(39271,186,23,81,10,102,'Free_Text','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 “immediate jeopardy”. 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 “immediate jeopardy” in the future, so this mandate shaped the perception of the provider’s 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’s services was part of their response as to how they would respond to MDH’s 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. ',1,NULL,NULL,NULL,NULL,NULL),(39272,186,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39273,186,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39274,186,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39275,186,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39276,186,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39277,186,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39278,186,23,81,10,109,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39279,186,23,81,10,110,'Free_Text','The provider – and the person’s team - expected the person’s 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’s 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’s case manager – who would typically be expected to also help find needed services – was very busy and unable to devote much time to the person’s case. A number of influences as to why case managers would be busy were identified – between high case load and recent federal and state initiatives changing services. ',1,NULL,NULL,NULL,NULL,NULL),(39280,186,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39281,186,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39282,186,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39283,186,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39284,186,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39285,186,23,81,10,116,'Free_Text','Influencing why the ICF/DD provider terminated this person’s 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. ',1,NULL,NULL,NULL,NULL,NULL),(39286,186,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39287,186,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39288,186,23,81,10,119,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39289,186,23,81,10,120,'Free_Text','The provider – and the person’s team - expected the person’s 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’s 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 “med holiday” – 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 “med holidays”, 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’t 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’t had much interest from other people in\r\n\r\nAlong with the provider being willing to take a risk by accepting the person’s placement in this atypical setting was that both the case manager and the person’s guardian were willing to take a risk by placing the person in a home that didn’t fit the ‘typical’ 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’t meet the supervision needs of the people living there.',1,NULL,NULL,NULL,NULL,NULL),(39290,186,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39291,186,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39292,186,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39293,186,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39294,186,23,81,10,125,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39295,186,23,81,10,126,'Free_Text','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',1,NULL,NULL,NULL,NULL,NULL),(39296,186,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39297,187,23,81,10,76,'Short_Answer','CY_Mains\'l-HC-2020-07',1,NULL,NULL,NULL,NULL,NULL),(39298,187,23,81,10,77,'Date','2020-07-28',1,NULL,NULL,NULL,NULL,NULL),(39299,187,23,81,10,78,'Multiple_Choice','Charles Young',1,NULL,NULL,NULL,NULL,NULL),(39300,187,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39301,187,23,81,10,80,'Short_Answer','Mains\'l Services',1,NULL,NULL,NULL,NULL,NULL),(39302,187,23,81,10,81,'Short_Answer','Kelly Boser McBroom',1,NULL,NULL,NULL,NULL,NULL),(39303,187,23,81,10,82,'Short_Answer','kbmcbroom@mainsl.com',1,NULL,NULL,NULL,NULL,NULL),(39304,187,23,81,10,83,'Short_Answer','763-494-4553',1,NULL,NULL,NULL,NULL,NULL),(39305,187,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(39306,187,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(39307,187,23,81,10,86,'Date','2020-05-29',1,NULL,NULL,NULL,NULL,NULL),(39308,187,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39309,187,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39310,187,23,81,10,91,'Short_Answer','Service termination was issued',1,NULL,NULL,NULL,NULL,NULL),(39311,187,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39312,187,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39313,187,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39314,187,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39315,187,23,81,10,100,'Free_Text','The provider issuing a person a service termination as necessary for her welfare and her needs couldn’t 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’s 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’s escalating elopement and physical aggression concerns. This lack of locked facilities in Minnesota is impacted by the state’s regulations that focus on providing services in a least restrictive setting, the Olmstead vs. LC lawsuit, Minnesota’s Olmstead Plan, Minnesota Statute 245D and the Jensen Settlement – which created the need for Minnesota’s Olmstead Plan and the stronger focus on utilizing less restrictive settings. Minnesota’s 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 – 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’s interfering behavior was psychiatric or behaviorally based, obtaining a specific diagnosis was difficult. MA doesn’t 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’s escalating and dangerous interfering behavior.  The person’s primary diagnosis couldn’t be resolved amongst the professionals, impacting the person’s inability to access mental health services. \r\nThe provider issuing a person a service termination as necessary for her welfare and her needs couldn’t be met was influenced by the person’s 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 – as well as their staff. This responsibility is assigned to providers by Minnesota Statutes 245D, the statute governing an HCBS provider’s 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’s 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’t have an actual medical concern, the hospitals and EMT would discharge or refuse services because they won’t serve someone in crisis if the underlying cause is “behavioral” 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’s 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’s philosophy was to avoid restrictive interventions such as restraint or rights restrictions. Because of the person’s demeanor and size, the provider also didn’t think restrictive interventions would safely resolve the person’s 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’s staffing to 1:1 did not decrease the incidence and intensity of the person’s 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’t living in a preferred setting was believed to contribute to the person’s 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’s 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’t 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. \r\n',1,NULL,NULL,NULL,NULL,NULL),(39316,187,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39317,187,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39318,187,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39319,187,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39320,187,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39321,187,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39322,187,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39323,187,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39324,187,23,81,10,103,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39325,187,23,81,10,104,'Free_Text','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. ',1,NULL,NULL,NULL,NULL,NULL),(39326,187,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39327,187,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39328,187,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39329,187,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39330,187,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39331,187,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39332,187,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39333,187,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39334,187,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39335,187,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39336,187,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39337,187,23,81,10,116,'Free_Text','The provider issuing a person a service termination as necessary for her welfare and her needs couldn’t be met was influenced by the person’s 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 – as well as their staff. This responsibility is assigned to providers by Minnesota Statutes 245D, the statute governing an HCBS provider’s license. The responsibility is also assigned to providers by the Coordinated Service and Support Plans created by lead agency or contracted HCBS case managers. ',1,NULL,NULL,NULL,NULL,NULL),(39338,187,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39339,187,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39340,187,23,81,10,119,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39341,187,23,81,10,120,'Free_Text','The provider issuing a person a service termination as necessary for her welfare and her needs couldn’t 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’s 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’s escalating elopement and physical aggression concerns. This lack of locked facilities in Minnesota is impacted by the state’s regulations that focus on providing services in a least restrictive setting, the Olmstead vs. LC lawsuit, Minnesota’s Olmstead Plan, Minnesota Statute 245D and the Jensen Settlement – which created the need for Minnesota’s Olmstead Plan and the stronger focus on utilizing less restrictive settings. Minnesota’s 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. ',1,NULL,NULL,NULL,NULL,NULL),(39342,187,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39343,187,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39344,187,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39345,187,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39346,187,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39347,187,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39348,187,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39349,188,23,81,10,76,'Short_Answer','DV_Kelly AFC-SLC-2020-11',1,NULL,NULL,NULL,NULL,NULL),(39350,188,23,81,10,77,'Date','2020-11-24',1,NULL,NULL,NULL,NULL,NULL),(39351,188,23,81,10,78,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(39352,188,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39353,188,23,81,10,80,'Short_Answer','Kelly Adult Foster Care',1,NULL,NULL,NULL,NULL,NULL),(39354,188,23,81,10,81,'Short_Answer','Kelly Postudensek',1,NULL,NULL,NULL,NULL,NULL),(39355,188,23,81,10,82,'Short_Answer','kellypost.987@gmail.com',1,NULL,NULL,NULL,NULL,NULL),(39356,188,23,81,10,83,'Short_Answer','218-780-0445',1,NULL,NULL,NULL,NULL,NULL),(39357,188,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(39358,188,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(39359,188,23,81,10,86,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39360,188,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39361,188,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39362,188,23,81,10,91,'Short_Answer','Individual was issued a 60 day termination notice.',1,NULL,NULL,NULL,NULL,NULL),(39363,188,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39364,188,23,81,10,97,'Date','2021-01-12',1,NULL,NULL,NULL,NULL,NULL),(39365,188,23,81,10,98,'Free_Text','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’ care prior to this AFC.  The individual is his own guardian.  \r\nPrior to the placement the provider had communicated with the individual’s 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’s 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.  \r\n',1,NULL,NULL,NULL,NULL,NULL),(39366,188,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39367,188,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39368,188,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39369,188,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39370,188,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39371,188,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39372,188,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39373,188,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39374,188,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39375,188,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39376,188,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39377,188,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39378,188,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39379,188,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39380,188,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39381,188,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39382,188,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39383,188,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39384,188,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39385,188,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39386,188,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39387,188,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39388,188,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39389,188,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39390,188,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39391,188,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39392,188,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39393,188,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39394,188,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39395,188,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39396,188,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39397,188,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39398,188,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39399,188,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39400,188,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39401,189,23,81,10,76,'Short_Answer','Care Manager',1,NULL,NULL,NULL,NULL,NULL),(39402,189,23,81,10,77,'Date','2020-01-28',1,NULL,NULL,NULL,NULL,NULL),(39403,189,23,81,10,78,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(39404,189,23,81,10,79,'Multiple_Choice','Scott Schifsky',1,NULL,NULL,NULL,NULL,NULL),(39405,189,23,81,10,80,'Short_Answer','Peace