(27455,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39055,'{\"report_id\":238,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"08\\/27\\/2020\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:34:47 pm\",\"created_at\":\"5\\/26\\/2021 5:34:47 pm\",\"id\":39055}','68.53.115.247','2021-05-26 22:34:47'),(27456,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39056,'{\"report_id\":238,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"Person was talking with (Alder House staff) about going downtown Duluth to get a haircut. The salons were closed due to the Governor\\u2019s Executive Order about COVID 19. DSP went to cook food for dinner. The DSP was the only staff working, normally two staff. SP was attending to the other residents who were asking questions while the SP was cooking food. The SP knocked on bedroom door and there was no answer. The room was empty. The SP began to search the house for 10-15 minutes and then called the crisis float for direction and next steps. The SP immediately began to write up report, Incident Report Internal Review (IRIR). The Alder House DSP worked alone most of March. Quote: \\u201cIf two staff were working this elopement could have been avoided because the other staff could drive person downtown Duluth\\u201d.\\r\\nCrisis float takes over the elopement incident and the decision to call 911. Arrives at home and begins the attempt to locate. Drives and searches streets and downtown Duluth for 4 hours. It is protocol to search for 1-2 hours before contacting a supervisor. The Program manager makes the decision to call 911 and report a missing person. The call 911 was to report a non-emergency and provide a description of the person. The role of the crisis float is to fill in gaps as needed in the residential setting. The Crisis float needs to be available to respond to other crisis. The night of the incident the crisis float was moving from a crisis, de-escalating attention seeking behaviors, and then came to Alder House. Priority goes to situations that require hospitalization. During the attempt to locate the Crisis float communicates with the Alder house DSP with updates as needed, about every 15-20 minutes.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:34:47 pm\",\"created_at\":\"5\\/26\\/2021 5:34:47 pm\",\"id\":39056}','68.53.115.247','2021-05-26 22:34:47'),(27457,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39057,'{\"report_id\":238,\"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\\/26\\/2021 5:34:47 pm\",\"created_at\":\"5\\/26\\/2021 5:34:47 pm\",\"id\":39057}','68.53.115.247','2021-05-26 22:34:47'),(27458,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39058,'{\"report_id\":238,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"The float staff waiting 4 hours (instead of the policy of 1 hour) to contact their supervisor about an individual eloping, was impacted by the staff not seeing it as an emergency . Staff had ideas of where the person would go and that they\\u2019d be able to find them. The float staff\\u2019s ideas were impacted by their familiarity with the person, they knew their favorite places to go, that they had no previous elopements, and the person mentioned wanting to get a haircut. The staff feeling like they could find the person was also influenced by the empty streets in Duluth due to the Governor\\u2019s Stay at Home order. The Governor\\u2019s Stay At Home Order was issued due to COVID-19 in an attempt to slow the curve of the virus spreading. The Order required people to stay in their home unless they were conducting essential business. This influenced the streets of Duluth to be empty, businesses to be closed and the staff feeling as though the person should have been easier to spot. Other contributing factors to not seeing this elopement as an emergency and waiting to call the supervisor was that the staff maintained constant communication with the house staff about search strategies and updates and they knew the person had the ability to navigate the community independently .  \\r\\nAdditional influences to waiting 4 hours to call the supervisor may have been the staff\\u2019s desire to avoid the 245D\\/Positive Support Rule reporting requirements because the process can be very time consuming . Additionally, staff waited to call the supervisor because it is provider practice is not to contact supervisors if the elopement is supervised or the person\\u2019s whereabouts are known and they were confident they would be able to find the person .  St. Louis County had a recent history of attempting to decrease 911 calls, and had brought together HCBS providers, Law Enforcement Officers, County staff and Healthcare staff to work on this issue and created a Person Centered Incident Matrix to help provider\\u2019s parse out when 911 should be called and how to avoid overusing the 911 relay. The staff noted they were aware of the Person-Centered Matrix and this influenced the staff to exhaust all known places the person might go before contacting the supervisor about the elopement .\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:34:47 pm\",\"created_at\":\"5\\/26\\/2021 5:34:47 pm\",\"id\":39058}','68.53.115.247','2021-05-26 22:34:47'),(27459,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39059,'{\"report_id\":238,\"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\\/26\\/2021 5:34:47 pm\",\"created_at\":\"5\\/26\\/2021 5:34:47 pm\",\"id\":39059}','68.53.115.247','2021-05-26 22:34:47'),(27460,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39060,'{\"report_id\":238,\"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\\/26\\/2021 5:34:47 pm\",\"created_at\":\"5\\/26\\/2021 5:34:47 pm\",\"id\":39060}','68.53.115.247','2021-05-26 22:34:47'),(27461,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39061,'{\"report_id\":238,\"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\\/26\\/2021 5:34:47 pm\",\"created_at\":\"5\\/26\\/2021 5:34:47 pm\",\"id\":39061}','68.53.115.247','2021-05-26 22:34:47'),(27462,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39062,'{\"report_id\":238,\"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\\/26\\/2021 5:34:47 pm\",\"created_at\":\"5\\/26\\/2021 5:34:47 pm\",\"id\":39062}','68.53.115.247','2021-05-26 22:34:47'),(27463,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39063,'{\"report_id\":238,\"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\\/26\\/2021 5:34:47 pm\",\"created_at\":\"5\\/26\\/2021 5:34:47 pm\",\"id\":39063}','68.53.115.247','2021-05-26 22:34:47'),(27464,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39064,'{\"report_id\":238,\"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\\/26\\/2021 5:34:47 pm\",\"created_at\":\"5\\/26\\/2021 5:34:47 pm\",\"id\":39064}','68.53.115.247','2021-05-26 22:34:47'),(27465,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39065,'{\"report_id\":238,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"102\",\"question_type\":\"Free_Text\",\"text_answer\":\"The float staff waiting 4 hours (instead of the policy of 1 hour) to contact their supervisor about an individual eloping, was impacted by the staff not seeing it as an emergency.\\r\\n\\r\\nOther contributing factors to not seeing this elopement as an emergency and waiting to call the supervisor was that the staff maintained constant communication with the house staff about search strategies and updates and they knew the person had the ability to navigate the community independently . \\r\\n\\r\\n  St. Louis County had a recent history of attempting to decrease 911 calls, and had brought together HCBS providers, Law Enforcement Officers, County staff and Healthcare staff to work on this issue and created a Person Centered Incident Matrix to help provider\\u2019s parse out when 911 should be called and how to avoid overusing the 911 relay. The staff noted they were aware of the Person-Centered Matrix and this influenced the staff to exhaust all known places the person might go before contacting the supervisor about the elopement .\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:34:47 pm\",\"created_at\":\"5\\/26\\/2021 5:34:47 pm\",\"id\":39065}','68.53.115.247','2021-05-26 22:34:47'),(27466,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39066,'{\"report_id\":238,\"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\\/26\\/2021 5:34:47 pm\",\"created_at\":\"5\\/26\\/2021 5:34:47 pm\",\"id\":39066}','68.53.115.247','2021-05-26 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22:35:20'),(27502,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39102,'{\"report_id\":239,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"01\\/02\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:35:20 pm\",\"created_at\":\"5\\/26\\/2021 5:35:20 pm\",\"id\":39102}','68.53.115.247','2021-05-26 22:35:20'),(27503,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39103,'{\"report_id\":239,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"VA is describing increasing frustration and low mood as a result of these incidents. He does not feel comfortable with staff assistance and therefore isolates himself in his room.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:35:20 pm\",\"created_at\":\"5\\/26\\/2021 5:35:20 pm\",\"id\":39103}','68.53.115.247','2021-05-26 22:35:20'),(27504,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39104,'{\"report_id\":239,\"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\\/26\\/2021 5:35:20 pm\",\"created_at\":\"5\\/26\\/2021 5:35:20 pm\",\"id\":39104}','68.53.115.247','2021-05-26 22:35:20'),(27505,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39105,'{\"report_id\":239,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff did not hear person call for assistance after falling\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:35:21 pm\",\"created_at\":\"5\\/26\\/2021 5:35:21 pm\",\"id\":39105}','68.53.115.247','2021-05-26 22:35:21'),(27506,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39106,'{\"report_id\":239,\"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\\/26\\/2021 5:35:21 pm\",\"created_at\":\"5\\/26\\/2021 5:35:21 pm\",\"id\":39106}','68.53.115.247','2021-05-26 22:35:21'),(27507,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39107,'{\"report_id\":239,\"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\\/26\\/2021 5:35:21 pm\",\"created_at\":\"5\\/26\\/2021 5:35:21 pm\",\"id\":39107}','68.53.115.247','2021-05-26 22:35:21'),(27508,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39108,'{\"report_id\":239,\"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\\/26\\/2021 5:35:21 pm\",\"created_at\":\"5\\/26\\/2021 5:35:21 pm\",\"id\":39108}','68.53.115.247','2021-05-26 22:35:21'),(27509,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39109,'{\"report_id\":239,\"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\\/26\\/2021 5:35:21 pm\",\"created_at\":\"5\\/26\\/2021 5:35:21 pm\",\"id\":39109}','68.53.115.247','2021-05-26 22:35:21'),(27510,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39110,'{\"report_id\":239,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"100\",\"question_type\":\"Free_Text\",\"text_answer\":\"The overnight asleep direct service provider\\u2019s ability to hear the vulnerable adult\\u2019s calls for assistance was impacted by the VA being a soft spoken individual and the existence of routine overnight \\u201cwhite\\u201d noise in the home from roommates (TV, radio, electronics, etc.).  \\r\\nThe direct service provider\\u2019s ability to hear the vulnerable adult\\u2019s call for assistance was impacted by the fact that the provider only provides overnight asleep staff at this site.  This decision was made by the provider based on the support needs of the other three residents in the home which reflected the information provided in their assessments and service plans and the information provided by the vulnerable adult\\u2019s CM before admission\\r\\nThe pre-admission information the case manager provides to the provider varies by person and may have been impacted by a lack of resources and options due to the current moratorium on new adult foster (CRS) beds.  Based on the information provided the case manager and provider discussed these needs prior to the VA moving into the home and all agreed that the provider could meet the needs of the VA with an asleep overnight staff person.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:35:21 pm\",\"created_at\":\"5\\/26\\/2021 5:35:21 pm\",\"id\":39110}','68.53.115.247','2021-05-26 22:35:21'),(27511,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39111,'{\"report_id\":239,\"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\\/26\\/2021 5:35:21 pm\",\"created_at\":\"5\\/26\\/2021 5:35:21 pm\",\"id\":39111}','68.53.115.247','2021-05-26 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This decision was made by the provider based on the support needs of the other three residents in the home which reflected the information provided in their assessments and service plans and the information provided by the vulnerable adult\\u2019s CM before admission.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:35:21 pm\",\"created_at\":\"5\\/26\\/2021 5:35:21 pm\",\"id\":39131}','68.53.115.247','2021-05-26 22:35:21'),(27532,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39132,'{\"report_id\":239,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"117\",\"question_type\":\"Multiple_Choice\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:35:21 pm\",\"created_at\":\"5\\/26\\/2021 5:35:21 pm\",\"id\":39132}','68.53.115.247','2021-05-26 22:35:21'),(27533,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39133,'{\"report_id\":239,\"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\\/26\\/2021 5:35:21 pm\",\"created_at\":\"5\\/26\\/2021 5:35:21 pm\",\"id\":39133}','68.53.115.247','2021-05-26 22:35:21'),(27534,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39134,'{\"report_id\":239,\"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\\/26\\/2021 5:35:21 pm\",\"created_at\":\"5\\/26\\/2021 5:35:21 pm\",\"id\":39134}','68.53.115.247','2021-05-26 22:35:21'),(27535,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39135,'{\"report_id\":239,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"120\",\"question_type\":\"Free_Text\",\"text_answer\":\"The pre-admission information the case manager provides to the provider varies by person and may have been impacted by a lack of resources and options due to the current moratorium on new adult foster (CRS) beds. Based on the information provided the case manager and provider discussed these needs prior to the VA moving into the home and all agreed that the provider could meet the needs of the VA with an asleep overnight staff person.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:35:21 pm\",\"created_at\":\"5\\/26\\/2021 5:35:21 pm\",\"id\":39135}','68.53.115.247','2021-05-26 22:35:21'),(27536,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39136,'{\"report_id\":239,\"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\\/26\\/2021 5:35:21 pm\",\"created_at\":\"5\\/26\\/2021 5:35:21 pm\",\"id\":39136}','68.53.115.247','2021-05-26 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22:35:48'),(27547,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39147,'{\"report_id\":240,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"80\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Meridian Services, Inc - Logan\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:35:48 pm\",\"created_at\":\"5\\/26\\/2021 5:35:48 pm\",\"id\":39147}','68.53.115.247','2021-05-26 22:35:48'),(27548,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39148,'{\"report_id\":240,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"81\",\"question_type\":\"Short_Answer\",\"text_answer\":null,\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:35:48 pm\",\"created_at\":\"5\\/26\\/2021 5:35:48 pm\",\"id\":39148}','68.53.115.247','2021-05-26 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22:35:48'),(27551,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39151,'{\"report_id\":240,\"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\\/26\\/2021 5:35:48 pm\",\"created_at\":\"5\\/26\\/2021 5:35:48 pm\",\"id\":39151}','68.53.115.247','2021-05-26 22:35:48'),(27552,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39152,'{\"report_id\":240,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"85\",\"question_type\":\"Multiple_Choice\",\"text_answer\":\"Hennepin County\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:35:48 pm\",\"created_at\":\"5\\/26\\/2021 5:35:48 pm\",\"id\":39152}','68.53.115.247','2021-05-26 22:35:48'),(27553,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39153,'{\"report_id\":240,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"86\",\"question_type\":\"Date\",\"text_answer\":\"06\\/19\\/2019\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:35:48 pm\",\"created_at\":\"5\\/26\\/2021 5:35:48 pm\",\"id\":39153}','68.53.115.247','2021-05-26 22:35:48'),(27554,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39154,'{\"report_id\":240,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"87\",\"question_type\":\"Free_Text\",\"text_answer\":\"On 6\\/19\\/19 at 7:00PM, AP was getting pills ready and accidently gave VA the other client\'s (unknown) medication.\\r\\n\\r\\nPills Given-\\r\\nRistidome 4mg\\r\\nBaclofen 20mg\\r\\nDivalporex 500mg\\r\\nMelatonin 3mg\\r\\nAtenolol 50mg\\r\\nCyproheptad 4mg\\r\\n\\r\\nReporter contacted Facility Nurse and Facility Nurse said to contact poison control. Poison control said to monitor VA and call 911 if VA had\\r\\nany labored breathing or any issues. Reporter did not feel comfortable with the information Poison Control provided so Reporter brought\\r\\nVA to Nicollet Park Brookdale Urgent Care. Urgent Care said to keep VA home from VA\'s day program and to monitor VA\'s blood pressure\\r\\nto make sure it doesn\'t get elevated and to contact Primary Doctor. No affects at this time; however, VA appears drowsier than usual.\\r\\n\\r\\nVA attends a day program called Workabilities Monday-Friday from 9am to 4PM or 5PM.\\r\\nAP gave VA another resident\'s medications (Resperidone 4 mg, Basisen 20 mg, Divalproep 500mg, Melatonin 3 mg., Attenolol 6 mg and\\r\\nCyproheptadine 4mg,\\r\\nAP had set up 2 medications at 1 time. Reporter contacted the facility Nurse and Poison Control.\\r\\nVA was taken to last night to be checked out.\\r\\nVA stayed home from day program today so staff could monitor VA.\\r\\nReporter stated she was going to ask Manager what hospital VA was taken to. Call was disconnected. Agent attempted to reach Reporter\\r\\n3 times but message came on to leave message. Agent unable to finish report.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:35:48 pm\",\"created_at\":\"5\\/26\\/2021 5:35:48 pm\",\"id\":39154}','68.53.115.247','2021-05-26 22:35:48'),(27555,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39155,'{\"report_id\":240,\"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\\/26\\/2021 5:35:48 pm\",\"created_at\":\"5\\/26\\/2021 5:35:48 pm\",\"id\":39155}','68.53.115.247','2021-05-26 22:35:48'),(27556,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39156,'{\"report_id\":240,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"Staff administered wrong medication to the person\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:35:48 pm\",\"created_at\":\"5\\/26\\/2021 5:35:48 pm\",\"id\":39156}','68.53.115.247','2021-05-26 22:35:48'),(27557,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39157,'{\"report_id\":240,\"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\\/26\\/2021 5:35:48 pm\",\"created_at\":\"5\\/26\\/2021 5:35:48 pm\",\"id\":39157}','68.53.115.247','2021-05-26 22:35:48'),(27558,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39158,'{\"report_id\":240,\"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\\/26\\/2021 5:35:48 pm\",\"created_at\":\"5\\/26\\/2021 5:35:48 pm\",\"id\":39158}','68.53.115.247','2021-05-26 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The\\r\\nclinic sent Geritom Pharmacy a prescription for 200mg and 300mg which was then denied by insurance. On 8\\/16\\/19 Geritom reported that\\r\\nthey contacted REM-Hennepin Inc\\/Columbus and said that the medication was no able to be refilled. The medication supply ran out on\\r\\n8\\/23\\/19 and was not administered from 8\\/23\\/19-9\\/27\\/19. Currently-contacting the doctor and asking for directives.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:36:25 pm\",\"created_at\":\"5\\/26\\/2021 5:36:25 pm\",\"id\":39206}','68.53.115.247','2021-05-26 22:36:25'),(27607,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39207,'{\"report_id\":241,\"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\\/26\\/2021 5:36:25 pm\",\"created_at\":\"5\\/26\\/2021 5:36:25 pm\",\"id\":39207}','68.53.115.247','2021-05-26 22:36:25'),(27608,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39208,'{\"report_id\":241,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"91\",\"question_type\":\"Short_Answer\",\"text_answer\":\"The DSP initialed the med log but did not administer the med.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:36:25 pm\",\"created_at\":\"5\\/26\\/2021 5:36:25 pm\",\"id\":39208}','68.53.115.247','2021-05-26 22:36:25'),(27609,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39209,'{\"report_id\":241,\"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\\/26\\/2021 5:36:25 pm\",\"created_at\":\"5\\/26\\/2021 5:36:25 pm\",\"id\":39209}','68.53.115.247','2021-05-26 22:36:25'),(27610,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39210,'{\"report_id\":241,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"97\",\"question_type\":\"Date\",\"text_answer\":\"01\\/30\\/2020\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:36:25 pm\",\"created_at\":\"5\\/26\\/2021 5:36:25 pm\",\"id\":39210}','68.53.115.247','2021-05-26 22:36:25'),(27611,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39211,'{\"report_id\":241,\"form_id\":\"23\",\"user_id\":81,\"organization_id\":10,\"question_id\":\"98\",\"question_type\":\"Free_Text\",\"text_answer\":\"The DSP has worked in this capacity for approximately 5 years and reports this is her first med error.  She describes the day of the incident (8\\/16\\/19) as \\u201cbusy\\u201d, with 1 of the four residents on an outing with the other staff person on duty.  The DSP volunteered that she was preparing meds for one resident at a time.  After signing the medication log for the resident in question, she noticed that one of the medications was different in color and realized the dosage was different (300 mg vs. his usual dosage of 200 mg) and notified the supervisor.  The supervisor instructed the DSP to look in the \\u201coverflow\\u201d medications and see if there were meds there until the meds could be re-ordered.  The DSP was able to administer the correct medication dosage from the resident\\u2019s \\u201coverflow\\u201d meds. However, the DSP had already initialed the med log when she pulled the incorrect dosage.  The supervisor notified the nurse and the correct dosage was ordered because there were not enough meds in overflow for more than one more day.  During her next shift, two days later, the DSP again signed the med log and then noticed the new medication bubble packs were still the wrong dosage. She again notified the house supervisor who worked with the nurse and the pharmacist to make the correction and get the correct dosage.  The DSP reports that the time lapse between the time she first noticed the incorrect dosage and when it finally arrived was no more than 4-5 days.  Because there were meds in the overflow, the resident only went without the medication a 2-3 day (not the 30+ days indicated on the CEP Report) and never received more than prescribed dosage.\",\"created_by\":81,\"updated_by\":81,\"updated_at\":\"5\\/26\\/2021 5:36:25 pm\",\"created_at\":\"5\\/26\\/2021 5:36:25 pm\",\"id\":39211}','68.53.115.247','2021-05-26 22:36:25'),(27612,'e6VDpcj7xuKlFWAHFjzCyIpYOvCCmp44Bbf6JqMy',81,'reports_answer','create',39212,'{\"report_id\":241,\"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\\/26\\/2021 5:36:25 pm\",\"created_at\":\"5\\/26\\/2021 5:36:25 pm\",\"id\":39212}','68.53.115.247','2021-05-26 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-- Dumping data for table `form`
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--
-- Table structure for table `general_configs`
--

CREATE TABLE `general_configs` (
  `id` int(10) NOT NULL AUTO_INCREMENT,
  `name` varchar(255) CHARACTER SET latin1 DEFAULT NULL,
  `tooltipval` mediumtext CHARACTER SET latin1,
  `status` tinyint(1) NOT NULL DEFAULT '1',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL,
  `created_by` int(10) DEFAULT NULL,
  `updated_by` int(10) DEFAULT NULL,
  `deleted_at` timestamp NULL DEFAULT NULL,
  `levels` varchar(20) CHARACTER SET utf8 NOT NULL,
  PRIMARY KEY (`id`)
) ENGINE=InnoDB AUTO_INCREMENT=7 DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `general_configs`
--

INSERT INTO `general_configs` VALUES (1,'Government and Regulatory Body','Factors influenced by legislation or mandated standards',1,'2019-10-03 19:47:07','2020-06-03 18:29:06',1,79,NULL,'level_1'),(2,'External Entities','Influencing Factors that exist outside organization',1,'2019-10-08 23:43:09','2020-06-03 18:29:07',1,79,NULL,'level_2'),(3,'Organizational Factors (Central)','Operations that are controlled within the central operations',1,'2019-10-09 22:25:38','2020-06-03 18:29:07',1,79,NULL,'level_3'),(4,'Organizational Factors (Regional)','Contextual features of the region and operations',1,'2020-02-03 12:41:52','2020-06-03 18:29:07',1,79,NULL,'level_4'),(5,'Processes Conditions Actor Activities','Local (front-line) environment in which work was carried out',1,'2020-02-03 12:42:44','2020-06-03 18:29:07',1,79,NULL,'level_5'),(6,'Outcome','Outcome help!',0,'2020-01-03 05:30:51','2020-01-03 05:30:51',1,1,'2020-01-24 18:55:23','level_6');

--
-- Table structure for table `migrations`
--

CREATE TABLE `migrations` (
  `id` int(10) unsigned NOT NULL AUTO_INCREMENT,
  `migration` varchar(255) COLLATE utf8mb4_unicode_ci NOT NULL,
  `batch` int(11) NOT NULL,
  PRIMARY KEY (`id`)
) ENGINE=InnoDB AUTO_INCREMENT=19 DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `migrations`
--

INSERT INTO `migrations` VALUES (1,'2020_02_18_030911_alter_reviewconfigs_table',1),(2,'2020_03_06_042230_add_gid_to_reviewconfigs_table',2),(3,'2020_06_01_002151_create_tab_table',3),(4,'2020_06_01_055822_create_questions_table',4),(5,'2020_06_01_071414_add_has_access_field_to_organizations_table',5),(6,'2020_06_01_055822_create_reports_table',6),(7,'2020_06_01_055822_create_filters_table',7),(8,'2020_06_01_055822_add_form_id_questions_table',8),(9,'2020_08_20_075525_create_forms_table',9),(10,'2020_09_22_033450_add_name_field_report_table',10),(11,'2020_09_23_035905_alter_filter_table',11),(12,'2020_10_29_032548_create_questions_triggered',12),(13,'2020_10_30_011014_create_reports_answer',13),(14,'2020_11_02_025303_alter_filter_add_qst_desc',14),(15,'2020_12_22_040537_alter_organizations_add_banner',15),(16,'2021_02_04_075630_create_documenttype_table',16),(17,'2021_02_05_080736_create_documents_table',17),(18,'2021_03_08_034041_document_doc_name_add',18);

--
-- Table structure for table `organization_users`
--

CREATE TABLE `organization_users` (
  `id` int(10) NOT NULL AUTO_INCREMENT,
  `user_id` int(10) NOT NULL,
  `organization_id` int(10) NOT NULL,
  `title` varchar(255) CHARACTER SET latin1 NOT NULL,
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL,
  `created_by` int(10) DEFAULT NULL,
  `updated_by` int(10) DEFAULT NULL,
  `deleted_at` timestamp NULL DEFAULT NULL,
  PRIMARY KEY (`id`)
) ENGINE=InnoDB AUTO_INCREMENT=231 DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `organization_users`
--

INSERT INTO `organization_users` VALUES (3,85,9,'Admin',NULL,NULL,NULL,NULL,NULL),(7,89,12,'Assistant Commissioner',NULL,NULL,NULL,NULL,NULL),(19,96,14,'DCF',NULL,NULL,NULL,NULL,NULL),(20,97,14,'DCF',NULL,NULL,NULL,NULL,NULL),(32,107,21,'CSTraining7',NULL,NULL,NULL,NULL,NULL),(33,108,21,'CSTraining9',NULL,NULL,NULL,NULL,NULL),(49,94,12,'Safety Analyst',NULL,NULL,NULL,NULL,NULL),(55,88,12,'Director',NULL,NULL,NULL,NULL,NULL),(56,87,12,'Director',NULL,NULL,NULL,NULL,NULL),(57,106,21,'CSTraining5',NULL,NULL,NULL,NULL,NULL),(58,105,21,'CSTraining3',NULL,NULL,NULL,NULL,NULL),(71,120,12,'NY ACS',NULL,NULL,NULL,NULL,NULL),(75,119,12,'NY ACS',NULL,NULL,NULL,NULL,NULL),(77,121,12,'NY ACS',NULL,NULL,NULL,NULL,NULL),(79,122,12,'OCFS Liaison',NULL,NULL,NULL,NULL,NULL),(80,118,12,'NY ACS',NULL,NULL,NULL,NULL,NULL),(82,123,10,'MN DSD',NULL,NULL,NULL,NULL,NULL),(84,124,10,'MN DSD',NULL,NULL,NULL,NULL,NULL),(85,95,19,'Hennepin DHS',NULL,NULL,NULL,NULL,NULL),(86,125,19,'Hennepin DHS',NULL,NULL,NULL,NULL,NULL),(88,127,19,'Hennepin DHS',NULL,NULL,NULL,NULL,NULL),(89,128,19,'Hennepin DHS',NULL,NULL,NULL,NULL,NULL),(90,129,19,'Hennepin DHS',NULL,NULL,NULL,NULL,NULL),(91,130,19,'Hennepin DHS',NULL,NULL,NULL,NULL,NULL),(92,131,19,'Hennepin DHS',NULL,NULL,NULL,NULL,NULL),(93,132,22,'SLR II Demo',NULL,NULL,NULL,NULL,NULL),(94,133,22,'SLR II Demo',NULL,NULL,NULL,NULL,NULL),(95,134,22,'SLR II Demo',NULL,NULL,NULL,NULL,NULL),(97,136,22,'SLR II Demo',NULL,NULL,NULL,NULL,NULL),(98,137,22,'SLR II Demo',NULL,NULL,NULL,NULL,NULL),(99,138,22,'SLR II Demo',NULL,NULL,NULL,NULL,NULL),(100,126,19,'Hennepin DHS',NULL,NULL,NULL,NULL,NULL),(101,139,23,'HCS',NULL,NULL,NULL,NULL,NULL),(103,140,15,'KY DCBS',NULL,NULL,NULL,NULL,NULL),(104,141,15,'KY DCBS',NULL,NULL,NULL,NULL,NULL),(105,142,15,'KY DCBS',NULL,NULL,NULL,NULL,NULL),(106,143,15,'KY DCBS',NULL,NULL,NULL,NULL,NULL),(107,144,15,'KY DCBS',NULL,NULL,NULL,NULL,NULL),(108,146,25,'NY OCFS',NULL,NULL,NULL,NULL,NULL),(109,147,25,'NY OCFS',NULL,NULL,NULL,NULL,NULL),(110,148,25,'NY OCFS',NULL,NULL,NULL,NULL,NULL),(112,150,25,'NY OCFS',NULL,NULL,NULL,NULL,NULL),(113,149,25,'NY OCFS',NULL,NULL,NULL,NULL,NULL),(117,152,16,'UT DCFS',NULL,NULL,NULL,NULL,NULL),(118,151,16,'UT DCFS',NULL,NULL,NULL,NULL,NULL),(124,135,22,'SLR II Demo',NULL,NULL,NULL,NULL,NULL),(136,159,39,'MN CQI',NULL,NULL,NULL,NULL,NULL),(137,90,13,'MN CSP',NULL,NULL,NULL,NULL,NULL),(138,160,39,'MN CQI',NULL,NULL,NULL,NULL,NULL),(139,91,13,'MN CSP',NULL,NULL,NULL,NULL,NULL),(145,161,13,'MN CSP',NULL,NULL,NULL,NULL,NULL),(151,163,32,'Racine County',NULL,NULL,NULL,NULL,NULL),(152,164,32,'Racine County',NULL,NULL,NULL,NULL,NULL),(153,165,32,'Racine County',NULL,NULL,NULL,NULL,NULL),(154,166,31,'Otter Tail County',NULL,NULL,NULL,NULL,NULL),(155,167,31,'Otter Tail County',NULL,NULL,NULL,NULL,NULL),(156,168,31,'Otter Tail County',NULL,NULL,NULL,NULL,NULL),(157,169,31,'Otter Tail County',NULL,NULL,NULL,NULL,NULL),(158,162,32,'Racine County',NULL,NULL,NULL,NULL,NULL),(162,92,13,'MN CSP',NULL,NULL,NULL,NULL,NULL),(163,170,39,'MN CQI',NULL,NULL,NULL,NULL,NULL),(164,93,13,'MN CSP',NULL,NULL,NULL,NULL,NULL),(175,171,39,'MN CQI',NULL,NULL,NULL,NULL,NULL),(176,172,39,'MN CQI',NULL,NULL,NULL,NULL,NULL),(177,173,39,'MN CQI',NULL,NULL,NULL,NULL,NULL),(178,174,39,'MN CQI',NULL,NULL,NULL,NULL,NULL),(179,175,39,'MN CQI',NULL,NULL,NULL,NULL,NULL),(180,156,14,'DCF',NULL,NULL,NULL,NULL,NULL),(186,176,10,'St. Louis County',NULL,NULL,NULL,NULL,NULL),(187,177,10,'St Louis County',NULL,NULL,NULL,NULL,NULL),(189,179,10,'Hennepin County',NULL,NULL,NULL,NULL,NULL),(191,181,10,'MN DSD',NULL,NULL,NULL,NULL,NULL),(192,182,10,'MN DSD',NULL,NULL,NULL,NULL,NULL),(193,183,10,'MN DSD',NULL,NULL,NULL,NULL,NULL),(194,184,10,'MN DSD',NULL,NULL,NULL,NULL,NULL),(196,186,10,'Olmsted County',NULL,NULL,NULL,NULL,NULL),(197,185,10,'Olmsted County',NULL,NULL,NULL,NULL,NULL),(198,187,10,'MN DSD',NULL,NULL,NULL,NULL,NULL),(199,188,10,'MN DSD',NULL,NULL,NULL,NULL,NULL),(200,189,10,'MN DSD',NULL,NULL,NULL,NULL,NULL),(201,190,10,'Clay County',NULL,NULL,NULL,NULL,NULL),(202,191,10,'Dakota County',NULL,NULL,NULL,NULL,NULL),(203,192,10,'Dakota County',NULL,NULL,NULL,NULL,NULL),(204,193,10,'MN DSD',NULL,NULL,NULL,NULL,NULL),(205,194,10,'MN DSD',NULL,NULL,NULL,NULL,NULL),(207,180,10,'Hennepin County',NULL,NULL,NULL,NULL,NULL),(210,104,21,'CSTraining1',NULL,NULL,NULL,NULL,NULL),(218,178,10,'Blue Earth County',NULL,NULL,NULL,NULL,NULL),(220,153,41,'NH OCA',NULL,NULL,NULL,NULL,NULL),(221,155,41,'NH OCA',NULL,NULL,NULL,NULL,NULL),(222,154,41,'NH OCA',NULL,NULL,NULL,NULL,NULL),(223,196,31,'Otter Tail County',NULL,NULL,NULL,NULL,NULL),(229,81,13,'Test user',NULL,NULL,NULL,NULL,NULL),(230,71,13,'Minnesota DHS CSP',NULL,NULL,NULL,NULL,NULL);

--
-- Table structure for table `organizations`
--

CREATE TABLE `organizations` (
  `id` int(10) NOT NULL AUTO_INCREMENT,
  `name` varchar(255) CHARACTER SET latin1 NOT NULL,
  `email` varchar(255) CHARACTER SET latin1 NOT NULL,
  `phone` varchar(255) CHARACTER SET latin1 DEFAULT NULL,
  `banner` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `banner_alt` varchar(255) COLLATE utf8mb4_unicode_ci DEFAULT NULL,
  `status` tinyint(1) NOT NULL DEFAULT '0',
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL,
  `created_by` int(10) DEFAULT NULL,
  `updated_by` int(10) DEFAULT NULL,
  `deleted_at` timestamp NULL DEFAULT NULL,
  `has_access` tinyint(1) NOT NULL DEFAULT '0',
  PRIMARY KEY (`id`)
) ENGINE=InnoDB AUTO_INCREMENT=43 DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `organizations`
--

INSERT INTO `organizations` VALUES (1,'5 row','',NULL,NULL,NULL,1,'2020-06-03 09:36:34','2020-06-03 09:38:28',1,1,'2020-06-03 09:38:28',0),(2,'five row q','',NULL,NULL,NULL,1,'2020-06-03 10:49:27','2020-06-03 10:50:55',1,1,'2020-06-03 10:50:55',0),(3,'Org. Row 5','',NULL,NULL,NULL,1,'2020-06-03 11:56:12','2020-06-03 13:36:23',72,72,'2020-06-03 13:36:23',0),(4,'Org. Row 4','',NULL,NULL,NULL,1,'2020-06-03 11:56:35','2020-06-03 13:36:23',72,72,'2020-06-03 13:36:23',0),(5,'Org. Row 3','',NULL,NULL,NULL,1,'2020-06-03 11:56:46','2020-06-03 13:36:23',72,72,'2020-06-03 13:36:23',0),(6,'Org. Row 2','',NULL,NULL,NULL,1,'2020-06-03 11:57:03','2020-06-03 13:36:23',72,72,'2020-06-03 13:36:23',0),(7,'Org. 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--
-- Table structure for table `password_resets`
--

CREATE TABLE `password_resets` (
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  `created_at` timestamp NULL DEFAULT NULL
) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci;

--
-- Dumping data for table `password_resets`
--

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--
-- Table structure for table `questions`
--

CREATE TABLE `questions` (
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--
-- Dumping data for table `questions`
--

