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15:51:17'),(13330,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16411,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-07-21 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16411}','68.53.115.247','2021-05-25 15:51:17'),(13331,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16412,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"Person had confirmed plans with staff to go to the metro area and see a friend. Due to staffing constraints, there was a change resulting in the cancellation or postponement of the trip. \\r\\n\\r\\nOn 7\\/21\\/19 the person went out for a cigarette at 2am and then allegedly went back to his room. That was the last time he was seen. It was during this time he eloped to Burnsville and MSP. Staff called 911 on or around 5:00 pm the next day once they noticed he was not in his bedroom.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16412}','68.53.115.247','2021-05-25 15:51:17'),(13332,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16413,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16413}','68.53.115.247','2021-05-25 15:51:17'),(13333,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16414,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Provider cancelled a person\'s planned trip\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16414}','68.53.115.247','2021-05-25 15:51:17'),(13334,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16415,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16415}','68.53.115.247','2021-05-25 15:51:17'),(13335,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16416,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16416}','68.53.115.247','2021-05-25 15:51:17'),(13336,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16417,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Person had been living at this house only months but had been with the same provider in a different home previously. He wanted to visit a friend near the metro area. Staff conveyed because of the distance and time for the trip it made sense that someone who was working a double shift would make the drive with him. Person followed usual and proper channels to schedule the out of town social activity.\\r\\nStaff felt that scheduling had become complicated at the time due to employees utilizing vacation time and also during that time the agency was very short staffed. The staff who was scheduled to take him on the trip during a double shift ended up not working the double shift because of how vacation was utilized. When the team saw this schedule conflict, the person was informed they couldn\\u2019t go on that weekend. He was initially disappointed, but he seemed to handle the news well after the initial disappointment. \\r\\nThe house manager usually has an assistant who arranges trips for residents. They work hard to prioritize social outings for people, trips and activities are accommodated. That assistant position was vacant and the house manager was feeling the \\u201cburn\\u201d of long hours and covering duties outside of her position. The staffing shortage made it hard to be sure residents were able to participate in desired activities.\\r\\nThe day they noticed person had eloped, staff had assumed he was sleeping in. He usually wakes by 9:00 but since he wasn\\u2019t utilizing a job coach during that time, there was no regular asleep\\/awake schedule. Also, there were no required checks in his plan. During counts, they noticed the bedroom door locked, but saw the window was open and that\\u2019s when they discovered he wasn\\u2019t there. Some of the staff were aware of his schedule change and that he was originally upset but had seemed to be fine with the change. \\r\\nPerson has history of elopement. He has a hard time making and keeping friends.  All of his housemates have girlfriends. When he elopes, they believe it is to see a female. Some of his housemates take trips together which he can\\u2019t attend due to his inability to afford the trips they take. \\r\\nHis adoptive mother\\/guardian is seen as unsupportive. There\\u2019s an impression among staff his adoptive mom and him bring out the worst in each other. They believe she expects the worst in him, affecting how he sees himself. They believe their relationship impacts his decisions in a negative way.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16417}','68.53.115.247','2021-05-25 15:51:17'),(13337,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16418,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16418}','68.53.115.247','2021-05-25 15:51:17'),(13338,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16419,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"The provider cancelling a planned trip for a person they served had a number of influences. On the morning the person was going to go on the trip, the provider was short staffed. Originally, the overnight staff was going to work a double shift by staying on for the morning shift. This staff ended up unable to work the morning shift, leaving the home with 2 staff instead of the typical 3. The provider agency was short staffed in general and did not fill the 3rd staff position for this day. The home served 4 people, 2 of which frequently exhibited challenging behavior. This level of need impacted the assignation of 3 staff to the day shifts. Also, the person\\u2019s CSSP addendum approved by the county required that the person be staffed at least 1:1 for trips, so due to short staffing it was not possible to send another staff on the trip. A factor into why 1:1 was necessary for trips was that the person had a history of abuse and because of this the guardian usually did not allow the person to meet people they met online without the 1:1 supervision required by the CSSP. Playing into the staffing requirements of the home too was the negotiation process between the county and the provider facilitated by DHS Form 6790 which determines staffing levels. This negotiation is impacted by each person in the home\\u2019s MnCHOICES assessment of need completed by the lead agency, as well as the Disability Waiver Rate Setting System which calculates service rates based on staffing needs. The Minnesota Legislature created both MnCHOICES and DWRS requirements. \\r\\nThis specific staff who couldn\\u2019t work the morning shift was the staff the person wanted to take him on the trip and he did not want to go with the other available staff. The person did not want the friend he was going to see to know he lived at the group home, and reportedly felt more comfortable going with the staff who was unable to work the morning shift. \\r\\nAnother influence to cancelling the trip was that the house manager felt burned out. The influences to the manager feeling burned out included the fact that the provider was \\u2013 as noted above - short staffed as an agency, the scheduler position who typically takes care of trips was also vacant, a number of staff were taking vacations at this time and the manager was filling a number of shifts themselves. Low unemployment rates in Minnesota and the region contributed to the provider\\u2019s short staff issue. Also, this specific trip required a staff to work more than 8 hours due to the distance of trip: driving from Duluth to the Twin Cities required 5-6 hours of drive time alone. This is why the overnight staff who was going to work the double was going to take the person. There was not any staff who could work an extra shift to take this person on the trip, let alone a staff the person wanted to go with. Typical policy was that the provider required 2 weeks notice before long trips to accommodate obtaining a guardian\\u2019s permission, case manager agreement and putting together the staffing needs, which made accommodating unexpected staff shortages difficult.  \\r\\nThe last of the influences identified was that this trip wasn\\u2019t a top priority for the staff. The person wanted to see a friend they met online in the metro area, but this person had a history of misusing social media. Specifically, when using social media, the person had a history of pretending to be someone else (known as catfishing) and, as mentioned above, had a history of being abused by people they met online. Partly due to this history, the staff wasn\\u2019t sure that the person their client wanted to visit was fully aware of who he was. Due to the vulnerability of the person and their history, the spontaneous trip didn\\u2019t meet the needs of the person.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16419}','68.53.115.247','2021-05-25 15:51:17'),(13339,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16420,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff did not perform visual checks between 2am and 5pm\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16420}','68.53.115.247','2021-05-25 15:51:17'),(13340,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16421,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"128\",\"question_type\":\"Yes_or_No\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16421}','68.53.115.247','2021-05-25 15:51:17'),(13341,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16422,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16422}','68.53.115.247','2021-05-25 15:51:17'),(13342,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16423,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":\"Person had been living at this house only months but had been with the same provider in a different home previously. He wanted to visit a friend near the metro area. Staff conveyed because of the distance and time for the trip it made sense that someone who was working a double shift would make the drive with him. Person followed usual and proper channels to schedule the out of town social activity.\\r\\nStaff felt that scheduling had become complicated at the time due to employees utilizing vacation time and also during that time the agency was very short staffed. The staff who was scheduled to take him on the trip during a double shift ended up not working the double shift because of how vacation was utilized. When the team saw this schedule conflict, the person was informed they couldn\\u2019t go on that weekend. He was initially disappointed, but he seemed to handle the news well after the initial disappointment. \\r\\nThe house manager usually has an assistant who arranges trips for residents. They work hard to prioritize social outings for people, trips and activities are accommodated. That assistant position was vacant and the house manager was feeling the \\u201cburn\\u201d of long hours and covering duties outside of her position. The staffing shortage made it hard to be sure residents were able to participate in desired activities.\\r\\nThe day they noticed person had eloped, staff had assumed he was sleeping in. He usually wakes by 9:00 but since he wasn\\u2019t utilizing a job coach during that time, there was no regular asleep\\/awake schedule. Also, there were no required checks in his plan. During counts, they noticed the bedroom door locked, but saw the window was open and that\\u2019s when they discovered he wasn\\u2019t there. Some of the staff were aware of his schedule change and that he was originally upset but had seemed to be fine with the change. \\r\\nPerson has history of elopement. He has a hard time making and keeping friends.  All of his housemates have girlfriends. When he elopes, they believe it is to see a female. Some of his housemates take trips together which he can\\u2019t attend due to his inability to afford the trips they take. \\r\\nHis adoptive mother\\/guardian is seen as unsupportive. There\\u2019s an impression among staff his adoptive mom and him bring out the worst in each other. They believe she expects the worst in him, affecting how he sees himself. They believe their relationship impacts his decisions in a negative way.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16423}','68.53.115.247','2021-05-25 15:51:17'),(13343,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16424,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16424}','68.53.115.247','2021-05-25 15:51:17'),(13344,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16425,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff not performing visual checks on a person between 2am and 5pm had a number of influences. On the day the checks were not performed, the staff did not have any reason to believe that the person had eloped. While the person did have a history of elopement, he usually exhibited telltale signs of leaving the house such as telling staff they were leaving and\\/or taking a bag with him. These typical signs were not present this day. Instead the person left without telling anyone or taking a bag with him. Adding to the lack of reason to believe the person eloped was that the person often slept in, had an inconsistent sleep schedule, and refused to eat breakfast on the weekends, so sleeping in on Saturdays was a norm . This person also did not like to be bothered and often wanted his privacy while in his room. Due to cultural norms to allow privacy to people in their bedrooms along with the provider\\u2019s licensing statute \\u2013 MS 245D \\u2013 guaranteeing a person the right to privacy, this was wish was respected. \\r\\nAn additional influence to why checks weren\\u2019t performed was that the morning shift was short staffed. The house typically required 3 staff to be on in the morning. The overnight staff was going to work a double shift by staying on for the morning shift, but was unable to work. This left the provider with only 2 staff working in the morning shift. It was a norm at the house that they were comfortable only having 2 staff on if both staff were veteran staff, which was the case this day. Although the veteran staff were comfortable working short staffed, this did mean that the two staff had more responsibilities and were thus somewhat overworked and busy that day . \\r\\n The last influence identified by the mapping team into why staff did not perform checks was that the person\\u2019s plan did not require visual checks when he was at home. The provider typically does not perform visual checks on any person while they are in their own home. This practice is impacted by cultural norms to allow people privacy in their bedroom, an emphasis on person-centered planning and thinking and 245D rights to privacy. The provider noted that the only scenario in which they provide visual checks on a person when they were at home was if the person\\u2019s Coordinated Service and Support Plan (CSSP), created by the person\\u2019s case manager at the lead agency, indicated a need for them and assigned the provider responsibility for it. But considering the person\\u2019s history and his desire for privacy, the CSSP did not identify this as a need for this person at the time . The CSSP is created after a MnCHOICES assessment of the person\\u2019s needs is completed and neither the assessment nor the plan identified this level of need. Levels of need identified in the CSSP are reflected in the negotiation between the lead agency and the provider facilitated by the DHS-6790 Form. This form is influenced by the provider\\u2019s needs, the lead agency\\u2019s identification of the person\\u2019s needs and the Disability Waiver Rates System which provides a calculation for the person\\u2019s service rates. It was the final 6790 which ultimately allowed for the home to sometimes have 3 staff working the morning shift.