of Mind of Duluth',1,NULL,NULL,NULL,NULL,NULL),(39406,189,23,81,10,81,'Short_Answer','Clayton Liend',1,NULL,NULL,NULL,NULL,NULL),(39407,189,23,81,10,82,'Short_Answer','clayton@pomduluth.com',1,NULL,NULL,NULL,NULL,NULL),(39408,189,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39409,189,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(39410,189,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(39411,189,23,81,10,86,'Date','2019-11-05',1,NULL,NULL,NULL,NULL,NULL),(39412,189,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39413,189,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39414,189,23,81,10,91,'Short_Answer','Individual was given a 60 day termination notice.',1,NULL,NULL,NULL,NULL,NULL),(39415,189,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39416,189,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39417,189,23,81,10,98,'Free_Text','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’s 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’s 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’s 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’t know about the termination, exercised his right to appeal, and the matter is still pending. \r\n',1,NULL,NULL,NULL,NULL,NULL),(39418,189,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39419,189,23,81,10,100,'Free_Text','The individual being issued a termination notice was influenced by the individual’s 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’s 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’s 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’s 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’s thought they didn’t 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’s 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. \r\n',1,NULL,NULL,NULL,NULL,NULL),(39420,189,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39421,189,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39422,189,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39423,189,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39424,189,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39425,189,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39426,189,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39427,189,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39428,189,23,81,10,103,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39429,189,23,81,10,104,'Free_Text','\'don\'t 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\r\n\r\nFrom 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.\"',1,NULL,NULL,NULL,NULL,NULL),(39430,189,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39431,189,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39432,189,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39433,189,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39434,189,23,81,10,109,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39435,189,23,81,10,110,'Free_Text','\"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. ',1,NULL,NULL,NULL,NULL,NULL),(39436,189,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39437,189,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39438,189,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39439,189,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39440,189,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39441,189,23,81,10,116,'Free_Text','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’s 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’s 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.  ',1,NULL,NULL,NULL,NULL,NULL),(39442,189,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39443,189,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39444,189,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39445,189,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39446,189,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39447,189,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39448,189,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39449,189,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39450,189,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39451,189,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39452,189,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39453,190,23,81,10,76,'Short_Answer','201905337',1,NULL,NULL,NULL,NULL,NULL),(39454,190,23,81,10,77,'Date','2019-08-15',1,NULL,NULL,NULL,NULL,NULL),(39455,190,23,81,10,78,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(39456,190,23,81,10,79,'Multiple_Choice','Scott Schifsky',1,NULL,NULL,NULL,NULL,NULL),(39457,190,23,81,10,80,'Short_Answer','Pinewood-Duluth',1,NULL,NULL,NULL,NULL,NULL),(39458,190,23,81,10,81,'Short_Answer','Dana Tchida',1,NULL,NULL,NULL,NULL,NULL),(39459,190,23,81,10,82,'Short_Answer','dana@pinewoodcloq-duluth.com',1,NULL,NULL,NULL,NULL,NULL),(39460,190,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39461,190,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(39462,190,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(39463,190,23,81,10,86,'Date','2019-07-23',1,NULL,NULL,NULL,NULL,NULL),(39464,190,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(39465,190,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39466,190,23,81,10,91,'Short_Answer','Staff was not aware the individual left the program.',1,NULL,NULL,NULL,NULL,NULL),(39467,190,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39468,190,23,81,10,97,'Date','2019-09-24',1,NULL,NULL,NULL,NULL,NULL),(39469,190,23,81,10,98,'Free_Text','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’s behaviors, SP1 describes her as “ninja like.”  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’s 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’t provide the optimal vantage point to the entrances/exits.  \r\nSP3 was unaware that the individual left the program/building.\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(39470,190,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39471,190,23,81,10,100,'Free_Text','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’s 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’s 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’s 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’s requirement to support the health, safety, and well-being of residents through the adherence to the fire codes.  \r\n',1,NULL,NULL,NULL,NULL,NULL),(39472,190,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39473,190,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39474,190,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39475,190,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39476,190,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39477,190,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39478,190,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39479,190,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39480,190,23,81,10,103,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39481,190,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39482,190,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39483,190,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39484,190,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39485,190,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39486,190,23,81,10,109,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39487,190,23,81,10,110,'Free_Text','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’s 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.\r\n',1,NULL,NULL,NULL,NULL,NULL),(39488,190,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39489,190,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39490,190,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39491,190,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39492,190,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39493,190,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39494,190,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39495,190,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39496,190,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39497,190,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39498,190,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39499,190,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39500,190,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39501,190,23,81,10,124,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(39502,190,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39503,190,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39504,190,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39505,191,23,81,10,76,'Short_Answer','201903632',1,NULL,NULL,NULL,NULL,NULL),(39506,191,23,81,10,77,'Date','2019-06-19',1,NULL,NULL,NULL,NULL,NULL),(39507,191,23,81,10,78,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(39508,191,23,81,10,79,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(39509,191,23,81,10,80,'Short_Answer','REM Arrowhead',1,NULL,NULL,NULL,NULL,NULL),(39510,191,23,81,10,81,'Short_Answer','Corey Labissoniere',1,NULL,NULL,NULL,NULL,NULL),(39511,191,23,81,10,82,'Short_Answer','Corey.LaBissoniere@thementornetwork.com',1,NULL,NULL,NULL,NULL,NULL),(39512,191,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39513,191,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(39514,191,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(39515,191,23,81,10,86,'Date','2019-05-18',1,NULL,NULL,NULL,NULL,NULL),(39516,191,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(39517,191,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39518,191,23,81,10,91,'Short_Answer','Individual left the home via the bathroom without staff knowledge.',1,NULL,NULL,NULL,NULL,NULL),(39519,191,23,81,10,94,'True_or_False','No',1,NULL,NULL,NULL,NULL,NULL),(39520,191,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39521,191,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39522,191,23,81,10,99,'Multiple_Choice','Staff No Longer Employed',1,NULL,NULL,NULL,NULL,NULL),(39523,191,23,81,10,100,'Free_Text','The individual eloping from the home was influenced by the staff’s 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’s 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’t experienced before.  The individual’s support team (guardian, case manager, etc.) also had varying views on what the individual’s needs were. Staff’s confusion around these new behaviors, the support team’s varying views and the ability to communicate with each other in real time were influencing the individual’s support plan not being updated to reflect the person’s updated safety considerations.  \r\n\r\nPer the individual’s 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’s 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).  ',1,NULL,NULL,NULL,NULL,NULL),(39524,191,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39525,191,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39526,191,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39527,191,23,81,10,130,'Free_Text',' ',1,NULL,NULL,NULL,NULL,NULL),(39528,191,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39529,191,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39530,191,23,81,10,101,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39531,191,23,81,10,102,'Free_Text','The individual eloping from the home was influenced by the staff’s 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’s decision not to provide direct supervision while the individual was using the bathroom.',1,NULL,NULL,NULL,NULL,NULL),(39532,191,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39533,191,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39534,191,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39535,191,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39536,191,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39537,191,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39538,191,23,81,10,109,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39539,191,23,81,10,110,'Free_Text','The individual’s support team (guardian, case manager, etc.) also had varying views on what the individual’s needs were. Staff’s confusion around these new behaviors, the support team’s varying views and the ability to communicate with each other in real time were influencing the individual’s support plan not being updated to reflect the person’s updated safety considerations.  ',1,NULL,NULL,NULL,NULL,NULL),(39540,191,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39541,191,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39542,191,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39543,191,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39544,191,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39545,191,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39546,191,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39547,191,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39548,191,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39549,191,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39550,191,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39551,191,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39552,191,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39553,191,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39554,191,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39555,191,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39556,191,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39557,192,23,81,10,76,'Short_Answer','DV_Rural Living Enivronment-SLC-2020-06',1,NULL,NULL,NULL,NULL,NULL),(39558,192,23,81,10,77,'Date','2020-07-10',1,NULL,NULL,NULL,NULL,NULL),(39559,192,23,81,10,78,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(39560,192,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39561,192,23,81,10,80,'Short_Answer','Rural Living Environment',1,NULL,NULL,NULL,NULL,NULL),(39562,192,23,81,10,81,'Short_Answer','Leanne Negley',1,NULL,NULL,NULL,NULL,NULL),(39563,192,23,81,10,82,'Short_Answer','lnegley@rurallivingmn.com',1,NULL,NULL,NULL,NULL,NULL),(39564,192,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39565,192,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(39566,192,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(39567,192,23,81,10,86,'Date','2019-04-23',1,NULL,NULL,NULL,NULL,NULL),(39568,192,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39569,192,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39570,192,23,81,10,91,'Short_Answer','Person was given a 60-day service termination',1,NULL,NULL,NULL,NULL,NULL),(39571,192,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39572,192,23,81,10,97,'Date','2020-08-11',1,NULL,NULL,NULL,NULL,NULL),(39573,192,23,81,10,98,'Free_Text','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’s 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’s 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’s mother wasn’t comfortable with her returning at that time.  