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. 

Other contributing factors to staff cleaning in an area where they were unable to observe the individual was that staff had no concerns that the individual would leave without confirming with staff and taking the walkie talkie. The individual frequently smoked outside without leaving, in particular, the individual had not previously left the house without telling this staff person. The individual mentioned they might go to the convenience store and staff asked him to take a walkie talkie with, which also influenced staff’s comfortability in cleaning the bathroom as the staff assumed he would take the walkie talkie if he left. The Staff's perception that the individual would follow alone time protocol was supported  by the individual’s plan which allowed him to go for a 30 minute walk without staff supervision.   This unsupervised time is driven from the CSSP which allows for unsupervised time and individual’s team developing specific parameters around unsupervised time.  The individual is his own guardian  which directly impacted the development of the CSSP and specific parameters around unsupervised time.   Per the individual’s 6790, they were not allocated one-on-one supervision which has a reciprocal relationship with  the person’s CSSP.  The 6790 is a tool created by DHS to implement the Disability Waiver Rate Setting statutes, created by the Minnesota Legislature, which provides a calculation for the person’s service rates based on  the staff ratios required of the provider. The ratios and rates in a 6790 are negotiated between the provider and the case manager based on the needs for supervision a person has in their CSSP and the provider’s assessment of the staff a person needs as well as the staff they have available. 

The 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.