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16:55:57',NULL),(38,31,NULL,6,'Production/Efficiency Pressure Illustrative Example','Production/Efficiency Pressure Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 16:57:43','2021-03-30 16:58:27',NULL),(39,31,NULL,6,'Service Availability Rating','Service Availability Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 16:59:17','2021-03-30 16:59:17',NULL),(40,31,NULL,6,'Service Availability Illustrative Example','Service Availability Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 16:59:34','2021-03-30 17:18:52',NULL),(41,31,NULL,6,'Supervisory Support Rating','Supervisory Support Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 17:00:05','2021-03-30 17:00:05',NULL),(42,31,NULL,6,'Supervisory Support Illustrative Example','Supervisory Support Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 17:00:26','2021-03-30 17:04:13',NULL),(43,31,NULL,6,'Procedural Drift Rating','Procedural Drift Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 17:00:59','2021-03-30 17:00:59',NULL),(44,31,NULL,6,'Procedural Drift Illustrative Example','Procedural Drift Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 17:01:26','2021-03-30 17:04:32',NULL),(45,31,NULL,6,'Fatigue Rating','Fatigue Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 17:03:24','2021-03-30 17:03:24',NULL),(46,31,NULL,6,'Fatigue Illustrative Example','Fatigue Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 17:03:53','2021-03-30 17:04:59',NULL),(47,31,NULL,5,'Learning Point(s)','Learning Point(s)','Multiple_Choice','1,2,3',NULL,0,3,1,80,80,'2021-03-30 17:05:46','2021-04-21 02:50:54',NULL),(48,31,NULL,5,'Review Notes','Review Notes','Free_Text',NULL,NULL,0,2,1,80,80,'2021-03-30 17:06:22','2021-04-21 02:50:54',NULL),(49,32,NULL,7,'Review Date','Review Date','Date',NULL,NULL,0,1,1,80,80,'2021-03-30 20:06:12','2021-04-23 19:47:29',NULL),(50,32,NULL,7,'Learning Point(s)','Learning Point(s)','Multiple_Choice','1,2,3',NULL,0,3,1,80,80,'2021-03-30 20:06:46','2021-04-23 19:47:29',NULL),(51,32,NULL,7,'Review Notes','Review Notes','Free_Text',NULL,NULL,0,2,1,80,80,'2021-03-30 20:07:05','2021-04-23 19:47:29',NULL),(52,32,NULL,8,'Cognition Rating','Cognition Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 20:08:59','2021-03-30 20:08:59',NULL),(53,32,NULL,8,'Cognition Illustrative Example','Cognition Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 20:09:20','2021-03-30 20:11:49',NULL),(54,32,NULL,8,'Demand-Resource Mismatch Rating','Demand-Resource Mismatch Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 20:09:46','2021-03-30 20:09:46',NULL),(55,32,NULL,8,'Demand-Resource Mismatch Illustrative Example','Demand-Resource Mismatch Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 20:10:11','2021-03-30 20:12:04',NULL),(56,32,NULL,8,'Documentation Rating','Documentation Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 20:10:38','2021-03-30 20:10:38',NULL),(57,32,NULL,8,'Documentation Illustrative Example','Documentation Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 20:10:52','2021-03-30 20:12:22',NULL),(58,32,NULL,8,'Equipment/Tools/Technology Rating','Equipment/Tools/Technology Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 20:11:12','2021-03-30 20:11:12',NULL),(59,32,NULL,8,'Equipment/Tools/Technology  Illustrative Example','Equipment/Tools/Technology  Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 20:11:33','2021-03-30 20:12:48',NULL),(60,32,NULL,8,'Teamwork/Coordinating Activities Rating','Teamwork/Coordinating Activities Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 20:13:50','2021-03-30 20:13:50',NULL),(61,32,NULL,8,'Teamwork/Coordinating Activities Illustrative Example','Teamwork/Coordinating Activities Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 20:14:08','2021-03-30 20:15:52',NULL),(62,32,NULL,8,'Knowledge Gap Rating','Knowledge Gap Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 20:14:35','2021-03-30 20:14:35',NULL),(63,32,NULL,8,'Knowledge Gap Illustrative Example','Knowledge Gap Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 20:14:52','2021-03-30 20:16:09',NULL),(64,32,NULL,8,'Prescribed Practice Rating','Prescribed Practice Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 20:15:11','2021-03-30 20:15:11',NULL),(65,32,NULL,8,'Prescribed Practice Illustrative Example','Prescribed Practice Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 20:15:29','2021-03-30 20:16:24',NULL),(66,32,NULL,8,'Production/Efficiency Pressure Rating','Production/Efficiency Pressure Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 20:17:09','2021-03-30 20:17:09',NULL),(67,32,NULL,8,'Production/Efficiency Pressure Illustrative Example','Production/Efficiency Pressure Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 20:17:23','2021-03-30 20:21:08',NULL),(68,32,NULL,8,'Service Availability Rating','Service Availability Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 20:17:42','2021-03-30 20:17:42',NULL),(69,32,NULL,8,'Service Availability Illustrative Example','Service Availability Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 20:17:57','2021-03-30 20:21:37',NULL),(70,32,NULL,8,'Supervisory Support Rating','Supervisory Support Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 20:18:15','2021-03-30 20:18:15',NULL),(71,32,NULL,8,'Supervisory Support Illustrative Example','Supervisory Support Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 20:18:33','2021-03-30 20:21:59',NULL),(72,32,NULL,8,'Procedural Drift Rating','Procedural Drift Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 20:18:55','2021-03-30 20:18:55',NULL),(73,32,NULL,8,'Procedural Drift Illustrative Example','Procedural Drift Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 20:19:15','2021-03-30 20:22:18',NULL),(74,32,NULL,8,'Fatigue Rating','Fatigue Rating','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-03-30 20:20:08','2021-03-30 20:20:08',NULL),(75,32,NULL,8,'Fatigue Illustrative Example','Fatigue Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-03-30 20:20:31','2021-03-30 20:22:34',NULL),(76,10,NULL,9,'Case ID','Case ID','Short_Answer',NULL,NULL,0,2,1,9,80,'2020-12-09 08:52:46','2021-04-12 14:55:11',NULL),(77,10,NULL,9,'Case Assignment Date','Case Assignment Date','Date',NULL,NULL,0,3,1,9,80,'2020-12-09 08:53:19','2021-04-12 14:55:11',NULL),(78,10,NULL,9,'Safety Analyst Lead','Safety Analyst Lead','Multiple_Choice','David Vukelich,Jill Tilbury,Kelly Sather,Kristie Pittman,Marilee Bengtson,Sara Beauchene,Scott Schifsky,Tim Sullivan,Tony Gantenbein,Julie Anderson,Leann Bieber,Emily Miller,Felicia Young,Chad Erdmann,Denise Dyer,Krystal Whisler,Rebekah Radiske,Liz Harri,Steven Bahl,Aric Gregg,Charles Young',NULL,0,4,1,9,80,'2020-12-09 08:55:01','2021-05-25 15:51:47',NULL),(79,10,NULL,9,'Safety Analyst Peer Reviewer','Safety Analyst Peer Reviewer','Multiple_Choice','David Vukelich,Jill Tilbury,Kelly Sather,Kristie Pittman,Marilee Bengtson,Sara Beauchene,Scott Schifsky,Tim Sullivan,Tony Gantenbein,Julie Anderson,Leann Bieber,Emily Miller,Felicia Young,Chad Erdmann,Denise Dyer,Krystal Whisler,Rebekah Radiske,Liz Harri,Steven Bahl,Aric Gregg,Charles Young',NULL,0,5,1,9,80,'2020-12-09 08:56:11','2021-05-25 15:52:10',NULL),(80,10,NULL,9,'Provider Organization Name','Provider Organization Name','Short_Answer',NULL,NULL,0,6,1,9,80,'2020-12-09 08:56:45','2021-04-12 15:03:33',NULL),(81,10,NULL,9,'Name of Provider Primary Contact','Name of Provider Primary Contact','Short_Answer',NULL,NULL,0,7,1,9,80,'2020-12-09 08:57:12','2021-04-12 15:03:33',NULL),(82,10,NULL,9,'Email of Provider Primary Contact','Email of Provider Primary Contact','Short_Answer',NULL,NULL,0,8,1,9,80,'2020-12-09 08:57:36','2021-04-12 15:03:33',NULL),(83,10,NULL,9,'Phone Number of Provider Primary Contact','Phone Number of Provider Primary Contact','Short_Answer',NULL,NULL,0,9,1,9,80,'2020-12-09 08:58:24','2021-04-12 15:03:33',NULL),(84,10,NULL,9,'Incident Type','Incident Type','Multiple_Choice','Elopement,Medication Error,Staff Sleeping on Duty,Wheelchair Safety,Use of Prone Restraint,Termination of Services,COVID',NULL,0,10,1,9,80,'2020-12-09 08:59:38','2021-04-12 15:03:33',NULL),(85,10,NULL,9,'Location of Incident (County)','Location of Incident','Multiple_Choice','Blue Earth County,Hennepin County,St. Louis County',NULL,0,11,1,9,80,'2020-12-09 09:02:36','2021-05-25 16:37:07',NULL),(86,10,NULL,9,'Date of Incident','Date of Incident','Date',NULL,NULL,0,12,1,9,80,'2020-12-09 09:03:13','2021-04-12 15:03:33',NULL),(87,10,NULL,9,'Incident Report Description (Use top section of case summary)','Incident Report Description','Free_Text',NULL,NULL,0,13,1,9,80,'2020-12-09 09:06:03','2021-04-12 15:03:33',NULL),(88,10,NULL,10,'Temp space holder for upload location','Temp space holder for upload location','Free_Text',NULL,NULL,0,NULL,1,9,9,'2020-12-09 09:07:49','2020-12-09 09:07:49',NULL),(89,10,NULL,11,'Number of Learning Points','Number of Learning Points','Multiple_Choice','1,2,Choice 3,Choice 4',NULL,0,NULL,1,9,9,'2020-12-09 09:09:12','2020-12-09 09:09:37','2020-12-09 09:09:37'),(90,10,NULL,11,'Number of Learning Points','Number of Learning Points','True_or_False','1,2',NULL,0,1,1,9,9,'2020-12-09 09:13:54','2020-12-10 11:42:07','2020-12-10 11:42:07'),(91,10,NULL,11,'Learning Point 1','Learning Point 1','Short_Answer',NULL,NULL,1,2,1,9,9,'2020-12-09 09:14:44','2020-12-10 11:51:08',NULL),(92,10,NULL,11,'Human Factors Debriefing (Learning Point 1)','Human Factors Debriefing (Learning Point 1)','Free_Text',NULL,NULL,0,4,1,9,9,'2020-12-09 09:15:37','2020-12-09 09:21:21','2020-12-09 09:21:21'),(93,10,NULL,11,'Date of Debriefing (Learning Point 1)','Date of Debriefing (Learning Point 1)','Date',NULL,NULL,1,5,1,9,9,'2020-12-09 09:17:08','2020-12-09 09:21:34','2020-12-09 09:21:34'),(94,10,NULL,11,'Human Factors Debriefing Completed LP1','Was a Human Factors Debriefing Completed for Learning Point 1','True_or_False','Yes,No',NULL,1,3,1,9,9,'2020-12-09 09:18:21','2020-12-17 05:11:08',NULL),(95,10,NULL,11,'Date of Debriefing (Learning Point 1)','Date of Debriefing (Learning Point 1)','Date',NULL,NULL,1,4,1,9,9,'2020-12-09 09:28:53','2020-12-10 11:45:54','2020-12-10 11:45:54'),(96,10,NULL,11,'Number of Learning Points','Number of Learning Points','Multiple_Choice','1,2',NULL,0,1,1,9,9,'2020-12-10 11:43:20','2020-12-17 05:09:48',NULL),(97,10,NULL,11,'Date of Debriefing (Learning Point 1)','Date of Debriefing (Learning Point 1)','Date',NULL,NULL,1,4,1,9,80,'2020-12-10 11:46:49','2021-04-12 15:18:17',NULL),(98,10,NULL,11,'Human Factors Debriefing Information (Learning Point 1)','Human Factors Debriefing Information (Learning Point 1)','Free_Text',NULL,NULL,1,5,1,9,80,'2020-12-10 11:48:49','2021-04-12 15:16:47',NULL),(99,10,NULL,11,'Reason for Not Debriefing (Learning Point 1)','Reason for Not Debriefing (Learning Point 1)','Multiple_Choice','Staff No Longer Employed,Provider Declined,Provider Did Not Respond,Other',NULL,1,6,1,9,80,'2020-12-10 11:49:44','2021-04-12 15:16:47',NULL),(100,10,NULL,11,'Case Narrative for Learning Point 1','Case Narrative for Learning Point 1','Free_Text',NULL,NULL,1,7,1,9,80,'2020-12-10 11:50:36','2021-04-13 20:44:48',NULL),(101,10,NULL,12,'Cognition Score','Cognition: A faulty understanding of a situation due to cognitive fixation or cognitive biases (e.g.,confirmation bias, focusing effect, tunneling).','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,80,'2020-12-11 06:58:51','2021-04-12 15:24:40',NULL),(102,10,NULL,12,'Cognition - Illustrative Example','Cognition - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2020-12-11 07:01:09','2020-12-11 07:01:09',NULL),(103,10,NULL,12,'Demand-Resource Mismatch Score','Demand-Resource Mismatch: When resources within the agency are not compatible with the needs of staff (e.g., training for onboarding staff, staff shortages).','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,80,'2020-12-11 07:03:13','2021-04-12 15:25:24',NULL),(104,10,NULL,12,'Demand-Resource Mismatch - Illustrative Example','Demand-Resource Mismatch - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2020-12-11 07:16:20','2020-12-11 07:16:20',NULL),(105,10,NULL,12,'Documentation Score','Documentation: Absent, incomplete, or inconsistent documentation within electronic or hard copy file','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,80,'2020-12-11 08:23:13','2021-04-12 15:26:00',NULL),(106,10,NULL,12,'Documentation - Illustrative Example','Documentation - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2020-12-17 05:08:58','2020-12-17 05:08:58',NULL),(107,10,NULL,12,'Equipment/Tools/Technology Score','Equipment/Tools/Technology: An absence or deficiency in the equipment, tools, and/or technology utilized to carry out safe work practices.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,80,'2020-12-17 11:05:11','2021-04-12 15:26:32',NULL),(108,10,NULL,12,'Equipment/Tools/Technology Illustrative Example','Equipment/Tools/Technology Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2020-12-17 11:06:19','2020-12-17 11:06:19',NULL),(109,10,NULL,12,'Teamwork/Coordinating Activities Score','Teamwork/Coordinating Activities: Ineffective joint coordination of activities between two or more entities including internal staff and external partners (e.g., DSP and Clinical Staff, Day Staff and Overnight Staff, Day Program and Residential Program, Provider Agency and Oversight bodies, etc.).','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,80,'2020-12-17 11:07:23','2021-04-12 15:27:00',NULL),(110,10,NULL,12,'Teamwork/Coordinating Activities Illustrative Example','Teamwork/Coordinating Activities Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2020-12-17 11:08:07','2020-12-17 11:08:07',NULL),(111,10,NULL,12,'Knowledge Gap  Score','Knowledge Gap: An absence of requisite experience and/or knowledge and/or difficulties applying knowledge and integrating it into practice (e.g., absence of knowledge regarding policy or practice).','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,80,'2020-12-17 11:09:07','2021-04-12 15:27:51',NULL),(112,10,NULL,12,'Knowledge Gap Illustrative Example','Knowledge Gap Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2020-12-17 11:09:55','2020-12-17 11:09:55',NULL),(113,10,NULL,12,'Medical  Score','Medical: Difficulties in obtaining or understanding medical records and/or integrating medical information into plans of care.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,80,'2020-12-17 11:11:09','2021-04-12 15:28:24',NULL),(114,10,NULL,12,'Medical Illustrative Example','Medical Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2020-12-17 11:11:56','2020-12-17 11:11:56',NULL),(115,10,NULL,12,'Prescribed Practice Score','Prescribed Practice: When practice prescribed by policy or practice standards is absent, conflicting, vague, or does not adequately support work.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,80,'2020-12-17 11:12:33','2021-04-12 15:30:07',NULL),(116,10,NULL,12,'Prescribed Practice Illustrative Example','Prescribed Practice Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2020-12-17 11:13:07','2020-12-17 11:13:07',NULL),(117,10,NULL,12,'Production/Efficiency Pressure Score','Production/Efficiency Pressure: Demands to increase production and/or efficiency (workload, economic), which impacts safe work practices.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,80,'2020-12-17 11:13:43','2021-04-12 15:30:41',NULL),(118,10,NULL,12,'Production/Efficiency Pressure Illustrative Example','Production/Efficiency Pressure Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2020-12-17 11:14:13','2020-12-17 11:14:13',NULL),(119,10,NULL,12,'Service Availability Score','Service Availability: The absence of or difficulty accessing a particular external service or support.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,80,'2020-12-17 11:14:53','2021-04-12 15:31:25',NULL),(120,10,NULL,12,'Service Availability Illustrative Example','Service Availability Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2020-12-17 11:15:34','2020-12-17 11:15:34',NULL),(121,10,NULL,12,'Supervisory Support Score','Supervisory Support: Difficulties in carrying out supervisory functions (e.g., decision support, clinical supervision, knowledge transfer, availability).','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,80,'2020-12-17 11:16:19','2021-04-12 15:34:36',NULL),(122,10,NULL,12,'Supervisory Support Illustrative Example','Supervisory Support Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2020-12-17 11:16:53','2020-12-17 11:16:53',NULL),(123,10,NULL,12,'Procedural Drift Score','Procedural Drift: An accepted gradual departure away from written procedure due to system constraints and influences, workforce/local team acceptance and experienced success.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,80,'2020-12-17 11:17:27','2021-04-12 15:35:13',NULL),(124,10,NULL,12,'Procedural Drift Illustrative Example','Procedural Drift Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2020-12-17 11:18:38','2020-12-17 11:18:38',NULL),(125,10,NULL,12,'Fatigue Score','Fatigue: Worker fatigue impacting safe work practices.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,80,'2020-12-17 11:19:32','2021-04-12 15:35:51',NULL),(126,10,NULL,12,'Fatigue Illustrative Example','Fatigue Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2020-12-17 11:20:05','2020-12-17 11:20:05',NULL),(127,10,NULL,11,'Learning Point 2','Learning Point 2','Short_Answer',NULL,NULL,1,8,1,9,80,'2020-12-17 11:22:20','2021-04-12 15:16:47',NULL),(128,10,NULL,11,'Human Factors Debriefing Completed LP2','Was a Human Factors Debriefing Completed for Learning Point 2','Yes_or_No','Yes,No',NULL,1,9,1,9,80,'2020-12-17 11:24:17','2021-04-12 15:20:50',NULL),(129,10,NULL,11,'Date of Debriefing Learning Point 2','Date of Debriefing Learning Point 2','Date',NULL,NULL,1,10,1,9,80,'2020-12-17 11:26:13','2021-04-12 15:21:17',NULL),(130,10,NULL,11,'Human Factors Debriefing Information LP2','Human Factors Debriefing Information (Learning Point 2)','Free_Text',NULL,NULL,1,11,1,9,80,'2020-12-17 11:28:36','2021-04-12 15:22:49',NULL),(131,10,NULL,11,'Reason for Not Debriefing LP2','Reason for Not Debriefing (Learning Point 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10:36:08',NULL),(137,13,NULL,10,'Other Review Type','Other Review Type','Short_Answer',NULL,NULL,1,NULL,1,9,9,'2021-01-26 10:37:09','2021-01-26 10:37:09',NULL),(138,13,NULL,10,'ICWA','ICWA','Yes_or_No','Yes,No',NULL,0,NULL,1,9,9,'2021-01-26 10:37:50','2021-01-26 10:37:50',NULL),(139,13,NULL,10,'Tribe','Tribe','Multiple_Choice','Bois Forte Band of Chippewa,Fond du Lac Band of Lake Superior Chippewa,Grand Portage Band of Lake Superior Chippewa,Leech Lake Band of Ojibwe,Lower Sioux Indian Community,Mille Lacs Band of Ojibwe,Prairie Island Indian Community,Red Lake Nation,Shakopee Mdewakanton Sioux Community,Upper Sioux Community,White Earth Nation,Other Tribe',NULL,1,NULL,1,9,9,'2021-01-26 10:41:20','2021-01-26 15:39:53',NULL),(140,13,NULL,10,'Other Tribe','\"Other\" Tribe','Short_Answer',NULL,NULL,1,NULL,1,9,9,'2021-01-26 10:41:49','2021-01-26 10:41:49',NULL),(141,13,NULL,10,'Facility','Facility','Yes_or_No','Yes,No',NULL,0,NULL,1,9,9,'2021-01-26 10:42:57','2021-01-26 10:44:20',NULL),(142,13,NULL,10,'Facility Type','Facility Type','Multiple_Choice','Licensed,Legally Unlicensed,Unlicensed',NULL,1,NULL,1,9,9,'2021-01-26 10:44:00','2021-01-26 10:44:00',NULL),(143,13,NULL,10,'Region','Region','Multiple_Choice','1,2,3,4,5,6,7,8,9',NULL,0,NULL,1,9,9,'2021-01-26 10:45:35','2021-01-26 10:45:35',NULL),(144,13,NULL,10,'County','County','Multiple_Choice','Aitkin,Anoka,Becker,Beltrami,Benton,Big Stone,Blue Earth,Brown,Carlton,Carver,Cass,Chippewa,Chisago,Clay,Clearwater,Cook,Crow Wing,Dakota,Des Moines Valley,Douglas,Fairbault-Martin,Fillmore,Freeborn,Goodhue,Grant,Hennepin,Houston,Hubbard,Insanti,Itasca,Kanabec,Kandiyohi,Kittson,Koochiching,Lac Qui Parle,Lake,Lake of the Woods,La Sueur,MN Prairie,Mahnomen,Marshall,McLeod,Meeker,Millie Lacs,Morrison,Mower Nicollet,Nobles,Norman,Olmstead,Otter Tail,Pwennington,Pine,Polk,Pope,Ramsey,Red Lake,Renville,Rice,Roseau,Scott,Sherburne,Sibley,Southwest,St. Louis,Stearns,Stevens,Swift,Todd,Traverse,Wabasha,Wadena,Washington,Watonwan,Wilkin,Winona,Wright,Yellow Medicine,Other County',NULL,0,NULL,1,9,9,'2021-01-26 10:56:25','2021-01-26 14:56:12',NULL),(145,13,NULL,10,'Other County','\"Other\" County','Short_Answer',NULL,NULL,1,NULL,1,9,9,'2021-01-26 11:06:23','2021-01-26 14:56:29',NULL),(146,13,NULL,11,'Child First Name','Child First Name','Short_Answer',NULL,NULL,0,NULL,1,9,9,'2021-01-26 14:58:37','2021-04-12 15:08:20','2021-04-12 15:08:20'),(147,13,NULL,11,'Child Last Name','Child Last Name','Short_Answer',NULL,NULL,0,NULL,1,9,9,'2021-01-26 14:59:05','2021-04-12 15:08:31','2021-04-12 15:08:31'),(148,13,NULL,11,'Date of Birth','Date of Birth','Date',NULL,NULL,0,NULL,1,9,9,'2021-01-26 14:59:26','2021-04-12 15:08:42','2021-04-12 15:08:42'),(149,13,NULL,11,'Date of Fatality','Date of Fatality','Date',NULL,NULL,0,NULL,1,9,9,'2021-01-26 15:01:19','2021-04-12 15:08:51','2021-04-12 15:08:51'),(150,13,NULL,11,'Date of Near Fatality','Date of Near Fatality','Date',NULL,NULL,0,NULL,1,9,9,'2021-01-26 15:01:47','2021-04-12 15:09:07','2021-04-12 15:09:07'),(151,13,NULL,11,'Age at Incident','Age at Incident','Multiple_Choice','< 1 Month,2 Months,3 Months,4 Months,5 Months,6 Months,7 Months,8 Months,9 Months,10 Months,11 Months,1 Year,2 Years,3 Years,4 Years,5 Years,6 Years,7 Years,8 Years,9 Years,10 Years,11 Years,12 Years,13 Years,14 Years,15 Years,16 Years,17 Years,18 Years',NULL,0,NULL,1,9,9,'2021-01-26 15:05:47','2021-04-12 15:09:16','2021-04-12 15:09:16'),(152,13,NULL,11,'Offender(s)','Offender(s)','Multiple_Choice','1,2,3,4,5',NULL,0,NULL,1,9,9,'2021-01-26 15:24:13','2021-04-12 15:09:25','2021-04-12 15:09:25'),(153,13,NULL,11,'Offender 1 Relationship','Offender 1 Relationship','Short_Answer',NULL,NULL,1,NULL,1,9,9,'2021-01-26 15:24:56','2021-04-12 15:09:37','2021-04-12 15:09:37'),(154,13,NULL,11,'Offender 2 Relationship','Offender 2 Relationship','Short_Answer',NULL,NULL,1,NULL,1,9,9,'2021-01-26 15:25:24','2021-04-12 15:09:45','2021-04-12 15:09:45'),(155,13,NULL,11,'Offender 3 Relationship','Offender 3 Relationship','Short_Answer',NULL,NULL,1,NULL,1,9,9,'2021-01-26 15:25:47','2021-04-12 15:09:55','2021-04-12 15:09:55'),(156,13,NULL,11,'Offender 4 Relationship','Offender 4 Relationship','Short_Answer',NULL,NULL,1,NULL,1,9,9,'2021-01-26 15:26:11','2021-04-12 15:10:06','2021-04-12 15:10:06'),(157,13,NULL,11,'Offender 5 Relationship','Offender 5 Relationship','Short_Answer',NULL,NULL,1,NULL,1,9,9,'2021-01-26 15:26:39','2021-04-12 15:10:16','2021-04-12 15:10:16'),(158,13,NULL,15,'Learning Points','Learning Point(s)','Multiple_Choice','1,2,3,4,5,6,7,8,9,10',NULL,0,NULL,1,9,9,'2021-02-12 12:00:46','2021-04-12 16:27:27','2021-04-12 16:27:27'),(159,13,NULL,15,'LP1','Learning Point 1','Short_Answer',NULL,NULL,1,NULL,1,9,9,'2021-02-12 12:02:27','2021-04-12 16:27:27','2021-04-12 16:27:27'),(160,13,NULL,15,'HFD1','Human Factors Debriefing 1','Free_Text',NULL,NULL,1,NULL,1,9,9,'2021-02-12 12:24:18','2021-04-12 16:27:27','2021-04-12 16:27:27'),(161,13,NULL,15,'Narrative1','Narrative LP1','Free_Text',NULL,NULL,1,NULL,1,9,9,'2021-02-12 12:25:07','2021-04-12 16:27:27','2021-04-12 16:27:27'),(162,36,NULL,28,'Mapping Date','Mapping Date','Date',NULL,NULL,0,1,1,9,80,'2021-03-10 14:44:09','2021-04-21 02:34:18',NULL),(163,36,NULL,29,'Cognition Rating','Cognition - A faulty understanding of a situation due to cognitive fixation or cognitive biases','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,9,'2021-03-10 14:48:30','2021-03-11 13:45:52',NULL),(164,36,NULL,29,'Cognition Illustrative Example','Cognition Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2021-03-10 14:49:23','2021-03-11 13:46:15',NULL),(165,36,NULL,29,'Demand-Resource Mismatch Rating','Demand-Resource Mismatch - Resources within the agency are not compatible with the needs of staff','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,9,'2021-03-10 14:53:28','2021-03-11 13:47:19',NULL),(166,36,NULL,29,'Demand-Resource Mismatch Illustrative 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13:51:04',NULL),(171,36,NULL,29,'Teamwork/Coordinating Activities Rating','Teamwork/Coordinating Activities - Ineffective coordination of activities between 2 or more entities','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,9,'2021-03-10 15:13:32','2021-03-11 13:51:42',NULL),(172,36,NULL,29,'Teamwork/Coordinating Activities Illustrative Example','Teamwork/Coordinating Activities Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2021-03-10 15:14:06','2021-03-11 13:52:04',NULL),(173,36,NULL,29,'Knowledge Gap Rating','Knowledge Gap - Absence of requisite experience/knowledge and or difficulties applying to practice','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,9,'2021-03-11 10:15:55','2021-03-11 13:54:08',NULL),(174,36,NULL,29,'Knowledge Gap Illustrative Example','Knowledge Gap Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2021-03-11 10:16:36','2021-03-11 13:55:05',NULL),(175,36,NULL,29,'Prescribed Practice Rating','Prescribed Practice - Practice prescribed by policy/standards is absent, conflicting, or vague','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,9,'2021-03-11 10:18:23','2021-03-11 14:35:47',NULL),(176,36,NULL,29,'Prescribed Practice Illustrative Example','Prescribed Practice Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2021-03-11 10:18:58','2021-03-11 14:36:14',NULL),(177,36,NULL,29,'Production/Efficiency Pressure Rating','Production/Efficiency Pressure - Demands on production/efficiency which impacts safe work practice','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,9,9,'2021-03-11 10:21:34','2021-03-11 14:36:41',NULL),(178,36,NULL,29,'Production/Efficiency Pressure Illustrative Example','Production/Efficiency Pressure Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,9,9,'2021-03-11 10:21:57','2021-03-11 14:36:58',NULL),(179,36,NULL,29,'Service Availability Rating','Service Availability - The absence of/difficulty accessing a particular external service or 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02:34:18',NULL),(335,36,NULL,28,'Considerations','Considerations','Free_Text',NULL,NULL,0,8,1,80,80,'2021-04-21 02:33:58','2021-04-21 02:34:18',NULL),(336,31,NULL,5,'Learning Point 1','Learning Point 1','Short_Answer',NULL,NULL,1,4,1,80,80,'2021-04-21 02:47:10','2021-04-21 02:50:54',NULL),(337,31,NULL,5,'Learning Point 2','Learning Point 2','Short_Answer',NULL,NULL,1,5,1,80,80,'2021-04-21 02:48:12','2021-04-21 02:50:54',NULL),(338,31,NULL,5,'Learning Point 3','Learning Point 3','Short_Answer',NULL,NULL,1,6,1,80,80,'2021-04-21 02:48:34','2021-04-21 02:50:54',NULL),(339,31,NULL,5,'Positive Capacities','Positive Capacities','Free_Text',NULL,NULL,0,7,1,80,80,'2021-04-21 02:49:31','2021-04-21 02:50:54',NULL),(340,31,NULL,5,'Key Learnings','Key Learnings','Free_Text',NULL,NULL,0,8,1,80,80,'2021-04-21 02:50:04','2021-04-21 02:50:54',NULL),(341,31,NULL,5,'Considerations','Considerations','Free_Text',NULL,NULL,0,9,1,80,80,'2021-04-21 02:50:20','2021-04-21 02:50:54',NULL),(342,13,NULL,41,'Mapping Date','Mapping Date','Date',NULL,NULL,0,4,1,80,80,'2021-04-22 14:22:16','2021-04-22 21:44:43',NULL),(343,13,NULL,43,'Learning Point 5','Learning Point 5','Short_Answer',NULL,NULL,1,NULL,1,80,80,'2021-04-22 15:40:07','2021-04-22 21:44:43',NULL),(344,13,NULL,43,'Human Factors Debriefing LP5','Human Factors Debriefing LP5','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 15:41:12','2021-04-22 21:44:43',NULL),(345,13,NULL,43,'Narrative LP5','Narrative LP5','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 15:41:43','2021-04-22 21:44:43',NULL),(346,13,NULL,44,'Cognition Score','Cognition - A faulty understanding of a situation due to cognitive fixation or cognitive biases (e.g., confirmation bias, focusing effect, tunneling).','Multiple_Choice','0,1,2,3',NULL,0,1,1,80,80,'2021-04-22 15:43:55','2021-04-22 21:44:43',NULL),(347,13,NULL,44,'Cognition Illustrative Example','Cognition Illustrative Example','Free_Text',NULL,NULL,1,2,1,80,80,'2021-04-22 15:45:50','2021-04-22 21:44:43',NULL),(348,13,NULL,44,'Demand-Resource Mismatch Score','Demand-Resource Mismatch - Resources within the agency are not compatible with the needs of staff (e.g., training for onboarding staff, staff shortages).','Multiple_Choice','0,1,2,3',NULL,0,3,1,80,80,'2021-04-22 15:46:43','2021-04-22 21:44:43',NULL),(349,13,NULL,44,'Demand-Resource Mismatch Illustrative Example','Demand-Resource Mismatch Illustrative Example','Free_Text',NULL,NULL,1,4,1,80,80,'2021-04-22 15:49:51','2021-04-22 21:44:43',NULL),(350,13,NULL,44,'Documentation Score','Documentation - Absent, incomplete or inconsistent documentation within electronic or hard copy case file','Multiple_Choice','0,1,2,3',NULL,0,5,1,80,80,'2021-04-22 15:50:19','2021-04-22 21:44:43',NULL),(351,13,NULL,44,'Documentation Illustrative Example','Documentation Illustrative Example','Free_Text',NULL,NULL,1,6,1,80,80,'2021-04-22 15:50:37','2021-04-22 21:44:43',NULL),(352,13,NULL,44,'Equipment/Tools/Technology Score','Equipment/Tools/Technology - An absence or deficiency in the equipment, tools and or technology utilized to carry out safe work practices','Multiple_Choice','0,1,2,3',NULL,0,7,1,80,80,'2021-04-22 15:51:03','2021-04-22 21:44:43',NULL),(353,13,NULL,44,'Equipment/Tools/Technology Illustrative Example','Equipment/Tools/Technology Illustrative Example','Free_Text',NULL,NULL,1,8,1,80,80,'2021-04-22 15:51:22','2021-04-22 21:44:43',NULL),(354,13,NULL,44,'Teamwork/Coordinating Activities Score','Teamwork/Coordinating Activities - Ineffective joint coordination of activities between two or more entities including internal staff and external partners (e.g., CPS and Licensing, CPS and Law Enforcement, Foster Care and other External Entities, etc.).','Multiple_Choice','0,1,2,3',NULL,0,9,1,80,80,'2021-04-22 15:52:13','2021-04-22 21:44:43',NULL),(355,13,NULL,44,'Teamwork/Coordinating Activities Illustrative Example','Teamwork/Coordinating Activities Illustrative Example','Free_Text',NULL,NULL,1,10,1,80,80,'2021-04-22 15:53:24','2021-04-22 21:44:43',NULL),(356,13,NULL,44,'Knowledge Gap Score','Knowledge Gap - An absence of requisite experience and or knowledge and or difficulties applying knowledge and integrating it into practice (e.g., absence of knowledge regarding policy or practice).','Multiple_Choice','0,1,2,3',NULL,0,11,1,80,80,'2021-04-22 15:55:12','2021-04-22 21:44:43',NULL),(357,13,NULL,44,'Knowledge Gap Illustrative Example','Knowledge Gap Illustrative Example','Free_Text',NULL,NULL,1,12,1,80,80,'2021-04-22 15:55:35','2021-04-22 21:44:43',NULL),(358,13,NULL,44,'Prescribed Practice Score','Prescribed Practice - Practice prescribed by policy or practice standards is absent, conflicting, vague or does not adequately support work','Multiple_Choice','0,1,2,3',NULL,0,15,1,80,80,'2021-04-22 15:56:33','2021-04-22 21:44:43',NULL),(359,13,NULL,44,'Prescribed Practice Illustrative Example','Prescribed Practice Illustrative Example','Free_Text',NULL,NULL,1,16,1,80,80,'2021-04-22 15:56:55','2021-04-22 21:44:43',NULL),(360,13,NULL,44,'Production/Efficiency Pressure Score','Production/Efficiency Pressure - Demands to increase production and or efficiency (workload, economic), which impacts safe work practices','Multiple_Choice','0,1,2,3',NULL,0,17,1,80,80,'2021-04-22 15:57:22','2021-04-22 21:44:43',NULL),(361,13,NULL,44,'Production/Efficiency Pressure Illustrative Example','Production/Efficiency Pressure Illustrative Example','Free_Text',NULL,NULL,1,18,1,80,80,'2021-04-22 15:57:42','2021-04-22 21:44:43',NULL),(362,13,NULL,44,'Service Availability Score','Service Availability - The absence of or difficulty accessing a particular external service or support','Multiple_Choice','0,1,2,3',NULL,0,19,1,80,80,'2021-04-22 15:58:01','2021-04-22 21:44:43',NULL),(363,13,NULL,44,'Service Availability Illustrative Example','Service Availability Illustrative Example','Free_Text',NULL,NULL,1,20,1,80,80,'2021-04-22 15:59:15','2021-04-22 21:44:43',NULL),(364,13,NULL,44,'Supervisory Support Score','Supervisory Support - Difficulties in carrying out supervisory functions (e.g., decision support, clinical supervision, knowledge transfer, availability).','Multiple_Choice','0,1,2,3',NULL,0,21,1,80,80,'2021-04-22 16:00:20','2021-04-22 21:44:43',NULL),(365,13,NULL,44,'Supervisory Support Illustrative Example','Supervisory Support Illustrative Example','Free_Text',NULL,NULL,1,22,1,80,80,'2021-04-22 16:03:01','2021-04-22 21:44:43',NULL),(366,13,NULL,44,'Procedural Drift Score','Procedural Drift - An accepted gradual departure away from written procedure due to system constraints and influences, workforce/local team acceptance and experienced success.','Multiple_Choice','0,1,2,3',NULL,0,23,1,80,80,'2021-04-22 16:05:43','2021-04-22 21:44:43',NULL),(367,13,NULL,44,'Procedural Drift Illustrative Example','Procedural Drift Illustrative Example','Free_Text',NULL,NULL,1,24,1,80,80,'2021-04-22 16:07:12','2021-04-22 21:44:43',NULL),(368,13,NULL,44,'Medical Score','Medical - Difficulties in obtaining or understanding medical records and/or integrating medical information into plans of care.','Multiple_Choice','0,1,2,3',NULL,0,13,1,80,80,'2021-04-22 16:07:45','2021-04-22 21:44:43',NULL),(369,13,NULL,44,'Medical Illustrative Example','Medical Illustrative Example','Free_Text',NULL,NULL,1,14,1,80,80,'2021-04-22 16:08:58','2021-04-22 21:44:43',NULL),(370,13,NULL,44,'Review Complete','Review Complete','Yes_or_No','Yes,No',NULL,0,25,1,80,80,'2021-04-22 16:32:13','2021-04-22 21:44:43',NULL),(371,39,NULL,40,'Stakeholder Meeting Date','Stakeholder Meeting Date','Date',NULL,NULL,1,6,1,80,80,'2021-04-22 17:12:24','2021-04-23 16:12:59',NULL),(372,39,NULL,40,'ICWA','ICWA','Yes_or_No','Yes,No',NULL,0,7,1,80,80,'2021-04-22 17:14:33','2021-04-23 16:12:51',NULL),(373,39,NULL,40,'Tribe','Tribe','Multiple_Choice','Bois Forte Band of Chippewa,Fond du Lac Band of Lake Superior Chippewa,Grand Portage Band of Lake Superior Chippewa,Leech Lake Band of Ojibwe,Lower Sioux Indian Community,Mille Lacs Band of Ojibwe,Prairie Island Indian Community,Red Lake Nation,Shakopee Mdewakanton Sioux Community,Upper Sioux Community,White Earth Nation,Other Tribe',NULL,1,8,1,80,80,'2021-04-22 17:18:18','2021-04-23 16:12:48',NULL),(374,39,NULL,40,'Other Tribe','Other Tribe','Short_Answer',NULL,NULL,1,9,1,80,80,'2021-04-22 17:18:52','2021-04-23 16:12:44',NULL),(375,39,NULL,40,'Facility','Facility','Yes_or_No','Yes,No',NULL,0,10,1,80,80,'2021-04-22 17:19:40','2021-04-23 16:12:40',NULL),(376,39,NULL,40,'Facility Type','Facility Type','Multiple_Choice','Licensed,Legally Unlicensed,Unlicensed',NULL,1,11,1,80,80,'2021-04-22 17:20:47','2021-04-23 16:12:36',NULL),(377,39,NULL,40,'Region','Region','Multiple_Choice','1,2,3,4,5,6,7,8,9',NULL,0,12,1,80,80,'2021-04-22 17:22:36','2021-04-23 16:12:32',NULL),(378,39,NULL,40,'County','County','Multiple_Choice','Aitkin,Anoka,Becker,Beltrami,Benton,Big Stone,Blue Earth,Brown,Carlton,Carver,Cass,Chippewa,Chisago,Clay,Clearwater,Cook,Crow Wing,Dakota,Des Moines Valley,Douglas,Fairbault-Martin,Fillmore,Frreborn,Goodhue,Grant,Hennepin,Houston,Hubbard,Insanti,Itasca,Kanabec,Kandiyohi,Kittson,Koochiching,Lac Qui Parle,Lake,Lake of the Woods,Le Sueuer,MN Prairie,Mahnomen,Marshall,McLeod,Meeker,Millie Lacs,Morrison,Mower,Nicollet,Nobles,Norman,Olmsted,Otter Tail,Pennington,Pine,Polk,Pope,Ramsey,Red Lake,Renville,Rice,Roseau,Scott,Sherburne,Sibley,Southwest,St. Louis,Stearns,Stevens,Swift,Todd,Traverse,Wabasha,Wadena,Washington,Watonwan,Wilkin,Winona,Wright,Yellow Medicine,Other County',NULL,0,13,1,80,80,'2021-04-22 17:23:49','2021-04-23 16:12:25',NULL),(379,39,NULL,40,'Other County','Other County','Short_Answer',NULL,NULL,1,14,1,80,80,'2021-04-22 17:24:14','2021-04-23 16:12:21',NULL),(380,39,NULL,45,'Child First Name','Child First Name','Short_Answer',NULL,NULL,0,NULL,1,80,80,'2021-04-22 17:51:23','2021-04-22 17:51:23',NULL),(381,39,NULL,45,'Child Last Name','Child Last Name','Short_Answer',NULL,NULL,0,NULL,1,80,80,'2021-04-22 17:52:35','2021-04-22 17:52:35',NULL),(382,39,NULL,45,'Child D.O.B.','Child\'s Date of Birth','Date',NULL,NULL,0,NULL,1,80,80,'2021-04-22 17:53:19','2021-04-22 17:53:19',NULL),(383,39,NULL,46,'Learning Point(s)','Learning Point(s)','Multiple_Choice','1,2,3,4,5',NULL,0,2,1,80,80,'2021-04-22 17:57:06','2021-04-22 18:25:28',NULL),(384,39,NULL,46,'Learning Point 1','Learning Point 1','Short_Answer',NULL,NULL,1,3,1,80,80,'2021-04-22 17:58:13','2021-04-22 18:25:28',NULL),(385,39,NULL,46,'Human Factors Debriefing - LP1','Human Factors Debriefing - LP1','Free_Text',NULL,NULL,1,4,1,80,80,'2021-04-22 17:58:55','2021-04-22 18:30:05',NULL),(386,39,NULL,46,'Narrative - LP1','Narrative - LP1','Free_Text',NULL,NULL,1,5,1,80,80,'2021-04-22 17:59:29','2021-04-22 18:30:39',NULL),(387,39,NULL,46,'Learning Point 2','Learning Point 2','Short_Answer',NULL,NULL,1,6,1,80,80,'2021-04-22 18:01:45','2021-04-22 18:30:47',NULL),(388,39,NULL,46,'Human Factors Debriefing - LP2','Human Factors Debriefing - LP2','Free_Text',NULL,NULL,1,7,1,80,80,'2021-04-22 18:02:42','2021-04-22 18:31:02',NULL),(389,39,NULL,46,'Narrative - LP2','Narrative - LP2','Free_Text',NULL,NULL,1,8,1,80,80,'2021-04-22 18:03:40','2021-04-22 18:31:02',NULL),(390,39,NULL,46,'Considerations','Considerations','Free_Text',NULL,NULL,1,1,1,80,80,'2021-04-22 18:21:50','2021-04-30 16:45:53',NULL),(391,39,NULL,46,'Learning Point 3','Learning Point 3','Short_Answer',NULL,NULL,1,9,1,80,80,'2021-04-22 18:23:58','2021-04-22 18:30:27',NULL),(392,39,NULL,46,'Human Factors Debriefing - LP3','Human Factors Debriefing - LP3','Free_Text',NULL,NULL,1,10,1,80,80,'2021-04-22 18:24:47','2021-04-22 18:31:18',NULL),(393,39,NULL,46,'Narrative - LP3','Narrative - LP3','Free_Text',NULL,NULL,1,11,1,80,80,'2021-04-22 18:25:10','2021-04-22 18:31:18',NULL),(394,39,NULL,46,'Learning Point 4','Learning Point 4','Short_Answer',NULL,NULL,1,12,1,80,80,'2021-04-22 18:58:14','2021-04-22 18:58:30',NULL),(395,39,NULL,46,'Human Factors Debriefing - LP4','Human Factors Debriefing - LP4','Free_Text',NULL,NULL,1,13,1,80,80,'2021-04-22 18:58:59','2021-04-22 18:59:15',NULL),(396,39,NULL,46,'Narrative - LP4','Narrative - LP4','Free_Text',NULL,NULL,1,14,1,80,80,'2021-04-22 18:59:42','2021-04-22 19:00:07',NULL),(397,39,NULL,46,'Learning Point 5','Learning Point 5','Short_Answer',NULL,NULL,1,15,1,80,80,'2021-04-22 19:01:10','2021-04-22 19:01:23',NULL),(398,39,NULL,46,'Human Factors Debriefing - LP5','Human Factors Debriefing - LP5','Free_Text',NULL,NULL,1,16,1,80,80,'2021-04-22 19:02:14','2021-04-22 19:02:25',NULL),(399,39,NULL,46,'Narrative - LP5','Narrative - LP5','Free_Text',NULL,NULL,1,17,1,80,80,'2021-04-22 19:02:58','2021-04-22 19:03:17',NULL),(400,39,NULL,47,'Cognition Score','Cognition - A faulty understanding of a situation due to cognitive fixation or cognitive biases (e.g., confirmation bias, focusing effect, tunneling).','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-04-22 19:07:07','2021-04-22 19:07:07',NULL),(401,39,NULL,47,'Cognition - Illustrative Example','Cognition - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 19:08:02','2021-04-22 19:08:02',NULL),(402,39,NULL,47,'Demand-Resource Mismatch Score','Demand-Resource Mismatch - When resources within the agency are not compatible with the needs of staff (e.g., training for onboarding staff, staff shortages).','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-04-22 19:08:49','2021-04-22 19:08:49',NULL),(403,39,NULL,47,'Demand-Resource Mismatch - Illustrative Example','Demand-Resource Mismatch - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 19:09:59','2021-04-22 19:09:59',NULL),(404,39,NULL,47,'Documentation Score','Documentation - Absent, incomplete or inconsistent documentation within electronic or hard copy case file.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-04-22 19:11:14','2021-04-22 19:11:14',NULL),(405,39,NULL,47,'Documentation - Illustrative Example','Documentation - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 19:11:36','2021-04-22 19:11:36',NULL),(406,39,NULL,47,'Equipment/Tools/Technology Score','Equipment/Tools/Technology - An absence or deficiency in the equipment, tools and or technology utilized to carry out safe work practices.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-04-22 19:12:42','2021-04-22 19:12:42',NULL),(407,39,NULL,47,'Equipment/Tools/Technology - Illustrative Example','Equipment/Tools/Technology - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 19:13:09','2021-04-22 19:13:09',NULL),(408,39,NULL,47,'Teamwork/Coordinating Activities Score','Teamwork/Coordinating Activities - Ineffective joint coordination of activities between two or more entities including internal staff and external partners (e.g., CPS and Licensing, CPS and Law Enforcement, Foster Care and other External Entities, etc.).','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-04-22 19:14:08','2021-04-22 19:14:08',NULL),(409,39,NULL,47,'Teamwork/Coordinating Activities - Illustrative Example','Teamwork/Coordinating Activities - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 19:14:30','2021-04-22 19:14:30',NULL),(410,39,NULL,47,'Knowledge Gap  Score','Knowledge Gap - An absence of requisite experience and/or knowledge and/or difficulties applying knowledge and integrating it into practice (e.g., absence of knowledge regarding policy or practice).','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-04-22 19:16:47','2021-04-22 19:16:47',NULL),(411,39,NULL,47,'Knowledge Gap - Illustrative Example','Knowledge Gap - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 19:17:06','2021-04-22 19:17:06',NULL),(412,39,NULL,47,'Medical Score','Medical - Difficulties in obtaining or understanding medical records and/or integrating medical information into plans of care.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-04-22 19:51:19','2021-04-22 19:51:43',NULL),(413,39,NULL,47,'Medical - Illustrative Example','Medical - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 19:52:06','2021-04-22 19:52:06',NULL),(414,39,NULL,47,'Prescribed Practice Score','Prescribed Practice - When practice prescribed by policy or practice standards is absent, conflicting, vague or does not adequately support work.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-04-22 19:52:48','2021-04-22 19:52:48',NULL),(415,39,NULL,47,'Prescribed Practice - Illustrative Example','Prescribed Practice - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 20:05:22','2021-04-22 20:05:22',NULL),(416,39,NULL,47,'Production/Efficiency Pressure Score','Production/Efficiency Pressure - Demands to increase production and/or efficiency (workload, economic), which impacts safe work practices.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-04-22 20:06:11','2021-04-22 20:06:11',NULL),(417,39,NULL,47,'Production/Efficiency Pressure - Illustrative Example','Production/Efficiency Pressure - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 20:06:35','2021-04-22 20:06:35',NULL),(418,39,NULL,47,'Service Availability Score','Service Availability - The absence of or difficulty accessing a particular external service or support.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-04-22 20:18:18','2021-04-22 20:18:18',NULL),(419,39,NULL,47,'Service Availability - Illustrative Example','Service Availability - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 20:18:43','2021-04-22 20:18:43',NULL),(420,39,NULL,47,'Supervisory Support Score','Supervisory Support - Difficulties in carrying out supervisory functions (e.g., decision support, clinical supervision, knowledge transfer, availability).','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-04-22 20:19:23','2021-04-22 20:19:23',NULL),(421,39,NULL,47,'Supervisory Support - Illustrative Example','Supervisory Support - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 20:20:16','2021-04-22 20:20:16',NULL),(422,39,NULL,47,'Procedural Drift Score','Procedural Drift - An accepted gradual departure away from written procedure due to system constraints and influences, workforce/local team acceptance and experienced success.','Multiple_Choice','0,1,2,3',NULL,0,NULL,1,80,80,'2021-04-22 20:20:59','2021-04-22 20:20:59',NULL),(423,39,NULL,47,'Procedural Drift - Illustrative Example','Procedural Drift - Illustrative Example','Free_Text',NULL,NULL,1,NULL,1,80,80,'2021-04-22 20:21:26','2021-04-22 20:21:26',NULL),(424,39,NULL,47,'Review Complete','Review Complete','Yes_or_No','Yes,No',NULL,0,NULL,1,80,80,'2021-04-22 20:21:53','2021-04-22 20:21:53',NULL),(425,39,NULL,40,'Indicator','Indicator','Multiple_Choice','Rate of experiencing child protection,Timeliness of visits for children reported to child protection,Discretionary investigation assignment,Placement into out-of-home care after conditionally safe SDM decision,Rate of experiencing out-of-home care,Caseworker visits (out-of-home care cases),Caseworker visits (in-home CP cases),Maltreatment while in out-of-home care,Placement moves while in foster care,Length of stay in out-of-home care,Re-entry into out-of-home care,Placement with siblings in out-of-home care,School change due to out-of-home care placement,Placement with relatives when in family foster care,CFSR Item 6 - Permanency: 24 months',NULL,0,3,1,80,80,'2021-04-23 16:08:40','2021-04-28 16:43:05',NULL),(426,32,NULL,7,'Learning Point 1','Learning Point 1','Short_Answer',NULL,NULL,1,4,1,80,80,'2021-04-23 19:44:58','2021-04-23 19:47:29',NULL),(427,32,NULL,7,'Learning Point 2','Learning Point 2','Short_Answer',NULL,NULL,1,5,1,80,80,'2021-04-23 19:45:18','2021-04-23 19:47:29',NULL),(428,32,NULL,7,'Learning Point 3','Learning Point 3','Short_Answer',NULL,NULL,1,6,1,80,80,'2021-04-23 19:45:33','2021-04-23 19:47:29',NULL),(429,32,NULL,7,'Positive Capacities','Positive Capacities','Free_Text',NULL,NULL,0,7,1,80,80,'2021-04-23 19:46:37','2021-04-23 19:47:29',NULL),(430,32,NULL,7,'Key Learnings','Key Learnings','Free_Text',NULL,NULL,0,8,1,80,80,'2021-04-23 19:46:54','2021-04-23 19:47:29',NULL),(431,32,NULL,7,'Considerations','Considerations','Free_Text',NULL,NULL,0,9,1,80,80,'2021-04-23 19:47:09','2021-04-23 19:47:29',NULL),(432,10,NULL,12,'Review Complete','Review Complete','Yes_or_No','Yes,No',NULL,0,NULL,1,80,80,'2021-04-28 21:27:44','2021-04-28 21:27:44',NULL),(433,15,NULL,50,'F/NF/AF# (Including SFY)','F/NF/AF# (Including SFY)','Short_Answer',NULL,NULL,0,NULL,1,80,80,'2021-05-07 18:38:54','2021-05-07 18:38:54',NULL),(434,15,NULL,50,'Date of Referral','Date of Referral','Date',NULL,NULL,0,NULL,1,80,80,'2021-05-07 18:39:08','2021-05-07 18:39:08',NULL),(435,15,NULL,50,'Child\'s Name','Child\'s Name','Short_Answer',NULL,NULL,0,NULL,1,80,80,'2021-05-07 18:39:30','2021-05-07 18:39:30',NULL),(436,15,NULL,50,'Child\'s DOB','Child\'s Date of Birth','Date',NULL,NULL,0,NULL,1,80,80,'2021-05-07 18:40:04','2021-05-07 18:40:04',NULL),(437,15,NULL,50,'Child\'s Age','Child\'s Age','Number',NULL,NULL,0,NULL,1,80,80,'2021-05-07 18:41:13','2021-05-07 18:41:13',NULL),(438,15,NULL,50,'Child\'s Gender','Child\'s Gender','Multiple_Choice','Male,Female',NULL,0,NULL,1,80,80,'2021-05-07 18:41:42','2021-05-07 18:41:42',NULL),(439,15,NULL,50,'Child\'s Race','Child\'s Race','Multiple_Choice','American Indian / Alaskan Native,Asian,Black or African American,Child Abandoned - unable to determine,Declined to disclose,Incapacitated or unable to inform,Multiracial – Races Unknown,Native Hawaiian or Other Pacific Islander,White',NULL,0,NULL,1,80,80,'2021-05-07 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--
-- Table structure for table `questions_triggered`
--