The individual’s 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’s 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’s management team was involved with the termination notice and issued the termination in accordance with policy/rules.  No previous terminations were noted.   \r\n',1,NULL,NULL,NULL,NULL,NULL),(39574,192,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39575,192,23,81,10,100,'Free_Text','The person being given a 60-day service termination was influenced by the individual’s 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’s 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 “camping trip”) and continue to hold the individual’s bed. The uncertainties of the pandemic influenced the provider to develop a creative plan to continue to support the individual in her mother’s 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’t approve this alternative service delivery.  The individual’s 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’s 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’s inability to support the alternative plan was influenced by the plan’s 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’s specific situation.\r\nThe provider’s 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’s orders.\r\n',1,NULL,NULL,NULL,NULL,NULL),(39576,192,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39577,192,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39578,192,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39579,192,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39580,192,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39581,192,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39582,192,23,81,10,101,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39583,192,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39584,192,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39585,192,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39586,192,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39587,192,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39588,192,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39589,192,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39590,192,23,81,10,109,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39591,192,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39592,192,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39593,192,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39594,192,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39595,192,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39596,192,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39597,192,23,81,10,116,'Free_Text','The County’s inability to support the alternative plan was influenced by the plan’s 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’s specific situation.\r\nThe provider’s 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’s orders.',1,NULL,NULL,NULL,NULL,NULL),(39598,192,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39599,192,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39600,192,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39601,192,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39602,192,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39603,192,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39604,192,23,81,10,123,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39605,192,23,81,10,124,'Free_Text','The person being given a 60-day service termination was influenced by the individual’s 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’s 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 “camping trip”) and continue to hold the individual’s bed. The uncertainties of the pandemic influenced the provider to develop a creative plan to continue to support the individual in her mother’s 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’t approve this alternative service delivery.  The individual’s 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’s 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.  ',1,NULL,NULL,NULL,NULL,NULL),(39606,192,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39607,192,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39608,192,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39609,193,23,81,10,76,'Short_Answer','A954660000',1,NULL,NULL,NULL,NULL,NULL),(39610,193,23,81,10,77,'Date','2019-10-15',1,NULL,NULL,NULL,NULL,NULL),(39611,193,23,81,10,78,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(39612,193,23,81,10,79,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(39613,193,23,81,10,80,'Short_Answer','Stepping Stones for Living',1,NULL,NULL,NULL,NULL,NULL),(39614,193,23,81,10,81,'Short_Answer','Laura Flynn',1,NULL,NULL,NULL,NULL,NULL),(39615,193,23,81,10,82,'Short_Answer','laura.flynn@sslduluth.com',1,NULL,NULL,NULL,NULL,NULL),(39616,193,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39617,193,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(39618,193,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(39619,193,23,81,10,86,'Date','2019-08-24',1,NULL,NULL,NULL,NULL,NULL),(39620,193,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(39621,193,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39622,193,23,81,10,91,'Short_Answer','Staff did not observe the individual leave the home',1,NULL,NULL,NULL,NULL,NULL),(39623,193,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39624,193,23,81,10,97,'Date','2019-12-09',1,NULL,NULL,NULL,NULL,NULL),(39625,193,23,81,10,98,'Free_Text','The day of the incident the staff person(SP) was supervising the individual who eloped as well as 3 other residents.   SP doesn’t 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 “walkie talkie” 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’t return after 30 minutes.  Following protocol, the SP called the agency’s 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’s and went to the mall.  The individual had recently received money from a renter’s 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.  ',1,NULL,NULL,NULL,NULL,NULL),(39626,193,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39627,193,23,81,10,100,'Free_Text','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’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. \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.\r\n',1,NULL,NULL,NULL,NULL,NULL),(39628,193,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39629,193,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39630,193,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39631,193,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39632,193,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39633,193,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39634,193,23,81,10,101,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39635,193,23,81,10,102,'Free_Text','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’s plan which allowed him to go for a 30 minute walk without staff supervision. \r\n',1,NULL,NULL,NULL,NULL,NULL),(39636,193,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39637,193,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39638,193,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39639,193,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39640,193,23,81,10,107,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39641,193,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39642,193,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39643,193,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39644,193,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39645,193,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39646,193,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39647,193,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39648,193,23,81,10,115,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39649,193,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39650,193,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39651,193,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39652,193,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39653,193,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39654,193,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39655,193,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39656,193,23,81,10,123,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39657,193,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39658,193,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39659,193,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39660,193,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39661,194,23,81,10,76,'Short_Answer','DV_Taylor SLS-SLC-2021-04',1,NULL,NULL,NULL,NULL,NULL),(39662,194,23,81,10,77,'Date','2021-04-28',1,NULL,NULL,NULL,NULL,NULL),(39663,194,23,81,10,78,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(39664,194,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39665,194,23,81,10,80,'Short_Answer','Taylor SLS',1,NULL,NULL,NULL,NULL,NULL),(39666,194,23,81,10,81,'Short_Answer','Jenifer Forneris',1,NULL,NULL,NULL,NULL,NULL),(39667,194,23,81,10,82,'Short_Answer','jenforneris.basswood@yahoo.com',1,NULL,NULL,NULL,NULL,NULL),(39668,194,23,81,10,83,'Short_Answer','218-591-2612',1,NULL,NULL,NULL,NULL,NULL),(39669,194,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(39670,194,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(39671,194,23,81,10,86,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39672,194,23,81,10,87,'Free_Text','\"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. \"',1,NULL,NULL,NULL,NULL,NULL),(39673,194,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39674,194,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39675,194,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(39676,194,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39677,194,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39678,194,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39679,194,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39680,194,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39681,194,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39682,194,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39683,194,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39684,194,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39685,194,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39686,194,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39687,194,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39688,194,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39689,194,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39690,194,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39691,194,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39692,194,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39693,194,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39694,194,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39695,194,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39696,194,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39697,194,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39698,194,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39699,194,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39700,194,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39701,194,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39702,194,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39703,194,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39704,194,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39705,194,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39706,194,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39707,194,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39708,194,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39709,194,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39710,194,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39711,194,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39712,194,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39713,195,23,81,10,76,'Short_Answer','JT_Beacon-HC-2021-03',1,NULL,NULL,NULL,NULL,NULL),(39714,195,23,81,10,77,'Date','2021-03-30',1,NULL,NULL,NULL,NULL,NULL),(39715,195,23,81,10,78,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(39716,195,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39717,195,23,81,10,80,'Short_Answer','Beacon Specialized Living',1,NULL,NULL,NULL,NULL,NULL),(39718,195,23,81,10,81,'Short_Answer','Barbara Turner',1,NULL,NULL,NULL,NULL,NULL),(39719,195,23,81,10,82,'Short_Answer','bturner@beaconspecialized.org',1,NULL,NULL,NULL,NULL,NULL),(39720,195,23,81,10,83,'Short_Answer','651-451-2889',1,NULL,NULL,NULL,NULL,NULL),(39721,195,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(39722,195,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(39723,195,23,81,10,86,'Date','2021-02-18',1,NULL,NULL,NULL,NULL,NULL),(39724,195,23,81,10,87,'Free_Text','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. ',1,NULL,NULL,NULL,NULL,NULL),(39725,195,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39726,195,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39727,195,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(39728,195,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39729,195,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39730,195,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39731,195,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39732,195,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39733,195,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39734,195,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39735,195,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39736,195,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39737,195,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39738,195,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39739,195,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39740,195,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39741,195,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39742,195,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39743,195,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39744,195,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39745,195,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39746,195,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39747,195,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39748,195,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39749,195,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39750,195,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39751,195,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39752,195,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39753,195,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39754,195,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39755,195,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39756,195,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39757,195,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39758,195,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39759,195,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39760,195,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39761,195,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39762,195,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39763,195,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39764,195,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39765,196,23,81,10,76,'Short_Answer','201901929',1,NULL,NULL,NULL,NULL,NULL),(39766,196,23,81,10,77,'Date','2019-05-22',1,NULL,NULL,NULL,NULL,NULL),(39767,196,23,81,10,78,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(39768,196,23,81,10,79,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(39769,196,23,81,10,80,'Short_Answer','MRCI',1,NULL,NULL,NULL,NULL,NULL),(39770,196,23,81,10,81,'Short_Answer','Cathy Groebner',1,NULL,NULL,NULL,NULL,NULL),(39771,196,23,81,10,82,'Short_Answer','cgroebner@mymrci.org',1,NULL,NULL,NULL,NULL,NULL),(39772,196,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39773,196,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(39774,196,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(39775,196,23,81,10,86,'Date','2019-03-19',1,NULL,NULL,NULL,NULL,NULL),(39776,196,23,81,10,87,'Free_Text','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’s 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 “yeah” and also asked if VA needed anything and they said “no”.  