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16425}','68.53.115.247','2021-05-25 15:51:17'),(13345,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16426,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16426}','68.53.115.247','2021-05-25 15:51:17'),(13346,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16427,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":\"On the day the checks were not performed, the staff did not have any reason to believe that the person had eloped. While the person did have a history of elopement, he usually exhibited telltale signs of leaving the house such as telling staff they were leaving and\\/or taking a bag with him. These typical signs were not present this day.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16427}','68.53.115.247','2021-05-25 15:51:17'),(13347,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16428,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16428}','68.53.115.247','2021-05-25 15:51:17'),(13348,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16429,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":\"On the morning the person was going to go on the trip, the provider was short staffed. The provider agency was short staffed in general and did not fill the 3rd staff position for this day.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16429}','68.53.115.247','2021-05-25 15:51:17'),(13349,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16430,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"105\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16430}','68.53.115.247','2021-05-25 15:51:17'),(13350,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16431,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"106\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16431}','68.53.115.247','2021-05-25 15:51:17'),(13351,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16432,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"107\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16432}','68.53.115.247','2021-05-25 15:51:17'),(13352,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16433,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"108\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16433}','68.53.115.247','2021-05-25 15:51:17'),(13353,'QI9n6AkFOHsaoSgfqeOGZzmQmprJdUhZqpFA0VMz',81,'reports_answer','create',16434,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"109\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:51:17 am\",\"created_at\":\"5\\/25\\/2021 10:51:17 am\",\"id\":16434}','68.53.115.247','2021-05-25 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15:53:06'),(13547,'GOCwttXP2JvBNEEw4jhSRITGbc9N3IypUHPyuqwp',183,'reports_answer','create',16620,'{\"report_id\":235,\"form_id\":\"23\",\"user_id\":183,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"The quality assurance staff and operations director were debriefed on 12\\/17\\/2020. The DSPs who were working at the time of this incident are no longer employed.\\r\\nOne of the residents ran out of medication several days early and staff noticed pills were missing. The house was searched until the empty packaging was discovered in a resident\\u2019s room. Quality assurance staff conducted an internal investigation where the person served (VA) admitted taking the medications. The residential facility was not able to determine when the medications went missing and therefore did not know what staff was working when the theft occurred. All staff working at the residential facility during the general time frame of the theft are no longer employed by the provider.\\r\\nMedication is stored in bins in a pantry located in the kitchen under lock and key. There is a key ring kept in a drawer for staff. The investigation revealed the key is not always used and there were times staff not sure where the key was or if the pantry is always locked. The facility provides medication management training for new staff at the time of hire and annually reviews medication policy and procedures with all staff on site during a team meetings.\\r\\nTypically the house is double staffed, two people on each shift. The majority of shifts had only one staff working. During the pandemic, there were times temporary staff was were used for some shifts. 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15:54:32'),(13591,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16664,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-05-18 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16664}','68.53.115.247','2021-05-25 15:54:32'),(13592,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16665,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16665}','68.53.115.247','2021-05-25 15:54:32'),(13593,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16666,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16666}','68.53.115.247','2021-05-25 15:54:32'),(13594,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16667,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Individual left the home via the bathroom without staff knowledge.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16667}','68.53.115.247','2021-05-25 15:54:32'),(13595,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16668,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"No\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16668}','68.53.115.247','2021-05-25 15:54:32'),(13596,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16669,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16669}','68.53.115.247','2021-05-25 15:54:32'),(13597,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16670,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16670}','68.53.115.247','2021-05-25 15:54:32'),(13598,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16671,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Staff No Longer Employed\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16671}','68.53.115.247','2021-05-25 15:54:32'),(13599,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16672,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"The individual eloping from the home was influenced by the staff\\u2019s 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\\u2019s 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\\u2019t experienced before.  The individual\\u2019s support team (guardian, case manager, etc.) also had varying views on what the individual\\u2019s needs were. Staff\\u2019s confusion around these new behaviors, the support team\\u2019s varying views and the ability to communicate with each other in real time were influencing the individual\\u2019s support plan not being updated to reflect the person\\u2019s updated safety considerations.  \\r\\n\\r\\nPer the individual\\u2019s 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\\u2019s 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).\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16672}','68.53.115.247','2021-05-25 15:54:32'),(13600,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16673,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16673}','68.53.115.247','2021-05-25 15:54:32'),(13601,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16674,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16674}','68.53.115.247','2021-05-25 15:54:32'),(13602,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16675,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16675}','68.53.115.247','2021-05-25 15:54:32'),(13603,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16676,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16676}','68.53.115.247','2021-05-25 15:54:32'),(13604,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16677,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16677}','68.53.115.247','2021-05-25 15:54:32'),(13605,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16678,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16678}','68.53.115.247','2021-05-25 15:54:32'),(13606,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16679,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":\"The individual eloping from the home was influenced by the staff\\u2019s 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\\u2019s decision not to provide direct supervision while the individual was using the bathroom.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16679}','68.53.115.247','2021-05-25 15:54:32'),(13607,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16680,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16680}','68.53.115.247','2021-05-25 15:54:32'),(13608,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16681,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16681}','68.53.115.247','2021-05-25 15:54:32'),(13609,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16682,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"105\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16682}','68.53.115.247','2021-05-25 15:54:32'),(13610,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16683,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"106\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16683}','68.53.115.247','2021-05-25 15:54:32'),(13611,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16684,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"107\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16684}','68.53.115.247','2021-05-25 15:54:32'),(13612,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16685,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"108\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16685}','68.53.115.247','2021-05-25 15:54:32'),(13613,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16686,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"109\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16686}','68.53.115.247','2021-05-25 15:54:32'),(13614,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16687,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"110\",\"question_type\":\"Free_Text\",\"text_answer\":\"The individual\\u2019s support team (guardian, case manager, etc.) also had varying views on what the individual\\u2019s needs were. Staff\\u2019s confusion around these new behaviors, the support team\\u2019s varying views and the ability to communicate with each other in real time were influencing the individual\\u2019s support plan not being updated to reflect the person\\u2019s updated safety considerations.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16687}','68.53.115.247','2021-05-25 15:54:32'),(13615,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16688,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"111\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:32 am\",\"created_at\":\"5\\/25\\/2021 10:54:32 am\",\"id\":16688}','68.53.115.247','2021-05-25 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15:54:33'),(13626,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16699,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"122\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:33 am\",\"created_at\":\"5\\/25\\/2021 10:54:33 am\",\"id\":16699}','68.53.115.247','2021-05-25 15:54:33'),(13627,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16700,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"123\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:33 am\",\"created_at\":\"5\\/25\\/2021 10:54:33 am\",\"id\":16700}','68.53.115.247','2021-05-25 15:54:33'),(13628,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16701,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"124\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:33 am\",\"created_at\":\"5\\/25\\/2021 10:54:33 am\",\"id\":16701}','68.53.115.247','2021-05-25 15:54:33'),(13629,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16702,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"125\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:33 am\",\"created_at\":\"5\\/25\\/2021 10:54:33 am\",\"id\":16702}','68.53.115.247','2021-05-25 15:54:33'),(13630,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16703,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"126\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:33 am\",\"created_at\":\"5\\/25\\/2021 10:54:33 am\",\"id\":16703}','68.53.115.247','2021-05-25 15:54:33'),(13631,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16704,'{\"report_id\":191,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"432\",\"question_type\":\"Yes_or_No\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:33 am\",\"created_at\":\"5\\/25\\/2021 10:54:33 am\",\"id\":16704}','68.53.115.247','2021-05-25 15:54:33'),(13632,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16705,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"76\",\"question_type\":\"Short_Answer\",\"text_answer\":\"A954660000\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16705}','68.53.115.247','2021-05-25 15:54:57'),(13633,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16706,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"10\\/15\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16706}','68.53.115.247','2021-05-25 15:54:57'),(13634,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16707,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"78\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"David Vukelich\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16707}','68.53.115.247','2021-05-25 15:54:57'),(13635,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16708,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"79\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Kelly Sather\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16708}','68.53.115.247','2021-05-25 15:54:57'),(13636,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16709,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"80\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Stepping Stones for Living\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16709}','68.53.115.247','2021-05-25 15:54:57'),(13637,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16710,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"81\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Laura Flynn\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16710}','68.53.115.247','2021-05-25 15:54:57'),(13638,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16711,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"82\",\"question_type\":\"Short_Answer\",\"text_answer\":\"laura.flynn@sslduluth.com\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16711}','68.53.115.247','2021-05-25 15:54:57'),(13639,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16712,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"83\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16712}','68.53.115.247','2021-05-25 15:54:57'),(13640,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16713,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Medication Error\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16713}','68.53.115.247','2021-05-25 15:54:57'),(13641,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16714,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16714}','68.53.115.247','2021-05-25 15:54:57'),(13642,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16715,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-08-24 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16715}','68.53.115.247','2021-05-25 15:54:57'),(13643,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16716,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16716}','68.53.115.247','2021-05-25 15:54:57'),(13644,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16717,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16717}','68.53.115.247','2021-05-25 15:54:57'),(13645,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16718,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff did not observe the individual leave the home\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16718}','68.53.115.247','2021-05-25 15:54:57'),(13646,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16719,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16719}','68.53.115.247','2021-05-25 15:54:57'),(13647,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16720,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2019-12-09 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16720}','68.53.115.247','2021-05-25 15:54:57'),(13648,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16721,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"The day of the incident the staff person(SP) was supervising the individual who eloped as well as 3 other residents.   