CREATE TABLE `questions_triggered` (
  `id` int(10) unsigned NOT NULL AUTO_INCREMENT,
  `question_id` int(10) unsigned DEFAULT NULL,
  `organization_id` int(10) unsigned DEFAULT NULL,
  `form_id` int(10) unsigned DEFAULT NULL,
  `tab_id` int(10) unsigned DEFAULT NULL,
  `triggered_question` int(10) unsigned DEFAULT NULL,
  `trigger_answer` text COLLATE utf8mb4_unicode_ci,
  `created_by` int(10) unsigned DEFAULT NULL,
  `updated_by` int(10) unsigned DEFAULT NULL,
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL,
  `deleted_at` timestamp NULL DEFAULT NULL,
  PRIMARY KEY (`id`)
) ENGINE=InnoDB AUTO_INCREMENT=331 DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci ROW_FORMAT=DYNAMIC;

--
-- Dumping data for table `questions_triggered`
--

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15:42:27','2021-04-22 15:42:27',NULL),(222,347,13,NULL,44,346,'2,3',80,80,'2021-04-22 16:10:15','2021-04-22 16:10:15',NULL),(223,349,13,NULL,44,348,'2,3',80,80,'2021-04-22 16:10:49','2021-04-22 16:10:49',NULL),(224,351,13,NULL,44,350,'2,3',80,80,'2021-04-22 16:11:30','2021-04-22 16:11:30',NULL),(225,353,13,NULL,44,352,'2,3',80,80,'2021-04-22 16:21:01','2021-04-22 16:21:01',NULL),(226,355,13,NULL,44,354,'2,3',80,80,'2021-04-22 16:22:06','2021-04-22 16:22:06',NULL),(227,357,13,NULL,44,356,'2,3',80,80,'2021-04-22 16:22:52','2021-04-22 16:22:52',NULL),(228,369,13,NULL,44,368,'2,3',80,80,'2021-04-22 16:24:41','2021-04-22 16:24:41',NULL),(229,359,13,NULL,44,358,'2,3',80,80,'2021-04-22 16:26:46','2021-04-22 16:26:46',NULL),(230,361,13,NULL,44,360,'2,3',80,80,'2021-04-22 16:27:51','2021-04-22 16:27:51',NULL),(231,363,13,NULL,44,362,'2,3',80,80,'2021-04-22 16:29:12','2021-04-22 16:29:12',NULL),(232,365,13,NULL,44,364,'2,3',80,80,'2021-04-22 16:30:21','2021-04-22 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--
-- Table structure for table `reports`
--

CREATE TABLE `reports` (
  `id` int(10) unsigned NOT NULL AUTO_INCREMENT,
  `form_id` int(10) unsigned DEFAULT NULL,
  `user_id` int(10) unsigned DEFAULT NULL,
  `question_id` int(10) unsigned DEFAULT NULL,
  `organization_id` int(10) unsigned DEFAULT NULL,
  `tab_id` int(10) unsigned DEFAULT NULL,
  `question_type` text COLLATE utf8mb4_unicode_ci,
  `text_answer` text COLLATE utf8mb4_unicode_ci,
  `mcq_answer` text COLLATE utf8mb4_unicode_ci,
  `other_answer` tinyint(4) NOT NULL DEFAULT '0',
  `status` tinyint(4) NOT NULL DEFAULT '1',
  `created_by` int(10) unsigned DEFAULT NULL,
  `updated_by` int(10) unsigned DEFAULT NULL,
  `created_at` timestamp NULL DEFAULT NULL,
  `updated_at` timestamp NULL DEFAULT NULL,
  `deleted_at` timestamp NULL DEFAULT NULL,
  `report_name` text COLLATE utf8mb4_unicode_ci,
  PRIMARY KEY (`id`)
) ENGINE=InnoDB AUTO_INCREMENT=375 DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci ROW_FORMAT=DYNAMIC;