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’s office.  At approximately 2:00pm, staff 1 notice VA’s 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 “good Samaritans” 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’s 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, “No”. The VA was asked why it wasn’t and safe and the response was “I could get hurt”. Supervisor asked VA if it will ever happen again and VA shook their head “no”. Supervisor walked VA to the bus and fastened seatbelt and sat patiently until the bus departed.  ',1,NULL,NULL,NULL,NULL,NULL),(39777,196,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39778,196,23,81,10,91,'Short_Answer','Staff didn’t continuously monitor the person in bathroom and the person eloped without being seen',1,NULL,NULL,NULL,NULL,NULL),(39779,196,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39780,196,23,81,10,97,'Date','2019-07-10',1,NULL,NULL,NULL,NULL,NULL),(39781,196,23,81,10,98,'Free_Text','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’t 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’s 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.  ',1,NULL,NULL,NULL,NULL,NULL),(39782,196,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39783,196,23,81,10,100,'Free_Text','The staff not continuously monitoring the person in the bathroom was impacted by the staff adapting the person’s supervision protocol to allow for privacy in the bathroom.  It is the providers practice to allow all of the individual’s 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’s 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’s 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. ',1,NULL,NULL,NULL,NULL,NULL),(39784,196,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39785,196,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39786,196,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39787,196,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39788,196,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39789,196,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39790,196,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39791,196,23,81,10,102,'Free_Text','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’s 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’s office.  ',1,NULL,NULL,NULL,NULL,NULL),(39792,196,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39793,196,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39794,196,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39795,196,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39796,196,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39797,196,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39798,196,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39799,196,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39800,196,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39801,196,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39802,196,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39803,196,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39804,196,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39805,196,23,81,10,116,'Free_Text','The staff not continuously monitoring the person in the bathroom was impacted by the staff adapting the person’s 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.',1,NULL,NULL,NULL,NULL,NULL),(39806,196,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39807,196,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39808,196,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39809,196,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39810,196,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39811,196,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39812,196,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39813,196,23,81,10,124,'Free_Text','The staff not continuously monitoring the person in the bathroom was impacted by the staff adapting the person’s supervision protocol to allow for privacy in the bathroom.  ',1,NULL,NULL,NULL,NULL,NULL),(39814,196,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39815,196,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39816,196,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39817,197,23,81,10,76,'Short_Answer','JT_Mary T-HC-2020-07',1,NULL,NULL,NULL,NULL,NULL),(39818,197,23,81,10,77,'Date','2020-07-28',1,NULL,NULL,NULL,NULL,NULL),(39819,197,23,81,10,78,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(39820,197,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39821,197,23,81,10,80,'Short_Answer','Mary T',1,NULL,NULL,NULL,NULL,NULL),(39822,197,23,81,10,81,'Short_Answer','Brent Krocak',1,NULL,NULL,NULL,NULL,NULL),(39823,197,23,81,10,82,'Short_Answer','brentk@marytinc.com',1,NULL,NULL,NULL,NULL,NULL),(39824,197,23,81,10,83,'Short_Answer','763-274-8463',1,NULL,NULL,NULL,NULL,NULL),(39825,197,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(39826,197,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(39827,197,23,81,10,86,'Date','2020-06-18',1,NULL,NULL,NULL,NULL,NULL),(39828,197,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39829,197,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39830,197,23,81,10,91,'Short_Answer','Staff assisted the person to leave for an overnight with people they had concerns about',1,NULL,NULL,NULL,NULL,NULL),(39831,197,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39832,197,23,81,10,97,'Date','2020-10-13',1,NULL,NULL,NULL,NULL,NULL),(39833,197,23,81,10,98,'Free_Text','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’s 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’s 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’s day.  \r\n',1,NULL,NULL,NULL,NULL,NULL),(39834,197,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39835,197,23,81,10,100,'Free_Text','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’s 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’s 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’s 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’s 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’s concerns about the person leaving with the person did not seem to outweigh the provider’s 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’s 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’t enough to take restrictive actions and weigh safety over the person’s own choice. Implementing restrictions on a person’s rights could create the liability of providers being incompliant with the conditions of Minnesota Statutes, Chapter 245D enforced by the Department of Human Services.\r\n',1,NULL,NULL,NULL,NULL,NULL),(39836,197,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39837,197,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39838,197,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39839,197,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39840,197,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39841,197,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39842,197,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39843,197,23,81,10,102,'Free_Text','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’s 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??\r\n',1,NULL,NULL,NULL,NULL,NULL),(39844,197,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39845,197,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39846,197,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39847,197,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39848,197,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39849,197,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39850,197,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39851,197,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39852,197,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39853,197,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39854,197,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39855,197,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39856,197,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(39857,197,23,81,10,116,'Free_Text','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’s 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’s 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’s 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’s 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’s concerns about the person leaving with the person did not seem to outweigh the provider’s 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’s 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’t enough to take restrictive actions and weigh safety over the person’s own choice. Implementing restrictions on a person’s rights could create the liability of providers being incompliant with the conditions of Minnesota Statutes, Chapter 245D enforced by the Department of Human Services.\r\n',1,NULL,NULL,NULL,NULL,NULL),(39858,197,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39859,197,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39860,197,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39861,197,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39862,197,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39863,197,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39864,197,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39865,197,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39866,197,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39867,197,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39868,197,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39869,198,23,81,10,76,'Short_Answer','201905316',1,NULL,NULL,NULL,NULL,NULL),(39870,198,23,81,10,77,'Date','2019-08-15',1,NULL,NULL,NULL,NULL,NULL),(39871,198,23,81,10,78,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(39872,198,23,81,10,79,'Multiple_Choice','Charles Young',1,NULL,NULL,NULL,NULL,NULL),(39873,198,23,81,10,80,'Short_Answer','Progressive Living Inc',1,NULL,NULL,NULL,NULL,NULL),(39874,198,23,81,10,81,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39875,198,23,81,10,82,'Short_Answer','nicole.s@progressivelivinginc.net',1,NULL,NULL,NULL,NULL,NULL),(39876,198,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39877,198,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(39878,198,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(39879,198,23,81,10,86,'Date','2019-07-20',1,NULL,NULL,NULL,NULL,NULL),(39880,198,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(39881,198,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39882,198,23,81,10,91,'Short_Answer','Staff did not count medications per provider policy',1,NULL,NULL,NULL,NULL,NULL),(39883,198,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39884,198,23,81,10,97,'Date','2019-09-13',1,NULL,NULL,NULL,NULL,NULL),(39885,198,23,81,10,98,'Free_Text','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’s 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’s 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’s 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 “file cabinet like’ 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.  \r\n',1,NULL,NULL,NULL,NULL,NULL),(39886,198,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39887,198,23,81,10,100,'Free_Text','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’ 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’s policy for the work of the direct care staff 1 and 2 was the nurse’s license in providing some position to the policy.  Overall the nurse’s license is regulated by legislation and statute.   ',1,NULL,NULL,NULL,NULL,NULL),(39888,198,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39889,198,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39890,198,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39891,198,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39892,198,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39893,198,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39894,198,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39895,198,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39896,198,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39897,198,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39898,198,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39899,198,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39900,198,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39901,198,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39902,198,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39903,198,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39904,198,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39905,198,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39906,198,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39907,198,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39908,198,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39909,198,23,81,10,116,'Free_Text','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.  ',1,NULL,NULL,NULL,NULL,NULL),(39910,198,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39911,198,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39912,198,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39913,198,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39914,198,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39915,198,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39916,198,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(39917,198,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39918,198,23,81,10,125,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(39919,198,23,81,10,126,'Free_Text','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’ plans to follow and also being fatigued because the staff had to work overtime prior to this shift.  ',1,NULL,NULL,NULL,NULL,NULL),(39920,198,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(39921,199,23,81,10,76,'Short_Answer','JT_REM Hennepin-HC-2020-11',1,NULL,NULL,NULL,NULL,NULL),(39922,199,23,81,10,77,'Date','2020-11-24',1,NULL,NULL,NULL,NULL,NULL),(39923,199,23,81,10,78,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(39924,199,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39925,199,23,81,10,80,'Short_Answer','REM Hennepin',1,NULL,NULL,NULL,NULL,NULL),(39926,199,23,81,10,81,'Short_Answer','Devin Nelson',1,NULL,NULL,NULL,NULL,NULL),(39927,199,23,81,10,82,'Short_Answer','devin.nelson@thementornetwork.com',1,NULL,NULL,NULL,NULL,NULL),(39928,199,23,81,10,83,'Short_Answer','507-233-4410',1,NULL,NULL,NULL,NULL,NULL),(39929,199,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(39930,199,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(39931,199,23,81,10,86,'Date','2020-08-06',1,NULL,NULL,NULL,NULL,NULL),(39932,199,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39933,199,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39934,199,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39935,199,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(39936,199,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39937,199,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39938,199,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39939,199,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39940,199,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39941,199,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39942,199,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39943,199,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39944,199,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39945,199,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39946,199,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39947,199,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39948,199,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39949,199,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39950,199,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39951,199,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39952,199,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39953,199,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39954,199,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39955,199,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39956,199,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39957,199,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39958,199,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39959,199,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39960,199,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39961,199,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39962,199,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39963,199,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39964,199,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39965,199,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39966,199,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39967,199,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39968,199,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39969,199,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39970,199,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39971,199,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39972,199,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39973,200,23,81,10,76,'Short_Answer','201906882',1,NULL,NULL,NULL,NULL,NULL),(39974,200,23,81,10,77,'Date','2019-10-15',1,NULL,NULL,NULL,NULL,NULL),(39975,200,23,81,10,78,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(39976,200,23,81,10,79,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(39977,200,23,81,10,80,'Short_Answer','Wingspan Life Resources',1,NULL,NULL,NULL,NULL,NULL),(39978,200,23,81,10,81,'Short_Answer','Therese Davis',1,NULL,NULL,NULL,NULL,NULL),(39979,200,23,81,10,82,'Short_Answer','tdavis@wingspanlife.org',1,NULL,NULL,NULL,NULL,NULL),(39980,200,23,81,10,83,'Short_Answer','651-242-5840',1,NULL,NULL,NULL,NULL,NULL),(39981,200,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(39982,200,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(39983,200,23,81,10,86,'Date','2019-08-30',1,NULL,NULL,NULL,NULL,NULL),(39984,200,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(39985,200,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(39986,200,23,81,10,91,'Short_Answer','Medication Error over an Extended Period of Time',1,NULL,NULL,NULL,NULL,NULL),(39987,200,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(39988,200,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39989,200,23,81,10,98,'Free_Text','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 “dial up” 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’t 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.   \r\n',1,NULL,NULL,NULL,NULL,NULL),(39990,200,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39991,200,23,81,10,100,'Free_Text','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’s 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’s role to update medication changes in the MAR.  The individual’s 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 “old” prescription because the physician did not change the prescription with the pharmacy.  ',1,NULL,NULL,NULL,NULL,NULL),(39992,200,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(39993,200,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(39994,200,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(39995,200,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39996,200,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39997,200,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(39998,200,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(39999,200,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40000,200,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40001,200,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40002,200,23,81,10,105,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40003,200,23,81,10,106,'Free_Text','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.  ',1,NULL,NULL,NULL,NULL,NULL),(40004,200,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40005,200,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40006,200,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40007,200,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40008,200,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40009,200,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40010,200,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40011,200,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40012,200,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40013,200,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40014,200,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40015,200,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40016,200,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40017,200,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40018,200,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40019,200,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40020,200,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40021,200,23,81,10,124,'Free_Text','At this home, it was the supervisor’s role to update medication changes in the MAR.  The individual’s 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.  ',1,NULL,NULL,NULL,NULL,NULL),(40022,200,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40023,200,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40024,200,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40025,201,23,81,10,76,'Short_Answer','KP_BridgesMN-BEC-2021-02',1,NULL,NULL,NULL,NULL,NULL),(40026,201,23,81,10,77,'Date','2021-02-25',1,NULL,NULL,NULL,NULL,NULL),(40027,201,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40028,201,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40029,201,23,81,10,80,'Short_Answer','Bridges MN',1,NULL,NULL,NULL,NULL,NULL),(40030,201,23,81,10,81,'Short_Answer','Shyla Kahle (completed the BIRF)',1,NULL,NULL,NULL,NULL,NULL),(40031,201,23,81,10,82,'Short_Answer','shylak@bridgesmn.com',1,NULL,NULL,NULL,NULL,NULL),(40032,201,23,81,10,83,'Short_Answer','651-328-0677',1,NULL,NULL,NULL,NULL,NULL),(40033,201,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(40034,201,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40035,201,23,81,10,86,'Date','2021-01-21',1,NULL,NULL,NULL,NULL,NULL),(40036,201,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40037,201,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40038,201,23,81,10,91,'Short_Answer','Staff unable to redirect a person from departing on a bus to Chicago.',1,NULL,NULL,NULL,NULL,NULL),(40039,201,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40040,201,23,81,10,97,'Date','2020-10-14',1,NULL,NULL,NULL,NULL,NULL),(40041,201,23,81,10,98,'Free_Text','Staff unable to redirect a person from departing on a bus to Chicago.',1,NULL,NULL,NULL,NULL,NULL),(40042,201,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40043,201,23,81,10,100,'Free_Text','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’t 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’t 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’s risk management plan and it was affirmed. Contributing factors that further influenced the staffs’ 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’t 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’s 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’s 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’s stay at home order also influenced the person’s decision to leave as his routine was limited to low activity. This elopement influenced the agency, team, and staff present to honor the person’s 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. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40044,201,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40045,201,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40046,201,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40047,201,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40048,201,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40049,201,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40050,201,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40051,201,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40052,201,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40053,201,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40054,201,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40055,201,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40056,201,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40057,201,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40058,201,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40059,201,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40060,201,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40061,201,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40062,201,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40063,201,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40064,201,23,81,10,115,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40065,201,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40066,201,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40067,201,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40068,201,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40069,201,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40070,201,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40071,201,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40072,201,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40073,201,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40074,201,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40075,201,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40076,201,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40077,202,23,81,10,76,'Short_Answer','KP_Habilitative Services-BEC-2020-07',1,NULL,NULL,NULL,NULL,NULL),(40078,202,23,81,10,77,'Date','2020-07-28',1,NULL,NULL,NULL,NULL,NULL),(40079,202,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40080,202,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40081,202,23,81,10,80,'Short_Answer','Habilitative Services',1,NULL,NULL,NULL,NULL,NULL),(40082,202,23,81,10,81,'Short_Answer','Nicole Schlagel',1,NULL,NULL,NULL,NULL,NULL),(40083,202,23,81,10,82,'Short_Answer','nicole.schlagel@thementornetwork.com',1,NULL,NULL,NULL,NULL,NULL),(40084,202,23,81,10,83,'Short_Answer','507-233-4400',1,NULL,NULL,NULL,NULL,NULL),(40085,202,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(40086,202,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40087,202,23,81,10,86,'Date','2020-05-07',1,NULL,NULL,NULL,NULL,NULL),(40088,202,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(40089,202,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40090,202,23,81,10,91,'Short_Answer','Person eloped from the home without staff knowledge',1,NULL,NULL,NULL,NULL,NULL),(40091,202,23,81,10,94,'True_or_False','No',1,NULL,NULL,NULL,NULL,NULL),(40092,202,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40093,202,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40094,202,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40095,202,23,81,10,100,'Free_Text','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’s 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’s 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’s 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’s 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\n',1,NULL,NULL,NULL,NULL,NULL),(40096,202,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40097,202,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40098,202,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40099,202,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40100,202,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40101,202,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40102,202,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40103,202,23,81,10,102,'Free_Text','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’s 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’s privacy in