SP doesn\\u2019t 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 \\u201cwalkie talkie\\u201d 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\\u2019t return after 30 minutes.  Following protocol, the SP called the agency\\u2019s 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\\u2019s and went to the mall.  The individual had recently received money from a renter\\u2019s 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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16721}','68.53.115.247','2021-05-25 15:54:57'),(13649,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16722,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16722}','68.53.115.247','2021-05-25 15:54:57'),(13650,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16723,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\\u2019s 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\\u2019s 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\\u2019s 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\\u2019s 6790, they were not allocated one-on-one supervision which has a reciprocal relationship with  the person\\u2019s 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\\u2019s 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\\u2019s 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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16723}','68.53.115.247','2021-05-25 15:54:57'),(13651,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16724,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16724}','68.53.115.247','2021-05-25 15:54:57'),(13652,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16725,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16725}','68.53.115.247','2021-05-25 15:54:57'),(13653,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16726,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16726}','68.53.115.247','2021-05-25 15:54:57'),(13654,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16727,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16727}','68.53.115.247','2021-05-25 15:54:57'),(13655,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16728,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16728}','68.53.115.247','2021-05-25 15:54:57'),(13656,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16729,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:54:57 am\",\"created_at\":\"5\\/25\\/2021 10:54:57 am\",\"id\":16729}','68.53.115.247','2021-05-25 15:54:57'),(13657,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16730,'{\"report_id\":193,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":\"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. 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15:56:08'),(13693,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16766,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-08-13 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16766}','68.53.115.247','2021-05-25 15:56:08'),(13694,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16767,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16767}','68.53.115.247','2021-05-25 15:56:08'),(13695,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16768,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16768}','68.53.115.247','2021-05-25 15:56:08'),(13696,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16769,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff administered the wrong medications to two individuals.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16769}','68.53.115.247','2021-05-25 15:56:08'),(13697,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16770,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16770}','68.53.115.247','2021-05-25 15:56:08'),(13698,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16771,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2019-10-22 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16771}','68.53.115.247','2021-05-25 15:56:08'),(13699,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16772,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\\u2019t 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\\u2019s 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\\u2019s medications.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16772}','68.53.115.247','2021-05-25 15:56:08'),(13700,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16773,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16773}','68.53.115.247','2021-05-25 15:56:08'),(13701,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16774,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\\u2019s 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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16774}','68.53.115.247','2021-05-25 15:56:08'),(13702,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16775,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16775}','68.53.115.247','2021-05-25 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15:56:08'),(13719,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16792,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"113\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16792}','68.53.115.247','2021-05-25 15:56:08'),(13720,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16793,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"114\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16793}','68.53.115.247','2021-05-25 15:56:08'),(13721,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16794,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"115\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16794}','68.53.115.247','2021-05-25 15:56:08'),(13722,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16795,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"116\",\"question_type\":\"Free_Text\",\"text_answer\":\"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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16795}','68.53.115.247','2021-05-25 15:56:08'),(13723,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16796,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"117\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16796}','68.53.115.247','2021-05-25 15:56:08'),(13724,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16797,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"118\",\"question_type\":\"Free_Text\",\"text_answer\":\"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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16797}','68.53.115.247','2021-05-25 15:56:08'),(13725,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16798,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"119\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16798}','68.53.115.247','2021-05-25 15:56:08'),(13726,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16799,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"120\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16799}','68.53.115.247','2021-05-25 15:56:08'),(13727,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16800,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"121\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16800}','68.53.115.247','2021-05-25 15:56:08'),(13728,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16801,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"122\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16801}','68.53.115.247','2021-05-25 15:56:08'),(13729,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16802,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"123\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16802}','68.53.115.247','2021-05-25 15:56:08'),(13730,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16803,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"124\",\"question_type\":\"Free_Text\",\"text_answer\":\"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).\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16803}','68.53.115.247','2021-05-25 15:56:08'),(13731,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16804,'{\"report_id\":209,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"125\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:56:08 am\",\"created_at\":\"5\\/25\\/2021 10:56:08 am\",\"id\":16804}','68.53.115.247','2021-05-25 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15:57:38'),(13744,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16817,'{\"report_id\":210,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2021-02-08 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:57:38 am\",\"created_at\":\"5\\/25\\/2021 10:57:38 am\",\"id\":16817}','68.53.115.247','2021-05-25 15:57:38'),(13745,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16818,'{\"report_id\":210,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:57:38 am\",\"created_at\":\"5\\/25\\/2021 10:57:38 am\",\"id\":16818}','68.53.115.247','2021-05-25 15:57:38'),(13746,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16819,'{\"report_id\":210,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:57:38 am\",\"created_at\":\"5\\/25\\/2021 10:57:38 am\",\"id\":16819}','68.53.115.247','2021-05-25 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Also our water scalds us here!\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:24 am\",\"created_at\":\"5\\/25\\/2021 10:58:24 am\",\"id\":16867}','68.53.115.247','2021-05-25 15:58:24'),(13795,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16868,'{\"report_id\":215,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:24 am\",\"created_at\":\"5\\/25\\/2021 10:58:24 am\",\"id\":16868}','68.53.115.247','2021-05-25 15:58:24'),(13796,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16869,'{\"report_id\":215,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Barriers to supporting people while implementing COVID policies\\/protocols.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:24 am\",\"created_at\":\"5\\/25\\/2021 10:58:24 am\",\"id\":16869}','68.53.115.247','2021-05-25 15:58:24'),(13797,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16870,'{\"report_id\":215,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:24 am\",\"created_at\":\"5\\/25\\/2021 10:58:24 am\",\"id\":16870}','68.53.115.247','2021-05-25 15:58:24'),(13798,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16871,'{\"report_id\":215,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2021-03-11 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:24 am\",\"created_at\":\"5\\/25\\/2021 10:58:24 am\",\"id\":16871}','68.53.115.247','2021-05-25 15:58:24'),(13799,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16872,'{\"report_id\":215,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\\u2019t 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. 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15:58:58'),(13839,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16912,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"82\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Pat.Masyga@TheMentorNetwork.com\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16912}','68.53.115.247','2021-05-25 15:58:58'),(13840,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16913,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"83\",\"question_type\":\"Short_Answer\",\"text_answer\":\"952-922-6776\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16913}','68.53.115.247','2021-05-25 15:58:58'),(13841,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16914,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Staff Sleeping on Duty\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16914}','68.53.115.247','2021-05-25 15:58:58'),(13842,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16915,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16915}','68.53.115.247','2021-05-25 15:58:58'),(13843,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16916,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2020-06-16 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16916}','68.53.115.247','2021-05-25 15:58:58'),(13844,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16917,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16917}','68.53.115.247','2021-05-25 15:58:58'),(13845,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16918,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16918}','68.53.115.247','2021-05-25 15:58:58'),(13846,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16919,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff was asleep during overnight awake shift\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16919}','68.53.115.247','2021-05-25 15:58:58'),(13847,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16920,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16920}','68.53.115.247','2021-05-25 15:58:58'),(13848,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16921,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2020-09-18 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16921}','68.53.115.247','2021-05-25 15:58:58'),(13849,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16922,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\\u2019d 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\\u2019t 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\\u2019t aware of this and recalled being \\u201cthrown off\\u201d 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 \\u201ccares\\u201d 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 \\u201cclose her eyes\\u201d, but at the time didn\\u2019t think to. She further explained thinking, \\u201cthere\\u2019s another person here, I\\u2019m just going to close my eyes.\\u201d 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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16922}','68.53.115.247','2021-05-25 15:58:58'),(13850,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16923,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16923}','68.53.115.247','2021-05-25 15:58:58'),(13851,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16924,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\\u2019t 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\\u2019s 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\\u2019s 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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16924}','68.53.115.247','2021-05-25 15:58:58'),(13852,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16925,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16925}','68.53.115.247','2021-05-25 15:58:58'),(13853,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16926,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16926}','68.53.115.247','2021-05-25 15:58:58'),(13854,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16927,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16927}','68.53.115.247','2021-05-25 15:58:58'),(13855,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16928,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16928}','68.53.115.247','2021-05-25 15:58:58'),(13856,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16929,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16929}','68.53.115.247','2021-05-25 15:58:58'),(13857,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16930,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16930}','68.53.115.247','2021-05-25 15:58:58'),(13858,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16931,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\\u2019s supervision requirements were met), the house was quiet (all residents were asleep).