--
-- Dumping data for table `reports`
--

INSERT INTO `reports` VALUES (1,1,157,NULL,29,NULL,NULL,'{\"Free_Text__1\":\"Ans of Q1\",\"Short_Answer__2\":\"Short answer\",\"Date__3\":\"03\\/17\\/2021\",\"Number__4\":\"10\",\"True_or_False__5\":\"True\",\"Yes_or_No__6\":\"Yes\",\"Multiple_Choice__7\":\"Choice_5\",\"Multiple_Select__8\":{\"Choice 5\":\"Choice 5\"},\"Free_Text__9\":\"Test Q9 Free text\",\"Short_Answer__10\":\"Trigger answer of q10\",\"Number__11\":\"10\",\"True_or_False__12\":\"False\",\"Multiple_Choice__13\":\"Choice_2\",\"Multiple_Select__14\":{\"Choice 3\":\"Choice 3\"},\"Free_Text__15\":\"Answer of Q1 tab 2\",\"Date__16\":\"03\\/17\\/2021\"}',NULL,0,1,157,157,'2021-03-17 12:45:34','2021-03-17 13:01:11',NULL,'Test 1'),(2,2,157,NULL,29,NULL,NULL,'',NULL,0,1,157,157,'2021-03-17 13:22:54','2021-03-17 13:22:54',NULL,''),(3,3,81,NULL,28,NULL,NULL,'',NULL,0,1,81,81,'2021-03-17 14:13:12','2021-03-17 14:13:43',NULL,'Test review1'),(4,4,81,NULL,31,NULL,NULL,'{\"Date__22\":\"03\\/30\\/2021\",\"Free_Text__48\":\"Notes from the mapping here if needed\",\"Multiple_Choice__47\":\"1\",\"Multiple_Choice__23\":\"1\",\"Multiple_Choice__25\":\"0\",\"Multiple_Choice__27\":\"2\",\"Free_Text__28\":\"Documentation............................\",\"Multiple_Choice__29\":\"1\",\"Multiple_Choice__31\":\"1\",\"Multiple_Choice__33\":\"0\",\"Multiple_Choice__35\":\"0\",\"Multiple_Choice__37\":\"1\",\"Multiple_Choice__39\":\"2\",\"Free_Text__40\":\"Service Availability.............................................\",\"Multiple_Choice__41\":\"1\",\"Multiple_Choice__43\":\"0\",\"Multiple_Choice__45\":\"1\"}',NULL,0,1,81,81,'2021-03-30 17:14:52','2021-04-21 02:58:07',NULL,'Delete this'),(13,16,158,NULL,38,NULL,NULL,'',NULL,0,1,158,158,'2021-04-14 05:06:37','2021-04-14 05:06:37',NULL,'Test1'),(14,17,158,NULL,38,NULL,NULL,'{\"Free_Text__280\":\"1\",\"Short_Answer__281\":\"2\",\"Date__282\":\"04\\/14\\/2021\",\"True_or_False__283\":\"Yes\",\"Yes_or_No__284\":\"Yes\",\"Free_Text__285\":\"6\",\"Free_Text__286\":\"7\"}',NULL,0,1,158,158,'2021-04-14 07:00:10','2021-04-14 07:00:27',NULL,'Test 2'),(16,21,81,NULL,31,NULL,NULL,'{\"Date__22\":\"04\\/21\\/2021\",\"Free_Text__48\":\"These are notes related to this particular review\",\"Multiple_Choice__47\":\"2\",\"Short_Answer__336\":\"LP one\",\"Short_Answer__337\":\"LP 2\",\"Free_Text__339\":\"Identified relevant conditional factors (identified during Systems Mapping) and discuss\\/capture strategies that are used to overcome those factors (e.g., high turnover)\",\"Free_Text__340\":\"Discussions that team members felt advantageous to think through\\r\\nMeaningful discussion that was identified by team members to support learning\\r\\nInformation that was discussed that team members think would be beneficial for others to receive\",\"Free_Text__341\":\"Relevant considerations are discussed with the Systems Mapping Team and documented by the Reviewer\\r\\nConsiderations will be collected for the purpose of informing formal recommendations which are an output of the Systems Review process\\r\\nFeatures of meaningful considerations are that they are High Level and Unintended Consequences are considered\",\"Multiple_Choice__23\":\"1\",\"Multiple_Choice__25\":\"1\",\"Multiple_Choice__27\":\"0\",\"Multiple_Choice__29\":\"0\",\"Multiple_Choice__31\":\"2\",\"Free_Text__32\":\"Place associated info gathered through mapping here\",\"Multiple_Choice__33\":\"1\",\"Multiple_Choice__35\":\"0\",\"Multiple_Choice__37\":\"1\",\"Multiple_Choice__39\":\"2\",\"Free_Text__40\":\"Place associated info gathered through mapping here\",\"Multiple_Choice__41\":\"1\",\"Multiple_Choice__43\":\"1\",\"Multiple_Choice__45\":\"1\"}',NULL,0,1,81,81,'2021-04-21 03:02:11','2021-04-21 03:08:41',NULL,'Demo review 4.21.21'),(17,21,81,NULL,31,NULL,NULL,'{\"Date__22\":\"05\\/04\\/2021\",\"Free_Text__48\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Multiple_Choice__47\":\"1\",\"Short_Answer__336\":\"Learning Point 1\",\"Free_Text__339\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Free_Text__340\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Free_Text__341\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Multiple_Choice__23\":\"0\",\"Multiple_Choice__25\":\"1\",\"Free_Text__26\":\"thsarthsrt5h\",\"Multiple_Choice__27\":\"0\",\"Multiple_Choice__29\":\"1\",\"Multiple_Choice__31\":\"2\",\"Free_Text__32\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Multiple_Choice__33\":\"0\",\"Multiple_Choice__35\":\"1\",\"Multiple_Choice__37\":\"0\",\"Multiple_Choice__39\":\"2\",\"Free_Text__40\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Multiple_Choice__41\":\"3\",\"Free_Text__42\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Multiple_Choice__43\":\"2\",\"Free_Text__44\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Multiple_Choice__45\":\"0\"}',NULL,0,1,81,81,'2021-04-21 15:24:31','2021-05-13 01:16:06',NULL,'TEST review demo'),(27,18,160,NULL,39,NULL,NULL,'{\"Multiple_Choice__287\":\"Brittany Lochner\",\"Short_Answer__288\":\"Janet Bowman, Jen Goodman, Wendy Woessner, Jess VanKuyk\",\"Multiple_Choice__425\":\"CFSR Item 6 - Permanency: 24 months\",\"Multiple_Choice__290\":\"SCIR\",\"Date__289\":\"10\\/29\\/2020\",\"Yes_or_No__372\":\"No\",\"Yes_or_No__375\":\"No\",\"Multiple_Choice__377\":\"9\",\"Multiple_Choice__378\":\"Ramsey\",\"Short_Answer__380\":\"Isabella\",\"Short_Answer__381\":\"Anderson\",\"Date__382\":\"06\\/20\\/2015\",\"Multiple_Choice__383\":\"2\",\"Short_Answer__384\":\"The subject child has been in foster care (in the pre-adoptive home) for 4 years, free for adoption for 3 years, and adoption has not been finalized.\",\"Free_Text__385\":\"The agency was committed to having all of the children remain in the same placement and prioritized the children being adopted by the grandparents. Following the TPR and when the children were all in grandparents\\u2019 home, the plan was for the grandparents to adopt the children. After about a year, the grandparents started reporting that the siblings\\u2019 behavior was too much for them to handle. The agency worked to support the grandparents and the children\\u2019s placements through frequent visits\\/conversations with the grandparents, engaging therapeutic foster care services, coaching and mentoring for the grandparents. According to the worker, the children had been in 10-11 placements and they were trying to salvage the placement so the children could stay together and be adopted by their grandparents and stay connected to their birth family. The agency felt that the placement was never stable enough to finalize adoption and did everything they could to keep all of the children in the grandparents\\u2019 home. They agency felt they would get to a point where they were ready to move forward with the adoption and then the grandparents would ask for more time. It appeared that the house was divided and the grandparents did not share the same goal for adoption. From the worker\\u2019s perspective, the grandparents were always committed to adopting the subject child and not as consistent with wanting to adopt the siblings. It came to a point during a recent court hearing that the Judge told the grandparents that they needed to make a decision as to whether or not they would adopt the 9-year old. Ultimately, they decided not to pursue adoption of either sibling. The agency is moving forward with adoption of the subject child with the grandparents.\",\"Free_Text__386\":\"Items identified during the mapping supporting adoption not being finalized after child being in foster care for 4 years, and free for adoption for 3 years, included a pressure to place with relatives, pressure to keep siblings together, child\\u2019s needs not being able to be met, and additional pressures placed on caregiver\\u2019s family.   \\r\\nPressure to place with relatives was supported by the courts\\u2019 role in the process. The court and DHS are responsible for approving sibling separations and those decisions are influenced by the federal measures of AFSA. Adherence to those measures supported the agency\\u2019s decision making process regarding preference for relative placements as opposed to non-relative placement. The grandfather wanted to adopt the siblings; however, the grandmother was apprehensive about adopting the siblings because she was the sole caregiver at times while the grandfather was working. The grandparents needed assistance for which the agency was unable to provide due to the unavailability of expertise to do so. \\r\\nThe competing priorities of placement stability versus sibling separation were influenced by the pressure to keep siblings together as outlined by the Sibling Bill of Rights (M.S. 260C.008). An additional factor contributing to pressures to keep the siblings together came from the recommendations by the Guardian ad Litem, which was guided by Minnesota statute 260C.212 subd. 2\\r\\nWhile the family wanted to finalize adoption, given their attachment to the child, their inability to meet the child\\u2019s needs supported their reluctance to move forward with the adoption. Due to the child\\u2019s need for permanency, an ultimatum was given by the courts for the caregivers to make a decision regarding adoption. The child\\u2019s behaviors and the grandmother being placed in the role as the primary caregiver without needed breaks, placed additional pressure on the family which influenced their decision to not adopt the child. Factors that contributed to these pressures included the children needing to be homeschooled due to COVID 19 and the grandfather being out of the home due to employment. Additionally, the family was reluctant to have providers in their home in order to reduce their exposure to the COVID virus.\\r\\nDue to the needs and age of the child, the child required many services to manage his needs. Services were often not available and when available, not consistent. Services often required pretesting or assessment to determine eligibility, however, these assessments often had a waitlist.  The grandparent\\u2019s lack of understanding about the children\\u2019s diagnosis and social interactions supported their inability to manage the child\\u2019s behaviors and needs and contributed to their reluctance to finalize adoption.\",\"Short_Answer__387\":\"Sibling separation and placement stability\",\"Free_Text__388\":\"The agency was committed to keeping all of the children together. When the dynamics of the household began to change, the worker indicated he worked closely with the Guardian ad Litem (GAL) to consult with and assist in providing support for the grandparents and the children. Therapeutic foster care services were put in place to support the grandparents and the siblings. The worker felt this was a challenging case for the siblings as they have needs that required additional support, which was difficult for the grandparents to manage at times. When decisions needed to be made whether to move the siblings, the worker stated that he consulted with his supervisor, the GAL and the agency\\u2019s screening team. In regards to the 12-year old, the grandparents didn\\u2019t feel they could meet his needs and requested that he move and once this occurred, the grandparents made the decision not to pursue adoption of the 12-year old. About a year after the 12-year old left the home, the grandparents began telling the worker that the 9-year old\\u2019s needs are becoming too much for them. The worker felt that the grandma was overwhelmed with having to home school the kids (during the pandemic), the grandpa being out of the home for work, and being confined to the house added stress to the grandma, which may have supported the grandparents decision to not pursue adoption with the 9-year old as well.\\r\\nThe worked stated that they couldn\\u2019t force the grandparents to adopt if they weren\\u2019t ready.\",\"Free_Text__389\":\"Items identified during the mapping supporting sibling separation and placement stability included a pressure to place with relatives, pressure to keep siblings together, child\\u2019s need and additional pressures placed on caregiver\\u2019s family.   \\r\\nPressure to place with relatives was supported by the courts\\u2019 role in the process. The court and DHS are responsible for approving sibling separations and those decisions are influenced by the federal measures of AFSA. Adherence to those measures supports the agency\\u2019s decision making process regarding preference for relative placements as opposed to non-relative placement.\\r\\nThe competing priorities of placement stability versus sibling separation were influenced by the pressure to keep siblings together as outlined by the Sibling Bill of Rights (M.S. 260C.008). An additional factor contributing to pressures to keep the siblings together came from the recommendations by the Guardian ad Litem, which was guided by Minnesota statute 260C.212 subd. 2\\r\\nWhile the family wanted to finalize adoption given their attachment to the child, their inability to meet the child\\u2019s needs supported their reluctance to move forward with the adoption. Due to the child\\u2019s need for permanency, an ultimatum was given by the courts for the caregivers to make a decision regarding adoption. The child\\u2019s behaviors and the grandmother being placed in the role as the primary caregiver without needed breaks, placed additional pressure on the family which influenced their decision to not adopt the child. Factors that contributed to these pressures included the children needing to be homeschooled due to COVID 19 and the grandfather being out of the home due to employment. Additionally, the family was reluctant to have providers in their home in order to reduce their exposure to the COVID 19 virus.\\r\\nDespite the caregivers having an attachment to the older sibling, they were unable to meet his needs, prompting the necessity of an outside placement, requiring sibling separation  A year after the sibling separation, a sibling child began exhibiting similar behaviors, again posing challenges to the family to meet his needs  Due to the challenging needs of the child, the caregivers determined they were not able to meet his needs, which led to another placement disruption and the siblings being separated.\",\"Multiple_Choice__400\":\"2\",\"Free_Text__401\":\"LP #1: Items identified during the mapping supporting adoption not being finalized after child being in foster care for 4 years, and free for adoption for 3 years, included a pressure to place with relatives, pressure to keep siblings together, child\\u2019s needs not being able to be met, and additional pressures placed on caregiver\\u2019s family.   \\r\\nPressure to place with relatives was supported by the courts\\u2019 role in the process. The court and DHS are responsible for approving sibling separations and those decisions are influenced by the federal measures of ASFA. Adherence to those measures supported the agency\\u2019s decision making process regarding preference for relative placements as opposed to non-relative placement. \\r\\n\\r\\nLP #2: Items identified during the mapping supporting sibling separation and placement stability included a pressure to place with relatives, pressure to keep siblings together, child\\u2019s need and additional pressures placed on caregiver\\u2019s family.   \\r\\nPressure to place with relatives was supported by the courts\\u2019 role in the process. The court and DHS are responsible for approving sibling separations and those decisions are influenced by the federal measures of AFSA. Adherence to those measures supports the agency\\u2019s decision making process regarding preference for relative placements as opposed to non-relative placement.\",\"Multiple_Choice__402\":\"2\",\"Free_Text__403\":\"LP #1: The grandparents needed assistance for which the agency was unable to provide due to the unavailability of expertise to do so (clarify what kind of assistance and from whom \\u2013 internal or external).\",\"Multiple_Choice__404\":\"0\",\"Multiple_Choice__406\":\"0\",\"Multiple_Choice__408\":\"0\",\"Multiple_Choice__410\":\"0\",\"Multiple_Choice__412\":\"0\",\"Multiple_Choice__414\":\"2\",\"Free_Text__415\":\"LP #1: The court and DHS are responsible for approving sibling separations and those decisions are influenced by the federal measures of ASFA. Adherence to those measures supported the agency\\u2019s decision making process regarding preference for relative placements as opposed to non-relative placement. \\r\\n\\r\\nThe competing priorities of placement stability versus sibling separation were influenced by the pressure to keep siblings together as outlined by the Sibling Bill of Rights (M.S. 260C.008). An additional factor contributing to pressures to keep the siblings together came from the recommendations by the Guardian ad Litem, which was guided by Minnesota statute 260C.212 subd. 2\\r\\n\\r\\nLP #2: . The court and DHS are responsible for approving sibling separations and those decisions are influenced by the federal measures of AFSA. Adherence to those measures supports the agency\\u2019s decision making process regarding preference for relative placements as opposed to non-relative placement.\\r\\nThe competing priorities of placement stability versus sibling separation were influenced by the pressure to keep siblings together as outlined by the Sibling Bill of Rights (M.S. 260C.008). An additional factor contributing to pressures to keep the siblings together came from the recommendations by the Guardian ad Litem, which was guided by Minnesota statute 260C.212 subd. 2\",\"Multiple_Choice__416\":\"0\",\"Multiple_Choice__418\":\"2\",\"Free_Text__419\":\"LP #1: Due to the needs and age of the child, the child required many services to manage his needs. Services were often not available and when available, not consistent. Services often required pretesting or assessment to determine eligibility, however, these assessments often had a waitlist.  The grandparent\\u2019s lack of understanding about the children\\u2019s diagnosis and social interactions supported their inability to manage the child\\u2019s behaviors and needs and contributed to their reluctance to finalize adoption.\",\"Multiple_Choice__420\":\"0\",\"Multiple_Choice__422\":\"0\",\"Yes_or_No__424\":\"Yes\"}',NULL,0,1,160,160,'2021-04-30 13:05:28','2021-05-03 16:34:46',NULL,'Ramsey Pilot'),(28,18,160,NULL,39,NULL,NULL,'{\"Multiple_Choice__287\":\"Brittany Lochner\",\"Short_Answer__288\":\"Janet Bowman, Jen Goodman, Wendy Woessner, Jess VanKuyk\",\"Multiple_Choice__425\":\"CFSR Item 6 - Permanency: 24 months\",\"Multiple_Choice__290\":\"SCIR\",\"Date__289\":\"10\\/27\\/2020\",\"Yes_or_No__372\":\"No\",\"Yes_or_No__375\":\"No\",\"Multiple_Choice__377\":\"4\",\"Multiple_Choice__378\":\"Wright\",\"Short_Answer__380\":\"Brooke\",\"Short_Answer__381\":\"Dahlheimer\",\"Date__382\":\"04\\/17\\/2009\",\"Multiple_Choice__383\":\"2\",\"Short_Answer__384\":\"The subject child was in placement for 3 years, 9 months prior to adoption being finalized.\",\"Free_Text__385\":\"The children were in a pre-adoptive home with an aunt and uncle when the case was transferred to the A\\/G worker. The worker did not identify any barriers in getting the adoption placement agreement (APA) signed by the aunt and uncle. Once the APA was signed, the worker indicated that things started to change. The aunt and uncle separated and the children stayed with the aunt. The agency was navigating through which one of them would adopt the children and ultimately, they both still wanted to adopt them. The agency consulted with DHS and it was determined to continue to pursue the aunt for adoption. The aunt signed a second APA and the worker continued to gather supporting documentation to accompany the APA, while working on completing the social\\/medical history. The worker stated that they had court hearings every 3 months during this time and did not feel the court contributed to the delay in getting the adoption finalized.\\r\\n\\r\\nThe worker talked about the amount of paperwork and time it takes to gather supporting documentation when working on an adoption. She indicated that getting the social\\/medical history filled out \\u201cgood enough\\u201d takes the most time; however, they have made some changes and are now having the ongoing worker get a start on the social\\/medical history and gathering the documentation to help speed up the process once it gets transferred to the A\\/G worker.\",\"Free_Text__386\":\"The subject child being in placement for 3 years, 9 months prior to adoption being finalized was influenced by complexity of cases for children who have been in OOHP, the amount of documentation, placing with relatives, and the ability of training to meet the needs of staff.  The complexity of these cases can create confusion of timelines for adoption finalization. Due to this complexity, agencies utilize support through consultation with other agencies, which may lead to misunderstandings and inconsistent practice regarding requirements of the licensing of families. Timelines for these cases are guided by statute and these statutory timelines may not be realistic for completing all aspects needed to finalize adoption. There are various influences contributing to the difficulty in meeting these timelines, including; the county attorney\\u2019s workload, the need to have exact information for the completion of court documents, and other court processes such as CHIPS cases and trials taking precedence over other court cases. \\r\\n\\r\\nAnother factor that influences the perception that timelines may not be realistic is the size of DHS. It can be difficult to identify where to go for assistance when needed and after finding this, agencies may need to contact multiple program areas within DHS to move forward; adding time to adoption finalization. Additionally, staffing levels at DHS lengthen the time it takes to process background studies and social histories and sometimes, more time is needed to adjust information on the background studies, ultimately leading to the time it takes to finalize adoption. After this information is processed, there also exists legal constraints; incomplete information results in the need for court orders to be amended and permanency finalization cannot be completed until all information is accurate. Further supporting the perception that timelines may not be realistic.\\r\\n\\r\\nAn additional influence into the length of time it takes for adoption to be finalized is the fact that social history information doesn\\u2019t automatically get pulled from SSIS, which results in workers having to manually locate this information. This information comes from many different sources; including other workers within the agency, as well as, other various medical, health, and educational records. Getting complete information from all of these sources can be difficult and it takes time depending on where this information is held. Pressure to place with relatives also exists at all levels of our system, which can influence the time it takes for adoption to be finalized (i.e. state statute, Judges, state and local levels). The time it takes to locate relatives, assess the ability to meet the child\\u2019s needs, and navigate through the uniqueness that each family brings, can lengthen the time it takes in the overall effort to finalize adoption.\\r\\n\\r\\nFurthermore, in relation to adoption, trainings are broad and may not teach what needs to be completed on each case and, although trainings exist, local agencies are not always aware of when these trainings are offered by DHS. Specifically, trainings are typically focused on Northstar and paperwork duties. Often times, non-relative providers have had training and supports prior to receiving a placement and this may not be the case for relative providers. Because of this, relative providers may require more support during onboarding and throughout the placement.\",\"Short_Answer__387\":\"The children experienced a placement disruption after being in relative\\/pre-adoptive home for 24 months.\",\"Free_Text__388\":\"The worker indicated that when the children were initially placed in foster care, they were placed with the siblings paternal grandparents and then the children went back home with the mother on a trial home visit for approximately 2 months. The children returned to foster care in February 2017 and were placed with an aunt and uncle (pre-adoptive home). The aunt and uncle separated in the summer\\/fall of 2018 and the children went to live with the aunt. At this point, the aunt and uncle both wanted to pursue adoption of the children and the agency was working with them to try and make that happen. However, following consultation within the agency and with DHS, it was determined that the agency would move forward with the aunt for adoption. The worker stated that the children and the aunt reported no concerns during home visits, which supported the agency continuing to pursue adoption with the aunt. During a home visit in January 2019, the siblings reported that things weren\\u2019t going very well in the aunt\\u2019s home and asked to move with the paternal grandparents. During this time, the grandparents had filed a petition with the court requesting that the children be placed with them. The agency continued efforts with the aunt; however, after talking with the children, the aunt, and the grandparents, it was decided that the children would move into the grandparents\\u2019 home, which took place in January 2019. The agency was hesitant to place and pursue adoption with the grandparents due to past experiences; however, they moved forward and the children were adopted in May 2020.\",\"Free_Text__389\":\"The children experienced a placement disruption after being in a relative\\/pre-adoptive home for 24 months which was influenced by the provider and child requesting a change in placement. Supporting a request for a change in placement was the availability of services, including culturally sensitive services to support children and families (i.e. transportation, mental health, etc.), coupled with the needs of the family and the children. Specifically, the services available did not match the needs of the child, including mental health and trauma related services. These services not being available for the child created additional stressors in the family environment. Additionally, in some cases, added stressors within the family and the absence of supportive services may increase the possibility of abuse and neglect occurring. When abuse and\\/or neglect occurs within a family, this can influence a provider or child requesting a change in placement. Additionally, a change in the family situation also supported the provider and the child requesting a change in placement.\\r\\nThere was also an existence of pressure to place the sibling group with relatives, which was supported by statutory and state guidance, such as, the Best Interest Factors and the Sibling Bill of Rights. This pressure to place with relatives creates gaps in training for prospective foster care providers and also impacts staff availability to provide the training to the providers, prior to a child being placed in their home. The availability of staff to provide support to families was influenced by the time it takes to enter required data into the system (SSIS, paperwork, etc.) and confusion about who provides the support when there are multiple workers on a case, which can contribute to a placement disruption.\",\"Multiple_Choice__400\":\"2\",\"Free_Text__401\":\"LP #1: The subject child being in placement for 3 years, 9 months prior to adoption being finalized was influenced by complexity of cases for children who have been in OOHP, the amount of documentation, placing with relatives, and the ability of training to meet the needs of staff.  The complexity of these cases can create confusion of timelines for adoption finalization. Due to this complexity, agencies utilize support through consultation with other agencies, which may lead to misunderstandings and inconsistent practice regarding requirements of the licensing of families.\",\"Multiple_Choice__402\":\"2\",\"Free_Text__403\":\"LP #1: Additionally, limited staffing levels at DHS lengthen the time it takes to process background studies and social histories and sometimes, more time is needed to adjust information on the background studies, ultimately leading to the time it takes to finalize adoption. \\r\\n\\r\\nLP #2: This pressure to place with relatives creates gaps in training for prospective foster care providers and also impacts staff availability to provide the training to the providers, prior to a child being placed in their home. The availability of staff to provide support to families was influenced by the time it takes to enter required data into the system (SSIS, paperwork, etc.) and confusion about who provides the support when there are multiple workers on a case, which can contribute to a placement disruption.\",\"Multiple_Choice__404\":\"0\",\"Multiple_Choice__406\":\"2\",\"Free_Text__407\":\"LP #1: An additional influence into the length of time it takes for adoption to be finalized is the fact that social history information doesn\\u2019t automatically get pulled from SSIS, which results in workers having to manually locate this information\",\"Multiple_Choice__408\":\"2\",\"Free_Text__409\":\"LP #1: Another factor that influences the perception that timelines may not be realistic is the size of DHS. It can be difficult to identify where to go for assistance when needed and after finding this, agencies may need to contact multiple program areas within DHS to move forward; adding time to adoption finalization. \\r\\n\\r\\nThis information comes from many different sources; including other workers within the agency, as well as, other various medical, health, and educational records. Getting complete information from all of these sources can be difficult and it takes time depending on where this information is held.\\r\\n\\r\\nLP #2: . The availability of staff to provide support to families was influenced by the time it takes to enter required data into the system (SSIS, paperwork, etc.) and confusion about who provides the support when there are multiple workers on a case, which can contribute to a placement disruption\",\"Multiple_Choice__410\":\"2\",\"Free_Text__411\":\"LP #1: Furthermore, in relation to adoption, trainings are broad and may not teach what needs to be completed on each case and, although trainings exist, local agencies are not always aware of when these trainings are offered by DHS. Specifically, trainings are typically focused on Northstar and paperwork duties. Often times, non-relative providers have had training and supports prior to receiving a placement and this may not be the case for relative providers.\",\"Multiple_Choice__412\":\"0\",\"Multiple_Choice__414\":\"2\",\"Free_Text__415\":\"LP #1: Timelines for these cases are guided by statute and these statutory timelines may not be realistic for completing all aspects needed to finalize adoption. \\r\\n\\r\\nPressure to place with relatives also exists at all levels of our system, which can influence the time it takes for adoption to be finalized (i.e. state statute, Judges, state and local levels).\\r\\n\\r\\nLP #2: There was also an existence of pressure to place the sibling group with relatives, which was supported by statutory and state guidance, such as, the Best Interest Factors and the Sibling Bill of Rights.\",\"Multiple_Choice__416\":\"2\",\"Free_Text__417\":\"LP #1: There are various influences contributing to the difficulty in meeting these timelines, including; the county attorney\\u2019s workload, the need to have exact information for the completion of court documents, and other court processes such as CHIPS cases and trials taking precedence over other court cases. \\r\\n\\r\\nThe time it takes to locate relatives, assess the ability to meet the child\\u2019s needs, and navigate through the uniqueness that each family brings, can lengthen the time it takes in the overall effort to finalize adoption.\\r\\n\\r\\nLP #2: The availability of staff to provide support to families was influenced by the time it takes to enter required data into the system (SSIS, paperwork, etc.) and confusion about who provides the support when there are multiple workers on a case, which can contribute to a placement disruption.\",\"Multiple_Choice__418\":\"2\",\"Free_Text__419\":\"LP #2: The children experienced a placement disruption after being in a relative\\/pre-adoptive home for 24 months which was influenced by the provider and child requesting a change in placement. Supporting a request for a change in placement was the availability of services, including culturally sensitive services to support children and families (i.e. transportation, mental health, etc.), coupled with the needs of the family and the children. Specifically, the services available did not match the needs of the child, including mental health and trauma related services.\",\"Multiple_Choice__420\":\"0\",\"Multiple_Choice__422\":\"0\",\"Yes_or_No__424\":\"Yes\"}',NULL,0,1,160,160,'2021-04-30 13:36:55','2021-05-03 16:35:35',NULL,'Wright Pilot'),(29,21,81,NULL,31,NULL,NULL,'{\"Date__22\":\"03\\/23\\/2021\",\"Free_Text__48\":\"Notes here\",\"Multiple_Choice__47\":\"2\",\"Short_Answer__336\":\"Learning Point 1\",\"Short_Answer__337\":\"Learning point 2\",\"Multiple_Choice__23\":\"1\",\"Multiple_Choice__25\":\"3\",\"Free_Text__26\":\"Resources within the agency are not compatible with the needs of staff\",\"Multiple_Choice__27\":\"0\",\"Free_Text__28\":\"Resources within the agency are not compatible with the needs of staff\",\"Multiple_Choice__29\":\"2\",\"Free_Text__30\":\"An absence or deficiency in the equipment, tools and or technology utilized to carry out safe work practices\"}',NULL,0,1,81,81,'2021-04-30 16:18:43','2021-05-12 16:41:40',NULL,'Test Review 123ABC'),(30,18,159,NULL,39,NULL,NULL,'{\"Multiple_Choice__287\":\"Ryan Hartneck\",\"Short_Answer__288\":\"Niki Hoglund, Steve Johnson, Jennifer Carlson\",\"Multiple_Choice__425\":\"CFSR Item 6 - Permanency: 24 months\",\"Multiple_Choice__290\":\"SCIR\",\"Date__289\":\"10\\/29\\/2020\",\"Yes_or_No__372\":\"No\",\"Yes_or_No__375\":\"No\",\"Multiple_Choice__377\":\"8\",\"Multiple_Choice__378\":\"Hennepin\",\"Short_Answer__380\":\"Ethan\",\"Short_Answer__381\":\"Sampson\",\"Date__382\":\"08\\/20\\/2007\",\"Multiple_Choice__383\":\"1\",\"Short_Answer__384\":\"Subject child remained in OOHP from 1\\/1\\/2019 to 12\\/31\\/2019 without finalization of permanency\",\"Free_Text__385\":\"Agency staff shared that while the subject child has been making interpersonal progress, there are inherent barriers to finalization of permanency (in this case adoption). Notable, these barriers include the child\\u2019s age and size. The staff shared that the child\\u2019s age of 13 at this time makes it a little harder for recruiting a forever home as he is larger and harder to contain, and this coupled with a developmental disability (FAS), make his day to day process functioning slower. For example, prospective adoptive families need to consider the subject child\\u2019s ability to be left alone. While at age 13 he technically could be home alone for a short period of time, his disability creates an unsafe situation in doing so as his processing is slower, and may not allow the child to realize the danger in some decision making. Staff also shared that simply reading about the child, their diagnosis and limitations, rather than seeing and interacting with the child, may not allow a prospective family to really grasp the whole personality of the child, reducing the likelihood for an adoption match. For this reason, more in-person meetings with children and potential adoptive parents would be helpful. It was also noted that outreach for homes in more rural areas may present challenges regarding both services (specifically for this child, FAS services) and community identification. This child is African American and adoption and residence in a community where he looks different than others may be a consideration for potential forever homes. Lastly, the Covid-19 pandemic has created fewer opportunities for adoption recruitment as in-person events and activities have either been cancelled or significantly limited.\",\"Free_Text__386\":\"Subject child remaining in OOHP from 1\\/1\\/2019 to 12\\/31\\/2019 without finalization of permanency was influenced by children\\u2019s special needs and services, recruitment efforts and also education for workers.\\r\\nChildren with special needs seeking adoption experience multiple factors that contribute to delays in adoption finalization. The specific needs of the children can influence available resources for that child (both service related and permanency). Often times the needs of the child(ren) can intimidate prospective families. This is manifested through a general lack of awareness of developmental disabilities and the services available for children and families of children with special needs. Barriers to receiving education and accessibility to mentors for families about developmental disability services include care beyond the age of 18 for children and also the understanding of waivered and related services. These barriers contribute to a reduced willingness and\\/or ability to care for children with special needs and ultimately, a lack of available foster homes for these children. One factor that has influenced both recruitment efforts and selection of children with special needs for adoption is the initial introduction of the child to the family. Typically, a prospective adoptive family\\u2019s first information about a child is the written summary on the child. This information includes the child\\u2019s disabilities, if any, and the possible needs\\/services that children may need. This written information, without the ability to see the child\\u2019s personality, may prevent the potential adoptive parents from getting the full picture of who the child really is. The current Covid-19 pandemic has also hindered recruitment efforts as in-person meetings and events have been cancelled. Additionally, the age of and size of the child can be influencing factors in finding an adoptive home and finalization of that adoption. For children with special needs, including those that have physical outbursts, the size of the child and a parent\\u2019s ability to intervene during an episode may be reduced. It is also common that the older the child, the harder it is to recruit adoptive homes.\",\"Multiple_Choice__400\":\"0\",\"Multiple_Choice__402\":\"0\",\"Multiple_Choice__404\":\"0\",\"Multiple_Choice__406\":\"0\",\"Multiple_Choice__408\":\"2\",\"Free_Text__409\":\"One factor that has influenced both recruitment efforts and selection of children with special needs for adoption is the initial introduction of the child to the family. Typically, a prospective adoptive family\\u2019s first information about a child is the written summary on the child. This information includes the child\\u2019s disabilities, if any, and the possible needs\\/services that children may need. This written information, without the ability to see the child\\u2019s personality, may prevent the potential adoptive parents from getting the full picture of who the child really is.\",\"Multiple_Choice__410\":\"2\",\"Free_Text__411\":\"Often times the needs of the child(ren) can intimidate prospective families. This is manifested through a general lack of awareness of developmental disabilities and the services available for children and families of children with special needs. Barriers to receiving education and accessibility to mentors for families about developmental disability services include care beyond the age of 18 for children and also the understanding of waivered and related services.\",\"Multiple_Choice__412\":\"0\",\"Multiple_Choice__414\":\"0\",\"Multiple_Choice__416\":\"0\",\"Multiple_Choice__418\":\"2\",\"Free_Text__419\":\"Example 1: Often times the needs of the child(ren) can intimidate prospective families. This is manifested through a general lack of awareness of developmental disabilities and the services available for children and families of children with special needs. Barriers to receiving education and accessibility to mentors for families about developmental disability services include care beyond the age of 18 for children and also the understanding of waivered and related services. These barriers contribute to a reduced willingness and\\/or ability to care for children with special needs and ultimately, a lack of available foster homes for these children.\\r\\n\\r\\nExample 2: The current Covid-19 pandemic has also hindered recruitment efforts as in-person meetings and events have been cancelled. Additionally, the age of and size of the child can be influencing factors in finding an adoptive home and finalization of that adoption. For children with special needs, including those that have physical outbursts, the size of the child and a parent\\u2019s ability to intervene during an episode may be reduced. It is also common that the older the child, the harder it is to recruit adoptive homes.\",\"Multiple_Choice__420\":\"0\",\"Multiple_Choice__422\":\"0\",\"Yes_or_No__424\":\"Yes\"}',NULL,0,1,159,159,'2021-05-03 16:03:05','2021-05-03 16:04:13',NULL,'Hennepin Pilot'),(31,18,159,NULL,39,NULL,NULL,'{\"Multiple_Choice__287\":\"Ryan Hartneck\",\"Short_Answer__288\":\"Niki Hoglund, Steve Johnson, Jennifer Carlson\",\"Multiple_Choice__425\":\"CFSR Item 6 - Permanency: 24 months\",\"Multiple_Choice__290\":\"SCIR\",\"Date__289\":\"10\\/27\\/2020\",\"Yes_or_No__372\":\"No\",\"Yes_or_No__375\":\"No\",\"Multiple_Choice__377\":\"5\",\"Multiple_Choice__378\":\"Des Moines Valley\",\"Short_Answer__380\":\"Keyira\",\"Short_Answer__381\":\"Wagner\",\"Date__382\":\"09\\/29\\/2005\",\"Multiple_Choice__400\":\"0\",\"Multiple_Choice__402\":\"0\",\"Multiple_Choice__404\":\"0\",\"Multiple_Choice__406\":\"0\",\"Multiple_Choice__408\":\"0\",\"Multiple_Choice__410\":\"0\",\"Multiple_Choice__412\":\"0\",\"Multiple_Choice__414\":\"0\",\"Multiple_Choice__416\":\"0\",\"Multiple_Choice__418\":\"0\",\"Multiple_Choice__420\":\"0\",\"Multiple_Choice__422\":\"0\",\"Yes_or_No__424\":\"Yes\"}',NULL,0,1,159,159,'2021-05-03 16:21:25','2021-05-03 16:51:31',NULL,'DVHHS Pilot'),(32,18,81,NULL,39,NULL,NULL,'{\"Multiple_Choice__287\":\"Ryan Hartneck\",\"Short_Answer__288\":\"Test case\",\"Multiple_Choice__425\":\"Rate of experiencing child protection\",\"Multiple_Choice__290\":\"SLR\",\"Date__289\":\"05\\/06\\/2021\",\"Free_Text__390\":\"None\",\"Multiple_Choice__383\":\"1\",\"Short_Answer__384\":\"LP1\",\"Free_Text__385\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Elit eget gravida cum sociis natoque penatibus et magnis. Proin nibh nisl condimentum id. Leo in vitae turpis massa sed elementum tempus egestas. Ac turpis egestas sed tempus urna et. Convallis convallis tellus id interdum velit laoreet id donec ultrices. Hac habitasse platea dictumst quisque sagittis purus sit amet volutpat. Augue neque gravida in fermentum et sollicitudin ac. Phasellus faucibus scelerisque eleifend donec pretium vulputate sapien. Egestas pretium aenean pharetra magna ac. Fermentum leo vel orci porta non pulvinar neque laoreet suspendisse. Suspendisse ultrices gravida dictum fusce ut placerat orci nulla. Sed risus ultricies tristique nulla aliquet. Sed id semper risus in hendrerit gravida. At consectetur lorem donec massa sapien.\\r\\n\\r\\nOrnare suspendisse sed nisi lacus sed viverra. Bibendum ut tristique et egestas quis ipsum. Viverra justo nec ultrices dui sapien eget mi proin. Et tortor at risus viverra. Aenean euismod elementum nisi quis eleifend quam adipiscing vitae. Proin nibh nisl condimentum id venenatis a condimentum. Fames ac turpis egestas sed tempus urna. Ipsum faucibus vitae aliquet nec ullamcorper sit. Faucibus et molestie ac feugiat sed lectus vestibulum mattis. Odio ut sem nulla pharetra diam sit amet nisl. Enim sit amet venenatis urna. Massa vitae tortor condimentum lacinia quis vel eros. Pulvinar elementum integer enim neque volutpat ac tincidunt vitae semper. Tortor pretium viverra suspendisse potenti. Condimentum lacinia quis vel eros donec ac odio tempor. In est ante in nibh. Volutpat lacus laoreet non curabitur gravida arcu. Nec dui nunc mattis enim ut tellus.\\r\\n\\r\\nConvallis posuere morbi leo urna molestie at elementum. Odio eu feugiat pretium nibh ipsum consequat nisl. Dolor sit amet consectetur adipiscing elit. Dignissim enim sit amet venenatis urna cursus eget. Velit dignissim sodales ut eu sem. Diam donec adipiscing tristique risus nec feugiat in. Phasellus vestibulum lorem sed risus ultricies tristique. Eu consequat ac felis donec. Venenatis lectus magna fringilla urna porttitor rhoncus dolor. Eu scelerisque felis imperdiet proin fermentum leo vel orci porta. Feugiat in ante metus dictum.\\r\\n\\r\\nSenectus et netus et malesuada fames ac turpis egestas. Eget arcu dictum varius duis at consectetur lorem. Semper auctor neque vitae tempus quam pellentesque nec. Morbi tempus iaculis urna id volutpat lacus laoreet non. Felis eget velit aliquet sagittis id. Quam viverra orci sagittis eu. In est ante in nibh mauris cursus mattis. Aliquam etiam erat velit scelerisque in dictum non. Quam elementum pulvinar etiam non quam lacus suspendisse. Ipsum dolor sit amet consectetur adipiscing elit ut. Et ultrices neque ornare aenean euismod elementum nisi. Congue nisi vitae suscipit tellus mauris a. Ac turpis egestas integer eget aliquet nibh praesent tristique magna. Placerat vestibulum lectus mauris ultrices eros.\\r\\n\\r\\nAccumsan tortor posuere ac ut consequat semper viverra. A erat nam at lectus urna duis convallis. Habitasse platea dictumst vestibulum rhoncus est. Nibh praesent tristique magna sit amet purus gravida quis blandit. Mattis rhoncus urna neque viverra justo nec ultrices dui. Quis vel eros donec ac odio tempor orci dapibus ultrices. Rhoncus mattis rhoncus urna neque viverra justo nec ultrices dui. Augue eget arcu dictum varius duis at consectetur. Malesuada fames ac turpis egestas maecenas pharetra convallis posuere morbi. Duis convallis convallis tellus id interdum velit laoreet. Purus gravida quis blandit turpis cursus in. Sed faucibus turpis in eu mi. Nisi est sit amet facilisis magna etiam. Aenean et tortor at risus viverra adipiscing. Natoque penatibus et magnis dis parturient. Iaculis urna id volutpat lacus laoreet. Posuere urna nec tincidunt praesent semper feugiat nibh. Risus viverra adipiscing at in. Nisl nisi scelerisque eu ultrices vitae auctor eu.