{"report_id":230,"form_id":"23","user_id":81,"organization_id":10,"question_id":"100","question_type":"Free_Text","text_answer":"Staff did not continuously monitor a public restroom door a person with dementia was using. This was influenced by staff\u2019s attention being diverted by both the crowded mall, as it was a busy Saturday at the food court, and assisting another person who was experiencing anxiety. The staff and the two people routinely went to this mall and the one person did not return from the restroom as anticipated.  Staff was within line of sight of the the entrance to the bathroom that only had one exit. The staff did not think using the restroom was a risk and assumed he\u2019d return safely given they frequent the mall and are familiar. Staff knew there was not a back door behind the restrooms. \r\n\r\nThe person had only recently been diagnosed with dementia. While the company nurse trained the staff on supporting people with dementia, the staff was not certain what that meant for the person, but did have familiarity with supporting the person. The person also had been grieving the loss  of a long-time friend\/room mate. Person-Centered practices influenced the decision to adhere to the person\u2019s routine and community inclusion activities to have lunch at the mall. This situation was further complicated as the definition of the need of support was not synonimous with the agency\u2019s definition. While the person\u2019s CSSP required 24\/7 supervision, it did not require \u201cdirect line of sight\u201d supervision in the community. Agencies are given flexibility in determining what level of supervision is required when the CSSP is not specific. Both the provider and case manager noted that \u201cdirect line of sight\u201d supervision would require 1:1 staffing, which was not supported in the person\u2019s CSSP or 6790 rate form. \r\n\r\n\r\nThe providers policies allowed for a 1:2 staffing ratio which is influenced by the county via the 6790 rates form and DHS\u2019s DWRS system. The person\u2019s MNCHOICES assessment was not up for renewal for several months which creates more complexity while the person\u2019s dementia as the condition possibly changes or is not understood over time and new symptoms develop. The provider noted that while many times a person with dementia has a higher staffing level in the community, this person did not yet have a higher staffing level as the person\u2019s dementia had just recently developed. The provider had not sought out additional staff or funding for the person yet because they weren\u2019t sure they could add more staff due to the workforce shortage and that the person had not yet had an episode of elopement. The provider noted that staffing levels were typically reactive after incidents rather than proactive to prevent them.","created_by":81,"updated_by":81,"updated_at":"5\/25\/2021 11:21:08 am","created_at":"5\/25\/2021 11:21:08 am","id":17590}