\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16931}','68.53.115.247','2021-05-25 15:58:58'),(13859,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16932,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16932}','68.53.115.247','2021-05-25 15:58:58'),(13860,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16933,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16933}','68.53.115.247','2021-05-25 15:58:58'),(13861,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16934,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"105\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16934}','68.53.115.247','2021-05-25 15:58:58'),(13862,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16935,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"106\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16935}','68.53.115.247','2021-05-25 15:58:58'),(13863,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16936,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"107\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16936}','68.53.115.247','2021-05-25 15:58:58'),(13864,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16937,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"108\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16937}','68.53.115.247','2021-05-25 15:58:58'),(13865,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16938,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"109\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16938}','68.53.115.247','2021-05-25 15:58:58'),(13866,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16939,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"110\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\\u2019t 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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16939}','68.53.115.247','2021-05-25 15:58:58'),(13867,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16940,'{\"report_id\":211,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"111\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:58:58 am\",\"created_at\":\"5\\/25\\/2021 10:58:58 am\",\"id\":16940}','68.53.115.247','2021-05-25 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15:59:21'),(13886,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16959,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"78\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Kelly Sather\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16959}','68.53.115.247','2021-05-25 15:59:21'),(13887,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16960,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"79\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"David Vukelich\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16960}','68.53.115.247','2021-05-25 15:59:21'),(13888,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16961,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"80\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Residential Services of NE MN\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16961}','68.53.115.247','2021-05-25 15:59:21'),(13889,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16962,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"81\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Shelia Fetters\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16962}','68.53.115.247','2021-05-25 15:59:21'),(13890,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16963,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"82\",\"question_type\":\"Short_Answer\",\"text_answer\":\"sheila.fetters@residentialservices.org\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16963}','68.53.115.247','2021-05-25 15:59:21'),(13891,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16964,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"83\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16964}','68.53.115.247','2021-05-25 15:59:21'),(13892,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16965,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Wheelchair Safety\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16965}','68.53.115.247','2021-05-25 15:59:21'),(13893,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16966,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16966}','68.53.115.247','2021-05-25 15:59:21'),(13894,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16967,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-06-10 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16967}','68.53.115.247','2021-05-25 15:59:21'),(13895,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16968,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16968}','68.53.115.247','2021-05-25 15:59:21'),(13896,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16969,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16969}','68.53.115.247','2021-05-25 15:59:21'),(13897,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16970,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff was not able to secure seat belt at waist.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16970}','68.53.115.247','2021-05-25 15:59:21'),(13898,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16971,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16971}','68.53.115.247','2021-05-25 15:59:21'),(13899,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16972,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2019-08-23 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16972}','68.53.115.247','2021-05-25 15:59:21'),(13900,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16973,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16973}','68.53.115.247','2021-05-25 15:59:21'),(13901,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16974,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:21 am\",\"created_at\":\"5\\/25\\/2021 10:59:21 am\",\"id\":16974}','68.53.115.247','2021-05-25 15:59:21'),(13902,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',16975,'{\"report_id\":212,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"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. 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15:59:40'),(13943,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17016,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Termination of Services\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17016}','68.53.115.247','2021-05-25 15:59:40'),(13944,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17017,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17017}','68.53.115.247','2021-05-25 15:59:40'),(13945,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17018,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-11-01 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17018}','68.53.115.247','2021-05-25 15:59:40'),(13946,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17019,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17019}','68.53.115.247','2021-05-25 15:59:40'),(13947,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17020,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17020}','68.53.115.247','2021-05-25 15:59:40'),(13948,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17021,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Services terminated due to concerns for staff safety.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17021}','68.53.115.247','2021-05-25 15:59:40'),(13949,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17022,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17022}','68.53.115.247','2021-05-25 15:59:40'),(13950,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17023,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2020-02-04 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17023}','68.53.115.247','2021-05-25 15:59:40'),(13951,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17024,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Debriefing 1 \\r\\nThe home was created in 2007 and licensed for 3 beds. Referrals were in from other counties; however, at the same time 2 MSOCS homes were being closed in the county and St. Louis County needed those beds. Host county concurrence from St. Louis County was denied on the 3 out of county individuals. Administration felt that they were forced into taking the three people who eventually moved in. All three had 1:1 staffing ratios when they came in. Even at that time, staff felt that the one individual should have been a 2:1; however, this was not approved by the county. He would bite himself, bite others, hit things which often resulted in daily restraints. He was on a Rule 40 program that created a plan for these restraints. Through the years adjustments were made to the home, attempting to reinforce walls, replacing toilets, industrial sheetrock, etc. \\r\\n\\r\\nIn 2017, one of the individuals in the home passed away. The home then went from 3 licensed beds to 2 licensed beds, subsequently only now having 2 staff members in the home where prior to 2017 there were 3. Through the next few years, the individual\\u2019s behaviors continued to be present but with the loss of the one staff member, it made it more difficult to intervene. This even resulted in a 60 day termination notice being issued in April 2018; however, no alternative housing option was ever found so the individual never did move from the home .The county was approached about developing a specialized home for the one individual; however, due to banding, which is when rates are locked only allowing incremental increases, they were told this couldn\\u2019t happen. In 2019, the banding was frozen so there was no slight increase they saw on their rate. They realize they could have put in 2:1 staffing, but they would have \\u201cate the cost\\u201d for this as they would not be reimbursed for the extra staffing. \\r\\nThrough the years, the individual worked with one staff member who he tended to do better with. This was helpful in having to bring the individual places because they would try to schedule it with the one staff member. However, the staff member resigned in the fall of 2019. With the staff member\\u2019s departure, it appeared that the individual\\u2019s behaviors started to increase. They attempted various things, some even being quite non-conventional such as getting \\u201cgay man pheromones\\u201d. At the time of the notice, 911 was called 2 days in a row. They eventually brought him to the Duluth ER where once there, he was restrained by 8 hospital staff.\\r\\n\\r\\nWhen asked about other impacts of the situation they found themselves in, the quality of employees was quickly brought up. There continues to be a staffing shortage and it is difficult to find staff, let alone finding staff with any experience or other qualifications. There is also a concern that our state is missing a part of the continuum of care, specifically that there is little to no institutional care option that would allow individuals a longer period of stabilization. \\r\\n\\r\\nDebriefing 2 \\r\\nStaff members were at a point where they were no longer being effective in managing the individual\\u2019s behaviors. He went to the annual assessment meeting and saw the extremely high number of PRN\\u2019s being given. He realized they were using that as a means to control and \\u201cif we\\u2019re doing that something is wrong.\\u201d In further looking at this, he discovered that the documentation wasn\\u2019t always consistent depending on what staff member was documenting. Many behaviors were not being reported in the documentation or if they were, it wasn\\u2019t consistent amongst staff on how they were recorded. He felt that they weren\\u2019t training staff right. It was difficult to get staff to recognize what they were seeing. The house manager did not experience the same behaviors as the other staff; therefore, what he was reporting was not consistent with what staff experienced. The individual tended to treat certain staff differently, being particularly worse for women.\\r\\n\\r\\nAbout three years ago, the number of injuries that staff were sustaining started to rise consistently. Many workman\\u2019s comp claims, particularly with concerns about staff being bit. It came down to the realization that they did not have the right house for him and the concerns for staff\\u2019s safety. He felt strongly that staff did not fail the individual but rather the individual needed different suppor\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17024}','68.53.115.247','2021-05-25 15:59:40'),(13952,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17025,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17025}','68.53.115.247','2021-05-25 15:59:40'),(13953,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17026,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\\u2019s compensation agency influenced the services terminated due to the concerns for staff safety. The number of workman\\u2019s 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\\u2019s 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\\u2019s residence in the home. The staff attached to the roommate who passed away would often intervene in de-escalating and responding to the person\\u2019s physically aggressive behavior. When the roommate passed away, the provider inquired about adding a staff but were told that 2:1 staff couldn\\u2019t 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\\u2019s 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\\u2019s 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\\u2019s needs. It also was influenced by county\\u2019s denial of the request to develop a new site around the person\\u2019s 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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17026}','68.53.115.247','2021-05-25 15:59:40'),(13954,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17027,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17027}','68.53.115.247','2021-05-25 15:59:40'),(13955,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17028,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17028}','68.53.115.247','2021-05-25 15:59:40'),(13956,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17029,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17029}','68.53.115.247','2021-05-25 15:59:40'),(13957,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17030,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17030}','68.53.115.247','2021-05-25 15:59:40'),(13958,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17031,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17031}','68.53.115.247','2021-05-25 15:59:40'),(13959,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17032,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17032}','68.53.115.247','2021-05-25 15:59:40'),(13960,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17033,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17033}','68.53.115.247','2021-05-25 15:59:40'),(13961,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17034,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17034}','68.53.115.247','2021-05-25 15:59:40'),(13962,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17035,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\\u2019s 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\\u2019s preference.  