their room as required by 245D rights and person-centered planning and directed in the CSSP. \r\n\r\nThe worker’s 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.',1,NULL,NULL,NULL,NULL,NULL),(40104,202,23,81,10,103,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40105,202,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40106,202,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40107,202,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40108,202,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40109,202,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40110,202,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40111,202,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40112,202,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40113,202,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40114,202,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40115,202,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40116,202,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40117,202,23,81,10,116,'Free_Text','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. ',1,NULL,NULL,NULL,NULL,NULL),(40118,202,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40119,202,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40120,202,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40121,202,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40122,202,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40123,202,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40124,202,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40125,202,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40126,202,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40127,202,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40128,202,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40129,203,23,81,10,76,'Short_Answer','KP_Harry Meyering-BEC-2021-01',1,NULL,NULL,NULL,NULL,NULL),(40130,203,23,81,10,77,'Date','2021-01-29',1,NULL,NULL,NULL,NULL,NULL),(40131,203,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40132,203,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40133,203,23,81,10,80,'Short_Answer','Harry Meyering Centers',1,NULL,NULL,NULL,NULL,NULL),(40134,203,23,81,10,81,'Short_Answer','Judi Leibbrand',1,NULL,NULL,NULL,NULL,NULL),(40135,203,23,81,10,82,'Short_Answer','jleibbrand@harrymeyeringcenter.org',1,NULL,NULL,NULL,NULL,NULL),(40136,203,23,81,10,83,'Short_Answer','507-387-8281',1,NULL,NULL,NULL,NULL,NULL),(40137,203,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(40138,203,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40139,203,23,81,10,86,'Date','2020-11-10',1,NULL,NULL,NULL,NULL,NULL),(40140,203,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(40141,203,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40142,203,23,81,10,91,'Short_Answer','Staff did not follow policy requiring 3 checks',1,NULL,NULL,NULL,NULL,NULL),(40143,203,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40144,203,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40145,203,23,81,10,98,'Free_Text','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’s 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.\r\n\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40146,203,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40147,203,23,81,10,100,'Free_Text','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’s medication administration policies are influenced by 245D and outlined in the CSSP.  The provider’s 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’s 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.\r\n\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40148,203,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40149,203,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40150,203,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40151,203,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40152,203,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40153,203,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40154,203,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40155,203,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40156,203,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40157,203,23,81,10,104,'Free_Text','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’s 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.\r\n\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40158,203,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40159,203,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40160,203,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40161,203,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40162,203,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40163,203,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40164,203,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40165,203,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40166,203,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40167,203,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40168,203,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40169,203,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40170,203,23,81,10,117,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40171,203,23,81,10,118,'Free_Text','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',1,NULL,NULL,NULL,NULL,NULL),(40172,203,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40173,203,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40174,203,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40175,203,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40176,203,23,81,10,123,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40177,203,23,81,10,124,'Free_Text','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’s medication administration policies are influenced by 245D and outlined in the CSSP.  The provider’s 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\n',1,NULL,NULL,NULL,NULL,NULL),(40178,203,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40179,203,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40180,203,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40181,204,23,81,10,76,'Short_Answer','201900985',1,NULL,NULL,NULL,NULL,NULL),(40182,204,23,81,10,77,'Date','2019-05-15',1,NULL,NULL,NULL,NULL,NULL),(40183,204,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40184,204,23,81,10,79,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(40185,204,23,81,10,80,'Short_Answer','Haugbeck Support Services',1,NULL,NULL,NULL,NULL,NULL),(40186,204,23,81,10,81,'Short_Answer','Mike Beckius',1,NULL,NULL,NULL,NULL,NULL),(40187,204,23,81,10,82,'Short_Answer','mikebeckius@gmail.com',1,NULL,NULL,NULL,NULL,NULL),(40188,204,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40189,204,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(40190,204,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40191,204,23,81,10,86,'Date','2018-11-13',1,NULL,NULL,NULL,NULL,NULL),(40192,204,23,81,10,87,'Free_Text','Staff was meeting at another location with client’s 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. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40193,204,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40194,204,23,81,10,91,'Short_Answer','Staff did not pursue person when they eloped',1,NULL,NULL,NULL,NULL,NULL),(40195,204,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40196,204,23,81,10,97,'Date','2019-06-24',1,NULL,NULL,NULL,NULL,NULL),(40197,204,23,81,10,98,'Free_Text','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. ',1,NULL,NULL,NULL,NULL,NULL),(40198,204,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40199,204,23,81,10,100,'Free_Text','Direct care staff not following the person who eloped from the facility was influenced foremost by the person’s 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’s decision not to follow the person was the team’s (case manager, guardian, provider staff) desire to ensure the safety of staff and the person which was impacted by the person’s 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’s home was in a rural location which also impacted staff’s 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’s 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’s 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’s decision to create an elopement protocol. This is further influenced by the provider’s license requirements of 245A and 245D to safeguard the person’s health, safety and well-being.',1,NULL,NULL,NULL,NULL,NULL),(40200,204,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40201,204,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40202,204,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40203,204,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40204,204,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40205,204,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40206,204,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40207,204,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40208,204,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40209,204,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40210,204,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40211,204,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40212,204,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40213,204,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40214,204,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40215,204,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40216,204,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40217,204,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40218,204,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40219,204,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40220,204,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40221,204,23,81,10,116,'Free_Text','Direct care staff not following the person who eloped from the facility was influenced foremost by the person’s 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’s decision not to follow the person was the team’s (case manager, guardian, provider staff) desire to ensure the safety of staff and the person which was impacted by the person’s 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’s home was in a rural location which also impacted staff’s decision to not follow in the dark due to safety concerns.',1,NULL,NULL,NULL,NULL,NULL),(40222,204,23,81,10,117,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40223,204,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40224,204,23,81,10,119,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40225,204,23,81,10,120,'Free_Text','There are a lack of crises services and placement options available in the area of the person’s home. Because of this, the provider created the elopement protocol as a way to try to balance the support and safety of the person.',1,NULL,NULL,NULL,NULL,NULL),(40226,204,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40227,204,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40228,204,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40229,204,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40230,204,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40231,204,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40232,204,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40233,205,23,81,10,76,'Short_Answer','KP_Maplewood Homes-SLC-2020-10',1,NULL,NULL,NULL,NULL,NULL),(40234,205,23,81,10,77,'Date','2020-10-28',1,NULL,NULL,NULL,NULL,NULL),(40235,205,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40236,205,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40237,205,23,81,10,80,'Short_Answer','Maplewood Homes',1,NULL,NULL,NULL,NULL,NULL),(40238,205,23,81,10,81,'Short_Answer','Tabitha Snider',1,NULL,NULL,NULL,NULL,NULL),(40239,205,23,81,10,82,'Short_Answer','snider.tabatha@yahoo.com',1,NULL,NULL,NULL,NULL,NULL),(40240,205,23,81,10,83,'Short_Answer','218-576-6874',1,NULL,NULL,NULL,NULL,NULL),(40241,205,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(40242,205,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40243,205,23,81,10,86,'Date','2020-08-13',1,NULL,NULL,NULL,NULL,NULL),(40244,205,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(40245,205,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40246,205,23,81,10,91,'Short_Answer','Provider terminated services due to challenging behaviors',1,NULL,NULL,NULL,NULL,NULL),(40247,205,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40248,205,23,81,10,97,'Date','2020-11-30',1,NULL,NULL,NULL,NULL,NULL),(40249,205,23,81,10,98,'Free_Text','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’s 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 “taxi” 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. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40250,205,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40251,205,23,81,10,100,'Free_Text','The provider terminating a person’s 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’s 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\r\n\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40252,205,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40253,205,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40254,205,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40255,205,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40256,205,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40257,205,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40258,205,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40259,205,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40260,205,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40261,205,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40262,205,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40263,205,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40264,205,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40265,205,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40266,205,23,81,10,109,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40267,205,23,81,10,110,'Free_Text','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. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40268,205,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40269,205,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40270,205,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40271,205,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40272,205,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40273,205,23,81,10,116,'Free_Text','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’s 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',1,NULL,NULL,NULL,NULL,NULL),(40274,205,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40275,205,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40276,205,23,81,10,119,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40277,205,23,81,10,120,'Free_Text',' 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\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40278,205,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40279,205,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40280,205,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40281,205,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40282,205,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40283,205,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40284,205,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40285,206,23,81,10,76,'Short_Answer','201904216',1,NULL,NULL,NULL,NULL,NULL),(40286,206,23,81,10,77,'Date','2019-07-15',1,NULL,NULL,NULL,NULL,NULL),(40287,206,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40288,206,23,81,10,79,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(40289,206,23,81,10,80,'Short_Answer','REM Heartland - Couger Court',1,NULL,NULL,NULL,NULL,NULL),(40290,206,23,81,10,81,'Short_Answer','Devin Nelson',1,NULL,NULL,NULL,NULL,NULL),(40291,206,23,81,10,82,'Short_Answer','507-223-4410',1,NULL,NULL,NULL,NULL,NULL),(40292,206,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40293,206,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(40294,206,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40295,206,23,81,10,86,'Date','2019-06-01',1,NULL,NULL,NULL,NULL,NULL),(40296,206,23,81,10,87,'Free_Text','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. ',1,NULL,NULL,NULL,NULL,NULL),(40297,206,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40298,206,23,81,10,91,'Short_Answer','Person received half of the prescribed dosage of medication.',1,NULL,NULL,NULL,NULL,NULL),(40299,206,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40300,206,23,81,10,97,'Date','2019-08-14',1,NULL,NULL,NULL,NULL,NULL),(40301,206,23,81,10,98,'Free_Text','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’s 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’s 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’s 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 “appeared off” 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. ',1,NULL,NULL,NULL,NULL,NULL),(40302,206,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40303,206,23,81,10,100,'Free_Text','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’s 9am medications and one bubble pack for person’s 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’s medication dosage must have changed because of the way the meds were packaged.  Contributing to the staff’s belief that medication dosage changed was further influenced by the person’s 3pm medication dosage matching the 9am medication dosage.  This was further supported by staff 2 not finding the second bubble pack in the person’s 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’s 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’s 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’s actions and assumed if there was a med change the veteran staff would have known as well as followed policies. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40304,206,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40305,206,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40306,206,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40307,206,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40308,206,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40309,206,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40310,206,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40311,206,23,81,10,102,'Free_Text','This was further supported by staff 2 not finding the second bubble pack in the person’s medication drawer, which was the house norm for storing all medications. Staff 2 also believed that staff 1 setup medications correctly.',1,NULL,NULL,NULL,NULL,NULL),(40312,206,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40313,206,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40314,206,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40315,206,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40316,206,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40317,206,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40318,206,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40319,206,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40320,206,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40321,206,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40322,206,23,81,10,113,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40323,206,23,81,10,114,'Free_Text','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’s 9am medications and one bubble pack for person’s 3pm medications.',1,NULL,NULL,NULL,NULL,NULL),(40324,206,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40325,206,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40326,206,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40327,206,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40328,206,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40329,206,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40330,206,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40331,206,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40332,206,23,81,10,123,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40333,206,23,81,10,124,'Free_Text','Staff 2 believed medications were set up correctly was influenced by the belief that the person’s medication dosage must have changed because of the way the meds were packaged.  Contributing to the staff’s belief that medication dosage changed was further influenced by the person’s 3pm medication dosage matching the 9am medication dosage.  \r\n\r\nAn additional factor that had other staff following staff 2’s 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’s actions and assumed if there was a med change the veteran staff would have known as well as followed policies. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40334,206,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40335,206,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40336,206,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40337,207,23,81,10,76,'Short_Answer','201905293',1,NULL,NULL,NULL,NULL,NULL),(40338,207,23,81,10,77,'Date','2019-09-16',1,NULL,NULL,NULL,NULL,NULL),(40339,207,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40340,207,23,81,10,79,'Multiple_Choice','Charles Young',1,NULL,NULL,NULL,NULL,NULL),(40341,207,23,81,10,80,'Short_Answer','REM Heartland, Inc. - Chastworth',1,NULL,NULL,NULL,NULL,NULL),(40342,207,23,81,10,81,'Short_Answer','Lori Larson',1,NULL,NULL,NULL,NULL,NULL),(40343,207,23,81,10,82,'Short_Answer','Lori.Larson@TheMentorNetwork.com',1,NULL,NULL,NULL,NULL,NULL),(40344,207,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40345,207,23,81,10,84,'Multiple_Choice','Staff Sleeping on Duty',1,NULL,NULL,NULL,NULL,NULL),(40346,207,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40347,207,23,81,10,86,'Date','2019-07-19',1,NULL,NULL,NULL,NULL,NULL),(40348,207,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(40349,207,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40350,207,23,81,10,91,'Short_Answer','Staff was sleeping during an evening shift',1,NULL,NULL,NULL,NULL,NULL),(40351,207,23,81,10,94,'True_or_False','No',1,NULL,NULL,NULL,NULL,NULL),(40352,207,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40353,207,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40354,207,23,81,10,99,'Multiple_Choice','Staff No Longer Employed',1,NULL,NULL,NULL,NULL,NULL),(40355,207,23,81,10,100,'Free_Text','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’s 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’s 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’s 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. \r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40356,207,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40357,207,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40358,207,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40359,207,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40360,207,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40361,207,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40362,207,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40363,207,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40364,207,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40365,207,23,81,10,104,'Free_Text','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’s 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’s overall reimbursement negotiated with the county through the 6790 and provides a lower rate asleep than awake hours',1,NULL,NULL,NULL,NULL,NULL),(40366,207,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40367,207,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40368,207,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40369,207,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40370,207,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40371,207,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40372,207,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40373,207,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40374,207,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40375,207,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40376,207,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40377,207,23,81,10,116,'Free_Text','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’s 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. ',1,NULL,NULL,NULL,NULL,NULL),(40378,207,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40379,207,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40380,207,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40381,207,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40382,207,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40383,207,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40384,207,23,81,10,123,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40385,207,23,81,10,124,'Free_Text','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    \r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40386,207,23,81,10,125,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40387,207,23,81,10,126,'Free_Text','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 ',1,NULL,NULL,NULL,NULL,NULL),(40388,207,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40389,208,23,81,10,76,'Short_Answer','201907799',1,NULL,NULL,NULL,NULL,NULL),(40390,208,23,81,10,77,'Date','2019-12-16',1,NULL,NULL,NULL,NULL,NULL),(40391,208,23,81,10,78,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40392,208,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40393,208,23,81,10,80,'Short_Answer','REM Heartland, Inc. - Cougar Drive',1,NULL,NULL,NULL,NULL,NULL),(40394,208,23,81,10,81,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40395,208,23,81,10,82,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40396,208,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40397,208,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(40398,208,23,81,10,85,'Multiple_Choice','Blue Earth County',1,NULL,NULL,NULL,NULL,NULL),(40399,208,23,81,10,86,'Date','2019-10-19',1,NULL,NULL,NULL,NULL,NULL),(40400,208,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(40401,208,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40402,208,23,81,10,91,'Short_Answer','Staff left person unsupervised duirng medication setup',1,NULL,NULL,NULL,NULL,NULL),(40403,208,23,81,10,94,'True_or_False','No',1,NULL,NULL,NULL,NULL,NULL),(40404,208,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40405,208,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40406,208,23,81,10,99,'Multiple_Choice','Staff No Longer Employed',1,NULL,NULL,NULL,NULL,NULL),(40407,208,23,81,10,100,'Free_Text','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’s 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’t 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’s 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’s awareness of the person’s history, which included a previous suicide attempt, further impacted the case manager assigning the provider medication set up assistance responsibility.  \r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40408,208,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40409,208,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40410,208,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40411,208,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40412,208,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40413,208,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40414,208,23,81,10,101,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40415,208,23,81,10,102,'Free_Text','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.  ',1,NULL,NULL,NULL,NULL,NULL),(40416,208,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40417,208,23,81,10,104,'Free_Text','\r\n\r\nThe training offered to staff is impacted by the funding that is allowed in the Disability Waiver Rate Setting Tool, which doesn’t always capture the training staff may need to support a person with mental health issues. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40418,208,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40419,208,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40420,208,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40421,208,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40422,208,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40423,208,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40424,208,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40425,208,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40426,208,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40427,208,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40428,208,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40429,208,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40430,208,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40431,208,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40432,208,23,81,10,119,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40433,208,23,81,10,120,'Free_Text','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.