,200,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40011,200,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40012,200,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40013,200,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40014,200,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40015,200,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40016,200,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40017,200,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40018,200,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40019,200,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40020,200,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40021,200,23,81,10,124,'Free_Text','At this home, it was the supervisor’s role to update medication changes in the MAR.  The individual’s medication administration had complexities to giving the medications that were not relayed in the MAR as the individual was to receive two different types of insulin and staff relied on the previous MAR to provide the medication.  The influence of the MAR not being updated is the provider experiencing frequent lapses in internet connectivity (which occurred frequently at the residence) and the MAR is an electronic document, thus the documentation is in two places and not reviewed by all staff.  ',1,NULL,NULL,NULL,NULL,NULL),(40022,200,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40023,200,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40024,200,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40025,201,23,81,10,76,'Short_Answer','KP_BridgesMN-BEC-2021-02',1,NULL,NULL,NULL,NULL,NULL),(40026,201,23,81,10,77,'Date','2021-02-25',1,NULL,NULL,NULL,NULL,NULL),(40027,201,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40028,201,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40029,201,23,81,10,80,'Short_Answer','Bridges MN',1,NULL,NULL,NULL,NULL,NULL),(40030,201,23,81,10,81,'Short_Answer','Shyla Kahle (completed the BIRF)',1,NULL,NULL,NULL,NULL,NULL),(40031,201,23,81,10,82,'Short_Answer','shylak@bridgesmn.com',1,NULL,NULL,NULL,NULL,NULL),(40032,201,23,81,10,83,'Short_Answer','651-328-0677',1,NULL,NULL,NULL,NULL,NULL),(40033,201,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(40034,201,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40035,201,23,81,10,86,'Date','2021-01-21',1,NULL,NULL,NULL,NULL,NULL),(40036,201,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40037,201,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40038,201,23,81,10,91,'Short_Answer','Staff unable to redirect a person from departing on a bus to Chicago.',1,NULL,NULL,NULL,NULL,NULL),(40039,201,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40040,201,23,81,10,97,'Date','2020-10-14',1,NULL,NULL,NULL,NULL,NULL),(40041,201,23,81,10,98,'Free_Text','Staff unable to redirect a person from departing on a bus to Chicago.',1,NULL,NULL,NULL,NULL,NULL),(40042,201,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40043,201,23,81,10,100,'Free_Text','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’t communicate with staff present.  All efforts to redirect the person were unsuccessful while exhausting all other safe alternatives. The person was earlier hospilatized regarding mental health and aggression and the staff was hesitant at the moment and didn’t want to anger the person further. Another contributing factor was that the person received a COVID stimulous 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’s risk management plan and it was affirmed. Contributing factors that further influenced the staffs’ 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 hesistant to anger the person. This was further supported by the person having a history of aggressive behavior. The person wouldn’t communicate with the staff present and they were hesitant to coherse 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 lended to the person was the agency’s 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’s 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’s stay at home order also influenced the person’s decision to leave as his routine was limited to low activity. This elopement influenced the agency, team, and staff present to honor the person’s 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. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40044,201,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40045,201,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40046,201,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40047,201,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40048,201,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40049,201,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40050,201,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40051,201,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40052,201,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40053,201,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40054,201,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40055,201,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40056,201,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40057,201,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40058,201,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40059,201,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40060,201,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40061,201,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40062,201,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40063,201,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40064,201,23,81,10,115,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40065,201,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40066,201,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40067,201,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40068,201,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40069,201,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40070,201,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40071,201,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40072,201,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40073,201,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40074,201,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40075,201,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40076,201,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40077,202,23,81,10,76,'Short_Answer','KP_Habilitative Services-BEC-2020-07',1,NULL,NULL,NULL,NULL,NULL),(40078,202,23,81,10,77,'Date','2020-07-28',1,NULL,NULL,NULL,NULL,NULL),(40079,202,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40080,202,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40081,202,23,81,10,80,'Short_Answer','Habilitative Services',1,NULL,NULL,NULL,NULL,NULL),(40082,202,23,81,10,81,'Short_Answer','Nicole Schlagel',1,NULL,NULL,NULL,NULL,NULL),(40083,202,23,81,10,82,'Short_Answer','nicole.schlagel@thementornetwork.com',1,NULL,NULL,NULL,NULL,NULL),(40084,202,23,81,10,83,'Short_Answer','507-233-4400',1,NULL,NULL,NULL,NULL,NULL),(40085,202,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(40086,202,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40087,202,23,81,10,86,'Date','2020-05-07',1,NULL,NULL,NULL,NULL,NULL),(40088,202,23,81,10,87,'Free_Text','Staff was assisting other people when it was brought to their attention that person entered a brown van that was parked outside the group home. Prior to this person being served told staff he was going to take a nap.',1,NULL,NULL,NULL,NULL,NULL),(40089,202,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40090,202,23,81,10,91,'Short_Answer','Person eloped from the home without staff knowledge',1,NULL,NULL,NULL,NULL,NULL),(40091,202,23,81,10,94,'True_or_False','No',1,NULL,NULL,NULL,NULL,NULL),(40092,202,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40093,202,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40094,202,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40095,202,23,81,10,100,'Free_Text','The person eloping from the home without staff knowledge was influenced by the person telling staff that they were going to take a nap in their room.   This was further influenced by the person’s plan that was agreed upon by a new case manager and guardian that allowed for 4 hours of alone time at home.  This included their bedroom and further supported by providers having to allow for person’s privacy in their room as required by 245D rights and person-centered planning and directed in the CSSP.    The person eloping from the home without staff knowledge was also impacted by the person being new to the home with no history of elopement resulting in staff having no reason for concern that they would elope. Another influence of person eloping without staff knowledge was the home was a 4-person residence, staffed by one person and during this time staff was assisting other people.   \r\n\r\nThe person being served had expectations that they would be able to visit with family and friends in the area when they moved into the group home.   COVID 19-Pandemic resulted in an Executive stay at home order and MDH guidelines limiting the persons opportunity to go into the community resulting in increased anxiety that was reported by staff, influencing the person eloping from the home.  This was further supported by providers being unsure what guidance to follow during COVID-19 therefore impacting the amount of community outings being offered to the people they serve.  Person being served had unsupervised time in the community only when at work.   Health issues from wearing a mask at work impacted person’s ability to work in the community resulting in limited time in the community is an additional influence of the person eloping from the home.  The worker’s focus of attention at the time was on the three individuals in the communal area while the other resident exercised their right to privacy in their room which is supported and required by 245D.\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40096,202,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40097,202,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40098,202,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40099,202,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40100,202,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40101,202,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40102,202,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40103,202,23,81,10,102,'Free_Text','The person eloping from the home without staff knowledge was influenced by the person telling staff that they were going to take a nap in their room.   This was further influenced by the person’s plan that was agreed upon by a new case manager and guardian that allowed for 4 hours of alone time at home.  This included their bedroom and further supported by providers having to allow for person’s privacy in their room as required by 245D rights and person-centered planning and directed in the CSSP. \r\n\r\nThe worker’s focus of attention at the time was on the three individuals in the communal area while the other resident exercised their right to privacy in their room which is supported and required by 245D.\r\n\r\nThe person eloping from the home without staff knowledge was also impacted by the person being new to the home with no history of elopement resulting in staff having no reason for concern that they would elope.',1,NULL,NULL,NULL,NULL,NULL),(40104,202,23,81,10,103,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40105,202,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40106,202,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40107,202,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40108,202,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40109,202,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40110,202,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40111,202,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40112,202,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40113,202,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40114,202,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40115,202,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40116,202,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40117,202,23,81,10,116,'Free_Text','The person being served had expectations that they would be able to visit with family and friends in the area when they moved into the group home.   \r\n\r\nCOVID 19-Pandemic resulted in an Executive stay at home order and MDH guidelines limiting the persons opportunity to go into the community resulting in increased anxiety that was reported by staff, influencing the person eloping from the home.  This was further supported by providers being unsure what guidance to follow during COVID-19 therefore impacting the amount of community outings being offered to the people they serve\r\n\r\n This was further supported by providers being unsure what guidance to follow during COVID-19 therefore impacting the amount of community outings being offered to the people they serve.  Person being served had unsupervised time in the community only when at work. ',1,NULL,NULL,NULL,NULL,NULL),(40118,202,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40119,202,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40120,202,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40121,202,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40122,202,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40123,202,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40124,202,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40125,202,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40126,202,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40127,202,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40128,202,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40129,203,23,81,10,76,'Short_Answer','KP_Harry Meyering-BEC-2021-01',1,NULL,NULL,NULL,NULL,NULL),(40130,203,23,81,10,77,'Date','2021-01-29',1,NULL,NULL,NULL,NULL,NULL),(40131,203,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40132,203,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40133,203,23,81,10,80,'Short_Answer','Harry Meyering Centers',1,NULL,NULL,NULL,NULL,NULL),(40134,203,23,81,10,81,'Short_Answer','Judi Leibbrand',1,NULL,NULL,NULL,NULL,NULL),(40135,203,23,81,10,82,'Short_Answer','jleibbrand@harrymeyeringcenter.org',1,NULL,NULL,NULL,NULL,NULL),(40136,203,23,81,10,83,'Short_Answer','507-387-8281',1,NULL,NULL,NULL,NULL,NULL),(40137,203,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(40138,203,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40139,203,23,81,10,86,'Date','2020-11-10',1,NULL,NULL,NULL,NULL,NULL),(40140,203,23,81,10,87,'Free_Text','Staff was administ3ring medication\'s on 11/11/2020 when they discovered that persons Spironolactone 25mg tablet had not been given from 11/7/2020 through 11/10/2020.',1,NULL,NULL,NULL,NULL,NULL),(40141,203,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40142,203,23,81,10,91,'Short_Answer','Staff did not follow policy requiring 3 checks',1,NULL,NULL,NULL,NULL,NULL),(40143,203,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40144,203,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40145,203,23,81,10,98,'Free_Text','Another contributing factor to staff feeling rushed was that the home is single staffed in the mornings. Staffing patterns are impacted by the staff ratio, which is determined by the MNCHOICES assessment and Disability waiver rate system, as well as the expectation that person centered choices at the home are provided.  This allows for the work schedule to be adapted to accommodate more staffing during day shifts to allow for more outings, resulting in morning staff being limited to one, further influencing staff need to hurry to ensure all morning task were completed.  COVID-19 lead to the Governor’s executive stay at home order and Day services were then closed.  This increased the need for more staff to cover shifts at a time when staff shortage was at an all-time high.\r\n\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40146,203,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40147,203,23,81,10,100,'Free_Text','The staff not following the policy that requires three medication checks prior to giving medications was influenced by the staff feeling comfortable and experienced with medication delivery after having worked at the facility for 6 years.  The people in the home being easy going and independent with some of their personal cares contributed to the staff feeling comfortable.  The Provider has a 2 step process for checking in meds from the pharmacy.  The first check is completed by the LPN, Program Manager, or Location Coordinator and the second check is completed by any of the aforementioned or a DSP.  The provider’s medication administration policies are influenced by 245D and outlined in the CSSP.  The provider’s policy are in place to protect the health and safety of people and to reduce errors that could result in Vulnerable Adult Maltreatment.  Medications are received in pill packs from the pharmacy and are checked two times, this further supports staff feeling comfortable when passing medications\r\nAnother influence to staff not completing the three medication check was that staff felt pressure to hurry to give person their morning medications. Person has a history of being inpatient to get morning medications as they then have to wait 30 minutes to eat as directed by their Physician.  The person being served has 12 morning medications that have to be recorded in the online Medication Administration Record which takes time for staff to complete. Staff was in a hurry to pass medications to avoid behaviors from person and to attend to other duties and responsibilities prior to the end of their shift.  Medication delivery is right before a shift change, so staff typically have to finish up with a number of tasks.   The home has 4 people and the people are active, interactive with staff, and need staff support which are additional influences to why the staff felt rushed.   \r\nAnother contributing factor to staff feeling rushed was that the home is single staffed in the mornings. Staffing patterns are impacted by the staff ratio, which is determined by the MNCHOICES assessment and Disability waiver rate system, as well as the expectation that person centered choices at the home are provided.  This allows for the work schedule to be adapted to accommodate more staffing during day shifts to allow for more outings, resulting in morning staff being limited to one, further influencing staff need to hurry to ensure all morning task were completed.  COVID-19 lead to the Governor’s executive stay at home order and Day services were then closed.  This increased the need for more staff to cover shifts at a time when staff shortage was at an all-time high.\r\n\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40148,203,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40149,203,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40150,203,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40151,203,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40152,203,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40153,203,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40154,203,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40155,203,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40156,203,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40157,203,23,81,10,104,'Free_Text','Another contributing factor to staff feeling rushed was that the home is single staffed in the mornings. Staffing patterns are impacted by the staff ratio, which is determined by the MNCHOICES assessment and Disability waiver rate system, as well as the expectation that person centered choices at the home are provided.  This allows for the work schedule to be adapted to accommodate more staffing during day shifts to allow for more outings, resulting in morning staff being limited to one, further influencing staff need to hurry to ensure all morning task were completed.  COVID-19 lead to the Governor’s executive stay at home order and Day services were then closed.  This increased the need for more staff to cover shifts at a time when staff shortage was at an all-time high.\r\n\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40158,203,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40159,203,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40160,203,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40161,203,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40162,203,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40163,203,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40164,203,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40165,203,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40166,203,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40167,203,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40168,203,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40169,203,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40170,203,23,81,10,117,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40171,203,23,81,10,118,'Free_Text','Another influence to staff not completing the three medication check was that staff felt pressure to hurry to give person their morning medications. Person has a history of being inpatient to get morning medications as they then have to wait 30 minutes to eat as directed by their Physician.  The person being served has 12 morning medications that have to be recorded in the online Medication Administration Record which takes time for staff to complete. Staff was in a hurry to pass medications to avoid behaviors from person and to attend to other duties and responsibilities prior to the end of their shift. \r\nAnother contributing factor to staff feeling rushed was that the home is single staffed in the mornings',1,NULL,NULL,NULL,NULL,NULL),(40172,203,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40173,203,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40174,203,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40175,203,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40176,203,23,81,10,123,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40177,203,23,81,10,124,'Free_Text','The staff not following the policy that requires three medication checks prior to giving medications was influenced by the staff feeling comfortable and experienced with medication delivery after having worked at the facility for 6 years.  The people in the home being easy going and independent with some of their personal cares contributed to the staff feeling comfortable.  The Provider has a 2 step process for checking in meds from the pharmacy.  The first check is completed by the LPN, Program Manager, or Location Coordinator and the second check is completed by any of the aforementioned or a DSP.  The provider’s medication administration policies are influenced by 245D and outlined in the CSSP.  The provider’s policy are in place to protect the health and safety of people and to reduce errors that could result in Vulnerable Adult Maltreatment.  