The low applicant pool was influenced by the current workforce shortage in the community and state.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17035}','68.53.115.247','2021-05-25 15:59:40'),(13963,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17036,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"105\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17036}','68.53.115.247','2021-05-25 15:59:40'),(13964,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17037,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"106\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17037}','68.53.115.247','2021-05-25 15:59:40'),(13965,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17038,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"107\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17038}','68.53.115.247','2021-05-25 15:59:40'),(13966,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17039,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"108\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17039}','68.53.115.247','2021-05-25 15:59:40'),(13967,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17040,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"109\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17040}','68.53.115.247','2021-05-25 15:59:40'),(13968,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17041,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"110\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\\u2019t 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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17041}','68.53.115.247','2021-05-25 15:59:40'),(13969,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17042,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"111\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17042}','68.53.115.247','2021-05-25 15:59:40'),(13970,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17043,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"112\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17043}','68.53.115.247','2021-05-25 15:59:40'),(13971,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17044,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"113\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17044}','68.53.115.247','2021-05-25 15:59:40'),(13972,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17045,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"114\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17045}','68.53.115.247','2021-05-25 15:59:40'),(13973,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17046,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"115\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17046}','68.53.115.247','2021-05-25 15:59:40'),(13974,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17047,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"116\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\\u2019s compensation agency influenced the services terminated due to the concerns for staff safety. The number of workman\\u2019s 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\\u2019s 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\\u2019s needs. It also was influenced by county\\u2019s denial of the request to develop a new site around the person\\u2019s 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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17047}','68.53.115.247','2021-05-25 15:59:40'),(13975,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17048,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"117\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17048}','68.53.115.247','2021-05-25 15:59:40'),(13976,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17049,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"118\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17049}','68.53.115.247','2021-05-25 15:59:40'),(13977,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17050,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"119\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17050}','68.53.115.247','2021-05-25 15:59:40'),(13978,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17051,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"120\",\"question_type\":\"Free_Text\",\"text_answer\":\"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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17051}','68.53.115.247','2021-05-25 15:59:40'),(13979,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17052,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"121\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17052}','68.53.115.247','2021-05-25 15:59:40'),(13980,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17053,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"122\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17053}','68.53.115.247','2021-05-25 15:59:40'),(13981,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17054,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"123\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17054}','68.53.115.247','2021-05-25 15:59:40'),(13982,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17055,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"124\",\"question_type\":\"Free_Text\",\"text_answer\":\"\\\"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\\u2019s 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\\u2019s residence in the home. The staff attached to the roommate who passed away would often intervene in de-escalating and responding to the person\\u2019s physically aggressive behavior. When the roommate passed away, the provider inquired about adding a staff but were told that 2:1 staff couldn\\u2019t 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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17055}','68.53.115.247','2021-05-25 15:59:40'),(13983,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17056,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"125\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17056}','68.53.115.247','2021-05-25 15:59:40'),(13984,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17057,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"126\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17057}','68.53.115.247','2021-05-25 15:59:40'),(13985,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17058,'{\"report_id\":213,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"432\",\"question_type\":\"Yes_or_No\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:40 am\",\"created_at\":\"5\\/25\\/2021 10:59:40 am\",\"id\":17058}','68.53.115.247','2021-05-25 15:59:40'),(13986,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17059,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"76\",\"question_type\":\"Short_Answer\",\"text_answer\":\"201901897\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17059}','68.53.115.247','2021-05-25 15:59:56'),(13987,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17060,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"05\\/15\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17060}','68.53.115.247','2021-05-25 15:59:56'),(13988,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17061,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"78\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Kelly Sather\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17061}','68.53.115.247','2021-05-25 15:59:56'),(13989,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17062,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"79\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"David Vukelich\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17062}','68.53.115.247','2021-05-25 15:59:56'),(13990,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17063,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"80\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Westview Services\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17063}','68.53.115.247','2021-05-25 15:59:56'),(13991,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17064,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"81\",\"question_type\":\"Short_Answer\",\"text_answer\":\"David Birkhofer JR\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17064}','68.53.115.247','2021-05-25 15:59:56'),(13992,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17065,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"82\",\"question_type\":\"Short_Answer\",\"text_answer\":\"dbirkhofer@westview-services.com\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17065}','68.53.115.247','2021-05-25 15:59:56'),(13993,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17066,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"83\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17066}','68.53.115.247','2021-05-25 15:59:56'),(13994,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17067,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Medication Error\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17067}','68.53.115.247','2021-05-25 15:59:56'),(13995,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17068,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17068}','68.53.115.247','2021-05-25 15:59:56'),(13996,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17069,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-03-12 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17069}','68.53.115.247','2021-05-25 15:59:56'),(13997,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17070,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"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\\u2019s 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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17070}','68.53.115.247','2021-05-25 15:59:56'),(13998,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17071,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17071}','68.53.115.247','2021-05-25 15:59:56'),(13999,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17072,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Individual had access to medications.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17072}','68.53.115.247','2021-05-25 15:59:56'),(14000,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17073,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"No\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17073}','68.53.115.247','2021-05-25 15:59:56'),(14001,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17074,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17074}','68.53.115.247','2021-05-25 15:59:56'),(14002,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17075,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17075}','68.53.115.247','2021-05-25 15:59:56'),(14003,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17076,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Staff No Longer Employed\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17076}','68.53.115.247','2021-05-25 15:59:56'),(14004,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17077,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"The individual\\u2019s access to medication was impacted by the staff\\u2019s 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\\u2019s attempts to maintain compliance. The staff\\u2019s 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 \\u2013 including staff hours \\u2013 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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17077}','68.53.115.247','2021-05-25 15:59:56'),(14005,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17078,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17078}','68.53.115.247','2021-05-25 15:59:56'),(14006,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17079,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17079}','68.53.115.247','2021-05-25 15:59:56'),(14007,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17080,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17080}','68.53.115.247','2021-05-25 15:59:56'),(14008,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17081,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17081}','68.53.115.247','2021-05-25 15:59:56'),(14009,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17082,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17082}','68.53.115.247','2021-05-25 15:59:56'),(14010,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17083,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17083}','68.53.115.247','2021-05-25 15:59:56'),(14011,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17084,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff was focused on completing a shift change task, of medication reconciling and money reconciling. The staff\\u2019s focus of attention to the tasks was impacted as the staff had limited time during shift change.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17084}','68.53.115.247','2021-05-25 15:59:56'),(14012,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17085,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17085}','68.53.115.247','2021-05-25 15:59:56'),(14013,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17086,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":\"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.