\",\"Free_Text__386\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Elit eget gravida cum sociis natoque penatibus et magnis. Proin nibh nisl condimentum id. Leo in vitae turpis massa sed elementum tempus egestas. Ac turpis egestas sed tempus urna et. Convallis convallis tellus id interdum velit laoreet id donec ultrices. Hac habitasse platea dictumst quisque sagittis purus sit amet volutpat. Augue neque gravida in fermentum et sollicitudin ac. Phasellus faucibus scelerisque eleifend donec pretium vulputate sapien. Egestas pretium aenean pharetra magna ac. Fermentum leo vel orci porta non pulvinar neque laoreet suspendisse. Suspendisse ultrices gravida dictum fusce ut placerat orci nulla. Sed risus ultricies tristique nulla aliquet. Sed id semper risus in hendrerit gravida. At consectetur lorem donec massa sapien.\\r\\n\\r\\nOrnare suspendisse sed nisi lacus sed viverra. Bibendum ut tristique et egestas quis ipsum. Viverra justo nec ultrices dui sapien eget mi proin. Et tortor at risus viverra. Aenean euismod elementum nisi quis eleifend quam adipiscing vitae. Proin nibh nisl condimentum id venenatis a condimentum. Fames ac turpis egestas sed tempus urna. Ipsum faucibus vitae aliquet nec ullamcorper sit. Faucibus et molestie ac feugiat sed lectus vestibulum mattis. Odio ut sem nulla pharetra diam sit amet nisl. Enim sit amet venenatis urna. Massa vitae tortor condimentum lacinia quis vel eros. Pulvinar elementum integer enim neque volutpat ac tincidunt vitae semper. Tortor pretium viverra suspendisse potenti. Condimentum lacinia quis vel eros donec ac odio tempor. In est ante in nibh. Volutpat lacus laoreet non curabitur gravida arcu. Nec dui nunc mattis enim ut tellus.\\r\\n\\r\\nConvallis posuere morbi leo urna molestie at elementum. Odio eu feugiat pretium nibh ipsum consequat nisl. Dolor sit amet consectetur adipiscing elit. Dignissim enim sit amet venenatis urna cursus eget. Velit dignissim sodales ut eu sem. Diam donec adipiscing tristique risus nec feugiat in. Phasellus vestibulum lorem sed risus ultricies tristique. Eu consequat ac felis donec. Venenatis lectus magna fringilla urna porttitor rhoncus dolor. Eu scelerisque felis imperdiet proin fermentum leo vel orci porta. Feugiat in ante metus dictum.\\r\\n\\r\\nSenectus et netus et malesuada fames ac turpis egestas. Eget arcu dictum varius duis at consectetur lorem. Semper auctor neque vitae tempus quam pellentesque nec. Morbi tempus iaculis urna id volutpat lacus laoreet non. Felis eget velit aliquet sagittis id. Quam viverra orci sagittis eu. In est ante in nibh mauris cursus mattis. Aliquam etiam erat velit scelerisque in dictum non. Quam elementum pulvinar etiam non quam lacus suspendisse. Ipsum dolor sit amet consectetur adipiscing elit ut. Et ultrices neque ornare aenean euismod elementum nisi. Congue nisi vitae suscipit tellus mauris a. Ac turpis egestas integer eget aliquet nibh praesent tristique magna. Placerat vestibulum lectus mauris ultrices eros.\\r\\n\\r\\nAccumsan tortor posuere ac ut consequat semper viverra. A erat nam at lectus urna duis convallis. Habitasse platea dictumst vestibulum rhoncus est. Nibh praesent tristique magna sit amet purus gravida quis blandit. Mattis rhoncus urna neque viverra justo nec ultrices dui. Quis vel eros donec ac odio tempor orci dapibus ultrices. Rhoncus mattis rhoncus urna neque viverra justo nec ultrices dui. Augue eget arcu dictum varius duis at consectetur. Malesuada fames ac turpis egestas maecenas pharetra convallis posuere morbi. Duis convallis convallis tellus id interdum velit laoreet. Purus gravida quis blandit turpis cursus in. Sed faucibus turpis in eu mi. Nisi est sit amet facilisis magna etiam. Aenean et tortor at risus viverra adipiscing. Natoque penatibus et magnis dis parturient. Iaculis urna id volutpat lacus laoreet. Posuere urna nec tincidunt praesent semper feugiat nibh. Risus viverra adipiscing at in. Nisl nisi scelerisque eu ultrices vitae auctor eu.\"}',NULL,0,1,81,81,'2021-05-03 17:15:39','2021-05-05 15:06:45',NULL,'Use this review to begin your next one'),(37,9,81,NULL,34,NULL,NULL,'',NULL,0,1,81,81,'2021-05-12 13:35:46','2021-05-12 13:35:46',NULL,'Review #1'),(38,9,81,NULL,34,NULL,NULL,'{\"Short_Answer__243\":\"Case 456DEF\",\"Date__244\":\"04\\/02\\/2021\",\"Multiple_Choice__245\":\"Analyst 2\",\"Multiple_Choice__246\":\"Analyst 4\",\"Multiple_Choice__247\":\"Other Critical Incident\",\"Date__249\":\"03\\/01\\/2021\",\"Free_Text__256\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Multiple_Choice__257\":\"3\",\"Free_Text__258\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Multiple_Choice__259\":\"2\",\"Free_Text__260\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Free_Text__255\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Short_Answer__250\":\"Jane\",\"Short_Answer__251\":\"Doe\",\"Date__252\":\"10\\/01\\/2020\",\"Date__253\":\"03\\/01\\/2021\",\"Free_Text__254\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\"}',NULL,0,1,81,81,'2021-05-12 13:40:21','2021-05-12 13:41:22',NULL,'Review #2'),(39,9,81,NULL,34,NULL,NULL,'',NULL,0,1,81,81,'2021-05-12 13:42:36','2021-05-12 13:42:36',NULL,'Review #3'),(40,9,81,NULL,34,NULL,NULL,'{\"Short_Answer__243\":\"Case 012JKL\",\"Date__244\":\"05\\/02\\/2021\",\"Multiple_Choice__245\":\"Analyst 1\",\"Multiple_Choice__246\":\"Analyst 4\",\"Date__249\":\"05\\/03\\/2021\",\"Multiple_Choice__247\":\"Near Fatality\",\"Free_Text__256\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Multiple_Choice__257\":\"0\",\"Multiple_Choice__259\":\"0\",\"Free_Text__255\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\",\"Short_Answer__250\":\"Jack\",\"Short_Answer__251\":\"Doe\",\"Date__252\":\"03\\/01\\/2020\",\"Date__253\":\"05\\/10\\/2021\",\"Free_Text__254\":\"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\"}',NULL,0,1,81,81,'2021-05-12 13:55:08','2021-05-12 14:58:09',NULL,'Review #4'),(41,5,81,NULL,32,NULL,NULL,'{\"Date__49\":\"05\\/01\\/2021\",\"Free_Text__51\":\"Notes\",\"Multiple_Choice__50\":\"1\",\"Short_Answer__426\":\"Learning Point one\",\"Multiple_Choice__52\":\"0\",\"Multiple_Choice__54\":\"1\",\"Multiple_Choice__56\":\"2\",\"Free_Text__57\":\"Related to what we found in the map\",\"Multiple_Choice__58\":\"0\",\"Multiple_Choice__60\":\"1\",\"Multiple_Choice__62\":\"0\",\"Multiple_Choice__64\":\"1\",\"Multiple_Choice__66\":\"0\",\"Multiple_Choice__68\":\"1\",\"Multiple_Choice__70\":\"1\",\"Multiple_Choice__72\":\"0\",\"Multiple_Choice__74\":\"1\"}',NULL,0,1,81,81,'2021-05-13 14:45:17','2021-05-13 14:49:25',NULL,'Kenny Review'),(42,21,167,NULL,31,NULL,NULL,'{\"Date__22\":\"05\\/13\\/2021\",\"Multiple_Choice__47\":\"1\",\"Multiple_Choice__23\":\"1\",\"Multiple_Choice__25\":\"0\",\"Multiple_Choice__27\":\"1\",\"Multiple_Choice__29\":\"1\",\"Multiple_Choice__31\":\"0\",\"Multiple_Choice__33\":\"1\",\"Multiple_Choice__37\":\"0\",\"Multiple_Choice__39\":\"1\",\"Multiple_Choice__41\":\"1\",\"Multiple_Choice__43\":\"1\",\"Multiple_Choice__45\":\"0\"}',NULL,0,1,167,167,'2021-05-13 14:45:22','2021-05-13 15:00:04',NULL,'Nikki - Practice Review'),(43,21,166,NULL,31,NULL,NULL,'',NULL,0,1,166,166,'2021-05-13 14:54:23','2021-05-13 14:54:23',NULL,'Laurie\'s review'),(44,5,164,NULL,32,NULL,NULL,'{\"Date__49\":\"5\\/13\\/2021\",\"Free_Text__51\":\"Notes\",\"Multiple_Choice__50\":\"1\",\"Short_Answer__426\":\"LP\",\"Free_Text__429\":\"Pos. Capacities\",\"Free_Text__430\":\"Key Learnings\",\"Free_Text__431\":\"Considerations\",\"Multiple_Choice__52\":\"0\",\"Multiple_Choice__54\":\"0\",\"Multiple_Choice__56\":\"1\",\"Multiple_Choice__58\":\"1\",\"Multiple_Choice__60\":\"1\",\"Multiple_Choice__62\":\"1\",\"Multiple_Choice__64\":\"0\",\"Multiple_Choice__66\":\"0\",\"Multiple_Choice__68\":\"0\",\"Multiple_Choice__70\":\"0\",\"Multiple_Choice__72\":\"0\",\"Multiple_Choice__74\":\"1\"}',NULL,0,1,164,164,'2021-05-13 14:54:32','2021-05-13 14:56:01',NULL,'Megan\'s Map'),(45,5,163,NULL,32,NULL,NULL,'{\"Date__49\":\"05\\/13\\/2021\",\"Free_Text__51\":\"Review Notes\",\"Multiple_Choice__50\":\"2\",\"Short_Answer__426\":\"Learning Point 1\",\"Short_Answer__427\":\"Learning Point 2\",\"Free_Text__429\":\"Positive Capacities\",\"Free_Text__430\":\"Key Learnings\",\"Free_Text__431\":\"Considerations\",\"Multiple_Choice__66\":\"3\",\"Free_Text__67\":\"Production\\/Efficiency Pressure Illustrative Example\"}',NULL,0,1,163,163,'2021-05-13 14:54:43','2021-05-13 14:57:52',NULL,'Test Map Review'),(46,21,168,NULL,31,NULL,NULL,'{\"Date__22\":\"05\\/13\\/2021\",\"Free_Text__48\":\"kims test\",\"Multiple_Choice__23\":\"1\",\"Multiple_Choice__25\":\"1\",\"Multiple_Choice__27\":\"1\",\"Multiple_Choice__29\":\"2\",\"Multiple_Choice__31\":\"1\",\"Multiple_Choice__33\":\"2\",\"Multiple_Choice__35\":\"1\",\"Multiple_Choice__37\":\"3\",\"Multiple_Choice__39\":\"2\",\"Multiple_Choice__41\":\"1\",\"Multiple_Choice__43\":\"0\",\"Multiple_Choice__45\":\"0\"}',NULL,0,1,168,168,'2021-05-13 14:55:41','2021-05-13 14:56:50',NULL,NULL),(47,5,165,NULL,32,NULL,NULL,'{\"Date__49\":\"05\\/13\\/2021\",\"Free_Text__51\":\"Review Mapping\",\"Multiple_Choice__50\":\"1\",\"Short_Answer__426\":\"ABC\",\"Free_Text__429\":\"HDVKJ\",\"Free_Text__430\":\"TDYTDFL\",\"Free_Text__431\":\"GHCT F\",\"Multiple_Choice__52\":\"1\",\"Multiple_Choice__54\":\"0\",\"Multiple_Choice__56\":\"1\",\"Multiple_Choice__58\":\"0\",\"Multiple_Choice__60\":\"1\",\"Multiple_Choice__62\":\"1\",\"Multiple_Choice__64\":\"1\",\"Multiple_Choice__66\":\"0\",\"Multiple_Choice__68\":\"1\",\"Multiple_Choice__70\":\"1\",\"Multiple_Choice__72\":\"1\",\"Multiple_Choice__74\":\"0\"}',NULL,0,1,165,165,'2021-05-13 14:55:59','2021-05-13 14:56:58',NULL,'Ofelia 1.'),(48,5,162,NULL,32,NULL,NULL,'{\"Date__49\":\"05\\/13\\/2021\",\"Free_Text__51\":\"Pending review\",\"Multiple_Choice__50\":\"1\",\"Short_Answer__426\":\"pending\",\"Free_Text__429\":\"TBD\",\"Free_Text__430\":\"TBD\",\"Free_Text__431\":\"TBD\"}',NULL,0,1,162,162,'2021-05-13 14:58:15','2021-05-13 14:59:22',NULL,'SC map'),(49,21,168,NULL,31,NULL,NULL,'{\"Date__22\":\"05\\/13\\/2021\",\"Multiple_Choice__47\":\"2\",\"Multiple_Choice__23\":\"0\",\"Multiple_Choice__25\":\"1\",\"Multiple_Choice__27\":\"1\",\"Multiple_Choice__29\":\"1\",\"Multiple_Choice__31\":\"2\",\"Multiple_Choice__33\":\"2\",\"Multiple_Choice__37\":\"2\"}',NULL,0,1,168,168,'2021-05-13 15:02:13','2021-05-13 15:27:39',NULL,'kims test'),(51,25,195,NULL,40,NULL,NULL,'',NULL,0,1,195,195,'2021-05-20 04:00:56','2021-05-20 04:00:56',NULL,'Test'),(52,25,195,NULL,40,NULL,NULL,'{\"Free_Text__452\":\"Test\"}',NULL,0,1,195,195,'2021-05-20 04:00:57','2021-05-20 04:00:57',NULL,'Test'),(186,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"Care Manager\",\"Date__77\":\"12\\/16\\/2019\",\"Multiple_Choice__78\":\"Charles Young\",\"Multiple_Choice__79\":\"Kristie Pittman\",\"Short_Answer__80\":\"Harry Meyering\",\"Short_Answer__81\":\"Emily Britz \\/ Tana Helleksen\",\"Short_Answer__82\":\"ebritz \\/ thelleksen \\/@harrymeyeringcenter.org\",\"Multiple_Choice__84\":\"Termination of Services\",\"Multiple_Choice__85\":\"Blue Earth County\",\"Multiple_Choice__96\":\"2\",\"Short_Answer__91\":\"Person\'s services were terminated due to challenging behavior\",\"True_or_False__94\":\"Yes\",\"Free_Text__98\":\"Yes\",\"Free_Text__100\":\"Influencing why the ICF\\/DD provider terminated this person\\u2019s services due to challenging behavior was that the person was posing a safety risk to others in the home. The other 3 individuals in the home were considered to be more vulnerable to abuse due to their lower functioning levels, and so the person posed a greater risk to them. The provider had to balance their responsibility to protect the health and safety of three people in the home with their responsibility to meet the needs of the person whose services they terminated. The guardians of the other 3 individuals had an expectation that the provider would keep them safe, and due to their higher vulnerability the guardians expressed their concern often in this instance. Another impact to the provider\\u2019s responsibility for people\\u2019s health and safety include county case managers assigning this function to providers via the CSSP. Unique to ICF\\/DDs is that they are licensed by both the Department of Human Services and the Minnesota Department of Health. Both Departments require providers to protect the health and safety of the people they serve. Minnesota Statutes 245D outlines the requirements for providers enforced by DHS while MDH relies on other statutory requirements in Minnesota statutes 144 and Rule. A unique requirement enforced by MDH is that ICF\\/DDs are expected to protect the people they serve from \\u201cimmediate jeopardy\\u201d. The provider in this instance noted that many times in the past they had been asked after a critical incident how they were going to protect the people they served from \\u201cimmediate jeopardy\\u201d in the future, so this mandate shaped the perception of the provider\\u2019s managers and supervisors whenever a health and safety concern arose and placed pressure on them to prioritize their response in a way that would satisfy MDH reviewers. The provider in this instance noted that terminating the person\\u2019s services was part of their response as to how they would respond to MDH\\u2019s questioning of how they were protecting the health and safety of the other people in the home. Between the requirements of DHS and MDH as well as the expectations of the guardians and case managers, the provider felt a strong need to act in this situation and felt that termination was the only way they could keep the majority of the people in the home safe. \\r\\nThe provider noted that the team had explored the possibility of implementing rights restrictions with the individual, but the team determined they wouldn\\u2019t be possible due to the requirements of 245D surrounding rights restrictions, or wouldn\\u2019t be sufficient to meet the safety needs of the person and others in the home. Due to the ineffectiveness of a rights restriction, the provider felt they had few options to address the person\\u2019s challenging behavior. \\r\\nAnother influence as to why the provider terminated a person\\u2019s services due to challenging behavior was that the person\\u2019s challenging behavior did not dissipate as expected after the person moved to the home. While it was known prior to intake that the person sometimes exhibited challenging behavior, there was an assumption by the team that this environment would likely help decrease the triggers that impacted the challenging behavior in the past. \\r\\nA number of factors were identified that  person\\u2019s challenging behavior not dissipating. For one, the provider noted that the staff at the site were trained more on meeting the medical needs of the other people in the home than de-escalating challenging behavior. While Minnesota Statutes 245D and the Positive Supports Rule (9544) required the provider to ensure their staff had training and were competent on positive support strategies, de-escalation techniques and the use of restrictive interventions, because the other people in the home didn\\u2019t exhibit challenging behavior, the focus of their training was centered more on medical needs than \\u2018behavioral needs\\u2019. The provider also noted that the staff felt a fear to administer pro re nata (PRN) medication to the person during mental health episodes due to the stigma of providing medication at these times and the training and reporting requirements of the Positive Supports Rule. The Positive Supports Rule (MN Rule 9544) requires providers to report the use of PRN medications when administered in a behavioral situation, and there was a belief among staff that the use of PRNs in this manner were not ok because they required reporting. \\r\\nThe provider \\u2013 and the person\\u2019s team - expected the person\\u2019s challenging behavior to dissipate after intake not only because they thought the environment would suit the person, but they assumed that a behavior support plan would positively effect change and decrease the person\\u2019s interfering behavior and that other external services would be able to assist with challenging episodes. Unfortunately, upon arrival the provider found there was a lack of external behavior services in their area and that they had a lack of information about what mental health services were available. Additionally, the person\\u2019s case manager \\u2013 who would typically be expected to also help find needed services \\u2013 was very busy and unable to devote much time to the person\\u2019s case. A number of influences as to why case managers would be busy were identified \\u2013 between high case load and recent federal and state initiatives changing services. MnCHOICES, HCBS rule and person-centered planning initiatives were all noted as positive changes, but changes that took a lot of time away from case managers to learn and meet the new requirements. This program was located in southern Minnesota, and the team noted that this region in particular has a scarcity of mental health resources. The provider and the team did find a neuropsych practitioner that was willing to work with the person, but unfortunately they were too far away and the drive was too long. This made it hard to make regular meetings and implement the neuropsych\\u2019s recommendations. Additionally, the provider was able to bring the person to a nearby hospital during challenging episodes, but noted that any interventions offered by the hospital unfortunately were ineffective.\\r\\nAlong with the lack of mental health resources, the provider also noted there was a lack of behavioral resources available to the person. Some practitioners had recommended that the person be admitted to an inpatient facility where they could try a \\u201cmed holiday\\u201d \\u2013 taking the person off all their meds and slowly re-introducing medication to determine their effectiveness. The provider could only find 1 program in the state that offered \\u201cmed holidays\\u201d, and that program had only 9 beds and waiting list of 25 people. The mapping team noted that the Jensen Settlement, which limited community base intensive services and the interventions they could use, influenced the lack of behavioral services like this one. \\r\\nWithout interventions that met the needs of the person, coupled with the lack of training of the staff, the provider noted their staff were stressed at the site. They often times engaged in power struggles with the individual and spent time trying to keep the other 3 residents safe. The provider did note that one option they wanted to explore before terminating the person\\u2019s services was to find out if they could obtain 1 on 1 staffing for the individual, but didn\\u2019t know who to ask or where to start. ICF\\/DD rates have many regulations and oftentimes hard to navigate they noted. The provider noted that the ability to obtain reimbursement beyond the facility\\u2019s establish rate was a mystifying process.\",\"Yes_or_No__128\":\"Yes\",\"Free_Text__130\":\"Influencing why this person was placed in what was seen as an atypical placement was that the person had never stayed at an ICF\\/DD before and the other people in the home were seen as having more medical needs than behavioral challenges. Despite these differences, the team, including the case manager, guardian and the provider thought this could be a good fit for the person because they could have more attention from staff and the person wouldn\\u2019t see the other roommates as a \\u2018threat\\u2019. \\r\\nAnother factor into this placement was that the provider had an open ICFs\\/DD bed. The fact it was an ICF\\/DD bed was one of the reasons why the bed was open. The providers in the room noted that there isn\\u2019t much interest in ICF\\/DD beds any more. Regionally, statewide and nationally, ICF or other institutional placements are seen as undesirable and passed over for foster care or other community-based settings. A number of factors have influenced this opinion about ICFs\\/DDs, including; public sentiment shifting away from institutions and large settings; the HCBS settings rule which has required systems to move towards community settings; the Minnesota Olmstead Plan which reflects the Supreme Court\\u2019s 1999 Olmstead ruling determining people should be served in the \\u201cmost integrated setting\\u201d, and; the Jensen Settlement Agreement which resulted in both Minnesota\\u2019s Olmstead Plan and the closure of some institutional services.\\r\\nAnother factor as to why this person was placed in an atypical placement was that the provider was willing to take a risk by accepting someone who didn\\u2019t fit the typical profile for this home. They were willing to take a risk because they did have an open ICF\\/DD bed that needed to be filled and hadn\\u2019t had much interest from other people in. The provider was also willing to take a risk because they determined the person could do well at the site.  This determination impacted the placement and was impacted by a number of factors. While the other people in the home didn\\u2019t have similar needs as this person, the team thought this might work well in this case. The other five people in the home had higher Activities of Daily Living (ADL) needs than this person so it was thought the person wouldn\\u2019t add much to the staff\\u2019s workload in this area. The five people also exhibited challenging behavior that was more easily redirected and managed by staff, so it was thought the house wouldn\\u2019t be overwhelming for staff to manage challenging behavior in the home as a whole. Additionally, it seemed to the provider that the person\\u2019s challenging behavior appeared manageable. This was due to a number of influences such as the case manager reporting there weren\\u2019t major recent behavioral concerns and the paperwork received from the person\\u2019s previous provider before intake. Beyond the concerns around the person\\u2019s challenging behavior, the paperwork from the previous provider supported the new provider\\u2019s assessment that the person could do well at this site. The person\\u2019s psychiatrist also weighed in and supported this particular placement, contributing to this assessment.\\r\\nAlong with the provider being willing to take a risk by accepting the person\\u2019s placement in this atypical setting was that both the case manager and the person\\u2019s guardian were willing to take a risk by placing the person in a home that didn\\u2019t fit the \\u2018typical\\u2019 profile. The person had failed at multiple community-based settings before so they both reported being interested in trying something different. Their options were likely limited too because this region has a lack of residential placement beds, which is also the trend statewide. This lack of residential beds is seen as influenced by a statewide moratorium on foster care beds as well as a moratorium on ICF\\/DD beds. The providers in the room also noted that the current statewide workforce shortage prohibits them from opening new programs as well as influences the closure of other residential sites. Without staff, programs cannot open or even stay open as providers can\\u2019t meet the supervision needs of the people living there.\",\"Multiple_Choice__101\":\"2\",\"Free_Text__102\":\"Unique to ICF\\/DDs is that they are licensed by both the Department of Human Services and the Minnesota Department of Health. Both Departments require providers to protect the health and safety of the people they serve. Minnesota Statutes 245D outlines the requirements for providers enforced by DHS while MDH relies on other statutory requirements in Minnesota statutes 144 and Rule. A unique requirement enforced by MDH is that ICF\\/DDs are expected to protect the people they serve from \\u201cimmediate jeopardy\\u201d. The provider in this instance noted that many times in the past they had been asked after a critical incident how they were going to protect the people they served from \\u201cimmediate jeopardy\\u201d in the future, so this mandate shaped the perception of the provider\\u2019s managers and supervisors whenever a health and safety concern arose and placed pressure on them to prioritize their response in a way that would satisfy MDH reviewers. The provider in this instance noted that terminating the person\\u2019s services was part of their response as to how they would respond to MDH\\u2019s questioning of how they were protecting the health and safety of the other people in the home. Between the requirements of DHS and MDH as well as the expectations of the guardians and case managers, the provider felt a strong need to act in this situation and felt that termination was the only way they could keep the majority of the people in the home safe.\",\"Multiple_Choice__109\":\"2\",\"Free_Text__110\":\"The provider \\u2013 and the person\\u2019s team - expected the person\\u2019s challenging behavior to dissipate after intake not only because they thought the environment would suit the person, but they assumed that a behavior support plan would positively effect change and decrease the person\\u2019s interfering behavior and that other external services would be able to assist with challenging episodes. Unfortunately, upon arrival the provider found there was a lack of external behavior services in their area and that they had a lack of information about what mental health services were available. Additionally, the person\\u2019s case manager \\u2013 who would typically be expected to also help find needed services \\u2013 was very busy and unable to devote much time to the person\\u2019s case. A number of influences as to why case managers would be busy were identified \\u2013 between high case load and recent federal and state initiatives changing services.\",\"Multiple_Choice__115\":\"3\",\"Free_Text__116\":\"Influencing why the ICF\\/DD provider terminated this person\\u2019s services due to challenging behavior was that the person was posing a safety risk to others in the home. The other 3 individuals in the home were considered to be more vulnerable to abuse due to their lower functioning levels, and so the person posed a greater risk to them. The provider had to balance their responsibility to protect the health and safety of three people in the home with their responsibility to meet the needs of the person whose services they terminated.\",\"Multiple_Choice__119\":\"3\",\"Free_Text__120\":\"The provider \\u2013 and the person\\u2019s team - expected the person\\u2019s challenging behavior to dissipate after intake not only because they thought the environment would suit the person, but they assumed that a behavior support plan would positively effect change and decrease the person\\u2019s interfering behavior and that other external services would be able to assist with challenging episodes. Unfortunately, upon arrival the provider found there was a lack of external behavior services in their area and that they had a lack of information about what mental health services were available. \\r\\nAlong with the lack of mental health resources, the provider also noted there was a lack of behavioral resources available to the person. Some practitioners had recommended that the person be admitted to an inpatient facility where they could try a \\u201cmed holiday\\u201d \\u2013 taking the person off all their meds and slowly re-introducing medication to determine their effectiveness. The provider could only find 1 program in the state that offered \\u201cmed holidays\\u201d, and that program had only 9 beds and waiting list of 25 people. The mapping team noted that the Jensen Settlement, which limited community base intensive services and the interventions they could use, influenced the lack of behavioral services like this one. \\r\\n\\r\\nAnother factor as to why this person was placed in an atypical placement was that the provider was willing to take a risk by accepting someone who didn\\u2019t fit the typical profile for this home. They were willing to take a risk because they did have an open ICF\\/DD bed that needed to be filled and hadn\\u2019t had much interest from other people in\\r\\n\\r\\nAlong with the provider being willing to take a risk by accepting the person\\u2019s placement in this atypical setting was that both the case manager and the person\\u2019s guardian were willing to take a risk by placing the person in a home that didn\\u2019t fit the \\u2018typical\\u2019 profile. The person had failed at multiple community-based settings before so they both reported being interested in trying something different. Their options were likely limited too because this region has a lack of residential placement beds, which is also the trend statewide. This lack of residential beds is seen as influenced by a statewide moratorium on foster care beds as well as a moratorium on ICF\\/DD beds. The providers in the room also noted that the current statewide workforce shortage prohibits them from opening new programs as well as influences the closure of other residential sites. Without staff, programs cannot open or even stay open as providers can\\u2019t meet the supervision needs of the people living there.\",\"Multiple_Choice__125\":\"2\",\"Free_Text__126\":\"Without interventions that met the needs of the person, coupled with the lack of training of the staff, the provider noted their staff were stressed at the site. They often times engaged in power struggles with the individual and spent time trying to keep the other 3 residents safe\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'2021-05-25 06:14:26','2021-05-25 21:58:40',NULL,'CY_Harry Meyering-BEC-2019-11'),(187,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"CY_Mains l-HC-2020-07\",\"Date__77\":\"07\\/28\\/2020\",\"Multiple_Choice__78\":\"Charles Young\",\"Short_Answer__80\":\"Mains l Services\",\"Short_Answer__81\":\"Kelly Boser McBroom\",\"Short_Answer__82\":\"kbmcbroom@mainsl.com\",\"Short_Answer__83\":\"763-494-4553\",\"Multiple_Choice__84\":\"Termination of Services\",\"Multiple_Choice__85\":\"Hennepin County\",\"Date__86\":\"05\\/29\\/2020\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Service termination was issued\",\"True_or_False__94\":\"Yes\",\"Free_Text__100\":\"The provider issuing a person a service termination as necessary for her welfare and her needs couldn\\u2019t be met was strongly influenced by the fact that available external mental health and crisis services required a person to be in danger of losing their housing. The provider noted that they did not have an actual intention of terminating the person\\u2019s services, but instead wanted to ensure that the person could access needed mental health services. The case manager had difficulty in finding other providers to work with her due to a lack of appropriate crisis services available statewide and so requested that the provider issue the service termination to help access alterative crisis and mental health services. People with a residential placement are deprioritized on crisis service waiting lists as priority must be given to people without or in danger of losing housing. There are also few locked facilities in Minnesota, which the team thoughtT this person could need to help manage the person\\u2019s escalating elopement and physical aggression concerns. This lack of locked facilities in Minnesota is impacted by the state\\u2019s regulations that focus on providing services in a least restrictive setting, the Olmstead vs. LC lawsuit, Minnesota\\u2019s Olmstead Plan, Minnesota Statute 245D and the Jensen Settlement \\u2013 which created the need for Minnesota\\u2019s Olmstead Plan and the stronger focus on utilizing less restrictive settings. Minnesota\\u2019s Moratorium on foster care and other residential settings (ICF\\/DDs) also prevented providers from opening settings that were sometimes seen as more restrictive settings, leaving fewer options for people who may need this type of environment. \\r\\nThe person had a primary diagnosis of developmental disability, which exempted her from accessing some of the mental health services the team thought she needed, such as IRTS \\u2013 which will only serve people with an MH diagnosis. Due to the confusion and\\/or disagreement among professionals involved with this person regarding whether the person\\u2019s interfering behavior was psychiatric or behaviorally based, obtaining a specific diagnosis was difficult. MA doesn\\u2019t allow for multidisciplinary assessments, so her team was not able to meet and work out a specific diagnosis or plan. Some professionals diagnosed her as primarily having a developmental disability (neurocognitive disorder) while others diagnosed her as primarily having a mental health disorder. Shortly before the termination was issued, one clinician diagnosed her with a primary mental health disorder, which the professional saw as primarily contributing to the person\\u2019s escalating and dangerous interfering behavior.  The person\\u2019s primary diagnosis couldn\\u2019t be resolved amongst the professionals, impacting the person\\u2019s inability to access mental health services. \\r\\nThe provider issuing a person a service termination as necessary for her welfare and her needs couldn\\u2019t be met was influenced by the person\\u2019s interfering behavior which was escalating and dangerous. The person regularly physically aggressed towards her roommates and staff. The other people in the home were considered vulnerable, and the provider has a responsibility to safeguard the health and safety of all residents \\u2013 as well as their staff. This responsibility is assigned to providers by Minnesota Statutes 245D, the statute governing an HCBS provider\\u2019s license. The responsibility is also assigned to providers by the Coordinated Service and Support Plans created by lead agency or contracted HCBS case managers. Along with endangering the other people in the home, the person also trespassed routinely on neighbor\\u2019s property and even their homes and called 911 often. Due to these 911 calls, the person was transported to the hospital often but rarely admitted. It was determined through a functional behavior assessment that the person enjoyed going to the hospital and receiving attention from the EMTs and hospital staff. This desire led to the person often falsely reporting medical concerns to the 911 dispatchers. When it was determined that the person didn\\u2019t have an actual medical concern, the hospitals and EMT would discharge or refuse services because they won\\u2019t serve someone in crisis if the underlying cause is \\u201cbehavioral\\u201d rather than medical. MA rules require hospitals to provide care if a person is a danger to themselves or others, and the medical professionals felt that the person\\u2019s issues were attention-seeking in nature and not a serious health or mental health concern. When the person eventually could not access medical and EMT services due to her false reporting, she started calling on issues that law enforcement would typically respond to. Her behavior escalated to eloping from the home and laying in the road despite oncoming traffic. Due to her size, staff were unable to move or remove her from this position without law enforcement assistance. The law enforcement officers involved reportedly eventually grew frustrated responding to issues they thought the residence should handle, and refused to work with the person.\\r\\nThe interventions that were implemented with the person by the provider appeared to not be effective. The provider\\u2019s philosophy was to avoid restrictive interventions such as restraint or rights restrictions. Because of the person\\u2019s demeanor and size, the provider also didn\\u2019t think restrictive interventions would safely resolve the person\\u2019s interfering behavior. This philosophy to avoid restrictive interventions was influenced by person-centered philosophy\\/ethics, as well as the requirements in the licensing statute MN Stat. 245D. Those interventions that were tried, such as positive support strategies and even increasing the person\\u2019s staffing to 1:1 did not decrease the incidence and intensity of the person\\u2019s interfering behaviors. The person had a person-centered plan created with them, and in that planning process it was determined that the person wanted to live alone, something the provider tried to work with the person to help them work towards a more independent placement. But the fact that the person wasn\\u2019t living in a preferred setting was believed to contribute to the person\\u2019s escalating interfering behavior. The provider requested support in the area of mental health training and staffing, but these services were either unavailable or not as intense as the provider was seeking. This lack of services was influenced by lower wages and compensation for these services. These lower wages were seen as lower than needed due to a statewide workforce shortage that increased the demand for staff which, in turn, increased the wages in other service sectors so that HCBS services were less desirable for workers. HCBS rates are mainly determined by Minnesota Statutes governing the Disability Waiver Rate Setting requirements. Creating higher wages\\/HCBS reimbursement required action by the Minnesota Legislature. \\r\\nThe provider was pressured to act in this situation due to the escalating and dangerous behavior and the neighbor\\u2019s concerns about their own welfare and placing pressure on the provider to prevent the behaviors and pressure from law enforcement to act. While the provider didn\\u2019t intend to actually terminate services, it appeared as though the only way to access needed crisis and mental health services for the person was to issue a service termination.\",\"Multiple_Choice__103\":\"2\",\"Free_Text__104\":\"The provider requested support in the area of mental health training and staffing, but these services were either unavailable or not as intense as the provider was seeking. This lack of services was influenced by lower wages and compensation for these services. These lower wages were seen as lower than needed due to a statewide workforce shortage that increased the demand for staff which, in turn, increased the wages in other service sectors so that HCBS services were less desirable for workers. HCBS rates are mainly determined by Minnesota Statutes governing the Disability Waiver Rate Setting requirements. Creating higher wages\\/HCBS reimbursement required action by the Minnesota Legislature.\",\"Multiple_Choice__115\":\"3\",\"Free_Text__116\":\"The provider issuing a person a service termination as necessary for her welfare and her needs couldn\\u2019t be met was influenced by the person\\u2019s interfering behavior which was escalating and dangerous. The person regularly physically aggressed towards her roommates and staff. The other people in the home were considered vulnerable, and the provider has a responsibility to safeguard the health and safety of all residents \\u2013 as well as their staff. This responsibility is assigned to providers by Minnesota Statutes 245D, the statute governing an HCBS provider\\u2019s license. The responsibility is also assigned to providers by the Coordinated Service and Support Plans created by lead agency or contracted HCBS case managers.\",\"Multiple_Choice__119\":\"3\",\"Free_Text__120\":\"The provider issuing a person a service termination as necessary for her welfare and her needs couldn\\u2019t be met was strongly influenced by the fact that available external mental health and crisis services required a person to be in danger of losing their housing. The provider noted that they did not have an actual intention of terminating the person\\u2019s services, but instead wanted to ensure that the person could access needed mental health services. The case manager had difficulty in finding other providers to work with her due to a lack of appropriate crisis services available statewide and so requested that the provider issue the service termination to help access alterative crisis and mental health services. People with a residential placement are deprioritized on crisis service waiting lists as priority must be given to people without or in danger of losing housing. There are also few locked facilities in Minnesota, which the team thoughtT this person could need to help manage the person\\u2019s escalating elopement and physical aggression concerns. This lack of locked facilities in Minnesota is impacted by the state\\u2019s regulations that focus on providing services in a least restrictive setting, the Olmstead vs. LC lawsuit, Minnesota\\u2019s Olmstead Plan, Minnesota Statute 245D and the Jensen Settlement \\u2013 which created the need for Minnesota\\u2019s Olmstead Plan and the stronger focus on utilizing less restrictive settings. Minnesota\\u2019s Moratorium on foster care and other residential settings (ICF\\/DDs) also prevented providers from opening settings that were sometimes seen as more restrictive settings, leaving fewer options for people who may need this type of environment.\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'2021-05-25 00:44:26','2021-05-26 21:15:27',NULL,'CY_Mains l - HC -2020 -07'),(188,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"DV_Kelly AFC-SLC-2020-11\",\"Date__77\":\"11\\/24\\/2020\",\"Multiple_Choice__78\":\"David Vukelich\",\"Short_Answer__80\":\"Kelly Adult Foster Care\",\"Short_Answer__81\":\"Kelly Postudensek\",\"Short_Answer__82\":\"kellypost.987@gmail.com\",\"Short_Answer__83\":\"218-780-0445\",\"Multiple_Choice__84\":\"Termination of Services\",\"Multiple_Choice__85\":\"St. Louis County\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Individual was issued a 60 day termination notice.\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"01\\/12\\/2021\",\"Free_Text__98\":\"Prior to the termination the individual was residing with this AFC provider for 15 months.  The setting was a family foster home with owner\\/operator on-site and no other residents.   The provider was newly licensed for 2 residents and this was the first individual that was placed in her home.   The individual was in his grandparents\\u2019 care prior to this AFC.  The individual is his own guardian.  \\r\\nPrior to the placement the provider had communicated with the individual\\u2019s grandparents and CADI case manager.  The provider was told that the individual was in special education in school and A few weeks after the placement the provider was given a file with additional information on the individual.  The file included police reports indicating the individual had been in physical fights.  After the placement the provider also learned that the individual had a history of stealing money, cigarettes and specifically an incident when he stole credit cards from his grandparents.   The provider also learned that he was expelled from Cloquet High School due to his behaviors and transferred to the Merit Creek Academy.  The provider stated that in conversations with the individual\\u2019s grandparents they stated that he was easily influenced by his friends.  \\r\\nThe provider stated while the individual was residing with her he would swear at her and try to physically intimidate her.  The provider noted that the individual never physically assaulted her.  The provider noted that the individual spent much of his time in his bedroom playing video games.  He ate the majority of this meals in his room alone.   Prior to COVID19, the individual was in therapy twice a week for depression and anger issues.  This moved to telehealth and soon ended all together.  The individual was also with Choice Unlimited for employment after he graduated school, but did not want to continue to work on employment.\\r\\nDue to the individual constantly isolating himself and physically intimidating behaviors the provider decided to issue a 60 day termination notice. The case manager was aware of the concerns and supported the individual moving.  The individual was not initially supportive of the move, but was excited to move once he toured the new facility.\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-25 16:47:23',NULL,'DV_Kelly AFC - SLC -2020 -11'),(189,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"Care Manager\",\"Date__77\":\"01\\/28\\/2020\",\"Multiple_Choice__78\":\"David Vukelich\",\"Multiple_Choice__79\":\"Scott Schifsky\",\"Short_Answer__80\":\"Peace of Mind of Duluth\",\"Short_Answer__81\":\"Clayton Liend\",\"Short_Answer__82\":\"clayton@pomduluth.com\",\"Multiple_Choice__84\":\"Termination of Services\",\"Multiple_Choice__85\":\"St. Louis County\",\"Date__86\":\"11\\/05\\/2019\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Individual was given a 60 day termination notice.\",\"True_or_False__94\":\"Yes\",\"Free_Text__98\":\"The individual had been served by this agency for 14 years.  He was in an AFC home with 3 other males.  Prior to the termination the individual was having increased sexual behaviors towards staff.  This included both verbal comments that were inappropriate and\\/or sexual in nature and physical contact with staff that was also inappropriate.  The individual was also using social media to make sexual comments towards staff.  \\r\\nThere was a specific incident in the community (Holiday gas station) where the individual allegedly touched a juvenile\\u2019s buttocks.  The individual was criminally charged and there is currently a pending criminal matter.  There was a similar incident that occurred prior to this at Wal-Mart where the individual grabbed a woman\\u2019s buttocks.  He was not charged during this incident.\\r\\nFollowing the criminal charges, the agency set parameters for the individual which included attending therapy and to cease inappropriate conversations with staff.  The agency identified a provider for therapy and had scheduled an appointment for the individual.  