{"Short_Answer__76":"2019-07-SLC-KS","Date__77":"07\/15\/2019","Multiple_Choice__78":"Kelly Sather","Multiple_Choice__79":"David Vukelich","Short_Answer__80":"Residential Services of NE MN","Short_Answer__81":"Shelia Fetters","Short_Answer__82":"sheila.fetters@residentialservices.org","Multiple_Choice__84":"Wheelchair Safety","Multiple_Choice__85":"St. Louis County","Date__86":"06\/10\/2019","Free_Text__87":"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\u2019t have the lap belt on correctly and that it was down around the individual\u2019s ankles at the time of the fall.","Multiple_Choice__96":"1","Short_Answer__91":"Staff was not able to secure seat belt at waist.","True_or_False__94":"Yes","Date__97":"08\/23\/2019","Free_Text__98":"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 \u201cmedical home\u201d. 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 \u201cthe crunch\u201d 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\u2019t 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\u2019t happen. She explained in the VOC training, they don\u2019t 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\u2019t account for this.","Free_Text__100":"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\u2019s 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\u2019s 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\u2019s 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\u2019s 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\u2019s position directly impacted staff\u2019s difficulty with the seat belt. \r\n\r\nFurther impacting the staff\u2019s increased anxiety was the staff\u2019s fear of repercussions of being late to the doctor\u2019s 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.","Multiple_Choice__101":"2","Free_Text__102":"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\u2019s increased anxiety had a reciprocal impact to one another.","Multiple_Choice__103":"0","Multiple_Choice__105":"0","Multiple_Choice__107":"0","Multiple_Choice__109":"0","Multiple_Choice__111":"3","Free_Text__112":"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\u2019s training was focused on medical needs rather than behavior management.","Multiple_Choice__113":"0","Multiple_Choice__115":"0","Multiple_Choice__117":"3","Free_Text__118":"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\u2019s increased anxiety and the attention this was drawing from the community members nearby. Further impacting the staff\u2019s increased anxiety was the staff\u2019s fear of repercussions of being late to the doctor\u2019s appointment. Further complicating the pressure on the agencies, if appointments are not made, there could be maltreatment reports made for failure to provide care.","Multiple_Choice__119":"0","Multiple_Choice__121":"0","Multiple_Choice__123":"0","Multiple_Choice__125":"0","Yes_or_No__432":"Yes"}