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17086}','68.53.115.247','2021-05-25 15:59:56'),(14014,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17087,'{\"report_id\":214,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"105\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 10:59:56 am\",\"created_at\":\"5\\/25\\/2021 10:59:56 am\",\"id\":17087}','68.53.115.247','2021-05-25 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16:00:29'),(14081,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17154,'{\"report_id\":222,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"122\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:00:29 am\",\"created_at\":\"5\\/25\\/2021 11:00:29 am\",\"id\":17154}','68.53.115.247','2021-05-25 16:00:29'),(14082,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17155,'{\"report_id\":222,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"123\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:00:29 am\",\"created_at\":\"5\\/25\\/2021 11:00:29 am\",\"id\":17155}','68.53.115.247','2021-05-25 16:00:29'),(14083,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17156,'{\"report_id\":222,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"124\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:00:29 am\",\"created_at\":\"5\\/25\\/2021 11:00:29 am\",\"id\":17156}','68.53.115.247','2021-05-25 16:00:29'),(14084,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17157,'{\"report_id\":222,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"125\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:00:29 am\",\"created_at\":\"5\\/25\\/2021 11:00:29 am\",\"id\":17157}','68.53.115.247','2021-05-25 16:00:29'),(14085,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17158,'{\"report_id\":222,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"126\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:00:29 am\",\"created_at\":\"5\\/25\\/2021 11:00:29 am\",\"id\":17158}','68.53.115.247','2021-05-25 16:00:29'),(14086,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17159,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"76\",\"question_type\":\"Short_Answer\",\"text_answer\":\"2019-08-SLC-SR\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17159}','68.53.115.247','2021-05-25 16:13:59'),(14087,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17160,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"08\\/15\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17160}','68.53.115.247','2021-05-25 16:13:59'),(14088,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17161,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"78\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Sara Beauchene\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17161}','68.53.115.247','2021-05-25 16:13:59'),(14089,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17162,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"79\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Kelly Sather\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17162}','68.53.115.247','2021-05-25 16:13:59'),(14090,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17163,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"80\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Northland AFC\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17163}','68.53.115.247','2021-05-25 16:13:59'),(14091,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17164,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"81\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Lindsay Nash\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17164}','68.53.115.247','2021-05-25 16:13:59'),(14092,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17165,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"82\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Lindsay Nash\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17165}','68.53.115.247','2021-05-25 16:13:59'),(14093,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17166,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"83\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17166}','68.53.115.247','2021-05-25 16:13:59'),(14094,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17167,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Elopement\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17167}','68.53.115.247','2021-05-25 16:13:59'),(14095,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17168,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17168}','68.53.115.247','2021-05-25 16:13:59'),(14096,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17169,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-07-21 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17169}','68.53.115.247','2021-05-25 16:13:59'),(14097,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17170,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"Person had confirmed plans with staff to go to the metro area and see a friend. Due to staffing constraints, there was a change resulting in the cancellation or postponement of the trip. \\r\\n\\r\\nOn 7\\/21\\/19 the person went out for a cigarette at 2am and then allegedly went back to his room. That was the last time he was seen. It was during this time he eloped to Burnsville and MSP. Staff called 911 on or around 5:00 pm the next day once they noticed he was not in his bedroom.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17170}','68.53.115.247','2021-05-25 16:13:59'),(14098,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17171,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17171}','68.53.115.247','2021-05-25 16:13:59'),(14099,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17172,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Provider cancelled a person\'s planned trip\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17172}','68.53.115.247','2021-05-25 16:13:59'),(14100,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17173,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17173}','68.53.115.247','2021-05-25 16:13:59'),(14101,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17174,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17174}','68.53.115.247','2021-05-25 16:13:59'),(14102,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17175,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Person had been living at this house only months but had been with the same provider in a different home previously. He wanted to visit a friend near the metro area. Staff conveyed because of the distance and time for the trip it made sense that someone who was working a double shift would make the drive with him. Person followed usual and proper channels to schedule the out of town social activity.\\r\\nStaff felt that scheduling had become complicated at the time due to employees utilizing vacation time and also during that time the agency was very short staffed. The staff who was scheduled to take him on the trip during a double shift ended up not working the double shift because of how vacation was utilized. When the team saw this schedule conflict, the person was informed they couldn\\u2019t go on that weekend. He was initially disappointed, but he seemed to handle the news well after the initial disappointment. \\r\\nThe house manager usually has an assistant who arranges trips for residents. They work hard to prioritize social outings for people, trips and activities are accommodated. That assistant position was vacant and the house manager was feeling the \\u201cburn\\u201d of long hours and covering duties outside of her position. The staffing shortage made it hard to be sure residents were able to participate in desired activities.\\r\\nThe day they noticed person had eloped, staff had assumed he was sleeping in. He usually wakes by 9:00 but since he wasn\\u2019t utilizing a job coach during that time, there was no regular asleep\\/awake schedule. Also, there were no required checks in his plan. During counts, they noticed the bedroom door locked, but saw the window was open and that\\u2019s when they discovered he wasn\\u2019t there. Some of the staff were aware of his schedule change and that he was originally upset but had seemed to be fine with the change. \\r\\nPerson has history of elopement. He has a hard time making and keeping friends.  All of his housemates have girlfriends. When he elopes, they believe it is to see a female. Some of his housemates take trips together which he can\\u2019t attend due to his inability to afford the trips they take. \\r\\nHis adoptive mother\\/guardian is seen as unsupportive. There\\u2019s an impression among staff his adoptive mom and him bring out the worst in each other. They believe she expects the worst in him, affecting how he sees himself. They believe their relationship impacts his decisions in a negative way.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17175}','68.53.115.247','2021-05-25 16:13:59'),(14103,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17176,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17176}','68.53.115.247','2021-05-25 16:13:59'),(14104,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17177,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"The provider cancelling a planned trip for a person they served had a number of influences. On the morning the person was going to go on the trip, the provider was short staffed. Originally, the overnight staff was going to work a double shift by staying on for the morning shift. This staff ended up unable to work the morning shift, leaving the home with 2 staff instead of the typical 3. The provider agency was short staffed in general and did not fill the 3rd staff position for this day. The home served 4 people, 2 of which frequently exhibited challenging behavior. This level of need impacted the assignation of 3 staff to the day shifts. Also, the person\\u2019s CSSP addendum approved by the county required that the person be staffed at least 1:1 for trips, so due to short staffing it was not possible to send another staff on the trip. A factor into why 1:1 was necessary for trips was that the person had a history of abuse and because of this the guardian usually did not allow the person to meet people they met online without the 1:1 supervision required by the CSSP. Playing into the staffing requirements of the home too was the negotiation process between the county and the provider facilitated by DHS Form 6790 which determines staffing levels. This negotiation is impacted by each person in the home\\u2019s MnCHOICES assessment of need completed by the lead agency, as well as the Disability Waiver Rate Setting System which calculates service rates based on staffing needs. The Minnesota Legislature created both MnCHOICES and DWRS requirements. \\r\\nThis specific staff who couldn\\u2019t work the morning shift was the staff the person wanted to take him on the trip and he did not want to go with the other available staff. The person did not want the friend he was going to see to know he lived at the group home, and reportedly felt more comfortable going with the staff who was unable to work the morning shift. \\r\\nAnother influence to cancelling the trip was that the house manager felt burned out. The influences to the manager feeling burned out included the fact that the provider was \\u2013 as noted above - short staffed as an agency, the scheduler position who typically takes care of trips was also vacant, a number of staff were taking vacations at this time and the manager was filling a number of shifts themselves. Low unemployment rates in Minnesota and the region contributed to the provider\\u2019s short staff issue. Also, this specific trip required a staff to work more than 8 hours due to the distance of trip: driving from Duluth to the Twin Cities required 5-6 hours of drive time alone. This is why the overnight staff who was going to work the double was going to take the person. There was not any staff who could work an extra shift to take this person on the trip, let alone a staff the person wanted to go with. Typical policy was that the provider required 2 weeks notice before long trips to accommodate obtaining a guardian\\u2019s permission, case manager agreement and putting together the staffing needs, which made accommodating unexpected staff shortages difficult.  \\r\\nThe last of the influences identified was that this trip wasn\\u2019t a top priority for the staff. The person wanted to see a friend they met online in the metro area, but this person had a history of misusing social media. Specifically, when using social media, the person had a history of pretending to be someone else (known as catfishing) and, as mentioned above, had a history of being abused by people they met online. Partly due to this history, the staff wasn\\u2019t sure that the person their client wanted to visit was fully aware of who he was. Due to the vulnerability of the person and their history, the spontaneous trip didn\\u2019t meet the needs of the person.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17177}','68.53.115.247','2021-05-25 16:13:59'),(14105,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17178,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff did not perform visual checks between 2am and 5pm\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17178}','68.53.115.247','2021-05-25 16:13:59'),(14106,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17179,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"128\",\"question_type\":\"Yes_or_No\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17179}','68.53.115.247','2021-05-25 16:13:59'),(14107,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17180,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17180}','68.53.115.247','2021-05-25 16:13:59'),(14108,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17181,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":\"Person had been living at this house only months but had been with the same provider in a different home previously. He wanted to visit a friend near the metro area. Staff conveyed because of the distance and time for the trip it made sense that someone who was working a double shift would make the drive with him. Person followed usual and proper channels to schedule the out of town social activity.\\r\\nStaff felt that scheduling had become complicated at the time due to employees utilizing vacation time and also during that time the agency was very short staffed. The staff who was scheduled to take him on the trip during a double shift ended up not working the double shift because of how vacation was utilized. When the team saw this schedule conflict, the person was informed they couldn\\u2019t go on that weekend. He was initially disappointed, but he seemed to handle the news well after the initial disappointment. \\r\\nThe house manager usually has an assistant who arranges trips for residents. They work hard to prioritize social outings for people, trips and activities are accommodated. That assistant position was vacant and the house manager was feeling the \\u201cburn\\u201d of long hours and covering duties outside of her position. The staffing shortage made it hard to be sure residents were able to participate in desired activities.\\r\\nThe day they noticed person had eloped, staff had assumed he was sleeping in. He usually wakes by 9:00 but since he wasn\\u2019t utilizing a job coach during that time, there was no regular asleep\\/awake schedule. Also, there were no required checks in his plan. During counts, they noticed the bedroom door locked, but saw the window was open and that\\u2019s when they discovered he wasn\\u2019t there. Some of the staff were aware of his schedule change and that he was originally upset but had seemed to be fine with the change. \\r\\nPerson has history of elopement. He has a hard time making and keeping friends.  All of his housemates have girlfriends. When he elopes, they believe it is to see a female. Some of his housemates take trips together which he can\\u2019t attend due to his inability to afford the trips they take. \\r\\nHis adoptive mother\\/guardian is seen as unsupportive. There\\u2019s an impression among staff his adoptive mom and him bring out the worst in each other. They believe she expects the worst in him, affecting how he sees himself. They believe their relationship impacts his decisions in a negative way.