{"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"}