Medications are received in pill packs from the pharmacy and are checked two times, this further supports staff feeling comfortable when passing medications\r\n',1,NULL,NULL,NULL,NULL,NULL),(40178,203,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40179,203,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40180,203,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40181,204,23,81,10,76,'Short_Answer','201900985',1,NULL,NULL,NULL,NULL,NULL),(40182,204,23,81,10,77,'Date','2019-05-15',1,NULL,NULL,NULL,NULL,NULL),(40183,204,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40184,204,23,81,10,79,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(40185,204,23,81,10,80,'Short_Answer','Haugbeck Support Services',1,NULL,NULL,NULL,NULL,NULL),(40186,204,23,81,10,81,'Short_Answer','Mike Beckius',1,NULL,NULL,NULL,NULL,NULL),(40187,204,23,81,10,82,'Short_Answer','mikebeckius@gmail.com',1,NULL,NULL,NULL,NULL,NULL),(40188,204,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40189,204,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(40190,204,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40191,204,23,81,10,86,'Date','2018-11-13',1,NULL,NULL,NULL,NULL,NULL),(40192,204,23,81,10,87,'Free_Text','Staff was meeting at another location with client’s guardian/mother. Client called her guardian/mother asking to have a private phone call, guardian reminded her that she could not do that, client abruptly ended the call.   A few minutes later a call came in that client ran away from the house.  Staff left to go look and kept in contact with guardian who was tracking client with the GPS on clients phone.   Staff arrived to clients location to a fire truck and someone directing traffic.  Staff was informed that client was struck by a vehicle and taken to the hospital by ambulance. \r\n\r\nIncident described by direct care staff.  Client came home from work and took phone without asking staff.  She locked herself in her room with the phone.  Staff knocked and asked her to open door, but did she did not respond.  Staff knocked again and explained to her the pone rules.  Client opened the door and yelled at staff using inappropriate words.  She then said she wanted to have a private phone call, locked herself in her room.  Staff unplugged the phone (per protocol) .  Client came out pissed and started kicking the pone and throwing it on the floor.  She picked the phone up and said she hated staff and that she was leaving.  She then got ready and left the house. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40193,204,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40194,204,23,81,10,91,'Short_Answer','Staff did not pursue person when they eloped',1,NULL,NULL,NULL,NULL,NULL),(40195,204,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40196,204,23,81,10,97,'Date','2019-06-24',1,NULL,NULL,NULL,NULL,NULL),(40197,204,23,81,10,98,'Free_Text','Client is a 25 year old female diagnosed with fetal alcohol syndrome and reactive attachment disorder. She had been living in a corporate foster care since 2014. She lives with her identical twin sister. Her mother is her legal guardian. In September 2019, client had a crises placement due to increase in behaviors. \r\n\r\nCouple months prior to incident, client\'s behaviors not as predictable. Client had medication changes, was demonstrating suicidal ideation (superficial cutting) and was eloping 1 to 2 times a week. Staff report they use to be able to tell when client was going to elope and then it became harder to identify antecedents leading up to elopement. \r\n\r\nClient had an incident prior to this incident of running into Mankato and meeting up with a young man that she later accused of abusing her. Staff followed her until she reached a crowded area around Mankato State campus. Distance was over 6 miles. Client is in good physical shape. \r\n\r\nThere are 2-3 staff on evening shift. Home has 4 clients. Direct care staff involved in incident are no longer employed with provider. Staff reports a long history of elopement. \r\n\r\nA team (consisting of a case manager, guardian, house manager and administrative staff) developed an elopement protocol. Staff meetings occurred bi-weekly to address behaviors and concerns about client. Client\'s guardian had attended staff meetings to assist in training staff on how to work with her daughter. \r\n\r\nElopement protocol states that staff are to follow client during daytime hours when safe. Protocol directs staff not to follow when dark outside as this is a safety concern for staff. On day of incident, staff followed protocol and called supervisor. \r\n\r\nClient has a protocol in place where she can ask to go on a run. Protocol specifically states how long and where client can run. CLient can not go on a planned run after dark. When she asked she always comes back. Protocol in place so staff can identify the difference. \r\n\r\nClient would call guardian/mom when not happy with what staff was doing. Mom would change the rules/programs that were established when her daughter was upset. Guardian/mom directed day to day activities and would tell staff what things her daughter should do that day. The consistency of protocols were difficult for staff to follow due to the changes in decision making process being made by the guardian/mom. Program direct reports that as guardian become more inconsistent with following programs that elopement increased. ',1,NULL,NULL,NULL,NULL,NULL),(40198,204,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40199,204,23,81,10,100,'Free_Text','Direct care staff not following the person who eloped from the facility was influenced foremost by the person’s elopement protocol. At the time of the elopement it was dark outside and the protocol directed staff to not follow when dark. Contributing to the staff’s decision not to follow the person was the team’s (case manager, guardian, provider staff) desire to ensure the safety of staff and the person which was impacted by the person’s history of exhibiting challenging behaviors when followed. When staff followed the person in past elopements, the person ran further and was difficult to find. The person’s home was in a rural location which also impacted staff’s decision to not follow in the dark due to safety concerns. The elopement protocol was developed by the provider and approved by the guardian and case manager. Staff were intimidated by the guardian, which influenced the staff’s decision to follow protocol the guardian helped create. Direct care staff not following during the elopement was further supported by the person wearing a tracking watch that allowed staff to track the person and not always rely on following them.\r\n\r\nThere are a lack of crises services and placement options available in the area of the person’s home. Because of this, the provider created the elopement protocol as a way to try to balance the support and safety of the person. Limited state funding for crises services impacted the provider’s decision to create an elopement protocol. This is further influenced by the provider’s license requirements of 245A and 245D to safeguard the person’s health, safety and well-being.',1,NULL,NULL,NULL,NULL,NULL),(40200,204,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40201,204,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40202,204,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40203,204,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40204,204,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40205,204,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40206,204,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40207,204,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40208,204,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40209,204,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40210,204,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40211,204,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40212,204,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40213,204,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40214,204,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40215,204,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40216,204,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40217,204,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40218,204,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40219,204,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40220,204,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40221,204,23,81,10,116,'Free_Text','Direct care staff not following the person who eloped from the facility was influenced foremost by the person’s elopement protocol. At the time of the elopement it was dark outside and the protocol directed staff to not follow when dark. Contributing to the staff’s decision not to follow the person was the team’s (case manager, guardian, provider staff) desire to ensure the safety of staff and the person which was impacted by the person’s history of exhibiting challenging behaviors when followed. When staff followed the person in past elopements, the person ran further and was difficult to find. The person’s home was in a rural location which also impacted staff’s decision to not follow in the dark due to safety concerns.',1,NULL,NULL,NULL,NULL,NULL),(40222,204,23,81,10,117,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40223,204,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40224,204,23,81,10,119,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40225,204,23,81,10,120,'Free_Text','There are a lack of crises services and placement options available in the area of the person’s home. Because of this, the provider created the elopement protocol as a way to try to balance the support and safety of the person.',1,NULL,NULL,NULL,NULL,NULL),(40226,204,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40227,204,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40228,204,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40229,204,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40230,204,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40231,204,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40232,204,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40233,205,23,81,10,76,'Short_Answer','KP_Maplewood Homes-SLC-2020-10',1,NULL,NULL,NULL,NULL,NULL),(40234,205,23,81,10,77,'Date','2020-10-28',1,NULL,NULL,NULL,NULL,NULL),(40235,205,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40236,205,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40237,205,23,81,10,80,'Short_Answer','Maplewood Homes',1,NULL,NULL,NULL,NULL,NULL),(40238,205,23,81,10,81,'Short_Answer','Tabitha Snider',1,NULL,NULL,NULL,NULL,NULL),(40239,205,23,81,10,82,'Short_Answer','snider.tabatha@yahoo.com',1,NULL,NULL,NULL,NULL,NULL),(40240,205,23,81,10,83,'Short_Answer','218-576-6874',1,NULL,NULL,NULL,NULL,NULL),(40241,205,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(40242,205,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40243,205,23,81,10,86,'Date','2020-08-13',1,NULL,NULL,NULL,NULL,NULL),(40244,205,23,81,10,87,'Free_Text','Termination of services is necessary for the person\'s welfare and the facility cannot meet the person\'s needs.  The safety of the person is endangered and positive support strategies were attempted and have not achieved and effectively maintained safety of the person or others.  The health of the person or others in the program would otherwise be endangered.',1,NULL,NULL,NULL,NULL,NULL),(40245,205,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40246,205,23,81,10,91,'Short_Answer','Provider terminated services due to challenging behaviors',1,NULL,NULL,NULL,NULL,NULL),(40247,205,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40248,205,23,81,10,97,'Date','2020-11-30',1,NULL,NULL,NULL,NULL,NULL),(40249,205,23,81,10,98,'Free_Text','October 2020 Case Assignment\r\nMaplewood Homes\r\n\r\nLearning Point:  Person had their services terminated due to challenging behavior \r\n\r\nPerson was being served in a rural Family Foster Home setting from May until August of 2020.  Prior to admission into the family foster home, person had been residing at a crises home following service termination from another provider.  Person had a long history of verbalizing suicidal thoughts, self-harm, verbal and physical aggression.  It was reported that he enjoyed the attention he was given when he would be hospitalized, resulting in numerous attempts to become hospitalized.   It was reported that his team was not being successful in finding placement for him.  The team felt that a family foster care who could provide a one to one setting was something that had not been tried before.  Provider had no other clients at the time of initial placement.  Provider has over 20 years of experience in working with vulnerable populations.\r\nProvider reported a good working relationship with the person’s Guardian/Grandmother along with county case manager. Provider worked closely with psychologist, psychiatrist and ARMS worker.  Provider felt that the team was very supportive.  Things went well for a period of time and the person enjoyed all the attention they received.\r\nAs time went on, the person started to verbalize suicidal ideation to his Grandmother when talking to her on the phone.  One night he eloped following a series of texts to his Grandmother saying he wanted to kill himself.  Provider followed him and called the Sheriff who stated that they were not a “taxi” service and would not assist.  He was taken to the Emergency Room and calmed down and was released with in a couple of hours.\r\nAnother client moved into the home shortly have this incident.  Person then stated he was going to burn the house down.  Provider had a volunteer at the home stay up all night to observe person as they were not sleeping.   The was again taken to the house admitted and released.   After he returned, he took a lighter and burned himself, this resulted in police being called to the home.  He calmed down once they arrived.  He started to text his Grandmother reporting that he wanted to kill himself.  Grandmother insisted that he return to the hospital.  Once at the hospital Grandmother insisted that he not return to providers home and he was admitted back to the crises home. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40250,205,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40251,205,23,81,10,100,'Free_Text','The provider terminating a person’s services due to challenging behaviors was influenced by the behaviors escalating in frequency and intensity since service admission.  This was further supported by the person making multiple suicide threats, acts of self-harm by burning themselves, and threats to burn the house down.  The person did not have a history of fire starting prior to admission which further supports the intensity of his escalating behaviors.  The person seemed motivated by the attention he received from his grandmother/guardian and the hospital.  Person was hospitalized twice and released quickly on two occasions prior to the threat to burn the house down.  On one occasion, law enforcement responded to the providers 911 call and stated that they were not a taxi services and did not provide any mental health support.  Police in the area were overtaxed with 911 calls related to mental health and COVID calls.  In addition to that, at the time of this call, law enforcement from across the state were reporting to Minneapolis to assist with the George Floyd incident, impacting the providers view that law enforcement may not assist.  \r\n\r\nThe guardian and provider agreed that the safety of the person, others in the home, and staff could not be maintained.  This agreement was influenced by the provider attempting to remove all objects that were deemed dangerous.  Room searches were conducted regularly to remove dangerous objects. After the person returned from the hospital, they were still in possession of a lighter.  This further supported their decision that they could not prevent him from self-harm and fire starting behavior or maintain the safety and protection of all involved. \r\n\r\nProviders have a responsibility to protect the health and wellbeing of all people in the home was another influence to the service termination.  Providers responsibility for safety is directed by MnCHOICES and required by the CSSP of each person and as well as the requirement of 245D.   This was supported by the Guardian who was worried about the provider’s safety and the safety of the other person who had just recently moved into the home, resulting in the guardian refusing to allow the person to return to the home.\r\n\r\nThe person being served had several ER visits for suicidal ideation and behaviors and was not given in-patient psychiatric care. Provider and guardian had exhausted available services and felt that service termination was seen as a way to help person obtain in-patient psychiatric services.   COVID-19 Pandemic influenced hospitals to discharge quickly, due to the demand for mental health resources in the area, resulting in person being released from hospital and not receiving the psychiatric attention the team thought he needed, further impacting providers decision to terminate services\r\n\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40252,205,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40253,205,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40254,205,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40255,205,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40256,205,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40257,205,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40258,205,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40259,205,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40260,205,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40261,205,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40262,205,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40263,205,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40264,205,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40265,205,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40266,205,23,81,10,109,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40267,205,23,81,10,110,'Free_Text','On one occasion, law enforcement responded to the providers 911 call and stated that they were not a taxi services and did not provide any mental health support.  Police in the area were overtaxed with 911 calls related to mental health and COVID calls\r\n\r\nThe guardian and provider agreed that the safety of the person, others in the home, and staff could not be maintained.  This agreement was influenced by the provider attempting to remove all objects that were deemed dangerous.  Room searches were conducted regularly to remove dangerous objects. After the person returned from the hospital, they were still in possession of a lighter.  This further supported their decision that they could not prevent him from self-harm and fire starting behavior or maintain the safety and protection of all involved. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40268,205,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40269,205,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40270,205,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40271,205,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40272,205,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40273,205,23,81,10,116,'Free_Text','The guardian and provider agreed that the safety of the person, others in the home, and staff could not be maintained.  This agreement was influenced by the provider attempting to remove all objects that were deemed dangerous.  Room searches were conducted regularly to remove dangerous objects. After the person returned from the hospital, they were still in possession of a lighter\r\n\r\nProviders have a responsibility to protect the health and wellbeing of all people in the home was another influence to the service termination.  Providers responsibility for safety is directed by MnCHOICES and required by the CSSP of each person and as well as the requirement of 245D.   This was supported by the Guardian who was worried about the provider’s safety and the safety of the other person who had just recently moved into the home, resulting in the guardian refusing to allow the person to return to the home. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40274,205,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40275,205,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40276,205,23,81,10,119,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40277,205,23,81,10,120,'Free_Text',' On one occasion, law enforcement responded to the providers 911 call and stated that they were not a taxi services and did not provide any mental health support.  Police in the area were overtaxed with 911 calls related to mental health and COVID calls.  \r\n\r\nThe person being served had several ER visits for suicidal ideation and behaviors and was not given in-patient psychiatric care. Provider and guardian had exhausted available services and felt that service termination was seen as a way to help person obtain in-patient psychiatric services.   COVID-19 Pandemic influenced hospitals to discharge quickly, due to the demand for mental health resources in the area, resulting in person being released from hospital and not receiving the psychiatric attention the team thought he needed, further impacting providers decision to terminate services\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40278,205,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40279,205,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40280,205,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40281,205,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40282,205,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40283,205,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40284,205,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40285,206,23,81,10,76,'Short_Answer','201904216',1,NULL,NULL,NULL,NULL,NULL),(40286,206,23,81,10,77,'Date','2019-07-15',1,NULL,NULL,NULL,NULL,NULL),(40287,206,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40288,206,23,81,10,79,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(40289,206,23,81,10,80,'Short_Answer','REM Heartland - Couger Court',1,NULL,NULL,NULL,NULL,NULL),(40290,206,23,81,10,81,'Short_Answer','Devin Nelson',1,NULL,NULL,NULL,NULL,NULL),(40291,206,23,81,10,82,'Short_Answer','507-223-4410',1,NULL,NULL,NULL,NULL,NULL),(40292,206,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40293,206,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(40294,206,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40295,206,23,81,10,86,'Date','2019-06-01',1,NULL,NULL,NULL,NULL,NULL),(40296,206,23,81,10,87,'Free_Text','On 6-8-2019, it was discovered that the person had been receiving only half of the prescribed dosage of her Mycophenolate.  The missed medications were then found in the medication cabinet.  Person received half of 9am and 3pm prescribed dosage from 6-1-2019 to 6-7-2019. ',1,NULL,NULL,NULL,NULL,NULL),(40297,206,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40298,206,23,81,10,91,'Short_Answer','Person received half of the prescribed dosage of medication.',1,NULL,NULL,NULL,NULL,NULL),(40299,206,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40300,206,23,81,10,97,'Date','2019-08-14',1,NULL,NULL,NULL,NULL,NULL),(40301,206,23,81,10,98,'Free_Text','Staff 1 has been working for the company for the past 4 years and her role is a direct care staff. Staff 1 typically picks up of the medication from the pharmacy.  Sometimes Staff 1’s supervisor picks up the medications.  The staff who picks up the medications is responsible for organizing and separating the medications.  This medication usually come with one pill in two separate bubble packs and sometimes it will come with two pills in one bubble pack.  The person receives this medication at 9am and 3pm.  \r\n\r\nStaff 1 picked up the medication and then organized them.  Staff 1 felt that she put the correct medication and dosage in person’s medication area in the locked medication cabinet.  