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17181}','68.53.115.247','2021-05-25 16:13:59'),(14109,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17182,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17182}','68.53.115.247','2021-05-25 16:13:59'),(14110,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17183,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":\"Staff not performing visual checks on a person between 2am and 5pm had a number of influences. On the day the checks were not performed, the staff did not have any reason to believe that the person had eloped. While the person did have a history of elopement, he usually exhibited telltale signs of leaving the house such as telling staff they were leaving and\\/or taking a bag with him. These typical signs were not present this day. Instead the person left without telling anyone or taking a bag with him. Adding to the lack of reason to believe the person eloped was that the person often slept in, had an inconsistent sleep schedule, and refused to eat breakfast on the weekends, so sleeping in on Saturdays was a norm . This person also did not like to be bothered and often wanted his privacy while in his room. Due to cultural norms to allow privacy to people in their bedrooms along with the provider\\u2019s licensing statute \\u2013 MS 245D \\u2013 guaranteeing a person the right to privacy, this was wish was respected. \\r\\nAn additional influence to why checks weren\\u2019t performed was that the morning shift was short staffed. The house typically required 3 staff to be on in the morning. The overnight staff was going to work a double shift by staying on for the morning shift, but was unable to work. This left the provider with only 2 staff working in the morning shift. It was a norm at the house that they were comfortable only having 2 staff on if both staff were veteran staff, which was the case this day. Although the veteran staff were comfortable working short staffed, this did mean that the two staff had more responsibilities and were thus somewhat overworked and busy that day . \\r\\n The last influence identified by the mapping team into why staff did not perform checks was that the person\\u2019s plan did not require visual checks when he was at home. The provider typically does not perform visual checks on any person while they are in their own home. This practice is impacted by cultural norms to allow people privacy in their bedroom, an emphasis on person-centered planning and thinking and 245D rights to privacy. The provider noted that the only scenario in which they provide visual checks on a person when they were at home was if the person\\u2019s Coordinated Service and Support Plan (CSSP), created by the person\\u2019s case manager at the lead agency, indicated a need for them and assigned the provider responsibility for it. But considering the person\\u2019s history and his desire for privacy, the CSSP did not identify this as a need for this person at the time . The CSSP is created after a MnCHOICES assessment of the person\\u2019s needs is completed and neither the assessment nor the plan identified this level of need. Levels of need identified in the CSSP are reflected in the negotiation between the lead agency and the provider facilitated by the DHS-6790 Form. This form is influenced by the provider\\u2019s needs, the lead agency\\u2019s identification of the person\\u2019s needs and the Disability Waiver Rates System which provides a calculation for the person\\u2019s service rates. It was the final 6790 which ultimately allowed for the home to sometimes have 3 staff working the morning shift.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17183}','68.53.115.247','2021-05-25 16:13:59'),(14111,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17184,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17184}','68.53.115.247','2021-05-25 16:13:59'),(14112,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17185,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":\"On the day the checks were not performed, the staff did not have any reason to believe that the person had eloped. While the person did have a history of elopement, he usually exhibited telltale signs of leaving the house such as telling staff they were leaving and\\/or taking a bag with him. These typical signs were not present this day.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17185}','68.53.115.247','2021-05-25 16:13:59'),(14113,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17186,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17186}','68.53.115.247','2021-05-25 16:13:59'),(14114,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17187,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":\"On the morning the person was going to go on the trip, the provider was short staffed. The provider agency was short staffed in general and did not fill the 3rd staff position for this day.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17187}','68.53.115.247','2021-05-25 16:13:59'),(14115,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17188,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"105\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17188}','68.53.115.247','2021-05-25 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16:13:59'),(14122,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17195,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"112\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17195}','68.53.115.247','2021-05-25 16:13:59'),(14123,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17196,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"113\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17196}','68.53.115.247','2021-05-25 16:13:59'),(14124,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17197,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"114\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17197}','68.53.115.247','2021-05-25 16:13:59'),(14125,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17198,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"115\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17198}','68.53.115.247','2021-05-25 16:13:59'),(14126,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17199,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"116\",\"question_type\":\"Free_Text\",\"text_answer\":\"Typical policy was that the provider required 2 weeks notice before long trips to accommodate obtaining a guardian\\u2019s permission, case manager agreement and putting together the staffing needs, which made accommodating unexpected staff shortages difficult.\\r\\n\\r\\nThe last influence identified by the mapping team into why staff did not perform checks was that the person\\u2019s plan did not require visual checks when he was at home.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17199}','68.53.115.247','2021-05-25 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16:13:59'),(14131,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17204,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"121\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17204}','68.53.115.247','2021-05-25 16:13:59'),(14132,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17205,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"122\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17205}','68.53.115.247','2021-05-25 16:13:59'),(14133,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17206,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"123\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:13:59 am\",\"created_at\":\"5\\/25\\/2021 11:13:59 am\",\"id\":17206}','68.53.115.247','2021-05-25 16:13:59'),(14134,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17207,'{\"report_id\":223,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"124\",\"question_type\":\"Free_Text\",\"text_answer\":\"The house typically required 3 staff to be on in the morning. The overnight staff was going to work a double shift by staying on for the morning shift, but was unable to work. This left the provider with only 2 staff working in the morning shift. 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16:15:21'),(14190,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17263,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"77\",\"question_type\":\"Date\",\"text_answer\":\"05\\/15\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:21 am\",\"created_at\":\"5\\/25\\/2021 11:15:21 am\",\"id\":17263}','68.53.115.247','2021-05-25 16:15:21'),(14191,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17264,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"78\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Sara Beauchene\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:21 am\",\"created_at\":\"5\\/25\\/2021 11:15:21 am\",\"id\":17264}','68.53.115.247','2021-05-25 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16:15:21'),(14194,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17267,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"81\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Corey Labissoniere\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:21 am\",\"created_at\":\"5\\/25\\/2021 11:15:21 am\",\"id\":17267}','68.53.115.247','2021-05-25 16:15:21'),(14195,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17268,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"82\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Corey.LaBissoniere@thementornetwork.com\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:21 am\",\"created_at\":\"5\\/25\\/2021 11:15:21 am\",\"id\":17268}','68.53.115.247','2021-05-25 16:15:21'),(14196,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17269,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"83\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:21 am\",\"created_at\":\"5\\/25\\/2021 11:15:21 am\",\"id\":17269}','68.53.115.247','2021-05-25 16:15:22'),(14197,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17270,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"84\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Medication Error\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17270}','68.53.115.247','2021-05-25 16:15:22'),(14198,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17271,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17271}','68.53.115.247','2021-05-25 16:15:22'),(14199,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17272,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"2019-10-02 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17272}','68.53.115.247','2021-05-25 16:15:22'),(14200,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17273,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"Several staff administered more than one dose of PRN on several occasions to a person who had been prescribed several PRNs.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17273}','68.53.115.247','2021-05-25 16:15:22'),(14201,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17274,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"96\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17274}','68.53.115.247','2021-05-25 16:15:22'),(14202,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17275,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff administered more than one dose of PRN on several days in October 2018.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17275}','68.53.115.247','2021-05-25 16:15:22'),(14203,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17276,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"94\",\"question_type\":\"True_or_False\",\"text_answer\":\"Yes\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17276}','68.53.115.247','2021-05-25 16:15:22'),(14204,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17277,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"2019-06-25 00:00:00\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17277}','68.53.115.247','2021-05-25 16:15:22'),(14205,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17278,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Several workers administered the medication in the same way resulting in the error. Their decision to administer the medication in the way they did was driven by the instructions on the MAR which they all interpreted the same way, and which was also the incorrect interpretation. The staff interpreted the instruction of \\u201cdaily\\u201d to mean he could have it daily instead it meant a maximum daily (meant once a day and must be 4-6 hours after the last medication and only once a day, not every 4-6 hours daily), thus the over administration. The instructions were on the MAR and not on the med label, which was common practice. The staff followed the policy to check the label and MAR 3x any time there\\u2019s a med pass. All staff had received the required training and followed the signature and other MAR review requirements.\\r\\nThere were four people who signed off as over-administering the PRN. Two were DSPs, one area manager and one program director. The area manager and program director were covering for DSP hours due to a staffing shortage. The DSPs there were new to the agency, as was the program supervisor and the person. It was also noted the person subjected to the overmedication was a new client to the provider. It was conveyed that in a perfect world the provider wouldn\\u2019t take new service recipients until all staff were trained specific to a person. He came into a house that was already short-staffed. \\r\\n\\r\\nThe person had a high level of care, high needs, compared to others served at the home and was a newer resident of the home, moved there in September and incidents occurred in October. He began receiving services from this home after being in a hospital long after he required a hospital level of care. The transition from the hospital was described as hard: hospital social worker and care team communications were strained and confusing, and the med orders were also described as confusing. When a person with controlled meds transfers from a hospital to a provider, that time was described as being filled with angst. The sense of urgency leads to added stress. He was at the hospital for almost a year and there was extreme pressure to move him out of the hospital. The transition and care planning for this person were complicated by the fact that his guardian and contracted case manager were from Ramsey County. \\r\\n\\r\\nHe had multiple controlled meds and overlapping PRNs. For example, one PRN can only be taken X# of hours after another PRN, and there were several of these time lines and instructions to monitor. There was also one other man at the home who had a high contingent of medications. \\r\\n\\r\\nThe decision to administer the PRNs was also driven by the prescriber\\u2019s instruction to \\u201cgive him the PRN if he asks for it.\\u201d Person had been asking for many PRNs frequently. It was common for him to have more than one agitation a day. He had a diagnosis that included schizophrenia, delusional behavior. He had a long history of chemical abuse. Some of his PRNs included an inhaler, med to reduce nausea, ointment for gums. Staff describe his as having high seeking behavior and describe him as liking to be in control of his medications. He was seen by the staff as being very anxious and demanding. He occasionally raised his voice, swore, used power moves, his thoughts could get \\u201cout of control\\u201d and turn delusional. It was difficult for staff who had no experience with that. \\r\\nStaff attribute staffing of the house as a challenge. The house was very short staffed. The provider was not receiving exception rates for the people at this home. They attempted to increase the wage. The location of the home may have been a barrier to keeping it staffed. \\r\\nThe incident on 11\\/20\\/2018, the omission of a medication on the MAR, was influenced by a staffing shortage. The medication was not added to the MAR and it would have been a supervisor\\u2019s role to ensure the MAR was correct. The supervisor in charge of the MAR at that time is no longer with the company and was not debriefed. The person who attended the appointment, which was likely the same supervisor, also had a duty to ensure the correct instructions were passed along but that did not happen.