The individual did not attend his appointment by continuing to reschedule the appointment without good reason.  With input from the house manager, program coordinator, manager and the president the agency issued the 60 day termination notice with the intention of dropping the termination if the individual resumed therapy and complied with the other parameters.  The individual did not resume therapy and ended up moving to another facility.  \\r\\nPrior to the termination there multiple meetings with the individual\\u2019s expanded support team to discuss how they could better support him in his current setting.  His support team concurred with the 60 day termination notice because at the time all other options had been exhausted.  The individual claims he didn\\u2019t know about the termination, exercised his right to appeal, and the matter is still pending.\",\"Free_Text__100\":\"The individual being issued a termination notice was influenced by the individual\\u2019s increased frequency of sexualized behaviors including sexualized behaviors towards staff which led to staff experiencing sexual harassment.  In response to the increase in the individual\\u2019s behaviors the provider and individual created a behavior agreement.  This agreement included the individual working with a therapeutic practitioner as well as working to reduce the sexualized behaviors.  The individual is their own guardian and did not think they needed to change, would often skip therapy meetings and chose not to comply with the behavior agreement.  The individual\\u2019s computer usage also influenced the increase in sexualized behaviors as they were using social media\\/internet in way that was sexually inappropriate and harassing.  Along with the previously mentioned factors, the lack of effectiveness of the behavior interventions led to the provider issuing the termination notice.  Person-centered requirements guided the provider to honor the individual\\u2019s choices during this process which influenced the person not comply with the behavior agreements.  Additionally the individual was criminally charged in regards to an incident in where they sexually assaulted a minor in the community.  The court did not order treatment for this individual which influenced the individual\\u2019s thought they didn\\u2019t need to change their behaviors as well as a continuation of increased sexual behaviors.  \\r\\nAn additional influence that led to the provider issuing the termination notice was that the individual\\u2019s formal support team including the case manager was involved throughout this process and in the end supported the termination.\\r\\n245D Individual Rights & Person-Centered requirements required that a legal representative consent with any rights restriction, and as the person did not think they needed to change a rights restriction was not an option. The rights afforded to a person in 245D supported the individual in not having rights restrictions as well as honoring their choices.  \\r\\nFurther contributing to the person being given a 60 day termination notice was that staffing the home was difficult.  In regards to the increased sexual behaviors and sexual harassment this led to staff reporting their work environment as hostile and increased the difficulty in staffing the home.  Adding to the difficulty in staffing the home was that the provider attempted to staff the home with males and a statewide workforce shortage.  Staffing only with males decreased the pool of applicants for the home.\",\"Multiple_Choice__101\":\"0\",\"Multiple_Choice__103\":\"2\",\"Free_Text__104\":\"dont count this as a \\\"2\\\" - notes below are to help with tracking some of things we re seeing around people tending to prefer certain types of staff From narrative: \\\"Adding to the difficulty in staffing the home was that the provider attempted to staff the home with males and a statewide workforce shortage.  Staffing only with males decreased the pool of applicants for the home.\\\"\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"2\",\"Free_Text__110\":\"\\\"Note: individual being their own guardian is considered part of the \\\"support team\\\" and them not following through on agreement impacts the teamwork. Guardian, case manager, and provider weren t all on the same page.\\\"\\r\\n\\r\\nThis agreement included the individual working with a therapeutic practitioner as well as working to reduce the sexualized behaviors.  The individual is their own guardian and did not think they needed to change, would often skip therapy meetings and chose not to comply with the behavior agreement.\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"3\",\"Free_Text__116\":\"This agreement included the individual working with a therapeutic practitioner as well as working to reduce the sexualized behaviors.  The individual is their own guardian and did not think they needed to change, would often skip therapy meetings and chose not to comply with the behavior agreement.  The individual\\u2019s computer usage also influenced the increase in sexualized behaviors as they were using social media\\/internet in way that was sexually inappropriate and harassing.  Along with the previously mentioned factors, the lack of effectiveness of the behavior interventions led to the provider issuing the termination notice.  Person-centered requirements guided the provider to honor the individual\\u2019s choices during this process which influenced the person not comply with the behavior agreements.  \\r\\n\\r\\n245D Individual Rights & Person-Centered requirements required that a legal representative consent with any rights restriction, and as the person did not think they needed to change a rights restriction was not an option. The rights afforded to a person in 245D supported the individual in not having rights restrictions as well as honoring their choices.\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"0\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:17:18',NULL,'DV_Peace of Mind - SLC -2020 -01'),(190,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"201905337\",\"Date__77\":\"08\\/15\\/2019\",\"Multiple_Choice__78\":\"David Vukelich\",\"Multiple_Choice__79\":\"Scott Schifsky\",\"Short_Answer__80\":\"Pinewood-Duluth\",\"Short_Answer__81\":\"Dana Tchida\",\"Short_Answer__82\":\"dana@pinewoodcloq-duluth.com\",\"Multiple_Choice__84\":\"Elopement\",\"Multiple_Choice__85\":\"St. Louis County\",\"Date__86\":\"07\\/23\\/2019\",\"Free_Text__87\":\"Theresa Reilly (TR) was found outside approximately of a city block away from the Pinewood building by staff\\r\\nSteve Anderson (SA) who was heading out to a job site. TR was at the business 4th Street Auto attempting to open a vehicle door (she\\r\\nlikes to go on car rides). SA was able to gain her attention and asked her to come with him back to Pinewood. She complied and\\r\\naccompanied SA back to Pinewood.\\r\\n\\r\\nEarlier that morning, the \\\"daily schedule\\\" created by staff Sherri Ross (SR) had listed staff Sherrill McDonald (SM) to provide supervision\\r\\nfor TR. TR is not a 1:1, however she requires close supervision as she has a history of elopements. SM had spoken to SR earlier in the\\r\\nmorning, before any clients had arrived, and told her she was not able to provide supervision for TR because she would be busy working\\r\\non a project in a separate area from where TR was going to be. SR was going to make the change on the \\\"daily schedule\\\" but got busy\\r\\nwith other things and forgot to update it with a different staff for TR s supervision. With no eligible staff listed for TR s supervision, TR was\\r\\nable to leave the building unnoticed. It is unknown exactly what time TR left Pinewood, but other staff member Connie Lepak (CL) reported\\r\\nthat she had last interacted with TR at 9:10am. SA reported that when he found TR it was approximately 9:15am.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Staff was not aware the individual left the program.\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"09\\/24\\/2019\",\"Free_Text__98\":\"Pinewood debriefing.  9\\/24\\/2019\\r\\nLearning point:  The staff was not aware that the individual left the program.\\r\\n\\r\\nDebrief SP1:   The day of the incident SP1 provided direct supervision of the individual in the early morning as the individual would ride with SP1 in her vehicle to drop off a different employee for off-site work.  SP1 had been doing this most of the summer as this staff person was not able to drive the company vehicles due to age restrictions.  SP1 returned to the facility with the individual around 9:00a.m. and the individual returned to her program area in the basement of the facility.  \\r\\nSP1 was not providing direct supervision to the individual beyond the ride in her vehicle.  SP1 did state that she makes a schedule every week that reflects which staff will be in what program areas.  She stated there is one individual that requires 1:1 supervision and the individual that eloped does not require 1:1 supervision, but the agency does designate a staff person to supervise her as she has a history of elopement.  SP1 stated that she creates this schedule (paper\\/electronic document) and on the day of the incident SP3 was scheduled to supervise the individual who eloped.  SP1 stated that there are generally a lot of changes to the schedule throughout the week, so staff utilizes a whiteboard to reflect the changes.  SP1 stated that there are approximately 11-14 clients and approximately 4 staff providing supervision.  \\r\\nIn regards to the individual\\u2019s behaviors, SP1 describes her as \\u201cninja like.\\u201d  SP1 stated that the individual will attempt to leave the program daily and some days she is really determined to leave and will make numerous attempts throughout the day.  \\r\\nSP1 was unaware that the individual left the program\\/building.\\r\\nDebrief SP2:  SP2 confirms SP1\\u2019s history of events.  SP2 stated that she has been working with the individual for 19 years and is very familiar with her behaviors.  \\r\\nSP2 was supervising multiple individuals in the program area the day of the incident and was unaware that the individual left the program\\/building.\\r\\n\\r\\nDebrief SP3:  SP3 was identified on the paper schedule as the staff person who would be working with the individual the day of the alleged incident.  SP3 stated that she was also scheduled to learn a different job duty the day of the incident, so she informed others that she was going to be working in an office that day. \\r\\nShe also noted that the physical location of the staff desk upstairs doesn\\u2019t provide the optimal vantage point to the entrances\\/exits.  \\r\\nSP3 was unaware that the individual left the program\\/building.\",\"Free_Text__100\":\"The staff \'s awareness that the individual left the program was influenced by Staff 3\'s assignments to two tasks, supervising the individual and completing a training. Staff 1 created staff assignments on paper. The paper schedule was not updated to reflect the staffing change after Staff 3 told Staff 1 they needed to complete the training instead of supervising. An additional influence was Staff 1 being new to the role of making staff assignments. This new role was further complicated as the staff assignments change frequently to support the varied needs of individuals. The facility also utilizes a whiteboard for staff assignments. As changes are made to the assignment schedule, the whiteboard is updated to reflect the changes. The whiteboard and paper schedules do not match once there are changes to the whiteboard. \\r\\n\\r\\nThe individual\\u2019s behaviors influenced staff\'s awareness of the individual leaving the facility.  The individual moves around a lot during her time in the program area and was described as elusive.  Staff indicated that the individual deliberately observes staff and when staff appears to be distracted or less attentive she will attempt to leave the program area. There are up to 17 participants and 5 staff in the program area at any given time. This ratio influences each staff person to provide support and supervision to multiple participants in the program area. Ideally, the provider said they\'d have more staff, but this staff to person ratio is typical. This ratio is influenced by a workforce shortage across the region and state that has impacted the provider\'s ability to increase their staff ratio. Per the individual\\u2019s 6790, they did not require one-on-one supervision impacting the decision to assign one staff to this individual. The 6790 is influenced by the DWRS which provides a calculation for the person\\u2019s service rates and the staff ratios required of day service facilities (DSFs) in Minn. Stat. 245D. The recent push by the legislature over the last few years shifting from daily and partial day payment in DSFs to community- and unit-based funding made the process of negotiating a 6790 more complex. This push to community- and unit-based employment was influenced by a number of national and regional initiatives such as the HCBS Final Rule, the Workforce Investment and Opportunities Act, the Minnesota Olmstead Plan and recent lawsuits regarding congregate work by the Department of Justice. The provider noted that adapting to this change influenced the business of the program and frequent staff changes as they moved to work with some clients in the community and some at their congregate site, which required staff to move around and pivot roles frequently. \\r\\n\\r\\nAlthough the individual\'s plan does not require 1:1 staffing, the day program assigned a specific staff person to supervise the individual on this day. The assigned staff person was unable provide 1:1 supervision to the individual as they were also required to supervise\\/support other people. The program area was described as busy and distracting.  Some participants are more vocal adding to the distractions and some participants require higher supervision than others including one-to-one supervision. Such distractions further supported staff not realizing that the individuals had left the home. The building has three levels and multiple exits which impacts staff\'s ability to see all exits while supporting people. The doors do have chimes; however, the staff have become desensitized to the chimes as the staff, people served, and community members use the entrances and exits frequently.  The doors are equipped with alarms because providers are responsible for the health, safety and well-bring of individuals served. Local fire codes influenced requirements for exits being unlocked and able to be used in case of emergency. The facility fire codes are influenced by 245D and city fire codes. The fire code says that exit doors shall have the ability to be opened from inside in case of a fire. This contributed to the individual\'s ability to exit the program.  As a result of the multiple exits with chimes continually occurring, staff have been desensitized to them. This desensitization further impacted staff not realizing that the individual left the program. The chimes were implemented as a result of the building needing multiple exits which is governed by the agency\\u2019s requirement to support the health, safety, and well-being of residents through the adherence to the fire codes.\",\"Multiple_Choice__101\":\"0\",\"Multiple_Choice__103\":\"1\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"3\",\"Free_Text__110\":\"The staff\' s awareness that the individual LEFT the program was influenced BY Staff 3 \'s assignments to two tasks, supervising the individual and completing a training.  The paper schedule was not updated to reflect the staffing change after Staff 3 told Staff 1 they needed to complete the training instead of supervising.  This new role was further complicated as the staff assignments change frequently to support the varied needs of individuals.  The facility also utilizes a whiteboard for staff assignments. As changes are made to the assignment schedule, the whiteboard is updated to reflect the changes. The whiteboard and paper schedules do not match once there are changes to the whiteboard. \\r\\nThe individual\\u2019s behaviors influenced staff\'s awareness of the individual leaving the facility.  The individual moves around a lot during her time in the program area and was described as elusive.  Staff indicated that the individual deliberately observes staff and when staff appears to be distracted or less attentive she will attempt to leave the program area. There are up to 17 participants and 5 staff in the program area at any given time. This ratio influences each staff person to provide support and supervision to multiple participants in the program area. Ideally, the provider said they\'d have more staff, but this staff to person ratio is typical.\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"0\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"2\",\"Free_Text__124\":\"The building has three levels and multiple exits which impacts staff\'s ability to see all exits while supporting people. The doors do have chimes; however, the staff have become desensitized to the chimes as the staff, people served, and community members use the entrances and exits frequently.  The doors are equipped with alarms because providers are responsible for the health, safety and well-bring of individuals served.\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:19:05',NULL,'DV_Pinewood - SLC -2019 -08'),(191,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"201903632\",\"Date__77\":\"06\\/19\\/2019\",\"Multiple_Choice__78\":\"David Vukelich\",\"Multiple_Choice__79\":\"Kelly Sather\",\"Short_Answer__80\":\"REM Arrowhead\",\"Short_Answer__81\":\"Corey Labissoniere\",\"Short_Answer__82\":\"Corey.LaBissoniere@thementornetwork.com\",\"Multiple_Choice__84\":\"Elopement\",\"Multiple_Choice__85\":\"St. Louis County\",\"Date__86\":\"05\\/18\\/2019\",\"Free_Text__87\":\"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.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Individual left the home via the bathroom without staff knowledge.\",\"True_or_False__94\":\"No\",\"Multiple_Choice__99\":\"Staff No Longer Employed\",\"Free_Text__100\":\"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).\",\"Multiple_Choice__101\":\"3\",\"Free_Text__102\":\"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.\",\"Multiple_Choice__103\":\"0\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"2\",\"Free_Text__110\":\"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.\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"0\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"0\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:19:47',NULL,'DV_REM Arrowhead - SLC -2019 -06'),(192,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"DV_Rural Living Enivronment-SLC-2020-06\",\"Date__77\":\"07\\/10\\/2020\",\"Multiple_Choice__78\":\"David Vukelich\",\"Short_Answer__80\":\"Rural Living Environment\",\"Short_Answer__81\":\"Leanne Negley\",\"Short_Answer__82\":\"lnegley@rurallivingmn.com\",\"Multiple_Choice__84\":\"Termination of Services\",\"Multiple_Choice__85\":\"St. Louis County\",\"Date__86\":\"04\\/23\\/2019\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Person was given a 60-day service termination\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"08\\/11\\/2020\",\"Free_Text__98\":\"The individual was living in a large 4000 sq. ft. adult foster care home in rural northern MN.  The individual has been served by this provider for approximately 10 years and was living in this particular home for the past 4 + years.   The individual\\u2019s mother is her legal guardian.  The AFC was home to two other females at the time the termination notice was issued.  The individual is diagnosed with Prader-Willi syndrome and has some challenging behaviors associated with her diagnosis.  These behaviors kept the provider cautious about adding additional people in the home even though there was capacity to do so.  The provider stated that recently the individual was given a new medication and her behaviors had improved.  Staff indicated that the provider was discussing a more individualized living arrangement for the individual, which would have included a larger area of the home designated to the individual.  \\r\\n\\r\\nWhen concerns for COVID19 arose in March, the provider sent out letters to the guardians of the people they serve to see if the guardians wanted to provide direct care for their respective program participants.  The individual\\u2019s mother responded and indicated that she wanted to provide care for her daughter.  The original plan was that this arrangement would last for two weeks.  The provider asked if the individual could return to the program and the individual\\u2019s mother wasn\\u2019t comfortable with her returning at that time.  The individual\\u2019s mother had previously worked for the provider.  In an effort to continue to support the individual the provider did the following: retrained the mother, employed her as a direct support staff for the individual, provided groceries and medications to the mother\\u2019s home, and provided an iPad so the individual could remain connected to others served by the provider as well as her mother being able to use the device for documentation.  The provider also provided remote support via Zoom meetings 2 hours a day, Monday through Friday.  County waiver case manager and supervisor were consulted about the alternative arrangement in response to the pandemic and they explained to the provider that they were not in support of this.  They had not been consulted until after the plan was in place.  The agency advised the provider to issue a termination notice if individual did not return to the program.  Mother and individual were notified of this recommendation and chose not to have the individual return to the program.  Mother and individual understood the termination was coming and agreed with it.  \\r\\n\\r\\nStaff reported that the provider\\u2019s management team was involved with the termination notice and issued the termination in accordance with policy\\/rules.  No previous terminations were noted.\",\"Free_Text__100\":\"The person being given a 60-day service termination was influenced by the individual\\u2019s legal guardian\\/mother deciding to not have the person return to the program after she was not comfortable with safety in the Adult Foster Care (AFC) setting during the COVID-19 pandemic and elected to provide care to the individual for a two week period. The service provider sent a letter to the individual\\u2019s mother that gave the guardian the option to provide care for two weeks to the individual in lieu of being in the AFC.  The two week timeline was based on the maximum time limit that a provider could bill for (under the guise of a \\u201ccamping trip\\u201d) and continue to hold the individual\\u2019s bed. The uncertainties of the pandemic influenced the provider to develop a creative plan to continue to support the individual in her mother\\u2019s home.  This plan included the provider having the mother become an employee to formally provide direct support to the individual.  This was influenced by the mother previously being a provider for the agency as well as what was deemed to be important to the individual.  The uncertainties of the pandemic again made timelines unclear for how long this arrangement would be appropriate.  The provider then reached out to the County to discuss the alternative plan that was currently in place.  The county couldn\\u2019t approve this alternative service delivery.  The individual\\u2019s mother was made aware of this but was still comfortable with the individual to return to an AFC setting and decided to continue to have the individual reside with her.   Based on the mother\\u2019s decision, the provider not being able to sustain the current plan and the County stance on the alternative plan the person was given a 60-day termination notice.  \\r\\nThe County\\u2019s inability to support the alternative plan was influenced by the plan\\u2019s language not matching service definitions for the service the provider was authorized to provide.  The provider was delivering residential Supported Living Services (SLS) which by regulations cannot be provided remotely.  Additionally parents cannot provide SLS in their own home and these rules were not flexible enough to accommodate the individual\\u2019s specific situation.\\r\\nThe provider\\u2019s decision to issue a service termination was additionally impacted by a  fiscal constraints.  Providers are unable to bill for long-term empty beds. The inability to bill is based on the Disability Waiver Rate System (DWRS) which already factors in absences in the daily rate but not the ability to bill for days away.  This billing constraint is impacted by CMS regulations which only allows one method of billing for absences.  This billing constraint is also impacted by the Minnesota State Legislature which chose this method of billing for absences. \\r\\nThe uncertainties surrounding the pandemic were influenced by ongoing changes to requirements and timelines that were demonstrated by ongoing changes in the Governor\\u2019s orders.\",\"Multiple_Choice__101\":\"1\",\"Multiple_Choice__103\":\"0\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"1\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"3\",\"Free_Text__116\":\"The County\\u2019s inability to support the alternative plan was influenced by the plan\\u2019s language not matching service definitions for the service the provider was authorized to provide.  The provider was delivering residential Supported Living Services (SLS) which by regulations cannot be provided remotely.  Additionally parents cannot provide SLS in their own home and these rules were not flexible enough to accommodate the individual\\u2019s specific situation.\\r\\nThe provider\\u2019s decision to issue a service termination was additionally impacted by a  fiscal constraints.  Providers are unable to bill for long-term empty beds. The inability to bill is based on the Disability Waiver Rate System (DWRS) which already factors in absences in the daily rate but not the ability to bill for days away.  This billing constraint is impacted by CMS regulations which only allows one method of billing for absences.  This billing constraint is also impacted by the Minnesota State Legislature which chose this method of billing for absences. \\r\\nThe uncertainties surrounding the pandemic were influenced by ongoing changes to requirements and timelines that were demonstrated by ongoing changes in the Governor\\u2019s orders.\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"3\",\"Free_Text__124\":\"The person being given a 60-day service termination was influenced by the individual\\u2019s legal guardian\\/mother deciding to not have the person return to the program after she was not comfortable with safety in the Adult Foster Care (AFC) setting during the COVID-19 pandemic and elected to provide care to the individual for a two week period. The service provider sent a letter to the individual\\u2019s mother that gave the guardian the option to provide care for two weeks to the individual in lieu of being in the AFC.  The two week timeline was based on the maximum time limit that a provider could bill for (under the guise of a \\u201ccamping trip\\u201d) and continue to hold the individual\\u2019s bed. The uncertainties of the pandemic influenced the provider to develop a creative plan to continue to support the individual in her mother\\u2019s home.  This plan included the provider having the mother become an employee to formally provide direct support to the individual.  This was influenced by the mother previously being a provider for the agency as well as what was deemed to be important to the individual.  The uncertainties of the pandemic again made timelines unclear for how long this arrangement would be appropriate.  The provider then reached out to the County to discuss the alternative plan that was currently in place.  The county couldn\\u2019t approve this alternative service delivery.  The individual\\u2019s mother was made aware of this but was still comfortable with the individual to return to an AFC setting and decided to continue to have the individual reside with her.   Based on the mother\\u2019s decision, the provider not being able to sustain the current plan and the County stance on the alternative plan the person was given a 60-day termination notice.\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:20:33',NULL,'DV_Rural Living Enivronment - SLC -2020 -06'),(193,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"A954660000\",\"Date__77\":\"10\\/15\\/2019\",\"Multiple_Choice__78\":\"David Vukelich\",\"Multiple_Choice__79\":\"Kelly Sather\",\"Short_Answer__80\":\"Stepping Stones for Living\",\"Short_Answer__81\":\"Laura Flynn\",\"Short_Answer__82\":\"laura.flynn@sslduluth.com\",\"Multiple_Choice__84\":\"Medication Error\",\"Multiple_Choice__85\":\"St. Louis County\",\"Date__86\":\"08\\/24\\/2019\",\"Free_Text__87\":\"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.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Staff did not observe the individual leave the home\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"12\\/09\\/2019\",\"Free_Text__98\":\"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.\",\"Free_Text__100\":\"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.\",\"Multiple_Choice__101\":\"3\",\"Free_Text__102\":\"Staff was preoccupied, cleaning the bathroom during the time the individual left the home. From the bathroom the staff did not have a vantage point to see the patio area where the individual was smoking prior to leaving the home.  The staff cleaning the bathroom was influenced by the provider assigning staff multiple duties such as cleaning, cooking, etc. Staff cleans the home as the home is required to be safe and sanitary which is also part of the licensing requirements through Minnesota Statutes, 245D.  The staffing ratio at the time of the incident also influenced the staff performing multiple duties.  There was a 1:4 ratio with no other staff on duty, so staff was supporting the four individuals as well as completing other support related tasks such as cleaning. \\r\\n\\r\\nOther contributing factors to staff cleaning in an area where they were unable to observe the individual was that staff had no concerns that the individual would leave without confirming with staff and taking the walkie talkie. The individual frequently smoked outside without leaving, in particular, the individual had not previously left the house without telling this staff person. The individual mentioned they might go to the convenience store and staff asked him to take a walkie talkie with, which also influenced staff\'s comfortability in cleaning the bathroom as the staff assumed he would take the walkie talkie if he left. The Staff\'s perception that the individual would follow alone time protocol was supported  by the individual\\u2019s plan which allowed him to go for a 30 minute walk without staff supervision.\",\"Multiple_Choice__103\":\"0\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"1\",\"Multiple_Choice__109\":\"0\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"1\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"1\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:21:24',NULL,'DV_Stepping Stones - SLC -2019 -10'),(194,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"DV_Taylor SLS-SLC-2021-04\",\"Date__77\":\"04\\/28\\/2021\",\"Multiple_Choice__78\":\"David Vukelich\",\"Short_Answer__80\":\"Taylor SLS\",\"Short_Answer__81\":\"Jenifer Forneris\",\"Short_Answer__82\":\"jenforneris.basswood@yahoo.com\",\"Short_Answer__83\":\"218-591-2612\",\"Multiple_Choice__84\":\"Termination of Services\",\"Multiple_Choice__85\":\"St. Louis County\",\"Free_Text__87\":\"\\\"We, at Taylor SLS, Inc., had always hoped that the Basswood House would be person\'s forever home. We understand that over the course of one\'s life now and challenging obstacles may arise, and while we take great pride in successfully navigating those challenges, we have come to the realization that we do not have the resources available to us to assist him in managing his moggies while providing him (and his housemates) with the best possible quality of life he (and they) deserve in the comfort of a home. In addition to the increased behavioral health \\r\\nconcerns that have arisen, we feel that he has been negatively affected by the COVID-19 pandemic, the shutdown of Stepping Stones for Living, and the decreased ability to access his community. All of these circumstances have in turn caused a tremendous increase in his obsessive and aggressive behaviors. As you are aware, Taylor SLS, Inc. has taken numerous steps to avoid the need for terminating services. We have worked on behavior modification programming, sought out additional behavioral health specialists, and received services from the Minnesota Department of Human Services Community Support Services, both in the form of temporary crisis placement and in receiving training for Taylor SLS, Inc. staff. Additionally, we have made attempts to increase staffing in order to provide additional support to him in his home. Unfortunately, our efforts to provide him with the support he needs have been unsuccessful. We feel it is in his best interest that we terminate services so that he can find a home that can meet his needs. Until the date of his discharge from Taylor SLS, Inc. we will continue to provide services, which will include working with the appropriate county agencies to develop a plan to provide for his continuity of care. \\\"\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:22:28',NULL,'DV_Taylor SLS - SLC -2021 -04'),(195,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"JT_Beacon-HC-2021-03\",\"Date__77\":\"03\\/30\\/2021\",\"Multiple_Choice__78\":\"Jill Tilbury\",\"Short_Answer__80\":\"Beacon Specialized Living\",\"Short_Answer__81\":\"Barbara Turner\",\"Short_Answer__82\":\"bturner@beaconspecialized.org\",\"Short_Answer__83\":\"651-451-2889\",\"Multiple_Choice__84\":\"Elopement\",\"Multiple_Choice__85\":\"Hennepin County\",\"Date__86\":\"02\\/18\\/2021\",\"Free_Text__87\":\"Concerns reported about the VA\'s continued elopement from the facility and missing\\/refusing his weekly Risperdal injections. In latest incident, VA eloped 2\\/18 and is still missing at time of assessment. The VA is his own guardian and can come\\/go from the facility as he wishes. Beacon recently acquired the facility and is making changes to staffing\\/supervision in the home as well as meeting with the VA\'s team. See investigator notes.\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:23:00',NULL,'JT_Beacon - HC -2021 -03'),(196,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"201901929\",\"Date__77\":\"05\\/22\\/2019\",\"Multiple_Choice__78\":\"Jill Tilbury\",\"Multiple_Choice__79\":\"Kristie Pittman\",\"Short_Answer__80\":\"MRCI\",\"Short_Answer__81\":\"Cathy Groebner\",\"Short_Answer__82\":\"cgroebner@mymrci.org\",\"Multiple_Choice__84\":\"Elopement\",\"Multiple_Choice__85\":\"Blue Earth County\",\"Date__86\":\"03\\/19\\/2019\",\"Free_Text__87\":\"Wednesday March 13, 2019 at approximately 1:40pm, staff 1 noticed VA leave the Department 123 work area. Staff 1 stepped outside the room and saw VA going into the women\\u2019s bathroom located off of the production floor nearest to Department 123.  Staff 1 checked on VA at about 1:45pm and saw that VA was in the handicap stall with their green jacket off.  Staff 1 asked if VA was OK and they replied \\u201cyeah\\u201d and also asked if VA needed anything and they said \\u201cno\\u201d.  Staff 1 then went back to that same bathroom to assist another individual at approximately 1:50pm and VA was still in the same stall.  Staff 1 went back to the room at about 1:55pm.  It should be noted that the VA had been diagnosed with a mild UTI on Sunday 3\\/10\\/19 and was sent home early on Monday 3\\/11\\/19 due to them not feeling well.  VA also came in late on Tuesday, 3\\/12\\/19.  \\r\\n\\r\\nVA has eloped in the past, VA takes her lunch box with her.  Because of that, VA is required to leave the lunch box in the Team Leader\\u2019s office.  At approximately 2:00pm, staff 1 notice VA\\u2019s lunch box was still in the office.  Support Specialist Staff 2 went to that same bathroom that VA was in approximately 2:05pm and that VA was no longer in the bathroom.  A bus drive for the day program was driving the buss back to the program and notice someone in a green jacket standing in the street on Map Drive around 2pm.  There are no sidewalks on Map Drive.  Staff recognized the person as the VA and immediately called her supervisor at the program. And drove back to where the VA was walking.  It was reported that two \\u201cgood Samaritans\\u201d pulled over and stopped the VA on the sidewalk along stadium drive, which is the road that connects with Map Drive, and started walking with her back to the program until the staff arrived.  \\r\\n\\r\\nAt 2:07 the Supervisor received a phone call from the transportation supervisor stating VA was found walking on the sidewalk along Stadium Drive and was being walked back to the program\\u2019s building.  The program supervisor ran outside and saw VA with about four other program staff walking with VA.  The supervisor walked alongside VA all the way back to the office and the VA waited in the office until was time for VA to board the bus to go home.  While the office, VA was ask if VA thought what happened was safe and the VA said, \\u201cNo\\u201d. The VA was asked why it wasn\\u2019t and safe and the response was \\u201cI could get hurt\\u201d. Supervisor asked VA if it will ever happen again and VA shook their head \\u201cno\\u201d. Supervisor walked VA to the bus and fastened seatbelt and sat patiently until the bus departed.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Staff didn\\u2019t continuously monitor the person in bathroom and the person eloped without being seen\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"07\\/10\\/2019\",\"Free_Text__98\":\"VA has worked at the employment program for 10 years and the staff interviewed reported they have worked with her for most of that time.  Over this 10 years the VA lived with an aunt, then in an adult foster care setting (near her employment program) and at the time of the incident was living in an apartment.  \\r\\n\\r\\nVA enjoyed coloring\\/crafts, being outside, working, having attention and encouragement from staff.  VA enjoyed food (lunch at work and wouldn\\u2019t necessarily heat up a meal that typically would be a meal to heat up).\\r\\n\\r\\nVA has a staffing ratio at the employment program of a 1:3, most individuals there have 1:6 or 1:7.  At home VA had a 2:1 staffing ratio.  The 2:1 at home was higher because VA was more physically aggressive at home than at work.  Less aggression towards male staff-staff interviewed stated VA has less male staff at residence than at the employment program.  \\r\\n\\r\\nThe employment program has 200 individuals in their facility and approximately 45 in the area where VA works.  The day of the event there was 7-8 staff in the area for all of those individuals being served.  \\r\\n\\r\\nThe elopement protocol at the employment program was for the staff to have eyes on VA, except in the bathroom and just do 5 minute checks.  Keep the lunch and duffle bag in the supervisor\\u2019s office.  VA would have no antecedents prior to elopements or other incidents of maladaptive behavior (this day was no different.  The team agreed to this plan including the guardians (parents).\\r\\n\\r\\nVA works at the employment program Monday-Friday from 9am-3pm and typically VA shows signs of being done with work at around 2pm.  The day of the incident the VA had arrive late or had not been ready when the bus arrived to pick her up.  This was a common occurrence.  \\r\\n\\r\\nWhen at work the VA was a great worker completing piece work on the work floor.  That day there was not a lot of work available and the group had been doing other craft activities (VA enjoyed).  It is believed that VA had a possible UTI infection and VA had a history of GERD\\/esophagus issues (causing her to vomit and cause pain), however VA could not verbalize their needs all of the time.  Verbal skills were limited.  Over the time VA worked at the employment program they were able to get her to improve her verbal skills by encouraging VA to use her words.  If she were sick and she was about to vomit VA would attempt to express this to the employment staff and sometimes ask them for a Tums.  \\r\\n\\r\\nThe VA did not take the duffle bag or lunch when the elopement occurred which typically the VA would not have left the building without either of the bags.  The VA never was able to explain the reason for elopement, however the staff believe there is a Kwik Trip nearby that was the direction VA was headed and her previous residence was near the employment program.  VA did things with no antecedents and would do things for attention.  The staff believe potentially VA was not feeling well and potentially wanted to go outside because VA really enjoyed being outside.  Staff went outside after receiving phone call from transportation company and got the VA from the Good Samaritan that was walking with VA.\",\"Free_Text__100\":\"The staff not continuously monitoring the person in the bathroom was impacted by the staff adapting the person\\u2019s supervision protocol to allow for privacy in the bathroom.  It is the providers practice to allow all of the individual\\u2019s privacy in the restroom as this is influenced by societal norms.  The other factors contributing to adapt the protocol the day of the event was the individual was not feeling well, typically towards the end of the day this individual participates in work less (the time of incident was at the end of the work day), and there is a history of the person taking a long time in the restroom.  Further influencing the person\\u2019s ability to elope without staff noticing was the staff did not see the historical antecedent the person would display before eloping because in this case the individual eloped without taking their lunch bag out of the staff\\u2019s office.  Additionally, during this event there were multiple staff checking on the individual since in this setting there is not a specific staff assigned to one individual person working.  This process is the norm for the department as it is shaped by the support plan stating the need for a 1:3 staffing ratio. Thus the ratio allows the county to manage the budget allocation they are given by the state and federal allocations which is determined through the legislation.  Overall legislation determines the rates that are set which then is strengthened by MNCHOICES to determine the needs are met, thus to create the staffing patterns for the provider in the support plan.\",\"Multiple_Choice__101\":\"2\",\"Free_Text__102\":\"The other factors contributing to adapt the protocol the day of the event was the individual was not feeling well, typically towards the end of the day this individual participates in work less (the time of incident was at the end of the work day), and there is a history of the person taking a long time in the restroom.  Further influencing the person\\u2019s ability to elope without staff noticing was the staff did not see the historical antecedent the person would display before eloping because in this case the individual eloped without taking their lunch bag out of the staff\\u2019s office.\",\"Multiple_Choice__103\":\"0\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"0\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"3\",\"Free_Text__116\":\"The staff not continuously monitoring the person in the bathroom was impacted by the staff adapting the person\\u2019s supervision protocol to allow for privacy in the bathroom.  \\r\\n\\r\\nAdditionally, during this event there were multiple staff checking on the individual since in this setting there is not a specific staff assigned to one individual person working.  This process is the norm for the department as it is shaped by the support plan stating the need for a 1:3 staffing ratio.\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"2\",\"Free_Text__124\":\"The staff not continuously monitoring the person in the bathroom was impacted by the staff adapting the person\\u2019s supervision protocol to allow for privacy in the bathroom.\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:23:55',NULL,'JT_MRCI - BEC -2019 -05'),(197,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"JT_Mary T-HC-2020-07\",\"Date__77\":\"07\\/28\\/2020\",\"Multiple_Choice__78\":\"Jill Tilbury\",\"Short_Answer__80\":\"Mary T\",\"Short_Answer__81\":\"Brent Krocak\",\"Short_Answer__82\":\"brentk@marytinc.com\",\"Short_Answer__83\":\"763-274-8463\",\"Multiple_Choice__84\":\"Elopement\",\"Multiple_Choice__85\":\"Hennepin County\",\"Date__86\":\"06\\/18\\/2020\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Staff assisted the person to leave for an overnight with people they had concerns about\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"10\\/13\\/2020\",\"Free_Text__98\":\"Staff #1: This staff has worked with this person for quite some time and this person has lived with this provider for over 14 years.  The staff informed during the debriefing she is the Manager and did not find out about what had happened until the Monday after this person left the residence on Saturday.  This Manager had received a phone call about that this person had left because she has the ability to do so, although this person had been asked not to due to COVID and the provider\\u2019s policy was no visitors were allowed in the staff, even family.  The staff stated it was reported to her that this person had asked to get ready, her aunt and uncle were coming to get her for a visit, and she was going to go.  The staff reported to this Manager they did not feel comfortable, however they could not make her stay in the home and the aunt and uncle came to get her and assisted her in the process, as she is non-ambulatory.  