Staff does not recall anything out of the norm when organizing medications.  She said she was not distracted and that it was quiet at the house.  Staff 1said all medications are kept in each person’s area in the medication cabinet. Staff 1 said it is common practice for this facility for the first person who gives medication on the first of each month to double check that the medications were set up correctly. \r\n\r\nDebriefing with Staff #2 on 8-21-2019\r\n\r\nStaff 2 has worked for the company for the past 35 years and has held various position within the company.  Staff currently works the overnight shift which is from 10pm to 9am.  She is very familiar with the person and her medications as she has been with that group home for a long time.  \r\n\r\nOn the morning of June 1st, Staff 2 went to give 9am medications and noted that something “appeared off” with the medications. The medication typically comes in two single bubble packs, but there was only one bubble pack with one pill in the 9am medication. She said however that they do occasionally come with two pills in one bubble pack.  Staff 2 checked the dosage and then checked the 3pm medication and reported that they were the same, so she concluded that the dosage must have changed.  \r\n\r\nStaff 2 was not aware of the current procedure for storing extra medications.  Staff 2 said in the past when she held a different position that she would lock extra medications in the office desk. ',1,NULL,NULL,NULL,NULL,NULL),(40302,206,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40303,206,23,81,10,100,'Free_Text','The person receiving half of the prescribed dosage of medication for six days was influenced by Staff 1 believing that they set up the medications correctly after receiving them from the pharmacy.  An additional feature that influenced staff believing that the medications were set up correctly, was the medications were not always packaged the same when they came from the pharmacy.  Therefore, staff did not question when there was only one bubble pack for the person’s 9am medications and one bubble pack for person’s 3pm medications.  Staff 2 was the first staff to give medications after staff 1 set up medications in the med drawer for the month.   Staff 2 believed medications were set up correctly was influenced by the belief that the person’s medication dosage must have changed because of the way the meds were packaged.  Contributing to the staff’s belief that medication dosage changed was further influenced by the person’s 3pm medication dosage matching the 9am medication dosage.  This was further supported by staff 2 not finding the second bubble pack in the person’s medication drawer, which was the house norm for storing all medications.  Staff 2 also believed that staff 1 set up medications correctly.  \r\n \r\nAn additional factor that had other staff following staff 2’s lead in only giving half the med, rather than following medication protocol and ensuring that the med label and the Medication Administration Record (MAR) match the dosage in the bubble pack, is that there are a lot of policies for staff to know. This provider’s medication policies had changed due to the acquisition of another company, which then had both companies revise their policies to match each other. The introduction of 245D also required this provider to revise their medication administration policies. In the absence of stable policies the staff likely followed the veteran staff’s actions and assumed if there was a med change the veteran staff would have known as well as followed policies. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40304,206,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40305,206,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40306,206,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40307,206,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40308,206,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40309,206,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40310,206,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40311,206,23,81,10,102,'Free_Text','This was further supported by staff 2 not finding the second bubble pack in the person’s medication drawer, which was the house norm for storing all medications. Staff 2 also believed that staff 1 setup medications correctly.',1,NULL,NULL,NULL,NULL,NULL),(40312,206,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40313,206,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40314,206,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40315,206,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40316,206,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40317,206,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40318,206,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40319,206,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40320,206,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40321,206,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40322,206,23,81,10,113,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40323,206,23,81,10,114,'Free_Text','The person receiving half of the prescribed dosage of medication for six days was influenced by Staff 1 believing that they set up the medications correctly after receiving them from the pharmacy. An additional feature that influenced staff believing that the medications were set up correctly, was the medications were not always packaged the same when they came from the pharmacy Therefore, staff did not question when there was only one bubble pack for the person’s 9am medications and one bubble pack for person’s 3pm medications.',1,NULL,NULL,NULL,NULL,NULL),(40324,206,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40325,206,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40326,206,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40327,206,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40328,206,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40329,206,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40330,206,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40331,206,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40332,206,23,81,10,123,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40333,206,23,81,10,124,'Free_Text','Staff 2 believed medications were set up correctly was influenced by the belief that the person’s medication dosage must have changed because of the way the meds were packaged.  Contributing to the staff’s belief that medication dosage changed was further influenced by the person’s 3pm medication dosage matching the 9am medication dosage.  \r\n\r\nAn additional factor that had other staff following staff 2’s lead in only giving half the med, rather than following medication protocol and ensuring that the med label and the Medication Administration Record (MAR) match the dosage in the bubble pack, is that there are a lot of policies for staff to know. In the absence of stable policies the staff likely followed the veteran staff’s actions and assumed if there was a med change the veteran staff would have known as well as followed policies. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40334,206,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40335,206,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40336,206,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40337,207,23,81,10,76,'Short_Answer','201905293',1,NULL,NULL,NULL,NULL,NULL),(40338,207,23,81,10,77,'Date','2019-09-16',1,NULL,NULL,NULL,NULL,NULL),(40339,207,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40340,207,23,81,10,79,'Multiple_Choice','Charles Young',1,NULL,NULL,NULL,NULL,NULL),(40341,207,23,81,10,80,'Short_Answer','REM Heartland, Inc. - Chastworth',1,NULL,NULL,NULL,NULL,NULL),(40342,207,23,81,10,81,'Short_Answer','Lori Larson',1,NULL,NULL,NULL,NULL,NULL),(40343,207,23,81,10,82,'Short_Answer','Lori.Larson@TheMentorNetwork.com',1,NULL,NULL,NULL,NULL,NULL),(40344,207,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40345,207,23,81,10,84,'Multiple_Choice','Staff Sleeping on Duty',1,NULL,NULL,NULL,NULL,NULL),(40346,207,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40347,207,23,81,10,86,'Date','2019-07-19',1,NULL,NULL,NULL,NULL,NULL),(40348,207,23,81,10,87,'Free_Text','As the only staff present in the facility, David laid down after Damon went to bed at approximately 8:00 pm. He inadvertently fell asleep and was awoken by the night shift staff when they reported for their shift at approximately 9:50 pm. Damon was apparently asleep the entire time, but his staffing ratios only for 1 hour of alone time during the day and sleeping night staff.',1,NULL,NULL,NULL,NULL,NULL),(40349,207,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40350,207,23,81,10,91,'Short_Answer','Staff was sleeping during an evening shift',1,NULL,NULL,NULL,NULL,NULL),(40351,207,23,81,10,94,'True_or_False','No',1,NULL,NULL,NULL,NULL,NULL),(40352,207,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40353,207,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40354,207,23,81,10,99,'Multiple_Choice','Staff No Longer Employed',1,NULL,NULL,NULL,NULL,NULL),(40355,207,23,81,10,100,'Free_Text','This house had an asleep overnight shift that began at 10pm, as directed by the CSSPs for the four people living in the home. The staff fell asleep at 8pm when all was quiet, and all the people were presumably in their rooms for the night. The people being served in this house demonstrated low needs which allowed them to have unsupervised time, contributing to the staff feeling comfortable to lie down. An additional factor into the staff laying down was that the staff was tired.  This staff had fallen asleep on previous shifts and disclosed to management that he was tired due to a personal situation that left him homeless. The staff typically slept in his car during this period.  The provider tried to work with him to move to the overnight position which would allow him to sleep but he did not accept this offer.  The provider noted that the overnight shift made nearly $5 less per hour, which was one of the influences into the person staying on the awake shift.  The provider was experiencing a staff shortage which is one of the factors into why they wanted to work with the staff to find a position that would meet both of their needs. An additional influence in staff falling asleep is that the staff laid down to try out a newly purchased weighted blanket   \r\n\r\nAll clients in the home had their needs assessed by MnCHOICES, which supported the individuals having sleep staff as well as alone time. The provider had seen this house as a potential house to replace overnight staff with remote monitoring technology due to the low needs of the individuals. The provider’s push for more alone time and remote monitoring was impacted by their efforts to allow the dignity of risk by providing more opportunities for people they serve to have a choice and control over their lives.  The effort to encourage dignity of risk was influenced by statewide person-centered planning requirements and emphasis. However, one guardian was resistant to remote monitoring but compromised by allowing the person alone time in their plan.  It was common knowledge among staff that the clients demonstrated low needs, contributing to the staff feeling comfortable to lie down. \r\n\r\nThe staff’s unwillingness to move to the overnight shift was influenced by the lower rate of pay that asleep staff were paid. The sleep rate is factored into the provider’s overall reimbursement negotiated with the county through the 6790 and provides a lower rate asleep than awake hours. The 6790-negotiation process is influenced by the rates determined by the Legislature in the Disability Waiver Rate System and the assessed needs identified in MnCHOICES and the resulting supervision levels identified in the CSSP. \r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40356,207,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40357,207,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40358,207,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40359,207,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40360,207,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40361,207,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40362,207,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40363,207,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40364,207,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40365,207,23,81,10,104,'Free_Text','The provider tried to work with him to move to the overnight position which would allow him to sleep but he did not accept this offer.  The provider noted that the overnight shift made nearly $5 less per hour, which was one of the influences into the person staying on the awake shift.  The provider was experiencing a staff shortage which is one of the factors into why they wanted to work with the staff to find a position that would meet both of their needs. \r\n\r\nThe staff’s unwillingness to move to the overnight shift was influenced by the lower rate of pay that asleep staff were paid. The sleep rate is factored into the provider’s overall reimbursement negotiated with the county through the 6790 and provides a lower rate asleep than awake hours',1,NULL,NULL,NULL,NULL,NULL),(40366,207,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40367,207,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40368,207,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40369,207,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40370,207,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40371,207,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40372,207,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40373,207,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40374,207,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40375,207,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40376,207,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40377,207,23,81,10,116,'Free_Text','All clients in the home had their needs assessed by MnCHOICES, which supported the individuals having sleep staff as well as alone time. The provider had seen this house as a potential house to replace overnight staff with remote monitoring technology due to the low needs of the individuals. The provider’s push for more alone time and remote monitoring was impacted by their efforts to allow the dignity of risk by providing more opportunities for people they serve to have a choice and control over their lives.  The effort to encourage dignity of risk was influenced by statewide person-centered planning requirements and emphasis. However, one guardian was resistant to remote monitoring but compromised by allowing the person alone time in their plan.  It was common knowledge among staff that the clients demonstrated low needs, contributing to the staff feeling comfortable to lie down. ',1,NULL,NULL,NULL,NULL,NULL),(40378,207,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40379,207,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40380,207,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40381,207,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40382,207,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40383,207,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40384,207,23,81,10,123,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40385,207,23,81,10,124,'Free_Text','The staff fell asleep at 8pm when all was quiet, and all the people were presumably in their rooms for the night. The people being served in this house demonstrated low needs which allowed them to have unsupervised time, contributing to the staff feeling comfortable to lie down.\r\n\r\nIt was common knowledge among staff that the clients demonstrated low needs, contributing to the staff feeing comfortable to lie down.  An additional influence in staff falling asleep is that the staff laid down to try out a newly purchased weighted blanket    \r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40386,207,23,81,10,125,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40387,207,23,81,10,126,'Free_Text','An additional factor into the staff laying down was that the staff was tired.  This staff had fallen asleep on previous shifts and disclosed to management that he was tired due to a personal situation that left him homeless. The staff typically slept in his car during this period ',1,NULL,NULL,NULL,NULL,NULL),(40388,207,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40389,208,23,81,10,76,'Short_Answer','201907799',1,NULL,NULL,NULL,NULL,NULL),(40390,208,23,81,10,77,'Date','2019-12-16',1,NULL,NULL,NULL,NULL,NULL),(40391,208,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40392,208,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40393,208,23,81,10,80,'Short_Answer','REM Heartland, Inc. - Cougar Drive',1,NULL,NULL,NULL,NULL,NULL),(40394,208,23,81,10,81,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40395,208,23,81,10,82,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40396,208,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40397,208,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(40398,208,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40399,208,23,81,10,86,'Date','2019-10-19',1,NULL,NULL,NULL,NULL,NULL),(40400,208,23,81,10,87,'Free_Text','The individual was setting up her medication for the week on Tuesday 10/15/19. The individual stated that she\r\ntook the bottle of pills from the box of medication that staff left unattended. Individual stated on 10/20/19 that she took 30 pills on 10/17/19\r\nand took 19 pills on 10/19/19. The medication was Hydroxyzine 25mg capsules. The individual did not have any apparent side effects from\r\ntaking the medications.',1,NULL,NULL,NULL,NULL,NULL),(40401,208,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40402,208,23,81,10,91,'Short_Answer','Staff left person unsupervised duirng medication setup',1,NULL,NULL,NULL,NULL,NULL),(40403,208,23,81,10,94,'True_or_False','No',1,NULL,NULL,NULL,NULL,NULL),(40404,208,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40405,208,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40406,208,23,81,10,99,'Multiple_Choice','Staff No Longer Employed',1,NULL,NULL,NULL,NULL,NULL),(40407,208,23,81,10,100,'Free_Text','Person was left unsupervised during medication set up was influenced by DSP perception that the people who are their own guardians can direct their own services.  Person was their own guardian. Also contributing to the staff’s perception is the training they receive on person center planning which is a requirement of 245D.  The training offered to staff is impacted by the funding that is allowed in the Disability Waiver Rate Setting Tool, which doesn’t always capture the training staff may need to support a person with mental health issues. \r\n Also influencing the staff to leave someone unsupervised that there were 4 people in the home and the time of the day at the home was busy.  Staff are responsible for ensuring the safety of all people in the home which is a requirement by the CSSP of each person as well as the requirements of 245D. \r\nFurther impacting staff leaving the person unsupervised during medication setup is that staff at the home would often prioritize the needs of the other 3 people in the home due to their higher and lower autonomy.  . The moratorium decreased the number of beds available and created a bed shortage.\r\nThe final influence as to why the staff left the person unsupervised was the staff was comfortable leaving the person alone.  The person was high functioning and their own guardian.  Person being served had no history of abusing medications while residing in the home and no history of issues during medication set up influencing staff to have a trusting relationship with the person further impacting the staff being comfortable leaving the person unsupervised during medication set up.  The person had chosen to set up their medications independently with supervision.  The provider was assigned responsibility for medication set up with supervision by the case manager and agreed to by the person.  The mental health professionals involved did agree that there was a need for medication set up assistance, influencing why the provider was assigned medication set up responsibilities. The person’s MnCHOICES assessment did identify a need for medication responsibilities, which in turn was impacted by the levels of medication responsibilities identified in 245D.  The case manager’s awareness of the person’s history, which included a previous suicide attempt, further impacted the case manager assigning the provider medication set up assistance responsibility.  \r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40408,208,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40409,208,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40410,208,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40411,208,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40412,208,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40413,208,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40414,208,23,81,10,101,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40415,208,23,81,10,102,'Free_Text','Person was left unsupervised during medication set up was influenced by DSP perception that the people who are their own guardians can direct their own services\r\n Person being served had no history of abusing medications while residing in the home and no history of issues during medication set up influencing staff to have a trusting relationship with the person further impacting the staff being comfortable leaving the person unsupervised during medication set up.  ',1,NULL,NULL,NULL,NULL,NULL),(40416,208,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40417,208,23,81,10,104,'Free_Text','\r\n\r\nThe training offered to staff is impacted by the funding that is allowed in the Disability Waiver Rate Setting Tool, which doesn’t always capture the training staff may need to support a person with mental health issues. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40418,208,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40419,208,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40420,208,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40421,208,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40422,208,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40423,208,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40424,208,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40425,208,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40426,208,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40427,208,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40428,208,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40429,208,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40430,208,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40431,208,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40432,208,23,81,10,119,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40433,208,23,81,10,120,'Free_Text','Impacting the mix of personal needs in the home that providers have serving people with different diagnosis in one home more often since the foster care moratorium took effectThe moratorium decreased the number of beds available and created a bed shortage.