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17278}','68.53.115.247','2021-05-25 16:15:22'),(14206,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17279,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"99\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17279}','68.53.115.247','2021-05-25 16:15:22'),(14207,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17280,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"Several staff were involved in administering more than one dose of PRN to a person on several dates. This was influenced by a misinterpretation of instructions on the Medication Administration Report (MAR) which is created by the pharmacy. The instructions on the MAR, on the medication bottle and on the referral form for this person were all different. Although the instructions were different enough in wording and readability to create misinterpretation, they were not directly conflicting. For example, the dosage and timing in relation to other PRNs and possible interactions were not fully outlined on each in the same way.  This explains why the confusion may not have been caught despite staff triple checking the instructions each time they administered medications.\\r\\n\\r\\nAdding to the potential confusion was that the PRN medication was also prescribed as part of the person\\u2019s daily regimen, meaning that in addition to the instructions that it was a daily medication, the PRN was also instructed to be given as needed, but instructions did not specify a timeframe for administering after the daily dose was administered.\\r\\n\\r\\nWhile the MAR and other medical instructions are typically reviewed and clarified at intake and then communicated with staff, this transition and intake was perceived as rushed, even urgent. The med instructions were reviewed, but the confusing nature of the instructions along with the rushed intake explain the eventual misinterpretation by staff.There are circumstances that can make a typical intake feel rushed and urgent, which is what happened here. In this case, prior to moving into the home, this person had been in the hospital for a year beyond when he was assessed to no longer require hospital level of care. Hospital administrators feel a high level of pressure to release people. Case managers, in turn, feel that high level of pressure from the hospital. Logically, the provider feels that urgency with which the transition is needed to occur. Since the hospital had been providing services for a year after the person no longer required hospital level of care, staff sensed urgency around the release. Once a provider is found, the timeline for release is nearly immediate. The federal rate structure does not allow for hospitals to bill for services to people who do not require hospital level of care. The length of time the person remained at the hospital was impacted, likely directly caused, by a statewide shortage of community placement options for people with complex needs. \\r\\nEven under the very best of circumstances, working under an urgent timeline to transition a person with a complex medication schedule, and the fact the residential program was very understaffed, increases the likelihood an incident can occur. The confusing nature of the medication instructions, along with an expedited or \\u201crushed\\u201d transition, explains how an error or misunderstanding could occur even if a manager conducted a med review during the transition and intake process. \\r\\n\\r\\nAnother factor that contributed to the administration of more than one dose of PRN was staff felt pressure to administer PRNs. The person\\u2019s history and diagnosis along with staff wanting to avoid a behavior incident added to the pressure to administer. The person asked for PRNs frequently and it was also the prescriber\\u2019s instruction to give the person the PRN when he asked for it. Additional dynamics contributing to the staff feeling a pressure to administer are that the person was new to the home; there were new staff recently hired, not necessarily fully trained for the exact unique needs of the person; and, the management staff covering for a staff shortage were just newly acquainted with the person.\\r\\n\\r\\nThe provider desired to make the placement successful, which also added to a perceived pressure to administer. There was a belief that administering PRNs as prescribed and when asked for would be one way to assist in a successful placement. Adding to the desire to facilitate a successful placement was the provider who has incentive to fill open beds which is directly impacted by the Disability Waiver Rates System, whose payment structure is determined by the number of people in a home.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17280}','68.53.115.247','2021-05-25 16:15:22'),(14208,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17281,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"127\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17281}','68.53.115.247','2021-05-25 16:15:22'),(14209,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17282,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"129\",\"question_type\":\"Date\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17282}','68.53.115.247','2021-05-25 16:15:22'),(14210,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17283,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"130\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17283}','68.53.115.247','2021-05-25 16:15:22'),(14211,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17284,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"131\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17284}','68.53.115.247','2021-05-25 16:15:22'),(14212,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17285,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"132\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17285}','68.53.115.247','2021-05-25 16:15:22'),(14213,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17286,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"101\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17286}','68.53.115.247','2021-05-25 16:15:22'),(14214,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17287,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":\"The person\\u2019s history and diagnosis along with staff wanting to avoid a behavior incident added to the pressure to administer. The person asked for PRNs frequently and it was also the prescriber\\u2019s instruction to give the person the PRN when he asked for it.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17287}','68.53.115.247','2021-05-25 16:15:22'),(14215,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17288,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"103\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17288}','68.53.115.247','2021-05-25 16:15:22'),(14216,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17289,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"104\",\"question_type\":\"Free_Text\",\"text_answer\":\"Additional dynamics contributing to the staff feeling a pressure to administer are that the person was new to the home; there were new staff recently hired, not necessarily fully trained for the exact unique needs of the person; and, the management staff covering for a staff shortage were just newly acquainted with the person.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17289}','68.53.115.247','2021-05-25 16:15:22'),(14217,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17290,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"105\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17290}','68.53.115.247','2021-05-25 16:15:22'),(14218,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17291,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"106\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17291}','68.53.115.247','2021-05-25 16:15:22'),(14219,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17292,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"107\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17292}','68.53.115.247','2021-05-25 16:15:22'),(14220,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17293,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"108\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17293}','68.53.115.247','2021-05-25 16:15:22'),(14221,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17294,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"109\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17294}','68.53.115.247','2021-05-25 16:15:22'),(14222,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17295,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"110\",\"question_type\":\"Free_Text\",\"text_answer\":\"Since the hospital had been providing services for a year after the person no longer required hospital level of care, staff sensed urgency around the release. Once a provider is found, the timeline for release is nearly immediate. Even under the very best of circumstances, working under an urgent timeline to transition a person with a complex medication schedule, and the fact the residential program was very understaffed, increases the likelihood an incident can occur. The confusing nature of the medication instructions, along with an expedited or \\u201crushed\\u201d transition, explains how an error or misunderstanding could occur even if a manager conducted a med review during the transition and intake process.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17295}','68.53.115.247','2021-05-25 16:15:22'),(14223,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17296,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"111\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17296}','68.53.115.247','2021-05-25 16:15:22'),(14224,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17297,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"112\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17297}','68.53.115.247','2021-05-25 16:15:22'),(14225,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17298,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"113\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17298}','68.53.115.247','2021-05-25 16:15:22'),(14226,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17299,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"114\",\"question_type\":\"Free_Text\",\"text_answer\":\"The instructions on the MAR, on the medication bottle and on the referral form for this person were all different. Although the instructions were different enough in wording and readability to create misinterpretation, they were not directly conflicting. For example, the dosage and timing in relation to other PRNs and possible interactions were not fully outlined on each in the same way.  This explains why the confusion may not have been caught despite staff triple checking the instructions each time they administered medications.\\r\\n\\r\\nAdding to the potential confusion was that the PRN medication was also prescribed as part of the person\\u2019s daily regimen, meaning that in addition to the instructions that it was a daily medication, the PRN was also instructed to be given as needed, but instructions did not specify a timeframe for administering after the daily dose was administered.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17299}','68.53.115.247','2021-05-25 16:15:22'),(14227,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17300,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"115\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17300}','68.53.115.247','2021-05-25 16:15:22'),(14228,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17301,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"116\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17301}','68.53.115.247','2021-05-25 16:15:22'),(14229,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17302,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"117\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"2\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17302}','68.53.115.247','2021-05-25 16:15:22'),(14230,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17303,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"118\",\"question_type\":\"Free_Text\",\"text_answer\":\"While the MAR and other medical instructions are typically reviewed and clarified at intake and then communicated with staff, this transition and intake was perceived as rushed, even urgent. The med instructions were reviewed, but the confusing nature of the instructions along with the rushed intake explain the eventual misinterpretation by staff. There are circumstances that can make a typical intake feel more urgent or even rushed, which is what happened here. In this case, prior to moving into the home, this person had been in the hospital for a year beyond when he was assessed to no longer require hospital level of care. Hospital administrators feel a high level of pressure to release people. Case managers, in turn, feel that high level of pressure from the hospital. Logically, the provider feels that urgency with which the transition is needed to occur. Since the hospital had been providing services for a year after the person no longer required hospital level of care, staff sensed urgency around the release. Once a provider is found, the timeline for release is nearly immediate. The federal rate structure does not allow for hospitals to bill for services to people who do not require hospital level of care. The length of time the person remained at the hospital was impacted, likely directly caused, by a statewide shortage of community placement options for people with complex needs. \\r\\n\\r\\nThe provider desired to make the placement successful, which also added to a perceived pressure to administer. There was a belief that administering PRNs as prescribed and when asked for would be one way to assist in a successful placement. Adding to the desire to facilitate a successful placement was the provider who has incentive to fill open beds which is directly impacted by the Disability Waiver Rates System, whose payment structure is determined by the number of people in a home.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17303}','68.53.115.247','2021-05-25 16:15:22'),(14231,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17304,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"119\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"3\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17304}','68.53.115.247','2021-05-25 16:15:22'),(14232,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17305,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"120\",\"question_type\":\"Free_Text\",\"text_answer\":\"The length of time the person remained at the hospital was impacted, likely directly caused, by a statewide shortage of community placement options for people with complex needs.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17305}','68.53.115.247','2021-05-25 16:15:22'),(14233,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17306,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"121\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"0\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17306}','68.53.115.247','2021-05-25 16:15:22'),(14234,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17307,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"122\",\"question_type\":\"Free_Text\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17307}','68.53.115.247','2021-05-25 16:15:22'),(14235,'BoSG0IqRqzvGaJ7M3RSky52KJmjx7BaE64YuuqSL',81,'reports_answer','create',17308,'{\"report_id\":225,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"123\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"1\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/25\\/2021 11:15:22 am\",\"created_at\":\"5\\/25\\/2021 11:15:22 am\",\"id\":17308}','68.53.115.247','2021-05-25 16:15:22'),