The staff stated they did not know she had family in Duluth and did not know she was going when she had left the house on Friday before the weekend.  Staff reported they called the known uncle and asked who these people in Duluth were and if they indeed were family members and the known uncle reported they were not family.  The person had misinformed the staff working who allowed her to go.  The Manager also stated staff reported to her they did not feel comfortable allowing her to go, aside from COVID, because they did not appear to be family, however this person seemed to be happy when the individuals came to pick her up.  It was reported to the Manager the staff had taken pictures of the car and the license plate number and the people as they were leaving the home on Saturday.  The Manager drove to Duluth to pick up the individual at the hospital as she had been transported there via ambulance after sitting in the restaurant informing the server she needed help via her iPad.  The individual had given her check card to the people who had picked her up and they had financially exploited her when they took her to Duluth.  \\r\\n\\r\\nStaff #2\\r\\n\\r\\nStaff had arrived to work at 8am on Saturday after picking up this extra shift (at the time this was his first month working for this provider).  This staff was informed by the overnight staff and the lead staff that this person was to get ready, that she was leaving, and the staff would need to help her get ready as well as pack her things for the weekend.  This staff person has had difficulties working this individual in the past as she calls this staff person names and is verbally aggressive through her iPad to the staff person.  Due to the person being non-ambulatory, it is the house policy to reposition her every two hours.  On this day the staff was going to change her brief and get her ready to leave for the day, she would not turn off her iPad prior to the changing to occur.  The staff wanted to be respectful and it is HIPAA policies as well as house policy to turn off the video when the staff are assisting.  Staff stated the person they would assist when she turned off her iPad so staff left the room and came back.  The person still would not turn off the iPad and began to call the staff names.  This staff gave 30 minutes this time and the person still had not gotten off the iPad and continued to call him names and verbal aggressions.  The staff person had asked Manager previously how to handle these matters and was aware of what was happening and continued to try to work with this person so they would not call staff names and how staff could assist better.  The staff went into the person\\u2019s room a third time and covered the iPad with a pillow during the dressing and changing process and continued to assist her with getting ready to be picked up for the day.  When the people arrived to pick up this person staff did not allow them into the house due to COVID and the new policies for no visitors.  The visitors assisted the person into the car with her and her wheelchair.  The staff did not say anything about it to anyone else as the lead staff had informed him what to do and the overnight staff had provided instructions on this was what was planned for this person\\u2019s day.\",\"Free_Text__100\":\"A factor into why staff assisted the person to leave for an overnight with people they had concerns about was that the person wanted to leave with the people (claiming to be family). The person she left with claimed to be the person\\u2019s uncle, which the person herself confirmed and she appeared to trust him. There was a perception that since the person was a family member, visiting with the person would be less risky than if the person was unrelated. The lead staff at the home also determined this trip was important to the person. The provider agency trusted the lead staff in this home and had been working to implement a person-centered philosophy which prioritized weighing supporting things that were important to the people they served over what was important for them. This philosophy was impacted by the statewide emphasis placed on supported decision making and person-centered thinking, the latter of which was supported by provider requirements in the provider\\u2019s licensing statute, Minnesota Statutes 245D. The provider had worked with this person for 14 years, so the relationship with the person influenced the provider to make supporting the person\\u2019s own decisions even stronger.  Influencing the lead staff to determine the trip was important to supporting the person was that it appeared that assisting the person to have a safe trip seemed to mitigate risk versus allowing the person to leave without assistance. The person appeared to be determined to go, and without help from the provider, it seemed more likely issues might arise. Mitigating risk is a priority for all HCBS providers for a number of reasons: Case managers assign this priority to providers in Coordinated Service and Support Plan, Minnesota Statutes 245D requires providers to ensure the health, safety and well-being of the people they serve, and providers could be liable to lawsuits, investigations or insurance claims if a person they serve is harmed. If someone is harmed while in the care of a provider, that provider could be found in violation of the Vulnerable Adult Act and additional penalties may be brought upon a provider by the Department of Human Services. \\r\\nAnother was that the provider felt they did not have a choice but to assist her in leaving. The person was their own guardian and had the power to make many choices independently.  Additionally, the person had attempted to leave with this person in the past, and the provider determined they would weigh what was important to the person over what was important for the person. This decision was impacted by the provider\\u2019s person-centered philosophy, which in turn was impacted by statewide emphasis on supported decision-making and person-centered thinking. This emphasis came from a number of sources including advocacy organizations and DHS, which released best practice guidance on both and enforced person-centered planning requirements governing providers in Minnesota Statutes Chapter 245D. The provider\\u2019s concerns about the person leaving with the person did not seem to outweigh the provider\\u2019s desire to empower and support the person.   \\r\\nAn additional influence into why the staff assisted the person to leave an overnight with people they had concerns about was that the staff wanted to empower the person during this time since they had attempted to leave with this person in the past. Although the provider had a practice in place to not allow people to take overnights at the time due to the threat of COVID-19 and MDH guidance on COVID-19 for residential programs, the provider determined they would weigh what was important to over what was important for the person. The provider\\u2019s person-centered philosophy, influenced by the statewide emphasis on supported decision making and person-centered thinking influenced this decision by the provider. Additionally, the provider staff determined the concerns they had about the person leaving weren\\u2019t enough to take restrictive actions and weigh safety over the person\\u2019s own choice. Implementing restrictions on a person\\u2019s rights could create the liability of providers being incompliant with the conditions of Minnesota Statutes, Chapter 245D enforced by the Department of Human Services.\",\"Multiple_Choice__101\":\"2\",\"Free_Text__102\":\"A factor into why staff assisted the person to leave for an overnight with people they had concerns about was that the person wanted to leave with the people (claiming to be family). The person she left with claimed to be the person\\u2019s uncle, which the person herself confirmed and she appeared to trust him. There was a perception that since the person was a family member, visiting with the person would be less risky than if the person was unrelated. \\r\\n\\r\\nMore??\",\"Multiple_Choice__103\":\"0\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"0\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"3\",\"Free_Text__116\":\"A factor into why staff assisted the person to leave for an overnight with people they had concerns about was that the person wanted to leave with the people (claiming to be family). The person she left with claimed to be the person\\u2019s uncle, which the person herself confirmed and she appeared to trust him. There was a perception that since the person was a family member, visiting with the person would be less risky than if the person was unrelated. The lead staff at the home also determined this trip was important to the person. The provider agency trusted the lead staff in this home and had been working to implement a person-centered philosophy which prioritized weighing supporting things that were important to the people they served over what was important for them. This philosophy was impacted by the statewide emphasis placed on supported decision making and person-centered thinking, the latter of which was supported by provider requirements in the provider\\u2019s licensing statute, Minnesota Statutes 245D. The provider had worked with this person for 14 years, so the relationship with the person influenced the provider to make supporting the person\\u2019s own decisions even stronger.  Influencing the lead staff to determine the trip was important to supporting the person was that it appeared that assisting the person to have a safe trip seemed to mitigate risk versus allowing the person to leave without assistance. The person appeared to be determined to go, and without help from the provider, it seemed more likely issues might arise. Mitigating risk is a priority for all HCBS providers for a number of reasons: Case managers assign this priority to providers in Coordinated Service and Support Plan, Minnesota Statutes 245D requires providers to ensure the health, safety and well-being of the people they serve, and providers could be liable to lawsuits, investigations or insurance claims if a person they serve is harmed. If someone is harmed while in the care of a provider, that provider could be found in violation of the Vulnerable Adult Act and additional penalties may be brought upon a provider by the Department of Human Services. \\r\\n\\r\\nAnother was that the provider felt they did not have a choice but to assist her in leaving. The person was their own guardian and had the power to make many choices independently.  Additionally, the person had attempted to leave with this person in the past, and the provider determined they would weigh what was important to the person over what was important for the person. This decision was impacted by the provider\\u2019s person-centered philosophy, which in turn was impacted by statewide emphasis on supported decision-making and person-centered thinking. This emphasis came from a number of sources including advocacy organizations and DHS, which released best practice guidance on both and enforced person-centered planning requirements governing providers in Minnesota Statutes Chapter 245D. The provider\\u2019s concerns about the person leaving with the person did not seem to outweigh the provider\\u2019s desire to empower and support the person.   \\r\\nAn additional influence into why the staff assisted the person to leave an overnight with people they had concerns about was that the staff wanted to empower the person during this time since they had attempted to leave with this person in the past. Although the provider had a practice in place to not allow people to take overnights at the time due to the threat of COVID-19 and MDH guidance on COVID-19 for residential programs, the provider determined they would weigh what was important to over what was important for the person. The provider\\u2019s person-centered philosophy, influenced by the statewide emphasis on supported decision making and person-centered thinking influenced this decision by the provider. Additionally, the provider staff determined the concerns they had about the person leaving weren\\u2019t enough to take restrictive actions and weigh safety over the person\\u2019s own choice. Implementing restrictions on a person\\u2019s rights could create the liability of providers being incompliant with the conditions of Minnesota Statutes, Chapter 245D enforced by the Department of Human Services.\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"0\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:24:37',NULL,'JT_Mary T - HC -2020 -07'),(198,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"201905316\",\"Date__77\":\"08\\/15\\/2019\",\"Multiple_Choice__78\":\"Jill Tilbury\",\"Multiple_Choice__79\":\"Charles Young\",\"Short_Answer__80\":\"Progressive Living Inc\",\"Short_Answer__82\":\"nicole.s@progressivelivinginc.net\",\"Multiple_Choice__84\":\"Medication Error\",\"Multiple_Choice__85\":\"Blue Earth County\",\"Date__86\":\"07\\/20\\/2019\",\"Free_Text__87\":\"on 7\\/20\\/19 It had been reported to On-call that a scheduled 2 medication had 2 tablets gone missing. Staff reported this to On-call right away in the AM. DCC complained about staff on the Overnight not being awake when he was attempting to wake them up for a PRN. Staff administered an Acetaminophen to DCC at 5:00am. It is suspected that the staff on the overnight were asleep not supervising DCC and after administering the medication DCC reported the staff went back to the couch to sleep after he took his PRN. Staff may have not locked up the office and DCC may have gotten the keys from the key lockbox by breaking into it to get the schedule 2 medication. DCC has in the past requested multiple times from staff stating he has not gotten this medication. DCC has had a problem with medication seeking.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Staff did not count medications per provider policy\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"09\\/13\\/2019\",\"Free_Text__98\":\"Staff 1 worked a double shift (working at other homes within agency) prior to arriving at 11pm and then came to work the overnight shift at the location of the incident.  Staff 2 stated this was the first shift of the day for them.  The provider\\u2019s shift are from 11p-7am; 7am-3pm; 3pm-11pm.  Both staff were float staff for several homes throughout the agency, however they had worked in this home prior to the event.  Staff 1 worked for the provider for over a year and Staff 2 had worked for the provider since February.  Each of the staff works approximately 40-48 hours per week.  Provider has a policy for a 2:4 staffing ratio at the home and both staff remain awake.  \\r\\n\\r\\nProvider\\u2019s policy is to go into the office and count medications upon arriving for a shift.  While in the office they are to also read the daily log notes on the people supported in the home.  The 11pm staff arrived for their shift, neither staff person had reviewed the notes from the previous shift or counted the medications.  This had been the pattern that staff did not typically check meds and\\/or notes when they arrived to the home because the norm was the individuals were awake and needed support.  The staff started interacting with the individuals in the home because many of them were awake on this evening and required the staff\\u2019s attention. Individual 1 typically was not awake and in the common area of the home, however they were on this evening.  \\r\\n\\r\\nIndividual 2 (with alone time) from the residence called and stated he needed a ride home.  Staff 1 left to go get individual 2.  Staff 1 did not take the office keys with them when they left the home.  Staff 1 did not know if the office was locked at this time.  \\r\\n\\r\\n\\r\\nWhen both staff arrive Individual 1 was typically in their room and this night the individual was awake more during the night and was talking to Staff 2 about videos games and film animation.  Individual 1 has no alone time.  Individual 1 is very planful, smart, he works at a department store, likes animation or playing videos games, funny, jokester, and typically calm.  \\r\\n\\r\\nAt 5am Individual 1 came to Staff 1 for a PRN and staff was watching YouTube videos.  The office is locked at all times per policy from the provider and staff carry the keys on a lanyard (on their person at all times).  One set of keys per two staff.  If keys are locked inside of the office there is another set in a lockbox (with a key code to get in).  Once in the office, the medications are set up per person in a \\u201cfile cabinet like\\u2019 with another set of keys required to get into the medications.  When staff 1 went into the office for the medications the office and the medications were all locked.  Staff 1 gave individual 1 medications and went back to watching youtube from 5am-6am.  Staff 1 was unable recall if they had fallen asleep.   Staff 1 was very tired due to the length of time they had worked during their shift and the previous two shifts at another home.\",\"Free_Text__100\":\"Staff did not count meds per provider policy was influenced by numerous factors.  The norm is to interact with the awake individuals and on this day there was someone awake which is impacted by staff wanting to support the individual based off of the plan of care created by the team and further influenced by societal norms to engage with others and implementing person centered culture mandated by DHS and CMS.  An additional factor was Individual 2 being in the community and needed transportation home. Staff 1 left the home to pick up Individual 2, thus leaving staff 2 alone with an awake Individual 1 who requires a 24-plan of care supported by norms to interact with others and person centered practices.  One element was there was no staff overlap upon both staff arriving to the home which resulted in staff prioritizing interaction with the individuals over counting medications.  The set wages and benefits which was indicative of the care plan therefore influenced by norms to interact with others and person centered practices.   \\r\\n\\r\\nThe final factor was both staff thought Individual 1 had no history of medication seeking supported by their staff not knowing the individual plan for medications due to being trained in several homes with several individuals\\u2019 plans to follow and also being fatigued because the staff had to work overtime prior to this shift.  The agency being shorted staffed is complicated to the set wages and benefits, low unemployment, thus constraining the college employees (seasonal) and this is byproduct of DWRS which was put in place by the legislature.  Contributing factors that further supported the provider\\u2019s policy for the work of the direct care staff 1 and 2 was the nurse\\u2019s license in providing some position to the policy.  Overall the nurse\\u2019s license is regulated by legislation and statute.\",\"Multiple_Choice__101\":\"0\",\"Multiple_Choice__103\":\"0\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"0\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"2\",\"Free_Text__116\":\"The norm is to interact with the awake individuals and on this day there was someone awake which is impacted by staff wanting to support the individual based off of the plan of care created by the team and further influenced by societal norms to engage with others and implementing person centered culture mandated by DHS and CMS.  \\r\\n\\r\\nOne element was there was no staff overlap upon both staff arriving to the home which resulted in staff prioritizing interaction with the individuals over counting medications.\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"0\",\"Multiple_Choice__125\":\"2\",\"Free_Text__126\":\"The final factor was both staff thought Individual 1 had no history of medication seeking supported by their staff not knowing the individual plan for medications due to being trained in several homes with several individuals\\u2019 plans to follow and also being fatigued because the staff had to work overtime prior to this shift.\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:25:24',NULL,'JT_Progressive Living - BEC -2019 -08'),(199,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"JT_REM Hennepin-HC-2020-11\",\"Date__77\":\"11\\/24\\/2020\",\"Multiple_Choice__78\":\"Jill Tilbury\",\"Short_Answer__80\":\"REM Hennepin\",\"Short_Answer__81\":\"Devin Nelson\",\"Short_Answer__82\":\"devin.nelson@thementornetwork.com\",\"Short_Answer__83\":\"507-233-4410\",\"Multiple_Choice__84\":\"Medication Error\",\"Multiple_Choice__85\":\"Hennepin County\",\"Date__86\":\"08\\/06\\/2020\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:26:03',NULL,'JT_REM Hennepin - HC -2020 -11'),(200,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"201906882\",\"Date__77\":\"10\\/15\\/2019\",\"Multiple_Choice__78\":\"Jill Tilbury\",\"Multiple_Choice__79\":\"Marilee Bengtson\",\"Short_Answer__80\":\"Wingspan Life Resources\",\"Short_Answer__81\":\"Therese Davis\",\"Short_Answer__82\":\"tdavis@wingspanlife.org\",\"Short_Answer__83\":\"651-242-5840\",\"Multiple_Choice__84\":\"Medication Error\",\"Multiple_Choice__85\":\"Hennepin County\",\"Date__86\":\"08\\/30\\/2019\",\"Free_Text__87\":\"VA was taken to the doctor and AP received a written script to increase one of the insulin medications (Tuejeo) by 2 units.\\r\\nOrder was given on 08\\/29\\/2019.\\r\\n\\r\\nAP is suppose to transcribe the right medication on the med sheet but instead he documented a referral for the appointment and\\r\\ndocumented the increase on the to visit note and informed staff. The med sheet was never updated and Staff are suppose to follow the\\r\\nmed sheet.\\r\\n\\r\\nThere was a couple days where VA did give the right dosage because AP gave it to her himself. Nurse discovered this on Thursday Morning 09\\/19\\/2019 and informed Reporter of the mistake.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Medication Error over an Extended Period of Time\",\"True_or_False__94\":\"Yes\",\"Free_Text__98\":\"The VA has had Type 1 diabetes since they were 6 years old and now is 44 years old.  The VA lives in an adult foster care setting for the past seven years with three other individuals.  The VA enjoys walking the dog, going to work 5 days a week, and being active in the community.  \\r\\n\\r\\nThe VA has a protocol that all staff are trained on and due to this regimen it is difficult to have any fill in staff cover shifts at the adult foster care home.  The VA completes the blood sugar checks without assistance from staff with an Accuchek machine.  The machine then tells the staff how much insulin is required at that time depending on how many carbs the VA is going to eat at that meal time for both medications.  The VA gets novolox 4x\\/day and the tuojeo 1x\\/day at dinner.   The protocol goes onto say if the numbers are within this range give this much insulin and if they are within this much give this amount.  The VA takes two different types of insulin along with several other medications. This protocol is listed on the computer within the MAR system that the provider utilizes to document medications and communications amongst the staff.   \\r\\n\\r\\nThe staff will then \\u201cdial up\\u201d the insulin for the VA and they will give themselves the insulin injections.  The insulin medications are not labeled with the amount of units that are to be given due to the variances based off of the blood sugar numbers and the amount of carbs that are about to be eaten by the VA.  The VA is aware of the regimen and understands the necessity to take her insulin each day. \\r\\n\\r\\nThe VA is unable to feel the effects of having blood sugar numbers out of the normal range (80-120) and their numbers will reach as high as 300-400 without any signs (dizzy, light headed, sweaty, etc.).  The VA understands when their numbers are high if they exercise they can reduce the numbers.  The VA had a checkup with their doctor regarding the blood sugar being high, although the staff will educate the VA on proper eating choices and the VA exercises frequently.  The doctor stated the Tuojeo needed to go from 15 units to 17 units at dinner time.  The supervisor of the house had taken the VA to the appointment and came home and documented this in the MAR and in the staff notes of the change and had given the VA the change in medications when giving the medication that evening.  The supervisor gave the other staff the information to follow.  \\r\\n\\r\\nThe nurse found the error in the medications after different staff had worked and not just the supervisor and the staff that was informed on 8\\/29\\/19 after the VA went to the doctor appointment.  The supervisor had been doing compliance checks once a week of the medications, however did not see it because the medications and the MAR don\\u2019t match because they never have matched because of the variances in the medication that is given based off what the numbers are and how many carbs are being eaten.  There are many moving parts to giving the insulin medications while the staff also must follow the protocol.  The staff typically give the medication after the supervisor has left for the day as well due to the supervisor working from 9a-5pm and the VA gets this medication at dinner time.\",\"Free_Text__100\":\"Staff not providing the correct medication dosage to an individual was influenced by the staff being unware of the increase in the medication dosage. A contributing factor to the unawareness of the increase was that information was not communicated to the staff in the transition time because there is not enough time available to read the health progress notes.  The short amount of staff transition time is impacted by the provider not building transition time into the staff schedules due to contributing factors of the weather, the staff\\u2019s second job, and the labor laws.  The other influencer is the CSSP and the 6790 does not allow the ability of the rate system to pay the provider more to have staff overlap on the shift change.  Another contributor of the staff not being able to communicate during the transition is there are several documentation points for communication for each individual living in the home thus requirements set for by licensing 245D.  \\r\\n\\r\\nStaff giving the incorrect dosage was also influenced by the documentation was not completed in the Medical Administration Record (MAR). At this home, it was the supervisor\\u2019s role to update medication changes in the MAR.  The individual\\u2019s medication administration had complexities to giving the medications that were not relayed in the MAR as the individual was to receive two different types of insulin and staff relied on the previous MAR to provide the medication.  The influence of the MAR not being updated is the provider experiencing frequent lapses in internet connectivity (which occurred frequently at the residence) and the MAR is an electronic document, thus the documentation is in two places and not reviewed by all staff.  The supervisor had relied on the protocol for the med changes that is given by the physician, which has an outside influence of the pharmaceutical laws that informs the physician on how to write the protocols.  \\r\\n\\r\\nA final influence to staff giving the incorrect dosage was that they were using an \\u201cold\\u201d prescription because the physician did not change the prescription with the pharmacy.\",\"Multiple_Choice__105\":\"2\",\"Free_Text__106\":\"A contributing factor to the unawareness of the increase was that information was not communicated to the staff in the transition time because there is not enough time available to read the health progress notes.\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"0\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"0\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"2\",\"Free_Text__124\":\"At this home, it was the supervisor\\u2019s role to update medication changes in the MAR.  The individual\\u2019s medication administration had complexities to giving the medications that were not relayed in the MAR as the individual was to receive two different types of insulin and staff relied on the previous MAR to provide the medication.  The influence of the MAR not being updated is the provider experiencing frequent lapses in internet connectivity (which occurred frequently at the residence) and the MAR is an electronic document, thus the documentation is in two places and not reviewed by all staff.\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:26:45',NULL,'JT_Wingspan Life - HC -2019 -10'),(201,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"KP_BridgesMN-BEC-2021-02\",\"Date__77\":\"02\\/25\\/2021\",\"Multiple_Choice__78\":\"Kristie Pittman\",\"Short_Answer__80\":\"Bridges MN\",\"Short_Answer__81\":\"Shyla Kahle (completed the BIRF)\",\"Short_Answer__82\":\"shylak@bridgesmn.com\",\"Short_Answer__83\":\"651-328-0677\",\"Multiple_Choice__84\":\"Elopement\",\"Multiple_Choice__85\":\"Blue Earth County\",\"Date__86\":\"01\\/21\\/2021\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Staff unable to redirect a person from departing on a bus to Chicago.\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"10\\/14\\/2020\",\"Free_Text__98\":\"Staff unable to redirect a person from departing on a bus to Chicago.\",\"Free_Text__100\":\"Staff was unable to redirect a person from departing on a bus to Chicago and this was influenced by wanting to go to Chicago to visit their sister. This matter was complicated given the person wouldn\\u2019t communicate with staff present.  All efforts to redirect the person were unsuccessful while exhausting all other safe alternatives. The person was earlier hospilatized regarding mental health and aggression and the staff was hesitant at the moment and didn\\u2019t want to anger the person further. Another contributing factor was that the person received a COVID stimulous check that created the means for the visit to Chicago.    \\r\\n\\r\\nStaff being unable to redirect the person was influenced by the provider ultimately determining the risk was low to take the trip without staff. After many unsuccessful attempts to redirect, the provider reviewed the person\\u2019s risk management plan and it was affirmed. Contributing factors that further influenced the staffs\\u2019 decision to remain at the bus station was the expectation of the lead agency and CSSP was not to follow a person to another state while eloping and assure full communication with all team members and agency staff.\\r\\n\\r\\nAnother influence to the inability to redirect was that staff were hesistant to anger the person. This was further supported by the person having a history of aggressive behavior. The person wouldn\\u2019t communicate with the staff present and they were hesitant to coherse the person too much in their efforts to support him in being safe. Staff also did offer to support this trip at a future date with proper planning to assure health and safety. This moment was further complicated by contacting the hospital who stated there was nothing they or staff could do given the person was his own guardian which further limited staff in their efforts to help him return home.\\r\\n\\r\\nAn additional feature that impacted the support lended to the person was the agency\\u2019s practice of person-centered efforts in trying to find balance of what was important to and for the person while making decisions at that moment. Their operating philosophy supported personal freedoms and choices based on experiences over time.  There is also an overall systemic expectation that providers support experiences, choices, and the person\\u2019s rights.   \\r\\n\\r\\nStaff being unable to redirect was influenced by the provider exhausting all safe alternatives. The person is their own guardian and did have a provisional discharge from the program.  Furthermore, COVID and the Governor\\u2019s stay at home order also influenced the person\\u2019s decision to leave as his routine was limited to low activity. This elopement influenced the agency, team, and staff present to honor the person\\u2019s civil rights which connected directly to their philosophy of protecting his rights which put him in charge of making the decision to leave on the bus.\",\"Multiple_Choice__115\":\"1\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:28:14',NULL,'KP_BridgesMN - BEC -2021 -02'),(202,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"KP_Habilitative Services-BEC-2020-07\",\"Date__77\":\"07\\/28\\/2020\",\"Multiple_Choice__78\":\"Kristie Pittman\",\"Short_Answer__80\":\"Habilitative Services\",\"Short_Answer__81\":\"Nicole Schlagel\",\"Short_Answer__82\":\"nicole.schlagel@thementornetwork.com\",\"Short_Answer__83\":\"507-233-4400\",\"Multiple_Choice__84\":\"Elopement\",\"Multiple_Choice__85\":\"Blue Earth County\",\"Date__86\":\"05\\/07\\/2020\",\"Free_Text__87\":\"Staff was assisting other people when it was brought to their attention that person entered a brown van that was parked outside the group home. Prior to this person being served told staff he was going to take a nap.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Person eloped from the home without staff knowledge\",\"True_or_False__94\":\"No\",\"Free_Text__100\":\"The person eloping from the home without staff knowledge was influenced by the person telling staff that they were going to take a nap in their room.   This was further influenced by the person\\u2019s plan that was agreed upon by a new case manager and guardian that allowed for 4 hours of alone time at home.  This included their bedroom and further supported by providers having to allow for person\\u2019s privacy in their room as required by 245D rights and person-centered planning and directed in the CSSP.    The person eloping from the home without staff knowledge was also impacted by the person being new to the home with no history of elopement resulting in staff having no reason for concern that they would elope. Another influence of person eloping without staff knowledge was the home was a 4-person residence, staffed by one person and during this time staff was assisting other people.   \\r\\n\\r\\nThe person being served had expectations that they would be able to visit with family and friends in the area when they moved into the group home.   COVID 19-Pandemic resulted in an Executive stay at home order and MDH guidelines limiting the persons opportunity to go into the community resulting in increased anxiety that was reported by staff, influencing the person eloping from the home.  This was further supported by providers being unsure what guidance to follow during COVID-19 therefore impacting the amount of community outings being offered to the people they serve.  Person being served had unsupervised time in the community only when at work.   Health issues from wearing a mask at work impacted person\\u2019s ability to work in the community resulting in limited time in the community is an additional influence of the person eloping from the home.  The worker\\u2019s focus of attention at the time was on the three individuals in the communal area while the other resident exercised their right to privacy in their room which is supported and required by 245D.\",\"Multiple_Choice__101\":\"2\",\"Free_Text__102\":\"The person eloping from the home without staff knowledge was influenced by the person telling staff that they were going to take a nap in their room.   This was further influenced by the person\\u2019s plan that was agreed upon by a new case manager and guardian that allowed for 4 hours of alone time at home.  This included their bedroom and further supported by providers having to allow for person\\u2019s privacy in their room as required by 245D rights and person-centered planning and directed in the CSSP. \\r\\n\\r\\nThe worker\\u2019s focus of attention at the time was on the three individuals in the communal area while the other resident exercised their right to privacy in their room which is supported and required by 245D.\\r\\n\\r\\nThe person eloping from the home without staff knowledge was also impacted by the person being new to the home with no history of elopement resulting in staff having no reason for concern that they would elope.\",\"Multiple_Choice__103\":\"1\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"0\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"2\",\"Free_Text__116\":\"The person being served had expectations that they would be able to visit with family and friends in the area when they moved into the group home.   \\r\\n\\r\\nCOVID 19-Pandemic resulted in an Executive stay at home order and MDH guidelines limiting the persons opportunity to go into the community resulting in increased anxiety that was reported by staff, influencing the person eloping from the home.  This was further supported by providers being unsure what guidance to follow during COVID-19 therefore impacting the amount of community outings being offered to the people they serve\\r\\n\\r\\n This was further supported by providers being unsure what guidance to follow during COVID-19 therefore impacting the amount of community outings being offered to the people they serve.  Person being served had unsupervised time in the community only when at work.\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"0\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:28:53',NULL,'KP_Habilitative Services - BEC -2020 -07'),(203,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"KP_Harry Meyering-BEC-2021-01\",\"Date__77\":\"01\\/29\\/2021\",\"Multiple_Choice__78\":\"Kristie Pittman\",\"Short_Answer__80\":\"Harry Meyering Centers\",\"Short_Answer__81\":\"Judi Leibbrand\",\"Short_Answer__82\":\"jleibbrand@harrymeyeringcenter.org\",\"Short_Answer__83\":\"507-387-8281\",\"Multiple_Choice__84\":\"Medication Error\",\"Multiple_Choice__85\":\"Blue Earth County\",\"Date__86\":\"11\\/10\\/2020\",\"Free_Text__87\":\"Staff was administ3ring medication\'s on 11\\/11\\/2020 when they discovered that persons Spironolactone 25mg tablet had not been given from 11\\/7\\/2020 through 11\\/10\\/2020.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Staff did not follow policy requiring 3 checks\",\"True_or_False__94\":\"Yes\",\"Free_Text__98\":\"Another contributing factor to staff feeling rushed was that the home is single staffed in the mornings. Staffing patterns are impacted by the staff ratio, which is determined by the MNCHOICES assessment and Disability waiver rate system, as well as the expectation that person centered choices at the home are provided.  This allows for the work schedule to be adapted to accommodate more staffing during day shifts to allow for more outings, resulting in morning staff being limited to one, further influencing staff need to hurry to ensure all morning task were completed.  COVID-19 lead to the Governor\\u2019s executive stay at home order and Day services were then closed.  This increased the need for more staff to cover shifts at a time when staff shortage was at an all-time high.\",\"Free_Text__100\":\"The staff not following the policy that requires three medication checks prior to giving medications was influenced by the staff feeling comfortable and experienced with medication delivery after having worked at the facility for 6 years.  The people in the home being easy going and independent with some of their personal cares contributed to the staff feeling comfortable.  The Provider has a 2 step process for checking in meds from the pharmacy.  The first check is completed by the LPN, Program Manager, or Location Coordinator and the second check is completed by any of the aforementioned or a DSP.  The provider\\u2019s medication administration policies are influenced by 245D and outlined in the CSSP.  The provider\\u2019s policy are in place to protect the health and safety of people and to reduce errors that could result in Vulnerable Adult Maltreatment.  Medications are received in pill packs from the pharmacy and are checked two times, this further supports staff feeling comfortable when passing medications\\r\\nAnother influence to staff not completing the three medication check was that staff felt pressure to hurry to give person their morning medications. Person has a history of being inpatient to get morning medications as they then have to wait 30 minutes to eat as directed by their Physician.  The person being served has 12 morning medications that have to be recorded in the online Medication Administration Record which takes time for staff to complete. Staff was in a hurry to pass medications to avoid behaviors from person and to attend to other duties and responsibilities prior to the end of their shift.  Medication delivery is right before a shift change, so staff typically have to finish up with a number of tasks.   The home has 4 people and the people are active, interactive with staff, and need staff support which are additional influences to why the staff felt rushed.   \\r\\nAnother contributing factor to staff feeling rushed was that the home is single staffed in the mornings. Staffing patterns are impacted by the staff ratio, which is determined by the MNCHOICES assessment and Disability waiver rate system, as well as the expectation that person centered choices at the home are provided.  This allows for the work schedule to be adapted to accommodate more staffing during day shifts to allow for more outings, resulting in morning staff being limited to one, further influencing staff need to hurry to ensure all morning task were completed.  COVID-19 lead to the Governor\\u2019s executive stay at home order and Day services were then closed.  This increased the need for more staff to cover shifts at a time when staff shortage was at an all-time high.\",\"Multiple_Choice__103\":\"3\",\"Free_Text__104\":\"Another contributing factor to staff feeling rushed was that the home is single staffed in the mornings. Staffing patterns are impacted by the staff ratio, which is determined by the MNCHOICES assessment and Disability waiver rate system, as well as the expectation that person centered choices at the home are provided.  This allows for the work schedule to be adapted to accommodate more staffing during day shifts to allow for more outings, resulting in morning staff being limited to one, further influencing staff need to hurry to ensure all morning task were completed.  COVID-19 lead to the Governor\\u2019s executive stay at home order and Day services were then closed.  This increased the need for more staff to cover shifts at a time when staff shortage was at an all-time high.\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"0\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"0\",\"Multiple_Choice__117\":\"3\",\"Free_Text__118\":\"Another influence to staff not completing the three medication check was that staff felt pressure to hurry to give person their morning medications. Person has a history of being inpatient to get morning medications as they then have to wait 30 minutes to eat as directed by their Physician.  The person being served has 12 morning medications that have to be recorded in the online Medication Administration Record which takes time for staff to complete. Staff was in a hurry to pass medications to avoid behaviors from person and to attend to other duties and responsibilities prior to the end of their shift. \\r\\nAnother contributing factor to staff feeling rushed was that the home is single staffed in the mornings\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__123\":\"3\",\"Free_Text__124\":\"The staff not following the policy that requires three medication checks prior to giving medications was influenced by the staff feeling comfortable and experienced with medication delivery after having worked at the facility for 6 years.  The people in the home being easy going and independent with some of their personal cares contributed to the staff feeling comfortable.  The Provider has a 2 step process for checking in meds from the pharmacy.  The first check is completed by the LPN, Program Manager, or Location Coordinator and the second check is completed by any of the aforementioned or a DSP.  The provider\\u2019s medication administration policies are influenced by 245D and outlined in the CSSP.  The provider\\u2019s policy are in place to protect the health and safety of people and to reduce errors that could result in Vulnerable Adult Maltreatment.  Medications are received in pill packs from the pharmacy and are checked two times, this further supports staff feeling comfortable when passing medications\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:29:28',NULL,'KP_Harry Meyering - BEC -2021 -01'),(204,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"201900985\",\"Date__77\":\"05\\/15\\/2019\",\"Multiple_Choice__78\":\"Kristie Pittman\",\"Multiple_Choice__79\":\"Jill Tilbury\",\"Short_Answer__80\":\"Haugbeck Support Services\",\"Short_Answer__81\":\"Mike Beckius\",\"Short_Answer__82\":\"mikebeckius@gmail.com\",\"Multiple_Choice__84\":\"Elopement\",\"Multiple_Choice__85\":\"Blue Earth County\",\"Date__86\":\"11\\/13\\/2018\",\"Free_Text__87\":\"Staff was meeting at another location with client\\u2019s guardian\\/mother. Client called her guardian\\/mother asking to have a private phone call, guardian reminded her that she could not do that, client abruptly ended the call.   A few minutes later a call came in that client ran away from the house.  Staff left to go look and kept in contact with guardian who was tracking client with the GPS on clients phone.   Staff arrived to clients location to a fire truck and someone directing traffic.  Staff was informed that client was struck by a vehicle and taken to the hospital by ambulance. \\r\\n\\r\\nIncident described by direct care staff.  Client came home from work and took phone without asking staff.  She locked herself in her room with the phone.  Staff knocked and asked her to open door, but did she did not respond.  Staff knocked again and explained to her the pone rules.  Client opened the door and yelled at staff using inappropriate words.  She then said she wanted to have a private phone call, locked herself in her room.  Staff unplugged the phone (per protocol) .  