\r\n',1,NULL,NULL,NULL,NULL,NULL),(40434,208,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40435,208,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40436,208,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40437,208,23,81,10,124,'Free_Text','Further impacting staff leaving the person unsupervised during medication setup is that staff at the home would often prioritize the needs of the other 3 people in the home due to their higher and lower autonomy',1,NULL,NULL,NULL,NULL,NULL),(40438,208,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40439,208,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40440,208,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40441,209,23,81,10,76,'Short_Answer','201905922',1,NULL,NULL,NULL,NULL,NULL),(40442,209,23,81,10,77,'Date','2019-09-16',1,NULL,NULL,NULL,NULL,NULL),(40443,209,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40444,209,23,81,10,79,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(40445,209,23,81,10,80,'Short_Answer','Bluewater Residential Services',1,NULL,NULL,NULL,NULL,NULL),(40446,209,23,81,10,81,'Short_Answer','Toni Martindale',1,NULL,NULL,NULL,NULL,NULL),(40447,209,23,81,10,82,'Short_Answer','toni.martindale@brsduluth.com',1,NULL,NULL,NULL,NULL,NULL),(40448,209,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40449,209,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(40450,209,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40451,209,23,81,10,86,'Date','2019-08-13',1,NULL,NULL,NULL,NULL,NULL),(40452,209,23,81,10,87,'Free_Text','Alix passed medications for the night to Rodney and the other residents. She had passed the meds to JT\r\n(resident) and she had to bring Rodney\'s upstairs to him because he says he has difficulty coming down the stairs. After giving Rodney\r\nhis medications JT came to her and told her that what she gave her was not her medications (250 mg of Clozapine). By the time Alix got to\r\nRodney he had already ingested the incorrect medications. She immediately called poison control and was referred to bring him to the\r\nER. The overnight staff arrived as the ambulance was getting there. Rodney was admitted for observation and intubated due to trouble\r\nbreathing and was released on 8/15/19 and is doing fine.',1,NULL,NULL,NULL,NULL,NULL),(40453,209,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40454,209,23,81,10,91,'Short_Answer','Staff administered the wrong medications to two individuals.',1,NULL,NULL,NULL,NULL,NULL),(40455,209,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40456,209,23,81,10,97,'Date','2019-10-22',1,NULL,NULL,NULL,NULL,NULL),(40457,209,23,81,10,98,'Free_Text','The staff member has worked at the agency since February 2019 and is experienced working in similar settings. \r\n\r\nThe night of the incident, the staff member was working with the house manager earlier in the day, but believed it was around 4:30-5:00 p.m. when she started working alone, which is not uncommon for the house. She prepared dinner and typically waits until approximately 6:30 to begin clean up as one individual living in the home takes longer to finish eating. This evening, she recalled being behind in the cleaning and at 7:30, individuals requested their medications.\r\n\r\nThere is a medication procedure in the home, which the staff member explained that they are to use hand sanitizer, check medications and MARS, she places a dot next to the medication signifying that it was given, removes medications from med box and places in cup. Once given to the individual, the staff returns to the MARS and signs where the dot was left previously. When further asked about this, the staff member explained that the MARS shouldn’t be signed until after you ensure that the individual took their medication in case of refusals. When asked about whether or not this is done all at once for everyone or individually, she stated it should be done with each person; however, she has done this combined. She explained that she felt this was okay because she has seen other people do it and normally she is very attentive. \r\n\r\nThe staff member explained that this night she was in a rush because she was behind in cleaning and knew she was due to be done soon. She did the medications as she normally does, reviewing them, dotting the medications, and putting them into the cups. She stacks the cups based on the order she distributes them. She brings Individual 1’s first since she is on the first floor. She brought the cup to individual 1 who was relaxing in her room. The staff member then went upstairs to bring Individual 2 his medications. She had to wake him up to give him his medications so she did recall that he did not look in the cup that she handed him and just took his medications. It was at this time that Individual 1 came up to the staff member and told her that these were the wrong medications. The staff member realized then that she switched up the two medication cups having given Individual 2, Individual 1’s medications. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40458,209,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40459,209,23,81,10,100,'Free_Text','The staff administering the wrong medications to two individuals was impacted by the staff member feeling rushed. It was towards the end of the shift and staff was behind in cleanup. The way the staff member manages the time and tasks such as when to begin cleaning and the time to dispense medications of the shift contributed to her being behind and feeling rushed as she waited until the end of the shift to complete many of her duties.  Another factor contributing to feeling rushed was when an individual approached the staff asking for his/her medications. The staff prioritized the medication administration over her other duties to which she was attending to accommodate the request. When the individual asked for their medications this impacted how staff chose to manage their time and tasks. The staff\'s being rushed influenced their decision not to follow the medication protocol having observed other staff members distribute all medications at one time for the residents. The staff member distributed all four medications at once and did not ask the individuals to verify the medications given. Both of these areas influenced the staff administering the wrong medications to the two individuals. The managing of time and tasks is influenced by the medication protocol and the houses having different schedules. The different schedules are impacted by the staff ratio, which is derived from the 6790 and the CSSP, as well as the expectation that there is person centered choice within the home. This choice allows for the schedule of the home to be more fluid adapting for the individuals that live in the home. Person Centered Choice is impacted by 245D licensing and the Home and Community Based Services (HCBS). \r\nAn additional factor in administering the wrong medication was that the staff feeling pressured to complete all her duties before the end of the shift, which contributed to the staff feeling rushed. Staff felt pressure because they were previously written up due to not meeting shift responsibilities/tasks. The provider’s expectations of staff impacted both the house responsibilities that each staff member must complete and writing up staff who don\'t follow through on their responsibilities. These house responsibilities influenced the staff feeling rushed. The provider\'s house responsibilities and staff expectations were influenced by the Community Services and Support Plan (CSSP). The CSSP is impacted by 245D licensing and the 6790 that identifies how staffing should be conducted.\r\n\r\n\r\nThe medication protocol was another influence of how the staff chose to manage the time and tasks. The protocol outlines the time frame that medications can be given and the procedure in distributing the medications. The medication protocol has a reciprocal impact with the medication protocol training. It is also impacted by the pharmacy consultation and sign off, 245D licensing and liability that exists for the provider. Medication administration errors can result in licensing violations, maltreatment investigations and even civil lawsuits. This Liability results in the provider creating medication protocols implementing a number of safeguards to reduce the likelihood of committing a med error, but those safeguards also increase the complexity of administering medications. This complexity can increase the amount of time it takes to administer medications, so when staff are rushed they are likely to weight efficiency over thoroughness. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40460,209,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40461,209,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40462,209,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40463,209,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40464,209,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40465,209,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40466,209,23,81,10,101,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40467,209,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40468,209,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40469,209,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40470,209,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40471,209,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40472,209,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40473,209,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40474,209,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40475,209,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40476,209,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40477,209,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40478,209,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40479,209,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40480,209,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40481,209,23,81,10,116,'Free_Text','This Liability results in the provider creating medication protocols implementing a number of safeguards to reduce the likelihood of committing a med error, but those safeguards also increase the complexity of administering medications. This complexity can increase the amount of time it takes to administer medications, so when staff are rushed they are likely to weight efficiency over thoroughness. The different schedules are impacted by the staff ratio, which is derived from the 6790 and the CSSP, as well as the expectation that there is person centered choice within the home.',1,NULL,NULL,NULL,NULL,NULL),(40482,209,23,81,10,117,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40483,209,23,81,10,118,'Free_Text','The staff administering the wrong medications to two individuals was impacted by the staff member feeling rushed. It was towards the end of the shift and staff was behind in cleanup. The way the staff member manages the time and tasks such as when to begin cleaning and the time to dispense medications of the shift contributed to her being behind and feeling rushed as she waited until the end of the shift to complete many of her duties.  Another factor contributing to feeling rushed was when an individual approached the staff asking for his/her medications. The staff prioritized the medication administration over her other duties to which she was attending to accommodate the request. When the individual asked for their medications this impacted how staff chose to manage their time and tasks. ',1,NULL,NULL,NULL,NULL,NULL),(40484,209,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40485,209,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40486,209,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40487,209,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40488,209,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40489,209,23,81,10,124,'Free_Text','This choice allows for the schedule of the home to be more fluid adapting for the individuals that live in the home. Person Centered Choice is impacted by 245D licensing and the Home and Community Based Services (HCBS).',1,NULL,NULL,NULL,NULL,NULL),(40490,209,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40491,209,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40492,209,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40493,210,23,81,10,76,'Short_Answer','KS_Heartland Homes-SLC-2021-03',1,NULL,NULL,NULL,NULL,NULL),(40494,210,23,81,10,77,'Date','2021-03-30',1,NULL,NULL,NULL,NULL,NULL),(40495,210,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40496,210,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40497,210,23,81,10,80,'Short_Answer','Heartland Homes',1,NULL,NULL,NULL,NULL,NULL),(40498,210,23,81,10,81,'Short_Answer','Jennifer Klaas',1,NULL,NULL,NULL,NULL,NULL),(40499,210,23,81,10,82,'Short_Answer','heartlandhomes.jk34@outlook.com',1,NULL,NULL,NULL,NULL,NULL),(40500,210,23,81,10,83,'Short_Answer','218-727-2110',1,NULL,NULL,NULL,NULL,NULL),(40501,210,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(40502,210,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40503,210,23,81,10,86,'Date','2021-02-08',1,NULL,NULL,NULL,NULL,NULL),(40504,210,23,81,10,87,'Free_Text','Monday, 2/8/21 11:15am. Darryl had left our facility to use independence. Darryl told the staff he would return home at 5pm. Darryl did not return on Monday 2/8/21.  \r\n\r\nTuesday 2/9/21, Darryl still had still not returned to our facility. We called 911 at 11am to report a missing person. Darryl called our facility at 2pm and stated he would be returning home in the evening. Darryl did not return home.  \r\n\r\nWednesday, 2/10/21. He called our facility at 8am and stated he would be returning home. A female grabbed the phone and started speaking to the house staff, and stated she took care of him and made sure he did his blood sugar tests. She used someone else\'s needles to do blood checks.  \r\n\r\nDarryl just returned to the facility at 10:45am.',1,NULL,NULL,NULL,NULL,NULL),(40505,210,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40506,210,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40507,210,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(40508,210,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40509,210,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40510,210,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40511,210,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40512,210,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40513,210,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40514,210,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40515,210,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40516,210,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40517,210,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40518,210,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40519,210,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40520,210,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40521,210,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40522,210,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40523,210,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40524,210,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40525,210,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40526,210,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40527,210,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40528,210,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40529,210,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40530,210,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40531,210,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40532,210,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40533,210,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40534,210,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40535,210,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40536,210,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40537,210,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40538,210,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40539,210,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40540,210,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40541,210,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40542,210,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40543,210,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40544,210,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40545,211,23,81,10,76,'Short_Answer','KS_REM Arrowhead-SLC-2020-07',1,NULL,NULL,NULL,NULL,NULL),(40546,211,23,81,10,77,'Date','2020-07-30',1,NULL,NULL,NULL,NULL,NULL),(40547,211,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40548,211,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40549,211,23,81,10,80,'Short_Answer','REM Arrowhead',1,NULL,NULL,NULL,NULL,NULL),(40550,211,23,81,10,81,'Short_Answer','Patrick Michael Masyga',1,NULL,NULL,NULL,NULL,NULL),(40551,211,23,81,10,82,'Short_Answer','Pat.Masyga@TheMentorNetwork.com',1,NULL,NULL,NULL,NULL,NULL),(40552,211,23,81,10,83,'Short_Answer','952-922-6776',1,NULL,NULL,NULL,NULL,NULL),(40553,211,23,81,10,84,'Multiple_Choice','Staff Sleeping on Duty',1,NULL,NULL,NULL,NULL,NULL),(40554,211,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40555,211,23,81,10,86,'Date','2020-06-16',1,NULL,NULL,NULL,NULL,NULL),(40556,211,23,81,10,87,'Free_Text','Kira was training in staff to the Springvale Program. Staff reported that Kira told her that there isn\'t anything that\r\nneeds to be done on overnights and that she sleeps. She then took her blanket into the tv room and slept the overnight shift leaving\r\nsomeone untrained along with 3 individuals.',1,NULL,NULL,NULL,NULL,NULL),(40557,211,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40558,211,23,81,10,91,'Short_Answer','Staff was asleep during overnight awake shift',1,NULL,NULL,NULL,NULL,NULL),(40559,211,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40560,211,23,81,10,97,'Date','2020-09-18',1,NULL,NULL,NULL,NULL,NULL),(40561,211,23,81,10,98,'Free_Text','REM Springvale is an adult foster home that has four ladies who reside there. The women in the home consists of one with sever autism who requires frequent cares, one who tends to remain in her room for much of the day and two women who are in wheelchairs and require assistance for transfers. The home is typically staffed with at least two staff members during awake times to accommodate these transfer assists but may also have three staff members working during the busier times to support functions and appointments. Overnight is typically staffed with one awake staff since the one resident will tend to get up every few hours throughout the night. \r\n\r\n\r\nThis was a fairly new job for the staff member, explaining she had previously worked in a nursing facility and came to this position approximately two months prior to the incident. The hours she worked were overnight shifts, 4 on and 10 off. The hours tended up to either 11 or 12 hour days depending on whether it was a weekend or weekday. The day of the incident, she believed this to be her second or third day of the 4 days she’d work in a row. The night prior she had another person during the entire overnight shift with her. This was not normal since she started working and she stated she believed they may have done this out of concern that she wouldn’t show up. The night of the incident, she came in at 9:00 p.m. for her shift and realized that she would be cross-training another staff member for the overnight shift. She wasn’t aware of this and recalled being “thrown off” by this as she still saw herself as a fairly new person to the agency. She decided that she would have the training staff shadow her as she went through and explained what she was doing and why she was doing it. She explained on a typical night shift she would start putting the ladies to bed once she arrived. She would clean the house but often times would spread this out throughout the night. She would take care of any “cares” that the residents required such as going to the bathroom. During the breaks in between cleaning, she would sit in the living room and watch tv. She explained she always brought a blanket as the house would get cold and she would use this while sitting in the living room.\r\n\r\nThe staff explained during that night she had a headache. She stated she was talking throughout the night with the staff who was training and mentioned having a headache. Around 3:30 in the morning, she decided to go into the other room where she could sit back and close her eyes. She states she realizes now that she could have been more direct in communicating that she was going to “close her eyes”, but at the time didn’t think to. She further explained thinking, “there’s another person here, I’m just going to close my eyes.” When she got up, she realized she dosed off for approximately 15-20 minutes. She then mentioned to the trainee that she had just dosed off and then resumed work. She stated there was no other discussion on this as the work continued into the morning.',1,NULL,NULL,NULL,NULL,NULL),(40562,211,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40563,211,23,81,10,100,'Free_Text','Staff sleeping during an overnight awake shift was impacted by the staff member laying down. Staff lying down was directly influenced by the staff member having a headache and that there was another awake staff present. The other awake staff present was due to a second staff member being scheduled for the shift. The second staff member being present was impacted by the provider lining up a second staff in case the first staff member couldn’t work. The lining up a second staff member was influenced due to the concern by the provider that the staff was potentially unable to make it to work. The staff member was having issues with their driver’s license and there was concern that this may have prevented them from working. A valid picture ID is required for employment. \r\n\r\nWhen staff laid down, this created a situation where the conditions were conducive for sleeping. Having the conditions conducive for sleeping was established by a multitude of influences such as there was another awake staff present (thus the people in the home’s supervision requirements were met), the house was quiet (all residents were asleep), the staff member laid down, and the staff member covered themself with a blanket. The staff member regularly brought a blanket to use when taking breaks due to the house being cold at night. The house being quiet and the home having natural downtime built into the night shift had a reciprocal effect on one another. Having the extra staff on shift impacted the natural downtime at the home since no major cares were needed during that time. One resident would wake up every couple of hours that did end up requiring some engagement by staff to redirect them back to bed. This need directly impacts the need for the provider to require an awake staff at night and this being calculated into the rate of care for that client through the 6790 process which sets the rate based on individual cares for the persons living in the home. The 6790 is impacted by the Community Services and Support Plan that outlines the supervision level based upon the MnCHOICES assessment.',1,NULL,NULL,NULL,NULL,NULL),(40564,211,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40565,211,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40566,211,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40567,211,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40568,211,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40569,211,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40570,211,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40571,211,23,81,10,102,'Free_Text','Staff lying down was directly influenced by the staff member having a headache and that there was another awake staff present. Having the conditions conducive for sleeping was established by a multitude of influences such as there was another awake staff present (thus the people in the home’s supervision requirements were met), the house was quiet (all