Client came out pissed and started kicking the pone and throwing it on the floor.  She picked the phone up and said she hated staff and that she was leaving.  She then got ready and left the house.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Staff did not pursue person when they eloped\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"06\\/24\\/2019\",\"Free_Text__98\":\"Client is a 25 year old female diagnosed with fetal alcohol syndrome and reactive attachment disorder. She had been living in a corporate foster care since 2014. She lives with her identical twin sister. Her mother is her legal guardian. In September 2019, client had a crises placement due to increase in behaviors. \\r\\n\\r\\nCouple months prior to incident, client\'s behaviors not as predictable. Client had medication changes, was demonstrating suicidal ideation (superficial cutting) and was eloping 1 to 2 times a week. Staff report they use to be able to tell when client was going to elope and then it became harder to identify antecedents leading up to elopement. \\r\\n\\r\\nClient had an incident prior to this incident of running into Mankato and meeting up with a young man that she later accused of abusing her. Staff followed her until she reached a crowded area around Mankato State campus. Distance was over 6 miles. Client is in good physical shape. \\r\\n\\r\\nThere are 2-3 staff on evening shift. Home has 4 clients. Direct care staff involved in incident are no longer employed with provider. Staff reports a long history of elopement. \\r\\n\\r\\nA team (consisting of a case manager, guardian, house manager and administrative staff) developed an elopement protocol. Staff meetings occurred bi-weekly to address behaviors and concerns about client. Client\'s guardian had attended staff meetings to assist in training staff on how to work with her daughter. \\r\\n\\r\\nElopement protocol states that staff are to follow client during daytime hours when safe. Protocol directs staff not to follow when dark outside as this is a safety concern for staff. On day of incident, staff followed protocol and called supervisor. \\r\\n\\r\\nClient has a protocol in place where she can ask to go on a run. Protocol specifically states how long and where client can run. CLient can not go on a planned run after dark. When she asked she always comes back. Protocol in place so staff can identify the difference. \\r\\n\\r\\nClient would call guardian\\/mom when not happy with what staff was doing. Mom would change the rules\\/programs that were established when her daughter was upset. Guardian\\/mom directed day to day activities and would tell staff what things her daughter should do that day. The consistency of protocols were difficult for staff to follow due to the changes in decision making process being made by the guardian\\/mom. Program direct reports that as guardian become more inconsistent with following programs that elopement increased.\",\"Free_Text__100\":\"Direct care staff not following the person who eloped from the facility was influenced foremost by the person\\u2019s elopement protocol. At the time of the elopement it was dark outside and the protocol directed staff to not follow when dark. Contributing to the staff\\u2019s decision not to follow the person was the team\\u2019s (case manager, guardian, provider staff) desire to ensure the safety of staff and the person which was impacted by the person\\u2019s history of exhibiting challenging behaviors when followed. When staff followed the person in past elopements, the person ran further and was difficult to find. The person\\u2019s home was in a rural location which also impacted staff\\u2019s decision to not follow in the dark due to safety concerns. The elopement protocol was developed by the provider and approved by the guardian and case manager. Staff were intimidated by the guardian, which influenced the staff\\u2019s decision to follow protocol the guardian helped create. Direct care staff not following during the elopement was further supported by the person wearing a tracking watch that allowed staff to track the person and not always rely on following them.\\r\\n\\r\\nThere are a lack of crises services and placement options available in the area of the person\\u2019s home. Because of this, the provider created the elopement protocol as a way to try to balance the support and safety of the person. Limited state funding for crises services impacted the provider\\u2019s decision to create an elopement protocol. This is further influenced by the provider\\u2019s license requirements of 245A and 245D to safeguard the person\\u2019s health, safety and well-being.\",\"Multiple_Choice__101\":\"0\",\"Multiple_Choice__103\":\"0\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"0\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"3\",\"Free_Text__116\":\"Direct care staff not following the person who eloped from the facility was influenced foremost by the person\\u2019s elopement protocol. At the time of the elopement it was dark outside and the protocol directed staff to not follow when dark. Contributing to the staff\\u2019s decision not to follow the person was the team\\u2019s (case manager, guardian, provider staff) desire to ensure the safety of staff and the person which was impacted by the person\\u2019s history of exhibiting challenging behaviors when followed. When staff followed the person in past elopements, the person ran further and was difficult to find. The person\\u2019s home was in a rural location which also impacted staff\\u2019s decision to not follow in the dark due to safety concerns.\",\"Multiple_Choice__117\":\"1\",\"Multiple_Choice__119\":\"3\",\"Free_Text__120\":\"There are a lack of crises services and placement options available in the area of the person\\u2019s home. Because of this, the provider created the elopement protocol as a way to try to balance the support and safety of the person.\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"0\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:30:19',NULL,'KP_HaugBeck - BEC -2019 -05'),(205,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"KP_Maplewood Homes-SLC-2020-10\",\"Date__77\":\"10\\/28\\/2020\",\"Multiple_Choice__78\":\"Kristie Pittman\",\"Short_Answer__80\":\"Maplewood Homes\",\"Short_Answer__81\":\"Tabitha Snider\",\"Short_Answer__82\":\"snider.tabatha@yahoo.com\",\"Short_Answer__83\":\"218-576-6874\",\"Multiple_Choice__84\":\"Termination of Services\",\"Multiple_Choice__85\":\"St. Louis County\",\"Date__86\":\"08\\/13\\/2020\",\"Free_Text__87\":\"Termination of services is necessary for the person\'s welfare and the facility cannot meet the person\'s needs.  The safety of the person is endangered and positive support strategies were attempted and have not achieved and effectively maintained safety of the person or others.  The health of the person or others in the program would otherwise be endangered.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Provider terminated services due to challenging behaviors\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"11\\/30\\/2020\",\"Free_Text__98\":\"October 2020 Case Assignment\\r\\nMaplewood Homes\\r\\n\\r\\nLearning Point:  Person had their services terminated due to challenging behavior \\r\\n\\r\\nPerson was being served in a rural Family Foster Home setting from May until August of 2020.  Prior to admission into the family foster home, person had been residing at a crises home following service termination from another provider.  Person had a long history of verbalizing suicidal thoughts, self-harm, verbal and physical aggression.  It was reported that he enjoyed the attention he was given when he would be hospitalized, resulting in numerous attempts to become hospitalized.   It was reported that his team was not being successful in finding placement for him.  The team felt that a family foster care who could provide a one to one setting was something that had not been tried before.  Provider had no other clients at the time of initial placement.  Provider has over 20 years of experience in working with vulnerable populations.\\r\\nProvider reported a good working relationship with the person\\u2019s Guardian\\/Grandmother along with county case manager. Provider worked closely with psychologist, psychiatrist and ARMS worker.  Provider felt that the team was very supportive.  Things went well for a period of time and the person enjoyed all the attention they received.\\r\\nAs time went on, the person started to verbalize suicidal ideation to his Grandmother when talking to her on the phone.  One night he eloped following a series of texts to his Grandmother saying he wanted to kill himself.  Provider followed him and called the Sheriff who stated that they were not a \\u201ctaxi\\u201d service and would not assist.  He was taken to the Emergency Room and calmed down and was released with in a couple of hours.\\r\\nAnother client moved into the home shortly have this incident.  Person then stated he was going to burn the house down.  Provider had a volunteer at the home stay up all night to observe person as they were not sleeping.   The was again taken to the house admitted and released.   After he returned, he took a lighter and burned himself, this resulted in police being called to the home.  He calmed down once they arrived.  He started to text his Grandmother reporting that he wanted to kill himself.  Grandmother insisted that he return to the hospital.  Once at the hospital Grandmother insisted that he not return to providers home and he was admitted back to the crises home.\",\"Free_Text__100\":\"The provider terminating a person\\u2019s services due to challenging behaviors was influenced by the behaviors escalating in frequency and intensity since service admission.  This was further supported by the person making multiple suicide threats, acts of self-harm by burning themselves, and threats to burn the house down.  The person did not have a history of fire starting prior to admission which further supports the intensity of his escalating behaviors.  The person seemed motivated by the attention he received from his grandmother\\/guardian and the hospital.  Person was hospitalized twice and released quickly on two occasions prior to the threat to burn the house down.  On one occasion, law enforcement responded to the providers 911 call and stated that they were not a taxi services and did not provide any mental health support.  Police in the area were overtaxed with 911 calls related to mental health and COVID calls.  In addition to that, at the time of this call, law enforcement from across the state were reporting to Minneapolis to assist with the George Floyd incident, impacting the providers view that law enforcement may not assist.  \\r\\n\\r\\nThe guardian and provider agreed that the safety of the person, others in the home, and staff could not be maintained.  This agreement was influenced by the provider attempting to remove all objects that were deemed dangerous.  Room searches were conducted regularly to remove dangerous objects. After the person returned from the hospital, they were still in possession of a lighter.  This further supported their decision that they could not prevent him from self-harm and fire starting behavior or maintain the safety and protection of all involved. \\r\\n\\r\\nProviders have a responsibility to protect the health and wellbeing of all people in the home was another influence to the service termination.  Providers responsibility for safety is directed by MnCHOICES and required by the CSSP of each person and as well as the requirement of 245D.   This was supported by the Guardian who was worried about the provider\\u2019s safety and the safety of the other person who had just recently moved into the home, resulting in the guardian refusing to allow the person to return to the home.\\r\\n\\r\\nThe person being served had several ER visits for suicidal ideation and behaviors and was not given in-patient psychiatric care. Provider and guardian had exhausted available services and felt that service termination was seen as a way to help person obtain in-patient psychiatric services.   COVID-19 Pandemic influenced hospitals to discharge quickly, due to the demand for mental health resources in the area, resulting in person being released from hospital and not receiving the psychiatric attention the team thought he needed, further impacting providers decision to terminate services\",\"Multiple_Choice__101\":\"0\",\"Multiple_Choice__103\":\"0\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"3\",\"Free_Text__110\":\"On one occasion, law enforcement responded to the providers 911 call and stated that they were not a taxi services and did not provide any mental health support.  Police in the area were overtaxed with 911 calls related to mental health and COVID calls\\r\\n\\r\\nThe guardian and provider agreed that the safety of the person, others in the home, and staff could not be maintained.  This agreement was influenced by the provider attempting to remove all objects that were deemed dangerous.  Room searches were conducted regularly to remove dangerous objects. After the person returned from the hospital, they were still in possession of a lighter.  This further supported their decision that they could not prevent him from self-harm and fire starting behavior or maintain the safety and protection of all involved.\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"3\",\"Free_Text__116\":\"The guardian and provider agreed that the safety of the person, others in the home, and staff could not be maintained.  This agreement was influenced by the provider attempting to remove all objects that were deemed dangerous.  Room searches were conducted regularly to remove dangerous objects. After the person returned from the hospital, they were still in possession of a lighter\\r\\n\\r\\nProviders have a responsibility to protect the health and wellbeing of all people in the home was another influence to the service termination.  Providers responsibility for safety is directed by MnCHOICES and required by the CSSP of each person and as well as the requirement of 245D.   This was supported by the Guardian who was worried about the provider\\u2019s safety and the safety of the other person who had just recently moved into the home, resulting in the guardian refusing to allow the person to return to the home.\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"3\",\"Free_Text__120\":\"On one occasion, law enforcement responded to the providers 911 call and stated that they were not a taxi services and did not provide any mental health support.  Police in the area were overtaxed with 911 calls related to mental health and COVID calls.  \\r\\n\\r\\nThe person being served had several ER visits for suicidal ideation and behaviors and was not given in-patient psychiatric care. Provider and guardian had exhausted available services and felt that service termination was seen as a way to help person obtain in-patient psychiatric services.   COVID-19 Pandemic influenced hospitals to discharge quickly, due to the demand for mental health resources in the area, resulting in person being released from hospital and not receiving the psychiatric attention the team thought he needed, further impacting providers decision to terminate services\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"0\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:31:04',NULL,'KP_Maplewood Homes - SLC -2020 -10'),(206,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"201904216\",\"Date__77\":\"07\\/15\\/2019\",\"Multiple_Choice__78\":\"Kristie Pittman\",\"Multiple_Choice__79\":\"Jill Tilbury\",\"Short_Answer__80\":\"REM Heartland - Couger Court\",\"Short_Answer__81\":\"Devin Nelson\",\"Short_Answer__82\":\"507-223-4410\",\"Multiple_Choice__84\":\"Medication Error\",\"Multiple_Choice__85\":\"Blue Earth County\",\"Date__86\":\"06\\/01\\/2019\",\"Free_Text__87\":\"On 6-8-2019, it was discovered that the person had been receiving only half of the prescribed dosage of her Mycophenolate.  The missed medications were then found in the medication cabinet.  Person received half of 9am and 3pm prescribed dosage from 6-1-2019 to 6-7-2019.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Person received half of the prescribed dosage of medication.\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"08\\/14\\/2019\",\"Free_Text__98\":\"Staff 1 has been working for the company for the past 4 years and her role is a direct care staff. Staff 1 typically picks up of the medication from the pharmacy.  Sometimes Staff 1\\u2019s supervisor picks up the medications.  The staff who picks up the medications is responsible for organizing and separating the medications.  This medication usually come with one pill in two separate bubble packs and sometimes it will come with two pills in one bubble pack.  The person receives this medication at 9am and 3pm.  \\r\\n\\r\\nStaff 1 picked up the medication and then organized them.  Staff 1 felt that she put the correct medication and dosage in person\\u2019s medication area in the locked medication cabinet.  Staff does not recall anything out of the norm when organizing medications.  She said she was not distracted and that it was quiet at the house.  Staff 1said all medications are kept in each person\\u2019s area in the medication cabinet. Staff 1 said it is common practice for this facility for the first person who gives medication on the first of each month to double check that the medications were set up correctly. \\r\\n\\r\\nDebriefing with Staff #2 on 8-21-2019\\r\\n\\r\\nStaff 2 has worked for the company for the past 35 years and has held various position within the company.  Staff currently works the overnight shift which is from 10pm to 9am.  She is very familiar with the person and her medications as she has been with that group home for a long time.  \\r\\n\\r\\nOn the morning of June 1st, Staff 2 went to give 9am medications and noted that something \\u201cappeared off\\u201d with the medications. The medication typically comes in two single bubble packs, but there was only one bubble pack with one pill in the 9am medication. She said however that they do occasionally come with two pills in one bubble pack.  Staff 2 checked the dosage and then checked the 3pm medication and reported that they were the same, so she concluded that the dosage must have changed.  \\r\\n\\r\\nStaff 2 was not aware of the current procedure for storing extra medications.  Staff 2 said in the past when she held a different position that she would lock extra medications in the office desk.\",\"Free_Text__100\":\"The person receiving half of the prescribed dosage of medication for six days was influenced by Staff 1 believing that they set up the medications correctly after receiving them from the pharmacy.  An additional feature that influenced staff believing that the medications were set up correctly, was the medications were not always packaged the same when they came from the pharmacy.  Therefore, staff did not question when there was only one bubble pack for the person\\u2019s 9am medications and one bubble pack for person\\u2019s 3pm medications.  Staff 2 was the first staff to give medications after staff 1 set up medications in the med drawer for the month.   Staff 2 believed medications were set up correctly was influenced by the belief that the person\\u2019s medication dosage must have changed because of the way the meds were packaged.  Contributing to the staff\\u2019s belief that medication dosage changed was further influenced by the person\\u2019s 3pm medication dosage matching the 9am medication dosage.  This was further supported by staff 2 not finding the second bubble pack in the person\\u2019s medication drawer, which was the house norm for storing all medications.  Staff 2 also believed that staff 1 set up medications correctly.  \\r\\n \\r\\nAn additional factor that had other staff following staff 2\\u2019s lead in only giving half the med, rather than following medication protocol and ensuring that the med label and the Medication Administration Record (MAR) match the dosage in the bubble pack, is that there are a lot of policies for staff to know. This provider\\u2019s medication policies had changed due to the acquisition of another company, which then had both companies revise their policies to match each other. The introduction of 245D also required this provider to revise their medication administration policies. In the absence of stable policies the staff likely followed the veteran staff\\u2019s actions and assumed if there was a med change the veteran staff would have known as well as followed policies.\",\"Multiple_Choice__101\":\"2\",\"Free_Text__102\":\"This was further supported by staff 2 not finding the second bubble pack in the person\\u2019s medication drawer, which was the house norm for storing all medications. Staff 2 also believed that staff 1 setup medications correctly.\",\"Multiple_Choice__103\":\"0\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"0\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"3\",\"Free_Text__114\":\"The person receiving half of the prescribed dosage of medication for six days was influenced by Staff 1 believing that they set up the medications correctly after receiving them from the pharmacy. An additional feature that influenced staff believing that the medications were set up correctly, was the medications were not always packaged the same when they came from the pharmacy Therefore, staff did not question when there was only one bubble pack for the person\\u2019s 9am medications and one bubble pack for person\\u2019s 3pm medications.\",\"Multiple_Choice__115\":\"0\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"3\",\"Free_Text__124\":\"Staff 2 believed medications were set up correctly was influenced by the belief that the person\\u2019s medication dosage must have changed because of the way the meds were packaged.  Contributing to the staff\\u2019s belief that medication dosage changed was further influenced by the person\\u2019s 3pm medication dosage matching the 9am medication dosage.  \\r\\n\\r\\nAn additional factor that had other staff following staff 2\\u2019s lead in only giving half the med, rather than following medication protocol and ensuring that the med label and the Medication Administration Record (MAR) match the dosage in the bubble pack, is that there are a lot of policies for staff to know. In the absence of stable policies the staff likely followed the veteran staff\\u2019s actions and assumed if there was a med change the veteran staff would have known as well as followed policies.\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:36:29',NULL,'KP_REM Heartland - BEC -2019 -07'),(207,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"201905293\",\"Date__77\":\"09\\/16\\/2019\",\"Multiple_Choice__78\":\"Kristie Pittman\",\"Multiple_Choice__79\":\"Charles Young\",\"Short_Answer__80\":\"REM Heartland, Inc. - Chastworth\",\"Short_Answer__81\":\"Lori Larson\",\"Short_Answer__82\":\"Lori.Larson@TheMentorNetwork.com\",\"Multiple_Choice__84\":\"Staff Sleeping on Duty\",\"Multiple_Choice__85\":\"Blue Earth County\",\"Date__86\":\"07\\/19\\/2019\",\"Free_Text__87\":\"As the only staff present in the facility, David laid down after Damon went to bed at approximately 8:00 pm. He inadvertently fell asleep and was awoken by the night shift staff when they reported for their shift at approximately 9:50 pm. Damon was apparently asleep the entire time, but his staffing ratios only for 1 hour of alone time during the day and sleeping night staff.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Staff was sleeping during an evening shift\",\"True_or_False__94\":\"No\",\"Multiple_Choice__99\":\"Staff No Longer Employed\",\"Free_Text__100\":\"This house had an asleep overnight shift that began at 10pm, as directed by the CSSPs for the four people living in the home. The staff fell asleep at 8pm when all was quiet, and all the people were presumably in their rooms for the night. The people being served in this house demonstrated low needs which allowed them to have unsupervised time, contributing to the staff feeling comfortable to lie down. An additional factor into the staff laying down was that the staff was tired.  This staff had fallen asleep on previous shifts and disclosed to management that he was tired due to a personal situation that left him homeless. The staff typically slept in his car during this period.  The provider tried to work with him to move to the overnight position which would allow him to sleep but he did not accept this offer.  The provider noted that the overnight shift made nearly $5 less per hour, which was one of the influences into the person staying on the awake shift.  The provider was experiencing a staff shortage which is one of the factors into why they wanted to work with the staff to find a position that would meet both of their needs. An additional influence in staff falling asleep is that the staff laid down to try out a newly purchased weighted blanket   \\r\\n\\r\\nAll clients in the home had their needs assessed by MnCHOICES, which supported the individuals having sleep staff as well as alone time. The provider had seen this house as a potential house to replace overnight staff with remote monitoring technology due to the low needs of the individuals. The provider\\u2019s push for more alone time and remote monitoring was impacted by their efforts to allow the dignity of risk by providing more opportunities for people they serve to have a choice and control over their lives.  The effort to encourage dignity of risk was influenced by statewide person-centered planning requirements and emphasis. However, one guardian was resistant to remote monitoring but compromised by allowing the person alone time in their plan.  It was common knowledge among staff that the clients demonstrated low needs, contributing to the staff feeling comfortable to lie down. \\r\\n\\r\\nThe staff\\u2019s unwillingness to move to the overnight shift was influenced by the lower rate of pay that asleep staff were paid. The sleep rate is factored into the provider\\u2019s overall reimbursement negotiated with the county through the 6790 and provides a lower rate asleep than awake hours. The 6790-negotiation process is influenced by the rates determined by the Legislature in the Disability Waiver Rate System and the assessed needs identified in MnCHOICES and the resulting supervision levels identified in the CSSP.\",\"Multiple_Choice__101\":\"0\",\"Multiple_Choice__103\":\"3\",\"Free_Text__104\":\"The provider tried to work with him to move to the overnight position which would allow him to sleep but he did not accept this offer.  The provider noted that the overnight shift made nearly $5 less per hour, which was one of the influences into the person staying on the awake shift.  The provider was experiencing a staff shortage which is one of the factors into why they wanted to work with the staff to find a position that would meet both of their needs. \\r\\n\\r\\nThe staff\\u2019s unwillingness to move to the overnight shift was influenced by the lower rate of pay that asleep staff were paid. The sleep rate is factored into the provider\\u2019s overall reimbursement negotiated with the county through the 6790 and provides a lower rate asleep than awake hours\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"0\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"2\",\"Free_Text__116\":\"All clients in the home had their needs assessed by MnCHOICES, which supported the individuals having sleep staff as well as alone time. The provider had seen this house as a potential house to replace overnight staff with remote monitoring technology due to the low needs of the individuals. The provider\\u2019s push for more alone time and remote monitoring was impacted by their efforts to allow the dignity of risk by providing more opportunities for people they serve to have a choice and control over their lives.  The effort to encourage dignity of risk was influenced by statewide person-centered planning requirements and emphasis. However, one guardian was resistant to remote monitoring but compromised by allowing the person alone time in their plan.  It was common knowledge among staff that the clients demonstrated low needs, contributing to the staff feeling comfortable to lie down.\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"3\",\"Free_Text__124\":\"The staff fell asleep at 8pm when all was quiet, and all the people were presumably in their rooms for the night. The people being served in this house demonstrated low needs which allowed them to have unsupervised time, contributing to the staff feeling comfortable to lie down.\\r\\n\\r\\nIt was common knowledge among staff that the clients demonstrated low needs, contributing to the staff feeing comfortable to lie down.  An additional influence in staff falling asleep is that the staff laid down to try out a newly purchased weighted blanket\",\"Multiple_Choice__125\":\"3\",\"Free_Text__126\":\"An additional factor into the staff laying down was that the staff was tired.  This staff had fallen asleep on previous shifts and disclosed to management that he was tired due to a personal situation that left him homeless. The staff typically slept in his car during this period\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:37:01',NULL,'KP_REM Heartland - BEC -2019 -09'),(208,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"201907799\",\"Date__77\":\"12\\/16\\/2019\",\"Multiple_Choice__78\":\"Kristie Pittman\",\"Short_Answer__80\":\"REM Heartland, Inc. - Cougar Drive\",\"Multiple_Choice__84\":\"Medication Error\",\"Multiple_Choice__85\":\"Blue Earth County\",\"Date__86\":\"10\\/19\\/2019\",\"Free_Text__87\":\"The individual was setting up her medication for the week on Tuesday 10\\/15\\/19. The individual stated that she\\r\\ntook the bottle of pills from the box of medication that staff left unattended. Individual stated on 10\\/20\\/19 that she took 30 pills on 10\\/17\\/19\\r\\nand took 19 pills on 10\\/19\\/19. The medication was Hydroxyzine 25mg capsules. The individual did not have any apparent side effects from\\r\\ntaking the medications.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Staff left person unsupervised duirng medication setup\",\"True_or_False__94\":\"No\",\"Multiple_Choice__99\":\"Staff No Longer Employed\",\"Free_Text__100\":\"Person was left unsupervised during medication set up was influenced by DSP perception that the people who are their own guardians can direct their own services.  Person was their own guardian. Also contributing to the staff\\u2019s perception is the training they receive on person center planning which is a requirement of 245D.  The training offered to staff is impacted by the funding that is allowed in the Disability Waiver Rate Setting Tool, which doesn\\u2019t always capture the training staff may need to support a person with mental health issues. \\r\\n Also influencing the staff to leave someone unsupervised that there were 4 people in the home and the time of the day at the home was busy.  Staff are responsible for ensuring the safety of all people in the home which is a requirement by the CSSP of each person as well as the requirements of 245D. \\r\\nFurther impacting staff leaving the person unsupervised during medication setup is that staff at the home would often prioritize the needs of the other 3 people in the home due to their higher and lower autonomy.  . The moratorium decreased the number of beds available and created a bed shortage.\\r\\nThe final influence as to why the staff left the person unsupervised was the staff was comfortable leaving the person alone.  The person was high functioning and their own guardian.  Person being served had no history of abusing medications while residing in the home and no history of issues during medication set up influencing staff to have a trusting relationship with the person further impacting the staff being comfortable leaving the person unsupervised during medication set up.  The person had chosen to set up their medications independently with supervision.  The provider was assigned responsibility for medication set up with supervision by the case manager and agreed to by the person.  The mental health professionals involved did agree that there was a need for medication set up assistance, influencing why the provider was assigned medication set up responsibilities. The person\\u2019s MnCHOICES assessment did identify a need for medication responsibilities, which in turn was impacted by the levels of medication responsibilities identified in 245D.  The case manager\\u2019s awareness of the person\\u2019s history, which included a previous suicide attempt, further impacted the case manager assigning the provider medication set up assistance responsibility.\",\"Multiple_Choice__101\":\"3\",\"Free_Text__102\":\"Person was left unsupervised during medication set up was influenced by DSP perception that the people who are their own guardians can direct their own services\\r\\n Person being served had no history of abusing medications while residing in the home and no history of issues during medication set up influencing staff to have a trusting relationship with the person further impacting the staff being comfortable leaving the person unsupervised during medication set up.\",\"Multiple_Choice__103\":\"3\",\"Free_Text__104\":\"The training offered to staff is impacted by the funding that is allowed in the Disability Waiver Rate Setting Tool, which doesn\\u2019t always capture the training staff may need to support a person with mental health issues.\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"0\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"2\",\"Free_Text__120\":\"Impacting the mix of personal needs in the home that providers have serving people with different diagnosis in one home more often since the foster care moratorium took effectThe moratorium decreased the number of beds available and created a bed shortage.\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"2\",\"Free_Text__124\":\"Further impacting staff leaving the person unsupervised during medication setup is that staff at the home would often prioritize the needs of the other 3 people in the home due to their higher and lower autonomy\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:37:40',NULL,'KP_REM Heartland - BEC -2019 -12'),(209,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"201905922\",\"Date__77\":\"09\\/16\\/2019\",\"Multiple_Choice__78\":\"Kelly Sather\",\"Multiple_Choice__79\":\"David Vukelich\",\"Short_Answer__80\":\"Bluewater Residential Services\",\"Short_Answer__81\":\"Toni Martindale\",\"Short_Answer__82\":\"toni.martindale@brsduluth.com\",\"Multiple_Choice__84\":\"Medication Error\",\"Multiple_Choice__85\":\"St. Louis County\",\"Date__86\":\"08\\/13\\/2019\",\"Free_Text__87\":\"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.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Staff administered the wrong medications to two individuals.\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"10\\/22\\/2019\",\"Free_Text__98\":\"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.\",\"Free_Text__100\":\"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.\",\"Multiple_Choice__101\":\"1\",\"Multiple_Choice__103\":\"0\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"0\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"2\",\"Free_Text__116\":\"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.\",\"Multiple_Choice__117\":\"3\",\"Free_Text__118\":\"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.\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"2\",\"Free_Text__124\":\"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).\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:38:28',NULL,'KS_Bluewater Residential - SLC -2019 -09'),(210,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"KS_Heartland Homes-SLC-2021-03\",\"Date__77\":\"03\\/30\\/2021\",\"Multiple_Choice__78\":\"Kelly Sather\",\"Short_Answer__80\":\"Heartland Homes\",\"Short_Answer__81\":\"Jennifer Klaas\",\"Short_Answer__82\":\"heartlandhomes.jk34@outlook.com\",\"Short_Answer__83\":\"218-727-2110\",\"Multiple_Choice__84\":\"Elopement\",\"Multiple_Choice__85\":\"St. Louis County\",\"Date__86\":\"02\\/08\\/2021\",\"Free_Text__87\":\"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.\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:39:08',NULL,'KS_Heartland Homes - SLC -2021 -03'),(211,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"KS_REM Arrowhead-SLC-2020-07\",\"Date__77\":\"07\\/30\\/2020\",\"Multiple_Choice__78\":\"Kelly Sather\",\"Short_Answer__80\":\"REM Arrowhead\",\"Short_Answer__81\":\"Patrick Michael Masyga\",\"Short_Answer__82\":\"Pat.Masyga@TheMentorNetwork.com\",\"Short_Answer__83\":\"952-922-6776\",\"Multiple_Choice__84\":\"Staff Sleeping on Duty\",\"Multiple_Choice__85\":\"St. Louis County\",\"Date__86\":\"06\\/16\\/2020\",\"Free_Text__87\":\"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.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Staff was asleep during overnight awake shift\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"09\\/18\\/2020\",\"Free_Text__98\":\"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.\",\"Free_Text__100\":\"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.\",\"Multiple_Choice__101\":\"2\",\"Free_Text__102\":\"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).\",\"Multiple_Choice__103\":\"0\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"2\",\"Free_Text__110\":\"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.\",\"Multiple_Choice__111\":\"0\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"0\",\"Multiple_Choice__117\":\"0\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"0\",\"Multiple_Choice__125\":\"1\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:39:56',NULL,'KS_REM Arrowhead - SLC -2020 -07'),(212,23,81,NULL,10,NULL,NULL,'{\"Short_Answer__76\":\"2019-07-SLC-KS\",\"Date__77\":\"07\\/15\\/2019\",\"Multiple_Choice__78\":\"Kelly Sather\",\"Multiple_Choice__79\":\"David Vukelich\",\"Short_Answer__80\":\"Residential Services of NE MN\",\"Short_Answer__81\":\"Shelia Fetters\",\"Short_Answer__82\":\"sheila.fetters@residentialservices.org\",\"Multiple_Choice__84\":\"Wheelchair Safety\",\"Multiple_Choice__85\":\"St. Louis County\",\"Date__86\":\"06\\/10\\/2019\",\"Free_Text__87\":\"Staff was transporting supported person to an appointment. She had secured the wheelchair to the four point restraints. This was a standard wheelchair and the supported person does not use a lap belt due to being able to transfer. While driving, the staff report that Denise fell out of the wheelchair and fell onto the floor of the van. Other staff came to assist and noticed the seat belt in the van was not being used. Staff later clarified that she didn\\u2019t have the lap belt on correctly and that it was down around the individual\\u2019s ankles at the time of the fall.\",\"Multiple_Choice__96\":\"1\",\"Short_Answer__91\":\"Staff was not able to secure seat belt at waist.\",\"True_or_False__94\":\"Yes\",\"Date__97\":\"08\\/23\\/2019\",\"Free_Text__98\":\"Staff has worked at the agency for approximately one year. She reported having some past experience in nursing home settings, which allowed her to feel comfortable working in a \\u201cmedical home\\u201d. The medical home was described as having individuals who were higher medical needs than some other homes. She reported that some staff members would come into the home and leave, not understanding the level of work that was done in the home. \\r\\n\\r\\nAt the time of the incident, the home was staffed with three staff members. This was recently increased as they admitted their fourth resident in the home a week to two weeks prior of the incident. She described that the individual involved in the incident was verbal, but had some limitations with speaking. She used a wheelchair, but staff described this as a hospital\\/standard wheelchair with no lap belt.\\r\\n\\r\\nThe day of the incident, the staff was bringing the individual to get labs drawn at the local clinic. However, once she got to the clinic, unloaded the wheelchair and went in; it was discovered that staff were at the wrong clinic. At this time the individual begun yelling and screaming in the wait area. Staff identified feeling increased anxiety as others were looking at them. She attempted to speak with the individual to calm her, but this did not help. She stated feeling \\u201cthe crunch\\u201d at the time because she knew how important it is to get the individuals to appointments when they have them. She proceeded to load the individual in the van. She placed the wheelchair in the harnesses and was attempting to place the seat belt on. The staff identified difficulties with the seat belt, stating it was difficult to pull. [It wasn\\u2019t until further conversation with the supervisors following the debriefing that the seat belt was explained to be an airplane style seat belt that latched in front and would be pulled to tighten.] During this time, the staff stated that the individual was leaning forward and would not sit up properly. She believes the individual was able to scoot down out of her wheelchair and fell out. She stated the seat belt was at the ankles of the individual when they had fallen. Once she realized what happened, she pulled into a nearby parking lot and attempted to lift her; however, when that was unsuccessful, she called the house staff and explained what happened. They sent an employee over to assist with transferring the individual into the wheelchair and returned her to the foster home.\\r\\n\\r\\nThe staff stated she received VOC (vehicle orientation class) prior to being able to drive, but also following the incident. She states she tends to be the main driver in the mornings and feels she is a very safe staff, often double checking and taking her time to make sure mistakes don\\u2019t happen. She explained in the VOC training, they don\\u2019t use the hospital model wheelchair that this individual has but instead a different one. She further explained that it is difficult because each person is different and transporting each person has its own struggles, but the training doesn\\u2019t account for this.\",\"Free_Text__100\":\"The staff being unable to secure the seat belt was impacted by the staff member identifying increased anxiety and struggling with the seat belt. The struggle with the seat belt and staff\\u2019s increased anxiety had a reciprocal impact to one another. The staff member was feeling rushed which was impacted by the staff going to the wrong clinic for the appointment. Once it was realized that they were at the wrong clinic, the individual served started to yell and scream which impacted the staff\\u2019s increased anxiety and the attention this was drawing from the community members nearby. The increased anxiety was further complicated by the staff being inexperienced with such behaviors. The individual being supported was new in the program and the staff member had limited experience and knowledge with their individual needs. Most of the staff\\u2019s training was focused on medical needs rather than behavior management. The agency develops the training based on what the county shares with them on the individual\\u2019s needs when they are moving into the home. With the individual being upset, yelling and screaming, the person was subsequently bent at the waist level. The person\\u2019s position directly impacted staff\\u2019s difficulty with the seat belt. \\r\\n\\r\\nFurther impacting the staff\\u2019s increased anxiety was the staff\\u2019s fear of repercussions of being late to the doctor\\u2019s appointment. There is a history of reprimands for late appointments within the agency. It is required in 245D licensing that the individuals attend appointments. Further complicating the pressure on the agencies, if appointments are not made, there could be maltreatment reports made for failure to provide care. Another contributing factor is the rigidity of the healthcare system influences the pressure on the agencies because of limited time options for appointments, it may be difficult to reschedule in a timely manner or the healthcare provider may discontinue seeing that individual due to missed appointments.\",\"Multiple_Choice__101\":\"2\",\"Free_Text__102\":\"The staff being unable to secure the seat belt was impacted by the staff member identifying increased anxiety and struggling with the seat belt. The struggle with the seat belt and staff\\u2019s increased anxiety had a reciprocal impact to one another.\",\"Multiple_Choice__103\":\"0\",\"Multiple_Choice__105\":\"0\",\"Multiple_Choice__107\":\"0\",\"Multiple_Choice__109\":\"0\",\"Multiple_Choice__111\":\"3\",\"Free_Text__112\":\"The increased anxiety was further complicated by the staff being inexperienced with such behaviors. The individual being supported was new in the program and the staff member had limited experience and knowledge with their individual needs. Most of the staff\\u2019s training was focused on medical needs rather than behavior management.\",\"Multiple_Choice__113\":\"0\",\"Multiple_Choice__115\":\"0\",\"Multiple_Choice__117\":\"3\",\"Free_Text__118\":\"The staff member was feeling rushed which was impacted by the staff going to the wrong clinic for the appointment. Once it was realized that they were at the wrong clinic, the individual served started to yell and scream which impacted the staff\\u2019s increased anxiety and the attention this was drawing from the community members nearby. Further impacting the staff\\u2019s increased anxiety was the staff\\u2019s fear of repercussions of being late to the doctor\\u2019s appointment. Further complicating the pressure on the agencies, if appointments are not made, there could be maltreatment reports made for failure to provide care.\",\"Multiple_Choice__119\":\"0\",\"Multiple_Choice__121\":\"0\",\"Multiple_Choice__123\":\"0\",\"Multiple_Choice__125\":\"0\",\"Yes_or_No__432\":\"Yes\"}',NULL,0,1,81,81,'0000-00-00 00:00:00','2021-05-26 21:44:20',NULL,'KS_RSI - SLC -2019 -07'),