residents were asleep).',1,NULL,NULL,NULL,NULL,NULL),(40572,211,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40573,211,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40574,211,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40575,211,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40576,211,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40577,211,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40578,211,23,81,10,109,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40579,211,23,81,10,110,'Free_Text','The other awake staff present was due to a second staff member being scheduled for the shift. The second staff member being present was impacted by the provider lining up a second staff in case the first staff member couldn’t work. The lining up a second staff member was influenced due to the concern by the provider that the staff was potentially unable to make it to work. Having the extra staff on shift impacted the natural downtime at the home since no major cares were needed during that time. ',1,NULL,NULL,NULL,NULL,NULL),(40580,211,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40581,211,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40582,211,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40583,211,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40584,211,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40585,211,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40586,211,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40587,211,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40588,211,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40589,211,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40590,211,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40591,211,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40592,211,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40593,211,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40594,211,23,81,10,125,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40595,211,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40596,211,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40597,212,23,81,10,76,'Short_Answer','2019-07-SLC-KS',1,NULL,NULL,NULL,NULL,NULL),(40598,212,23,81,10,77,'Date','2019-07-15',1,NULL,NULL,NULL,NULL,NULL),(40599,212,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40600,212,23,81,10,79,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(40601,212,23,81,10,80,'Short_Answer','Residential Services of NE MN',1,NULL,NULL,NULL,NULL,NULL),(40602,212,23,81,10,81,'Short_Answer','Shelia Fetters',1,NULL,NULL,NULL,NULL,NULL),(40603,212,23,81,10,82,'Short_Answer','sheila.fetters@residentialservices.org',1,NULL,NULL,NULL,NULL,NULL),(40604,212,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40605,212,23,81,10,84,'Multiple_Choice','Wheelchair Safety',1,NULL,NULL,NULL,NULL,NULL),(40606,212,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40607,212,23,81,10,86,'Date','2019-06-10',1,NULL,NULL,NULL,NULL,NULL),(40608,212,23,81,10,87,'Free_Text','Staff was transporting supported person to an appointment. She had secured the wheelchair to the four point restraints. This was a standard wheelchair and the supported person does not use a lap belt due to being able to transfer. While driving, the staff report that Denise fell out of the wheelchair and fell onto the floor of the van. Other staff came to assist and noticed the seat belt in the van was not being used. Staff later clarified that she didn’t have the lap belt on correctly and that it was down around the individual’s ankles at the time of the fall. ',1,NULL,NULL,NULL,NULL,NULL),(40609,212,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40610,212,23,81,10,91,'Short_Answer','Staff was not able to secure seat belt at waist.',1,NULL,NULL,NULL,NULL,NULL),(40611,212,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40612,212,23,81,10,97,'Date','2019-08-23',1,NULL,NULL,NULL,NULL,NULL),(40613,212,23,81,10,98,'Free_Text','Staff has worked at the agency for approximately one year. She reported having some past experience in nursing home settings, which allowed her to feel comfortable working in a “medical home”. The medical home was described as having individuals who were higher medical needs than some other homes. She reported that some staff members would come into the home and leave, not understanding the level of work that was done in the home. \r\n\r\nAt the time of the incident, the home was staffed with three staff members. This was recently increased as they admitted their fourth resident in the home a week to two weeks prior of the incident. She described that the individual involved in the incident was verbal, but had some limitations with speaking. She used a wheelchair, but staff described this as a hospital/standard wheelchair with no lap belt.\r\n\r\nThe day of the incident, the staff was bringing the individual to get labs drawn at the local clinic. However, once she got to the clinic, unloaded the wheelchair and went in; it was discovered that staff were at the wrong clinic. At this time the individual begun yelling and screaming in the wait area. Staff identified feeling increased anxiety as others were looking at them. She attempted to speak with the individual to calm her, but this did not help. She stated feeling “the crunch” at the time because she knew how important it is to get the individuals to appointments when they have them. She proceeded to load the individual in the van. She placed the wheelchair in the harnesses and was attempting to place the seat belt on. The staff identified difficulties with the seat belt, stating it was difficult to pull. [It wasn’t until further conversation with the supervisors following the debriefing that the seat belt was explained to be an airplane style seat belt that latched in front and would be pulled to tighten.] During this time, the staff stated that the individual was leaning forward and would not sit up properly. She believes the individual was able to scoot down out of her wheelchair and fell out. She stated the seat belt was at the ankles of the individual when they had fallen. Once she realized what happened, she pulled into a nearby parking lot and attempted to lift her; however, when that was unsuccessful, she called the house staff and explained what happened. They sent an employee over to assist with transferring the individual into the wheelchair and returned her to the foster home.\r\n\r\nThe staff stated she received VOC (vehicle orientation class) prior to being able to drive, but also following the incident. She states she tends to be the main driver in the mornings and feels she is a very safe staff, often double checking and taking her time to make sure mistakes don’t happen. She explained in the VOC training, they don’t use the hospital model wheelchair that this individual has but instead a different one. She further explained that it is difficult because each person is different and transporting each person has its own struggles, but the training doesn’t account for this.\r\n',1,NULL,NULL,NULL,NULL,NULL),(40614,212,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40615,212,23,81,10,100,'Free_Text','The staff being unable to secure the seat belt was impacted by the staff member identifying increased anxiety and struggling with the seat belt. The struggle with the seat belt and staff’s increased anxiety had a reciprocal impact to one another. The staff member was feeling rushed which was impacted by the staff going to the wrong clinic for the appointment. Once it was realized that they were at the wrong clinic, the individual served started to yell and scream which impacted the staff’s increased anxiety and the attention this was drawing from the community members nearby. The increased anxiety was further complicated by the staff being inexperienced with such behaviors. The individual being supported was new in the program and the staff member had limited experience and knowledge with their individual needs. Most of the staff’s training was focused on medical needs rather than behavior management. The agency develops the training based on what the county shares with them on the individual’s needs when they are moving into the home. With the individual being upset, yelling and screaming, the person was subsequently bent at the waist level. The person’s position directly impacted staff’s difficulty with the seat belt. \r\n\r\nFurther impacting the staff’s increased anxiety was the staff’s fear of repercussions of being late to the doctor’s appointment. There is a history of reprimands for late appointments within the agency. It is required in 245D licensing that the individuals attend appointments. Further complicating the pressure on the agencies, if appointments are not made, there could be maltreatment reports made for failure to provide care. Another contributing factor is the rigidity of the healthcare system influences the pressure on the agencies because of limited time options for appointments, it may be difficult to reschedule in a timely manner or the healthcare provider may discontinue seeing that individual due to missed appointments.',1,NULL,NULL,NULL,NULL,NULL),(40616,212,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40617,212,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40618,212,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40619,212,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40620,212,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40621,212,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40622,212,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40623,212,23,81,10,102,'Free_Text','The staff being unable to secure the seat belt was impacted by the staff member identifying increased anxiety and struggling with the seat belt. The struggle with the seat belt and staff’s increased anxiety had a reciprocal impact to one another.',1,NULL,NULL,NULL,NULL,NULL),(40624,212,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40625,212,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40626,212,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40627,212,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40628,212,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40629,212,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40630,212,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40631,212,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40632,212,23,81,10,111,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40633,212,23,81,10,112,'Free_Text','The increased anxiety was further complicated by the staff being inexperienced with such behaviors. The individual being supported was new in the program and the staff member had limited experience and knowledge with their individual needs. Most of the staff’s training was focused on medical needs rather than behavior management.',1,NULL,NULL,NULL,NULL,NULL),(40634,212,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40635,212,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40636,212,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40637,212,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40638,212,23,81,10,117,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40639,212,23,81,10,118,'Free_Text','The staff member was feeling rushed which was impacted by the staff going to the wrong clinic for the appointment. Once it was realized that they were at the wrong clinic, the individual served started to yell and scream which impacted the staff’s increased anxiety and the attention this was drawing from the community members nearby. Further impacting the staff’s increased anxiety was the staff’s fear of repercussions of being late to the doctor’s appointment. Further complicating the pressure on the agencies, if appointments are not made, there could be maltreatment reports made for failure to provide care.',1,NULL,NULL,NULL,NULL,NULL),(40640,212,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40641,212,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40642,212,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40643,212,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40644,212,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40645,212,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40646,212,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40647,212,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40648,212,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40649,213,23,81,10,76,'Short_Answer','KS_Rural Living Environment-SLC-2019-12',1,NULL,NULL,NULL,NULL,NULL),(40650,213,23,81,10,77,'Date','2019-12-16',1,NULL,NULL,NULL,NULL,NULL),(40651,213,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40652,213,23,81,10,79,'Multiple_Choice','Mor Vue',1,NULL,NULL,NULL,NULL,NULL),(40653,213,23,81,10,80,'Short_Answer','Rural Living Environment',1,NULL,NULL,NULL,NULL,NULL),(40654,213,23,81,10,81,'Short_Answer','Don Negley',1,NULL,NULL,NULL,NULL,NULL),(40655,213,23,81,10,82,'Short_Answer','dnegley@rurallivingmn.com',1,NULL,NULL,NULL,NULL,NULL),(40656,213,23,81,10,83,'Short_Answer','218-827-2322',1,NULL,NULL,NULL,NULL,NULL),(40657,213,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(40658,213,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40659,213,23,81,10,86,'Date','2019-11-01',1,NULL,NULL,NULL,NULL,NULL),(40660,213,23,81,10,87,'Free_Text','The reason for the service termination is: \r\n- the termination is necessary for Dominic\'s welfare and his needs cannot be met in our programs\r\n- Dominic\'s safety and that of his housemate and staff is endangered and positive support strategies that have been attempted have not achieved and effectively maintained safety for Dominic and others. \r\n- Dominic requires a minimum of 2:1 staffing which is not possible with banded rates nor does RLE have the ability to provider additional staffing for this purpose',1,NULL,NULL,NULL,NULL,NULL),(40661,213,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40662,213,23,81,10,91,'Short_Answer','Services terminated due to concerns for staff safety.',1,NULL,NULL,NULL,NULL,NULL),(40663,213,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40664,213,23,81,10,97,'Date','2020-02-04',1,NULL,NULL,NULL,NULL,NULL),(40665,213,23,81,10,98,'Free_Text','Debriefing 1 \r\nThe home was created in 2007 and licensed for 3 beds. Referrals were in from other counties; however, at the same time 2 MSOCS homes were being closed in the county and St. Louis County needed those beds. Host county concurrence from St. Louis County was denied on the 3 out of county individuals. Administration felt that they were forced into taking the three people who eventually moved in. All three had 1:1 staffing ratios when they came in. Even at that time, staff felt that the one individual should have been a 2:1; however, this was not approved by the county. He would bite himself, bite others, hit things which often resulted in daily restraints. He was on a Rule 40 program that created a plan for these restraints. Through the years adjustments were made to the home, attempting to reinforce walls, replacing toilets, industrial sheetrock, etc. \r\n\r\nIn 2017, one of the individuals in the home passed away. The home then went from 3 licensed beds to 2 licensed beds, subsequently only now having 2 staff members in the home where prior to 2017 there were 3. Through the next few years, the individual’s behaviors continued to be present but with the loss of the one staff member, it made it more difficult to intervene. This even resulted in a 60 day termination notice being issued in April 2018; however, no alternative housing option was ever found so the individual never did move from the home .The county was approached about developing a specialized home for the one individual; however, due to banding, which is when rates are locked only allowing incremental increases, they were told this couldn’t happen. In 2019, the banding was frozen so there was no slight increase they saw on their rate. They realize they could have put in 2:1 staffing, but they would have “ate the cost” for this as they would not be reimbursed for the extra staffing. \r\nThrough the years, the individual worked with one staff member who he tended to do better with. This was helpful in having to bring the individual places because they would try to schedule it with the one staff member. However, the staff member resigned in the fall of 2019. With the staff member’s departure, it appeared that the individual’s behaviors started to increase. They attempted various things, some even being quite non-conventional such as getting “gay man pheromones”. At the time of the notice, 911 was called 2 days in a row. They eventually brought him to the Duluth ER where once there, he was restrained by 8 hospital staff.\r\n\r\nWhen asked about other impacts of the situation they found themselves in, the quality of employees was quickly brought up. There continues to be a staffing shortage and it is difficult to find staff, let alone finding staff with any experience or other qualifications. There is also a concern that our state is missing a part of the continuum of care, specifically that there is little to no institutional care option that would allow individuals a longer period of stabilization. \r\n\r\nDebriefing 2 \r\nStaff members were at a point where they were no longer being effective in managing the individual’s behaviors. He went to the annual assessment meeting and saw the extremely high number of PRN’s being given. He realized they were using that as a means to control and “if we’re doing that something is wrong.” In further looking at this, he discovered that the documentation wasn’t always consistent depending on what staff member was documenting. Many behaviors were not being reported in the documentation or if they were, it wasn’t consistent amongst staff on how they were recorded. He felt that they weren’t training staff right. It was difficult to get staff to recognize what they were seeing. The house manager did not experience the same behaviors as the other staff; therefore, what he was reporting was not consistent with what staff experienced. The individual tended to treat certain staff differently, being particularly worse for women.\r\n\r\nAbout three years ago, the number of injuries that staff were sustaining started to rise consistently. Many workman’s comp claims, particularly with concerns about staff being bit. It came down to the realization that they did not have the right house for him and the concerns for staff’s safety. He felt strongly that staff did not fail the individual but rather the individual needed different suppor\r\n',1,NULL,NULL,NULL,NULL,NULL),(40666,213,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40667,213,23,81,10,100,'Free_Text','The services being terminated for a person due to concerns for staff safety were impacted by increased staff injuries. The physical aggression displayed by the person was increasing, which led to the increased staff injuries and the person damaging the house. Staff were not always able to be consistent when redirecting behavior with just one staff which impacted the increased staff injuries. The pressure from the worker’s compensation agency influenced the services terminated due to the concerns for staff safety. The number of workman’s comp claims influenced the pressure from this agency, which was impacted by the increased injuries to staff.\r\n\r\nStaff injuries was also influenced by the staff being unable to consistently redirect behaviors with one staff. One of the impacts to the inconsistency in redirecting behaviors, which included physical aggression, property distruction and self injurious, was the physical layout of the house due to narrow hallways and bathroom made it difficult to give space or intervene so the way staff chose to intervene was dependent on where the staff and individual were physically at in the home at the time of the behavior.The physical layout of the house not only impacted the consistency of redirecting these behaviors, but this also directly impacted the increased staff injuries and the requests to develop a new site around the person’s sensory needs. This request was subsequently denied by the county due to the county being unaware of available funds for modification for new development and that the county had limited foster care development. The limited foster care development was influenced by the county having a high number of foster care homes serving individuals from other counties along with a statewide moratorium on the creation of foster care beds, which in essence was a hold in developing further beds. This moratorium not only limited the foster care development in the county, but it also impacted the elimination of institutions in the state and left few alternative housing options. Other influences of the elimination of institutions was the Jensen Settlement and the Minnesota Olmstead Plan which found that individuals with disabilities were unconstitutionally secluded and the plan detailed a way to ensure that individuals with disabilities live in the most integrated setting appropriate for their needs. Another impact of staff being unable to consistently redirect behaviors with one staff was the staffing level dropped in the home in 2017 after a roommate passed away. When the person passed away, the home reduced their staff level to coincide with the reduced reimbursement that came from that person’s residence in the home. The staff attached to the roommate who passed away would often intervene in de-escalating and responding to the person’s physically aggressive behavior. When the roommate passed away, the provider inquired about adding a staff but were told that 2:1 staff couldn’t be reimbursed. This was impacted by the county not moving forward with the rate exception due to the needs of the person not changing, which in turn was influenced by the banding for the state rate allowing limited rate increase for service intensity. The Disability Waiver Rate System (DWRS) has impacted the banding requirements. The last impact to the staff being unable to consistently redirect behavior with one staff was the difficulty in matching staff to the needs of the people in the home. The difficulty in matching staff was influenced by the person tending to work best with male staff (2 particular staff) but also the low applicant pool fitting the person’s preference.  The low applicant pool was influenced by the current workforce shortage in the community and state. \r\n\r\nThe attempts and barriers to create the right service environment were also an influence to the terminating the person’s services due to concerns for staff safety. This was due to the 2:1 staff not being able to be reimbursed as previously mentioned because the staffing in the home changed but not the person’s needs. It also was influenced by county’s denial of the request to develop a new site around the person’s sensory needs. Subsequently, previous attempts to terminate service were not followed through on due to lack of providers which was impacted by the view that a part of the continuum of care for people with challenging behaviors statewide is missing. This missing part of the continuum is influenced by the lack of crisis respite providers, a lack of service availability between crisis residential services and hospitals, and few services for adults with autism. The effort to eliminate institutions and the DWRS has impacted the missing part of the continuum. The goal of the elimination of institutions to promote community living is generally seen as good; however, the lack of alternatives is what is most problematic to serve this population. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40668,213,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40669,213,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40670,213,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40671,213,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40672,213,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40673,213,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40674,213,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40675,213,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40676,213,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40677,213,23,81,10,104,'Free_Text','Staff injuries was also influenced by the staff being unable to consistently redirect behaviors with one staff. One of the impacts to the inconsistency in redirecting behaviors, which included physical aggression, property destruction and self injurious, was the physical layout of the house due to narrow hallways and bathroom made it difficult to give space or intervene so the way staff chose to intervene was dependent on where the staff and individual were physically at in the home at the time of the behavior.The physical layout of the house not only impacted the consistency of redirecting these behaviors, but this also directly impacted the increased staff injuries and the requests to develop a new site around the person’s sensory needs. \r\n\r\nThe last impact to the staff being unable to consistently redirect behavior with one staff was the difficulty in matching staff to the needs of the people in the home. The difficulty in matching staff was influenced by the person tending to work best with male staff (2 particular staff) but also the low applicant pool fitting the person’s preference.  The low applicant pool was influenced by the current workforce shortage in the community and state. ',1,NULL,NULL,NULL,NULL,NULL),(40678,213,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40679,213,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40680,213,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40681,213,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40682,213,23,81,10,109,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40683,213,23,81,10,110,'Free_Text','The examples of Demand Resource Mismatch & Prescribed Practice (policies, resource constraints, etc.) influenced the ability to have \"success\" working as a team. \r\n\r\nThis request was subsequently denied by the county due to the county being unaware of available funds for modification for new development and that the county had limited foster care development. The limited foster care development was influenced by the county having a high number of foster care homes serving individuals from other counties along with a statewide moratorium on the creation of foster care beds, which in essence was a hold in developing further beds. This moratorium not only limited the foster care development in the county, but it also impacted the elimination of institutions in the state and left few alternative housing options. Other influences of the elimination of institutions was the Jensen Settlement and the Minnesota Olmstead Plan which found that individuals with disabilities were unconstitutionally secluded and the plan detailed a way to ensure that individuals with disabilities live in the most integrated setting appropriate for their needs.\r\n\r\nWhen the roommate passed away, the provider inquired about adding a staff but were told that 2:1 staff couldn’t be reimbursed. This was impacted by the county not moving forward with the rate exception due to the needs of the person not changing, which in turn was influenced by the banding for the state rate allowing limited rate increase for service intensity. ',1,NULL,NULL,NULL,NULL,NULL),(40684,213,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40685,213,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40686,213,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40687,213,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40688,213,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40689,213,23,81,10,116,'Free_Text','The services being terminated for a person due to concerns for staff safety were impacted by increased staff injuries. The physical aggression displayed by the person was increasing, which led to the increased staff injuries and the person damaging the house. Staff were not always able to be consistent when redirecting behavior with just one staff which impacted the increased staff injuries. The pressure from the worker’s compensation agency influenced the services terminated due to the concerns for staff safety. The number of workman’s comp claims influenced the pressure from this agency, which was impacted by the increased injuries to staff.\r\n\r\nThe attempts and barriers to create the right service environment were also an influence to the terminating the person’s services due to concerns for staff safety. This was due to the 2:1 staff not being able to be reimbursed as previously mentioned because the staffing in the home changed but not the person’s needs. It also was influenced by county’s denial of the request to develop a new site around the person’s sensory needs. Subsequently, previous attempts to terminate service were not followed through on due to lack of providers which was impacted by the view that a part of the continuum of care for people with challenging behaviors statewide is missing. This missing part of the continuum is influenced by the lack of crisis respite providers, a lack of service availability between crisis residential services and hospitals, and few services for adults with autism. The effort to eliminate institutions and the DWRS has impacted the missing part of the continuum. The goal of the elimination of institutions to promote community living is generally seen as good; however, the lack of alternatives is what is most problematic to serve this population. ',1,NULL,NULL,NULL,NULL,NULL),(40690,213,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40691,213,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40692,213,23,81,10,119,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40693,213,23,81,10,120,'Free_Text','This missing part of the continuum is influenced by the lack of crisis respite providers, a lack of service availability between crisis residential services and hospitals, and few services for adults with autism. The effort to eliminate institutions and the DWRS has impacted the missing part of the continuum. The goal of the elimination of institutions to promote community living is generally seen as good; however, the lack of alternatives is what is most problematic to serve this population.',1,NULL,NULL,NULL,NULL,NULL),(40694,213,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40695,213,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40696,213,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40697,213,23,81,10,124,'Free_Text','\"Note: a key part of the example of drift stems out of this...The staff attached to the roommate who passed away would often intervene in de-escalating and responding to the person’s physically aggressive behavior...then additional system constraints with DWRS impacted not being able to change the staff ratio to 2:1.\"\r\n\r\nAnother impact of staff being unable to consistently redirect behaviors with one staff was the staffing level dropped in the home in 2017 after a roommate passed away. When the person passed away, the home reduced their staff level to coincide with the reduced reimbursement that came from that person’s residence in the home. The staff attached to the roommate who passed away would often intervene in de-escalating and responding to the person’s physically aggressive behavior. When the roommate passed away, the provider inquired about adding a staff but were told that 2:1 staff couldn’t be reimbursed. This was impacted by the county not moving forward with the rate exception due to the needs of the person not changing, which in turn was influenced by the banding for the state rate allowing limited rate increase for service intensity. ',1,NULL,NULL,NULL,NULL,NULL),(40698,213,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40699,213,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40700,213,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40701,214,23,81,10,76,'Short_Answer','201901897',1,NULL,NULL,NULL,NULL,NULL),(40702,214,23,81,10,77,'Date','2019-05-15',1,NULL,NULL,NULL,NULL,NULL),(40703,214,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40704,214,23,81,10,79,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(40705,214,23,81,10,80,'Short_Answer','Westview Services',1,NULL,NULL,NULL,NULL,NULL),(40706,214,23,81,10,81,'Short_Answer','David Birkhofer JR',1,NULL,NULL,NULL,NULL,NULL),(40707,214,23,81,10,82,'Short_Answer','dbirkhofer@westview-services.com',1,NULL,NULL,NULL,NULL,NULL),(40708,214,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40709,214,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(40710,214,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40711,214,23,81,10,86,'Date','2019-03-12',1,NULL,NULL,NULL,NULL,NULL),(40712,214,23,81,10,87,'Free_Text','Staff was doing shift change on overnight shift and became distracted, leaving a card of a controlled medication (lorazepam) on the counter. Isaiah saw the med card, took in and brought it to his room. In the morning it was discovered after doing controlled medication counts that a sheet of the bubble wrapped Ativan was missing. The medication card was found in Isaiah’s possession and there were 12 tablets missing. Isaiah reported that he had taken 12 tablets of the medication. Once discovered, staff called nurse immediately to report. Nurse instructed staff to bring Isaiah to the emergency room. Isaiah was able to be aroused but groggy. After the emergency room evaluation, it was determined that Isaiah could return to the foster care home. No hospitalization required.',1,NULL,NULL,NULL,NULL,NULL),(40713,214,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40714,214,23,81,10,91,'Short_Answer','Individual had access to medications.',1,NULL,NULL,NULL,NULL,NULL),(40715,214,23,81,10,94,'True_or_False','No',1,NULL,NULL,NULL,NULL,NULL),(40716,214,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40717,214,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40718,214,23,81,10,99,'Multiple_Choice','Staff No Longer Employed',1,NULL,NULL,NULL,NULL,NULL),(40719,214,23,81,10,100,'Free_Text','The individual’s access to medication was impacted by the staff’s shift change and set up of the office. Staff was focused on completing a shift change task, of medication reconciling and money reconciling. The medication reconciling and money reconciling are necessary by M.S. 245 licensing requirements and reflected the provider’s attempts to maintain compliance. The staff’s focus of attention to the tasks was impacted as the staff had limited time during shift change. Often times, overlap of staff is only a few minutes, which is why staff adapted to combine the reconciliation processes to complete it quickly. \r\n\r\nImpacting the limited amount of time for shift changes was that the provider could not schedule much overlap between staff during shift changes. Contributing to the limited time was that routine staffing patterns do not allow for staff overlap at shift change. Labor laws can influence staffing patterns by dictating the number of hours individuals can work and the requirement to receive compensation for time worked, including overtime pay. The staffing patterns are both impacted by and impacting the fiscal constraints of the provider. These patterns dictate the level of staffing required for individuals in the home and does not allow for the provider to hire additional staff.  The Rate Management Worksheet (6790) identifies the staffing need of the individual, but does not account for the needs of the provider to support the individual; therefore this impacts the staffing patterns of the home. The MnCHOICES assessment which is completed by the county influences the 6790 by determining the level of care – including staff hours – a person may need. The Rate Management System (RMS) which calculates rates based on information received in the 6790 has a reciprocating impact with the 6790 in that RMS factors in legislative constraints to rates as well as the flexible components negotiated during the 6790 process. The RMS is influenced by both the Disability Waiver Rate System (DWRS) and The Center for Medicare and Medicaid Services (CMS) defined services for indirect and direct care. Only direct service time as defined by CMS and the waiver plan can be included on a 6790 for this service, and as staff coordination is indirect time, this time cannot be added to the worksheet. Therefore, there is no compensation to the provider for overlap in staffing to allow for a shift change because this is considered to be indirect time. The Legislative decisions also impact the DWRS as the legislature creates and amends the rate components set in Minnesota statutes (256B) which directly impacts the rates providers receive to staff homes.',1,NULL,NULL,NULL,NULL,NULL),(40720,214,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40721,214,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40722,214,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40723,214,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40724,214,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40725,214,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40726,214,23,81,10,101,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40727,214,23,81,10,102,'Free_Text','Staff was focused on completing a shift change task, of medication reconciling and money reconciling. The staff’s focus of attention to the tasks was impacted as the staff had limited time during shift change.',1,NULL,NULL,NULL,NULL,NULL),(40728,214,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40729,214,23,81,10,104,'Free_Text','The staffing patterns are both impacted by and impacting the fiscal constraints of the provider. These patterns dictate the level of staffing required for individuals in the home and does not allow for the provider to hire additional staff.  ',1,NULL,NULL,NULL,NULL,NULL),(40730,214,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40731,214,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40732,214,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40733,214,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40734,214,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40735,214,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40736,214,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40737,214,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40738,214,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40739,214,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40740,214,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40741,214,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40742,214,23,81,10,117,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40743,214,23,81,10,118,'Free_Text','Often times, overlap of staff is only a few minutes, which is why staff adapted to combine the reconciliation processes to complete it quickly. ',1,NULL,NULL,NULL,NULL,NULL),(40744,214,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40745,214,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40746,214,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40747,214,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40748,214,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40749,214,23,81,10,124,'Free_Text','Often times, overlap of staff is only a few minutes, which is why staff adapted to combine the reconciliation processes to complete it quickly. ',1,NULL,NULL,NULL,NULL,NULL),(40750,214,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40751,214,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40752,214,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40753,215,23,81,10,76,'Short_Answer','KS_Westview-SLC-2021-02',1,NULL,NULL,NULL,NULL,NULL),(40754,215,23,81,10,77,'Date','2021-02-25',1,NULL,NULL,NULL,NULL,NULL),(40755,215,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40756,215,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40757,215,23,81,10,80,'Short_Answer','Westview Services',1,NULL,NULL,NULL,NULL,NULL),(40758,215,23,81,10,81,'Short_Answer','David Birkhofer',1,NULL,NULL,NULL,NULL,NULL),(40759,215,23,81,10,82,'Short_Answer','dbirkhofer@westview-services.com',1,NULL,NULL,NULL,NULL,NULL),(40760,215,23,81,10,83,'Short_Answer','218-348-1040',1,NULL,NULL,NULL,NULL,NULL),(40761,215,23,81,10,84,'Multiple_Choice','COVID',1,NULL,NULL,NULL,NULL,NULL),(40762,215,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40763,215,23,81,10,86,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40764,215,23,81,10,87,'Free_Text','Westview Services staff are not wearing masks while working or following the COVID-19 safety policies  put into effect by Department of Health and human services such as sanitizing every 2 hours, socially distancing clients and themselves, not sharing items and not wearing gloves during food prep. Also our water scalds us here!',1,NULL,NULL,NULL,NULL,NULL),(40765,215,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40766,215,23,81,10,91,'Short_Answer','Barriers to supporting people while implementing COVID policies/protocols.',1,NULL,NULL,NULL,NULL,NULL),(40767,215,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40768,215,23,81,10,97,'Date','2021-03-11',1,NULL,NULL,NULL,NULL,NULL),(40769,215,23,81,10,98,'Free_Text','Westview has 6 homes in total with 4 residents living at each home. The staffing patterns typically consist of two workers from 7:00 a.m. to 11:30 p.m. and one awake overnight. The homes tend to be fairly active with trying to do outings and activities such as ball games, bowling, going for drives, etc.\r\n\r\nWhen the CDC and Department of Health set out instructions for individuals to not go anywhere if they don’t have to, residents who were working were pulled back from work and remained in their home. Activities that the workers typically brought people to were pulled back as well. Consequently, there ended up being a sense of fear from the residents. Many of them watch the news and that seemed to be all they were seeing and hearing. There was some increased frustration with some residents as they were unable to do the things they typically do, particularly as these delays went on for so long.\r\n\r\nWhen a home needed to quarantine, it tended to feel like a crazy two weeks. Each time a staff member needed to quarantine or residents ended up positive, there were a core group of staff members who tended to pull together to ensure coverage was provided. While they saw some staff members leave when the $600 unemployment went into effect and people felt they could remain at home and be safe while getting paid. There were attempts made to ensure that sanitizing and safety protocols were in place to minimize risk, but when staff chose to participate in non-work activities that were outside of their work schedule which presented risks, this created a greater burden. Supervisors reminded them to keep the individuals they support in mind when they choose to do certain activities. Individual texts would get sent out to provide those reminders as well. If traveling, quarantining for 3 days (unpaid) and negative COVID test were required.\r\n\r\nThere was some concern of decompensation that was noticed in residents. Some remained fearful to the point where there was concern noted that some may be developing agoraphobia. Many residents did in fact choose to get vaccinated with only one declining. They are hopeful to get back to normal for the majority, but there remain a handful of individuals who will require work and time to get back to where they were at prior to COVID. There are some concerns that pressures will occur from social workers to work on goals where some individuals will simply need time to slowly acclimate back into society again. Some residents really struggled with the mask wearing by staff members. They were unable to recognize the staff members and this frightened them. Many staff members learned that they would need to greet the resident with their mask pulled down so the resident could identify them prior to beginning their work day. \r\n\r\nThere are some things that were identified during this that go against the work that has tried to be done. One of those is having a person centered organization. They’ve worked hard to keep people’s choices in mind, but in the last year found them minimizing these choices and at times telling someone no, they couldn’t do something. The other concern is that staff have lost confidence in making decisions as this time has created some uncertainty for them in their day to day work and the quick changes that have occurred. The impact on staff can be notable for some. Since there are not as many outings and activities happening, they have found increased down time with some staff members. They anticipate losing some staff members as the work changes because expectations will be higher and the work will inadvertently become busier as they resume activities.\r\n',1,NULL,NULL,NULL,NULL,NULL),(40770,215,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40771,215,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40772,215,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40773,215,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40774,215,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40775,215,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40776,215,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40777,215,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40778,215,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40779,215,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40780,215,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40781,215,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40782,215,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40783,215,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40784,215,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40785,215,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40786,215,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40787,215,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40788,215,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40789,215,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40790,215,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40791,215,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40792,215,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40793,215,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40794,215,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40795,215,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40796,215,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40797,215,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40798,215,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40799,215,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40800,215,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40801,215,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40802,215,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40803,215,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40804,215,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40805,216,23,81,10,76,'Short_Answer','201904881',1,NULL,NULL,NULL,NULL,NULL),(40806,216,23,81,10,77,'Date','2019-08-15',1,NULL,NULL,NULL,NULL,NULL),(40807,216,23,81,10,78,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(40808,216,23,81,10,79,'Multiple_Choice','Tim Sullivan',1,NULL,NULL,NULL,NULL,NULL),(40809,216,23,81,10,80,'Short_Answer','Accessible Spaces - Silver Lake',1,NULL,NULL,NULL,NULL,NULL),(40810,216,23,81,10,81,'Short_Answer','Stephen Vander Schaaf',1,NULL,NULL,NULL,NULL,NULL),(40811,216,23,81,10,82,'Short_Answer','svanderschaaf@accessiblespace.org',1,NULL,NULL,NULL,NULL,NULL),(40812,216,23,81,10,83,'Short_Answer','6516457271',1,NULL,NULL,NULL,NULL,NULL),(40813,216,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(40814,216,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(40815,216,23,81,10,86,'Date','2019-07-04',1,NULL,NULL,NULL,NULL,NULL),(40816,216,23,81,10,87,'Free_Text','Reporter heard from staff at VA\'s group home today that VA left sometime between mid day on 7/3/2019 and early morning 7/4/2019. VA\r\ntold one staff member on 7/3/2019, \"I\'m moving out.\" and when the staff asked where VA told him \"I\'m not going to tell you.\" and VA was\r\nnoticed gone early in the morning of 7/4/2019. VA\'s Case manager has received a voice message from VA saying that she is ok and\r\neverything is fine but has not spoken with VA yet. Reporter has tried contacting VA but after ringing a few times VA\'s phone goes to voice\r\nmail and VA\'s voice mail is currently full.',1,NULL,NULL,NULL,NULL,NULL),(40817,216,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40818,216,23,81,10,91,'Short_Answer','Staff did not report Individual\'s absence for 5 days.',1,NULL,NULL,NULL,NULL,NULL),(40819,216,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40820,216,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40821,216,23,81,10,98,'Free_Text','Incident report description\r\nIncident date:	07/04/2019\r\nIt was reported to CEP, that the individual left her group home, which was noted the early morning of 7-4-19, and has not returned for 5 days.  The reporter of the incident had been told by group home staff that the individual had told staff “I’m moving out”.   When staff asked where, the individual stated, “I’m not going to tell you”.  The individual’s case manager reportedly tried calling the individual, but her phone goes to voicemail and message states it is full.\r\n\r\nDebriefing information for Learning Point \r\nDebriefing date: November 18, 2019\r\nPerson debriefed: Home Supervisor\r\nIndividual is her own guardian and has an ongoing medical condition which requires her to attend numerous and frequent medical appointments and at times hospitalizations.  There is only one staff on site at the 4-person group home at a time.  This individual makes and attends her medical appointments by herself and is allowed to be in the community unsupervised.  \r\n\r\nDuring the time of the incident, the home supervisor was on vacation.  Several days prior to the incident, the individual reported to staff that she was moving out of the group home.  The individual reportedly stated she was not going to tell staff where.  One staff emailed the home supervisor (who was on vacation) a day after the incident asking the supervisor if she was aware the individual was moving out of the group home.  \r\n\r\nThe morning of the incident, the individual reported to early morning staff she was moving and would not say where to.  At the time she left the group home, she told a different staff she was going to the hospital.  The individual had unspecified alone time in the community, so staff did not follow her. It was typical for her to leave to do what she wanted without telling staff where she was going. Staff also believed the individual was going to the hospital and did not follow elopement protocol. \r\n\r\nThe individual did not come back to the group home the evening she left.  Staff did not follow up with trying to call the individual, or the covering supervisor, case manager of individual or 911.  Staff believed the individual had either moved out of the home or was hospitalized and due to individual being her own guardian, did not consider this an elopement.   \r\n\r\nWhen the supervisor returned from vacation, she followed up by calling case manager, individual, and reporting the incident.  The individual did go to the hospital and was hospitalized inpatient.  She returned to the group home.\r\n',1,NULL,NULL,NULL,NULL,NULL),(40822,216,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40823,216,23,81,10,100,'Free_Text','Narrative\r\nElopement\r\nDecember 12, 2019 Mapping\r\n\r\n\r\nLearning Point:  Staff did not report individual’s absence for 5 days.\r\n\r\nStaff not following-up about where the individual was for 5 days after she left the group home was influenced by the staff believing the notification policy wasn\'t applicable to this individual and situation. Several factors influenced staff believing the policy wasn\'t applicable including the staff and the individual being newer to the home and the individual being her own guardian.  The two newer staff were less familiar with the support needs of this individual.  As her own guardian, the individual made her own healthcare decisions and did not have to share the information with staff. The individual had a history of being admitted to a hospital without staff knowledge.  The individual had a history of hospitalizations lasting several days which further contributed to staff not believing the policy was applicable.  The provider did have a policy that emergency contacts should be notified if an individual who is their own guardian is hospitalized which was not followed because staff did not know the individual went to the hospital. \r\nOther contributing factors to staff believing the notification policy wasn\'t applicable was the individual was her own guardian and allowed to be in the community unsupervised for an indeterminate amount of time.  The individual’s Community Support Plan (CSP) and Community Support Service Plan (CSSP), which is completed by the individual and a county case manager, did not indicate how much time the individual could have.  Staff would have to follow the consented to CSP and CSSP.  Case Manager’s comply with 245D for how and what is written in an individual’s CSP and CSSP.  The individual approved what was included in the plans.  The individual having unspecified time in the community influenced staff\'s decision that documenting when the individual left was sufficient. The individual regularly was in the community unsupervised so staff felt like it was okay to not notify anyone beyond the logging of their activity in the individual’s logbook. It was noted that staff didn’t have much time to communicate between shifts, so communication often took place in the logbooks instead of staff communication directly with one another regarding the individual.  The individual was admitted to this home directly from a discharge from a hospital and this home was one of only two choices.\r\n\r\nAnother influencing factor affecting staff not following-up to individual’s whereabouts was the staff being worried about calling their supervisor or manager when it wasn\'t necessary due to being of a culture that deffers to authority figures.   Staff were not of the dominant culture and may have felt intimidated by calling a supervisor with questions.\r\n\r\n\r\nAdditionally, staff not following up on the individual was influenced by the house supervisor being on vacation.  At the time, the provider was short staffed and some of the shifts at this residence were covered by non-routine or fill-in staff.  A lack of cross-training on the individuals supports needs and plan of care could influence staff not reporting the individual’s whereabouts.  The provider\'s overall staff shortage, and not just this residence, contributed to having non-routine staff supporting individuals and not having enough time to train non-routine staff on all the support needs of individuals in the group home.  Staff shortage is influenced by the state and national wide direct support professional workforce shortage. \r\n\r\nStaff not following up on their individual’s whereabouts was influenced by the individual keeping an irregular schedule and would often not tell staff where she was going or would tell different information to different staff about where she was going or would be. The individual was described as having much different support needs than the three other individuals living in the group home.  The decision to place the individual in a four person home was impacted by an overall lack of community residential settings in Minnesota.  \r\n',1,NULL,NULL,NULL,NULL,NULL),(40824,216,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40825,216,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40826,216,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40827,216,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40828,216,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40829,216,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40830,216,23,81,10,101,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40831,216,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40832,216,23,81,10,103,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40833,216,23,81,10,104,'Free_Text','The individual was admitted to this home directly from a discharge from a hospital and this home was one of only two choices. The individual was admitted to this home directly from a discharge from a hospital and this home was one of only two choices.\r\n\r\nThe individual was described as having much different support needs than the three other individuals living in the group home.  The decision to place the individual in a home was impacted by an overall lack of community residential settings in Minnesota.  \r\n\r\nThe two newer staff were less familiar with the support needs of this individual.\r\n\r\nAt the time, the provider was short staffed and some of the shifts at this residence were covered by non-routine or fill-in staff.  A lack of cross-training on the individuals supports needs and plan of care could influence staff not reporting the individual’s whereabouts.  The provider\'s overall staff shortage, and not just this residence, contributed to having non-routine staff supporting individuals and not having enough time to train non-routine staff on all the support needs of individuals in the group home.  \r\n\r\n\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40834,216,23,81,10,105,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40835,216,23,81,10,106,'Free_Text','The individual’s Community Support Plan (CSP) and Community Support Service Plan (CSSP), which is completed by the individual and a county case manager, did not indicate how much time the individual could have.  Staff would have to follow the consented to CSP and CSSP.  Case Manager’s comply with 245D for how and what is written in an individual’s CSP and CSSP.  ',1,NULL,NULL,NULL,NULL,NULL),(40836,216,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40837,216,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40838,216,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40839,216,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40840,216,23,81,10,111,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40841,216,23,81,10,112,'Free_Text','Staff not following-up about where the individual was for 5 days after she left the group home was influenced by the staff believing the notification policy wasn\'t applicable to this individual and situation. Several factors influenced staff believing the policy wasn\'t applicable including the staff and the individual being newer to the home and the individual being her own guardian.  \r\n\r\nThe individual having unspecified time in the community influenced staff\'s decision that documenting when the individual left was sufficient. The individual regularly was in the community unsupervised so staff felt like it was okay to not notify anyone beyond the logging of their activity in the individual’s logbook. \r\n\r\n As her own guardian, the individual made her own healthcare decisions and did not have to share the information with staff. The individual had a history of being admitted to a hospital without staff knowledge.  The individual had a history of hospitalizations lasting several days which further contributed to staff not believing the policy was applicable. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40842,216,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40843,216,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40844,216,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40845,216,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40846,216,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40847,216,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40848,216,23,81,10,119,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40849,216,23,81,10,120,'Free_Text','The individual was described as having much different support needs than the three other individuals living in the group home.  The decision to place the individual in a four person home was impacted by an overall lack of community residential settings in Minnesota.  ',1,NULL,NULL,NULL,NULL,NULL),(40850,216,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40851,216,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40852,216,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40853,216,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40854,216,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40855,216,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40856,216,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40857,217,23,81,10,76,'Short_Answer','MB_Dungarvin-HC-2020-05',1,NULL,NULL,NULL,NULL,NULL),(40858,217,23,81,10,77,'Date','2020-05-29',1,NULL,NULL,NULL,NULL,NULL),(40859,217,23,81,10,78,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(40860,217,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40861,217,23,81,10,80,'Short_Answer','Dungarvin',1,NULL,NULL,NULL,NULL,NULL),(40862,217,23,81,10,81,'Short_Answer','Shari Newgard',1,NULL,NULL,NULL,NULL,NULL),(40863,217,23,81,10,82,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40864,217,23,81,10,83,'Short_Answer','651-699-6050 (x5682)',1,NULL,NULL,NULL,NULL,NULL),(40865,217,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(40866,217,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(40867,217,23,81,10,86,'Date','2020-02-24',1,NULL,NULL,NULL,NULL,NULL),(40868,217,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40869,217,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40870,217,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40871,217,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(40872,217,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40873,217,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40874,217,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40875,217,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40876,217,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40877,217,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40878,217,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40879,217,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40880,217,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40881,217,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40882,217,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40883,217,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40884,217,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40885,217,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40886,217,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40887,217,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40888,217,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40889,217,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40890,217,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40891,217,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40892,217,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40893,217,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40894,217,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40895,217,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40896,217,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40897,217,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40898,217,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40899,217,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40900,217,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40901,217,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40902,217,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40903,217,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40904,217,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40905,217,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40906,217,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40907,217,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40908,217,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40909,218,23,81,10,76,'Short_Answer','201905859',1,NULL,NULL,NULL,NULL,NULL),(40910,218,23,81,10,77,'Date','2019-09-16',1,NULL,NULL,NULL,NULL,NULL),(40911,218,23,81,10,78,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(40912,218,23,81,10,79,'Multiple_Choice','Sara Romagnoli',1,NULL,NULL,NULL,NULL,NULL),(40913,218,23,81,10,80,'Short_Answer','Meridian Services, Inc - Kentucky',1,NULL,NULL,NULL,NULL,NULL),(40914,218,23,81,10,81,'Short_Answer','Ginny Benson',1,NULL,NULL,NULL,NULL,NULL),(40915,218,23,81,10,82,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40916,218,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40917,218,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(40918,218,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(40919,218,23,81,10,86,'Date','2019-08-09',1,NULL,NULL,NULL,NULL,NULL),(40920,218,23,81,10,87,'Free_Text','Vincent was released from the hospital on 8/9/2019 at approximately 10:30am to Meridian Services-Kentucky site.\r\nThis is a short term transition/crisis home home until permanent placement can be found. On Vincent\'s discharge orders he was\r\nprescribed Depakote 500mg each morning and 2000mg each evening for mood irritability. This order was not put on Vincent\'s medication\r\nadministration record at the Meridian site. Due to not being on the MAR, Vincent was not administered this medication. The error was\r\ndiscovered today at approximately 3:50pm. After consulting with our LPN, the medication will be started tonight as ordered. Vincent\'s last\r\ndose of administration would have been on Friday, August 9th 8:00am at the hospital before discharge.\r\n\r\nThe MAR was created by Alan Sloan, Program Manager at Kentucky. He also did the initial set-up in the medi-set. Stephanie Hughes did\r\nthe double check on the medi-set prior to being made available to staff for administration.',1,NULL,NULL,NULL,NULL,NULL),(40921,218,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40922,218,23,81,10,91,'Short_Answer','Individual\'s Medication Administration Record (MAR) listed a daily medication as a PRN (as needed) medication.',1,NULL,NULL,NULL,NULL,NULL),(40923,218,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40924,218,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40925,218,23,81,10,98,'Free_Text','Incident report description\r\nIndividual was discharged directly from the hospital to Meridian Kentucky, a Transition Home for adults.  Individual was prescribed Depakote 500 mg in the morning and 2000 mg in the evening every day for mood irritability per his discharge medication order.  Depakote was not put on the Medication Administration Record (MAR) at Meridian Kentucky as a daily medication, but as a PRN.  Due to not being on the MAR as a daily medication, the individual was not administered his medication for 8 administrations from 8/9 to 8/13.  The error was discovered mid-afternoon on 8/13 and the Meridian LPN called and who recommended medication be started again at individual’s night administration. \r\n\r\nDebriefing Information for Learning Point \r\nDebriefing date:	November 18, 2019\r\nPerson debriefed:	Program Administrator\r\nMeridian staff, including the Program Manager of Kentucky went to the hospital to pick up individual to transport to Meridian Kentucky.  The Program Manager was given the individual’s Medication Orders signed by a physician, a Discharge Summary and the individual’s medication in prescription bottles.   At Meridian Kentucky, the Program Manager then completed the Medication Administration Record from the Discharge Summary which listed all the individual’s prescribed medications.  The MAR’s is used for staff to follow when administering the individual’s medication.  Then a lead staff reviewed/checked the MARS completed by the Program Manager for accuracy.  The lead staff signed off on the correctness of MARS.  \r\n\r\nThe Program Manager who completed the MARS no longer works for Meridian, not due to this incident but leaving state and was not available to be debriefed.  The Program Administrator (PA) of Meridian Kentucky was debriefed.  PA explained there are several checks and double checks documented in the process of completing a MARS.  The first was that when an individual is admitted directly from being discharged at hospital, that the actual signed Medication Order and the prescription bottles are to be reviewed to assure they match at the hospital.  Then the Program Manager should review the Medication Orders, and prescription bottles at the group home to again insure the match and then complete the MARS.  The PA stated that this was the first time the Program Manager had completed the MARS without supervision.  Then the process is the double checker, Lead Staff in this case, who was recently promoted and was her first time being a double checker, was to compare the signed order Medication Order, with the completed MARS, then compare the MARS to the created “medi-set” of prescribed medications, then the completed medi-set back to the prescribed bottles. \r\n\r\nThe PA explained that the Program Manager was a newer employee to Meridian Services, had worked at this job for about 8 months, and again, it was the first time completing an intake and MARS independently.  The PA also stated the Program Manager developed the MARS with medication information from the Discharge Summary which also listed the prescribed medications.  The individual had an over the counter PRN listed on the Discharge Summary, and right below this PRN, Depakote was listed so it appeared it was also a PRN.  As stated previously, this was also the first time the Lead Staff, recently promoted, was responsible for double checking a MARS.  The Lead Staff noted the error around 4 days later.\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40926,218,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40927,218,23,81,10,100,'Free_Text','The Program Manager (PM) listing the daily medication as a PRN medication in the Medication Administration Record (MAR) was influenced by it being the PM\'s first time creating a MAR for a new admission of a person that was coming from a hospital discharge. The PM was working in an unfamiliar environment coordinating a discharge from the hospital and had never completed the forms related to both a hospital discharge and new admission to the provider. Further complicating this process was that PM felt pressure from the hospital to complete the discharge quickly. In turn, the PM felt rushed to complete the discharge process which includes creating a MARS due to hospital beds are in high demand due to a very low availability of psychiatric beds. This is influenced by the state regulating the number of hospital beds that need to be available as psychiatric beds.   \r\n\r\nOn the hospital discharge summary report the medications were in a list. The daily medication was listed right below the PRN category which influenced the PM\'s decision to list it as a PRN. The confusing layout of the discharge summary was influenced by the hospital\'s lack of understanding of licensed crisis homes.\r\n\r\nAdditionally, the PM listing the daily medication as a PRN medication was influenced by it being their first time creating a MAR without the house supervisor. The PM didn\'t typically work with PRNs and when they did, the house supervisor was leading the process in creating the MAR. \r\n\r\nAfter the MAR was completed, the home’s House Supervisor double checked the MAR for accuracy. Further contributing to the daily medication being incorrectly listed in the MAR is that the House Supervisor that completed the double check didn\'t catch the error on the MAR. The House Supervisor not identifying the error was influenced by her being new to the position and it was the first time they completed a double check of a MAR after a hospital discharge.   The double checker  may have been hesitant to correct her direct supervisor.\r\n\r\nAn additional factor influencing the PM listing the daily med as a PRN was that the MAR is created by the provider. Staff felt like the provider staff are not as knowledgeable about medications as a hospital or pharmacy would be. It was the provider\'s responsibility to create the MAR when the person was discharged from the hospital. The provider had a practice of signing and preparing medication orders 24-48 hours before admission to the provider’s residence. Confirming medication regimen prior to admission was a practice developed to decrease medication errors and ensure continuity between settings. However, sometimes there are medication changes at the hospital during that 24-48 hour window and that information may not be shared or updated within the MAR. While this practice of preparing the medication order in advance wasn’t required, it was influenced by licensing and liability laws for providers and the medication administration policies the provider created.  The provider’s medication administration policies were influenced by the county assigning the responsibility to providers and 245D licensing requirements.\r\n',1,NULL,NULL,NULL,NULL,NULL),(40928,218,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40929,218,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40930,218,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40931,218,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40932,218,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40933,218,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40934,218,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40935,218,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40936,218,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40937,218,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40938,218,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40939,218,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40940,218,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40941,218,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40942,218,23,81,10,109,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40943,218,23,81,10,110,'Free_Text','On the hospital discharge summary report the medications were in a list. The daily medication was listed right below the PRN category which influenced the PM\'s decision to list it as a PRN. The confusing layout of the discharge summary was influenced by the hospital\'s lack of understanding of licensed crisis homes.\r\n\r\nThe provider had a practice of signing and preparing medication orders 24-48 hours before admission to the provider’s residence. Confirming medication regimen prior to admission was a practice developed to decrease medication errors and ensure continuity between settings. However, sometimes there are medication changes at the hospital during that 24-48 hour window and that information may not be shared or updated within the MAR. While this practice of preparing the medication order in advance wasn’t required, it was influenced by licensing and liability laws for providers and the medication administration policies the provider created.  The provider’s medication administration policies were influenced by the county assigning the responsibility to providers and 245D licensing requirements.',1,NULL,NULL,NULL,NULL,NULL),(40944,218,23,81,10,111,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40945,218,23,81,10,112,'Free_Text','The Program Manager (PM) listing the daily medication as a PRN medication in the Medication Administration Record (MAR) was influenced by it being the PM\'s first time creating a MAR for a new admission of a person that was coming from a hospital discharge.  The PM was working in an unfamiliar environment coordinating a discharge from the hospital and had never completed the forms related to both a hospital discharge and new admission to the provider.\r\n\r\nAdditionally, the PM listing the daily medication as a PRN medication was influenced by it being their first time creating a MAR without the house supervisor. The PM didn\'t typically work with PRNs and when they did, the house supervisor was leading the process in creating the MAR. \r\n\r\nFurther contributing to the daily medication being incorrectly listed in the MAR is that the House Supervisor that completed the double check didn\'t catch the error on the MAR. The House Supervisor not identifying the error was influenced by her being new to their position and it was the first time they completed a double check of a MAR after a hospital discharge.   ',1,NULL,NULL,NULL,NULL,NULL),(40946,218,23,81,10,113,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40947,218,23,81,10,114,'Free_Text','On the hospital discharge summary report the medications were in a list. The daily medication was listed right below the PRN category which influenced the PM\'s decision to list it as a PRN. The confusing layout of the discharge summary was influenced by the hospital\'s lack of understanding of licensed crisis homes.',1,NULL,NULL,NULL,NULL,NULL),(40948,218,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40949,218,23,81,10,116,'Free_Text','The provider had a practice of signing and preparing medication orders 24-48 hours before admission to the provider’s residence. Confirming medication regimen prior to admission was a practice developed to decrease medication errors and ensure continuity between settings. However, sometimes there are medication changes at the hospital during that 24-48 hour window and that information may not be shared or updated within the MAR. While this practice of preparing the medication order in advance wasn’t required, it was influenced by licensing and liability laws for providers and the medication administration policies the provider created.  The provider’s medication administration policies were influenced by the county assigning the responsibility to providers and 245D licensing requirements.',1,NULL,NULL,NULL,NULL,NULL),(40950,218,23,81,10,117,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40951,218,23,81,10,118,'Free_Text','Further complicating this process was that PM felt pressure from the hospital to complete the discharge quickly. In turn, the PM felt rushed to complete the discharge process which includes creating a MARS due to hospital beds are in high demand due to a very low availability of psychiatric beds',1,NULL,NULL,NULL,NULL,NULL),(40952,218,23,81,10,119,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40953,218,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40954,218,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40955,218,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40956,218,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40957,218,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40958,218,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40959,218,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40960,218,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40961,219,23,81,10,76,'Short_Answer','Care Manager',1,NULL,NULL,NULL,NULL,NULL),(40962,219,23,81,10,77,'Date','2020-01-28',1,NULL,NULL,NULL,NULL,NULL),(40963,219,23,81,10,78,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(40964,219,23,81,10,79,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40965,219,23,81,10,80,'Short_Answer','Options Residential',1,NULL,NULL,NULL,NULL,NULL),(40966,219,23,81,10,81,'Short_Answer','Chantal Kraemer',1,NULL,NULL,NULL,NULL,NULL),(40967,219,23,81,10,82,'Short_Answer','CKraemer@optionsminnesota.com',1,NULL,NULL,NULL,NULL,NULL),(40968,219,23,81,10,83,'Short_Answer','952-564-3030',1,NULL,NULL,NULL,NULL,NULL),(40969,219,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(40970,219,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(40971,219,23,81,10,86,'Date','2019-11-05',1,NULL,NULL,NULL,NULL,NULL),(40972,219,23,81,10,87,'Free_Text','Individual’s DD Waiver residential services were terminated.  The provider stated that the termination was “necessary for your welfare and your needs cannot be met in this facility”, the “safety of you or others in the program is endangered and positive strategies were attempted and have not achieved and effectively maintained safety of you and others” and lastly that the “health of you and others in the program would otherwise be endangered”.  ',1,NULL,NULL,NULL,NULL,NULL),(40973,219,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40974,219,23,81,10,91,'Short_Answer','Service Termination due to individual’s needs not being able to be met in the group home.',1,NULL,NULL,NULL,NULL,NULL),(40975,219,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40976,219,23,81,10,97,'Date','2020-05-01',1,NULL,NULL,NULL,NULL,NULL),(40977,219,23,81,10,98,'Free_Text','The individual was admitted to this home in 2015 directly from the hospital.  He is diagnosed with Autism Spectrum Disorder and Other Intellectual Disability.  At the time of his admission the individual was described as only communicating in 2-3 word utterances and by pointing.  Those debriefed made the comment he is very smart.  The individual was admitted directly from a psychiatric hospital discharge and described as very medicated.  The individual’s parents are his guardians.\r\nAt the beginning, the individual had significant interfering behavioral issues including aggression towards others and significant property destruction.  The provider implemented positive behavioral support strategies and with a decrease in medications, notice the individual gained communication abilities.\r\nThere was a time period where the individual had a decrease in behavioral issues, was better able to express his wants and needs and advocate for himself, developed relationships with his peers in the home and became more independent and needing less support.   The provider described using the positive support strategies of using a punching bag and speed bag to provide the individual with needed physical activity he found rewarding, used white noise in his room to help with his sensitivity to sounds his housemates made and he was able to go to his favorite activity Comacon.  \r\nUnfortunately, a housemate the individual was very close to in the home, described more like a sibling, passed away.  A new resident was eventually admitted, who was smaller in stature, cognitively functioned lower and made loud verbalizations.  \r\nThe individual began aggressing towards the new peer and had an increase in behaviors, again including significant property destruction.  The provider enlisted the services of a Behavior Analyst who found clear antecedents to the individual’s interfering behaviors which were his housemates waking earlier than he would like and making noise or peers doing an activity he did not want them to do. \r\nBeing aware the antecedents couldn’t be changed; the provider advocated the individual have a Person-Centered Plan completed.  The individual was very clear that he wanted to live on his own where he could control the environment. The provider also agreed this would be an appropriate setting with supports and even offered a residential setting where this could happen.  The individual’s guardians did not agree with this plan as they felt the individual required 24 hour support.\r\nThe provider decided to demit the individual as the setting he was in was not meeting his needs, nor was it the environment the client wanted to live in. ',1,NULL,NULL,NULL,NULL,NULL),(40978,219,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40979,219,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40980,219,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40981,219,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40982,219,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40983,219,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40984,219,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40985,219,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40986,219,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40987,219,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40988,219,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40989,219,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40990,219,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40991,219,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40992,219,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40993,219,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40994,219,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40995,219,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40996,219,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40997,219,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40998,219,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40999,219,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41000,219,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41001,219,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41002,219,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41003,219,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41004,219,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41005,219,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41006,219,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41007,219,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41008,219,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41009,219,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41010,219,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41011,219,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41012,219,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41013,220,23,81,10,76,'Short_Answer','MB_Pathways to Community-HC-2021-04',1,NULL,NULL,NULL,NULL,NULL),(41014,220,23,81,10,77,'Date','2021-04-28',1,NULL,NULL,NULL,NULL,NULL),(41015,220,23,81,10,78,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(41016,220,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41017,220,23,81,10,80,'Short_Answer','Pathways to Community',1,NULL,NULL,NULL,NULL,NULL),(41018,220,23,81,10,81,'Short_Answer','Paul McDowell',1,NULL,NULL,NULL,NULL,NULL),(41019,220,23,81,10,82,'Short_Answer','paul.mcdowell@pathwaystocommunity.com',1,NULL,NULL,NULL,NULL,NULL),(41020,220,23,81,10,83,'Short_Answer','651-641-4009',1,NULL,NULL,NULL,NULL,NULL),(41021,220,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(41022,220,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41023,220,23,81,10,86,'Date','2020-03-30',1,NULL,NULL,NULL,NULL,NULL),(41024,220,23,81,10,87,'Free_Text','Arron eloped out of sight of Pathways staff, resulting in him being missing for nearly 24 hours at the time of this report\'s submission (3/31/21, 3:00pm).  reported that staff were following Arron engaging in fast walking in the community to deescalate, that he was at a bus stop at the time staff no longer could see him, and that it is unknown whether he boarded a bus or not. \r\nEmergency services, including police departments of Minneapolis, St. Paul, and Bloomington, have reportedly been notified and are assisting in the search, and a missing person\'s report was reportedly completed as soon as supervisor was aware that he was gone from staff\'s sight. have been looking for Arron since 4:00am 3/31 and that Arron\'s mom, Linda Huber, has been looking for him all day 3/31 as well. reported the concern that if Arron liked an initial bus ride, he may have ridden several busses and now be out of range of the police departments searching for him.  \r\nArron has an autism diagnosis and a history of police-related trauma and severe aggression. He has limited verbal skills and little to no awareness of whether something is safe or dangerous, who is safe to seek assistance from, or how to keep himself safe. \r\nIt is unknown at this point if Arron is still alive, the timeline in which he will be found, if has sustained physical and/or emotional injury at this point as the result of the lack of supervision. He has for sure missed medication, supervision, access to food, and access to shelter.',1,NULL,NULL,NULL,NULL,NULL),(41025,220,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41026,220,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41027,220,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(41028,220,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41029,220,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41030,220,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41031,220,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41032,220,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41033,220,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41034,220,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41035,220,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41036,220,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41037,220,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41038,220,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41039,220,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41040,220,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41041,220,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41042,220,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41043,220,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41044,220,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41045,220,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41046,220,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41047,220,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41048,220,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41049,220,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41050,220,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41051,220,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41052,220,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41053,220,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41054,220,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41055,220,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41056,220,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41057,220,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41058,220,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41059,220,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41060,220,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41061,220,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41062,220,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41063,220,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41064,220,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41065,221,23,81,10,76,'Short_Answer','201900883',1,NULL,NULL,NULL,NULL,NULL),(41066,221,23,81,10,77,'Date','2019-05-16',1,NULL,NULL,NULL,NULL,NULL),(41067,221,23,81,10,78,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(41068,221,23,81,10,79,'Multiple_Choice','Scott Schifsky',1,NULL,NULL,NULL,NULL,NULL),(41069,221,23,81,10,80,'Short_Answer','Residential Transitions',1,NULL,NULL,NULL,NULL,NULL),(41070,221,23,81,10,81,'Short_Answer','Chrysa Reichel',1,NULL,NULL,NULL,NULL,NULL),(41071,221,23,81,10,82,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41072,221,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41073,221,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(41074,221,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41075,221,23,81,10,86,'Date','2019-02-02',1,NULL,NULL,NULL,NULL,NULL),(41076,221,23,81,10,87,'Free_Text','Individual is a 25 year old woman who lives in a 1 bedroom 245D group home in a residential area in Maple Grove.  It was reported in the CEP Intake Form that the individual was agitated around 12:00 am due to being told she could not call friends as it was too late.  An on call staff was called to help support the individual to understand it was too late to call friends.  The individual went to bed around 1:30 and locked her bedroom door.\r\n\r\nMorning staff arrived at 8:00 and knocked on individual’s door as medications needed to be administered.  Staff heard no response.  Being the door was locked, the staff obtained the key and it was then discovered the individual was not in her room.  Staff followed elopement protocol and notified on-call staff and non-emergency police.  Staff and police searched local area and found individual walking near the home and she was taken back home.\r\n\r\nIndividual stated she waited until overnight staff were in bathroom and then left the home.  She reported she walked to local Walmart, called a friend and then walked to his apartment as he was going call her an Uber.  Her friend came down to meet her, called her an Uber, she instructed the driver to drop her off at park near her group home vs her group home as she wanted to swing.  Originally the individual stated she left at 12:30 am but then stated she wasn’t sure when she left the home.\r\n\r\nIndividual complained of back and foot pain but refused to go to Urgent Care but opted to sleep.  The next morning she was willing to go and was diagnosed with First Degree Frostbite.  Doctor prescribed over the counter medication for blistering and pain.',1,NULL,NULL,NULL,NULL,NULL),(41077,221,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41078,221,23,81,10,91,'Short_Answer','The individual’s plan was to have one awake and one asleep staff on overnight shift. There was no asleep staff.',1,NULL,NULL,NULL,NULL,NULL),(41079,221,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(41080,221,23,81,10,97,'Date','2019-06-10',1,NULL,NULL,NULL,NULL,NULL),(41081,221,23,81,10,98,'Free_Text','orning staff arrived at 8:00 and knocked on individual’s door as medications needed to be administered.  Staff heard no response.  Being the door was locked, the staff obtained the key and it was then discovered the individual was not in her room.  Staff followed elopement protocol and notified on-call staff and non-emergency police.  Staff and police searched local area and found individual walking near the home and she was taken back home.\r\n\r\nIndividual stated she waited until overnight staff were in bathroom and then left the home.  She reported she walked to local Walmart, called friend and then walked to his apartment as he was going call her an Uber.  Her friend came down to meet her, called her an Uber, she instructed the driver to drop her off at park near her group home vs her group home as she wanted to swing.  Originally the individual stated she left at 12:30 am but then stated she wasn’t sure when she left the home.\r\n\r\nIndividual complained of back and foot pain but refused to go to Urgent Care but opted to sleep.  The next morning she was willing to go and was diagnosed with First Degree Frostbite.  Doctor prescribed over the counter medication for blistering and pain.',1,NULL,NULL,NULL,NULL,NULL),(41082,221,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),