\r\n',1,NULL,NULL,NULL,NULL,NULL),(40434,208,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40435,208,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40436,208,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40437,208,23,81,10,124,'Free_Text','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',1,NULL,NULL,NULL,NULL,NULL),(40438,208,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40439,208,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40440,208,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40441,209,23,81,10,76,'Short_Answer','201905922',1,NULL,NULL,NULL,NULL,NULL),(40442,209,23,81,10,77,'Date','2019-09-16',1,NULL,NULL,NULL,NULL,NULL),(40443,209,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40444,209,23,81,10,79,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(40445,209,23,81,10,80,'Short_Answer','Bluewater Residential Services',1,NULL,NULL,NULL,NULL,NULL),(40446,209,23,81,10,81,'Short_Answer','Toni Martindale',1,NULL,NULL,NULL,NULL,NULL),(40447,209,23,81,10,82,'Short_Answer','toni.martindale@brsduluth.com',1,NULL,NULL,NULL,NULL,NULL),(40448,209,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40449,209,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(40450,209,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40451,209,23,81,10,86,'Date','2019-08-13',1,NULL,NULL,NULL,NULL,NULL),(40452,209,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(40453,209,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40454,209,23,81,10,91,'Short_Answer','Staff administered the wrong medications to two individuals.',1,NULL,NULL,NULL,NULL,NULL),(40455,209,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40456,209,23,81,10,97,'Date','2019-10-22',1,NULL,NULL,NULL,NULL,NULL),(40457,209,23,81,10,98,'Free_Text','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’t 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’s 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’s medications. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40458,209,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40459,209,23,81,10,100,'Free_Text','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’s 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. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40460,209,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40461,209,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40462,209,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40463,209,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40464,209,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40465,209,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40466,209,23,81,10,101,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40467,209,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40468,209,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40469,209,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40470,209,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40471,209,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40472,209,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40473,209,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40474,209,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40475,209,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40476,209,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40477,209,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40478,209,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40479,209,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40480,209,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40481,209,23,81,10,116,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(40482,209,23,81,10,117,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40483,209,23,81,10,118,'Free_Text','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. ',1,NULL,NULL,NULL,NULL,NULL),(40484,209,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40485,209,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40486,209,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40487,209,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40488,209,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40489,209,23,81,10,124,'Free_Text','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).',1,NULL,NULL,NULL,NULL,NULL),(40490,209,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40491,209,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40492,209,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40493,210,23,81,10,76,'Short_Answer','KS_Heartland Homes-SLC-2021-03',1,NULL,NULL,NULL,NULL,NULL),(40494,210,23,81,10,77,'Date','2021-03-30',1,NULL,NULL,NULL,NULL,NULL),(40495,210,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40496,210,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40497,210,23,81,10,80,'Short_Answer','Heartland Homes',1,NULL,NULL,NULL,NULL,NULL),(40498,210,23,81,10,81,'Short_Answer','Jennifer Klaas',1,NULL,NULL,NULL,NULL,NULL),(40499,210,23,81,10,82,'Short_Answer','heartlandhomes.jk34@outlook.com',1,NULL,NULL,NULL,NULL,NULL),(40500,210,23,81,10,83,'Short_Answer','218-727-2110',1,NULL,NULL,NULL,NULL,NULL),(40501,210,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(40502,210,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40503,210,23,81,10,86,'Date','2021-02-08',1,NULL,NULL,NULL,NULL,NULL),(40504,210,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(40505,210,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40506,210,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40507,210,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(40508,210,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40509,210,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40510,210,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40511,210,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40512,210,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40513,210,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40514,210,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40515,210,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40516,210,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40517,210,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40518,210,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40519,210,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40520,210,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40521,210,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40522,210,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40523,210,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40524,210,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40525,210,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40526,210,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40527,210,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40528,210,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40529,210,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40530,210,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40531,210,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40532,210,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40533,210,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40534,210,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40535,210,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40536,210,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40537,210,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40538,210,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40539,210,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40540,210,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40541,210,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40542,210,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40543,210,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40544,210,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40545,211,23,81,10,76,'Short_Answer','KS_REM Arrowhead-SLC-2020-07',1,NULL,NULL,NULL,NULL,NULL),(40546,211,23,81,10,77,'Date','2020-07-30',1,NULL,NULL,NULL,NULL,NULL),(40547,211,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40548,211,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40549,211,23,81,10,80,'Short_Answer','REM Arrowhead',1,NULL,NULL,NULL,NULL,NULL),(40550,211,23,81,10,81,'Short_Answer','Patrick Michael Masyga',1,NULL,NULL,NULL,NULL,NULL),(40551,211,23,81,10,82,'Short_Answer','Pat.Masyga@TheMentorNetwork.com',1,NULL,NULL,NULL,NULL,NULL),(40552,211,23,81,10,83,'Short_Answer','952-922-6776',1,NULL,NULL,NULL,NULL,NULL),(40553,211,23,81,10,84,'Multiple_Choice','Staff Sleeping on Duty',1,NULL,NULL,NULL,NULL,NULL),(40554,211,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40555,211,23,81,10,86,'Date','2020-06-16',1,NULL,NULL,NULL,NULL,NULL),(40556,211,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(40557,211,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40558,211,23,81,10,91,'Short_Answer','Staff was asleep during overnight awake shift',1,NULL,NULL,NULL,NULL,NULL),(40559,211,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40560,211,23,81,10,97,'Date','2020-09-18',1,NULL,NULL,NULL,NULL,NULL),(40561,211,23,81,10,98,'Free_Text','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’d 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’t 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’t aware of this and recalled being “thrown off” 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 “cares” 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 “close her eyes”, but at the time didn’t think to. She further explained thinking, “there’s another person here, I’m just going to close my eyes.” 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.',1,NULL,NULL,NULL,NULL,NULL),(40562,211,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40563,211,23,81,10,100,'Free_Text','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’t 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’s 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’s 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.',1,NULL,NULL,NULL,NULL,NULL),(40564,211,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40565,211,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40566,211,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40567,211,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40568,211,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40569,211,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40570,211,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40571,211,23,81,10,102,'Free_Text','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’s supervision requirements were met), the house was quiet (all residents were asleep).',1,NULL,NULL,NULL,NULL,NULL),(40572,211,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40573,211,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40574,211,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40575,211,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40576,211,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40577,211,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40578,211,23,81,10,109,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40579,211,23,81,10,110,'Free_Text','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’t 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. ',1,NULL,NULL,NULL,NULL,NULL),(40580,211,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40581,211,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40582,211,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40583,211,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40584,211,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40585,211,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40586,211,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40587,211,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40588,211,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40589,211,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40590,211,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40591,211,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40592,211,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40593,211,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40594,211,23,81,10,125,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40595,211,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40596,211,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40597,212,23,81,10,76,'Short_Answer','2019-07-SLC-KS',1,NULL,NULL,NULL,NULL,NULL),(40598,212,23,81,10,77,'Date','2019-07-15',1,NULL,NULL,NULL,NULL,NULL),(40599,212,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40600,212,23,81,10,79,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(40601,212,23,81,10,80,'Short_Answer','Residential Services of NE MN',1,NULL,NULL,NULL,NULL,NULL),(40602,212,23,81,10,81,'Short_Answer','Shelia Fetters',1,NULL,NULL,NULL,NULL,NULL),(40603,212,23,81,10,82,'Short_Answer','sheila.fetters@residentialservices.org',1,NULL,NULL,NULL,NULL,NULL),(40604,212,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40605,212,23,81,10,84,'Multiple_Choice','Wheelchair Safety',1,NULL,NULL,NULL,NULL,NULL),(40606,212,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40607,212,23,81,10,86,'Date','2019-06-10',1,NULL,NULL,NULL,NULL,NULL),(40608,212,23,81,10,87,'Free_Text','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’t have the lap belt on correctly and that it was down around the individual’s ankles at the time of the fall. ',1,NULL,NULL,NULL,NULL,NULL),(40609,212,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40610,212,23,81,10,91,'Short_Answer','Staff was not able to secure seat belt at waist.',1,NULL,NULL,NULL,NULL,NULL),(40611,212,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40612,212,23,81,10,97,'Date','2019-08-23',1,NULL,NULL,NULL,NULL,NULL),(40613,212,23,81,10,98,'Free_Text','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 “medical home”. 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 “the crunch” 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’t 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’t happen. She explained in the VOC training, they don’t 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’t account for this.\r\n',1,NULL,NULL,NULL,NULL,NULL),(40614,212,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40615,212,23,81,10,100,'Free_Text','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’s 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’s 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’s 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’s 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’s position directly impacted staff’s difficulty with the seat belt. \r\n\r\nFurther impacting the staff’s increased anxiety was the staff’s fear of repercussions of being late to the doctor’s 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.',1,NULL,NULL,NULL,NULL,NULL),(40616,212,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40617,212,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40618,212,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40619,212,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40620,212,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40621,212,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40622,212,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40623,212,23,81,10,102,'Free_Text','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’s increased anxiety had a reciprocal impact to one another.',1,NULL,NULL,NULL,NULL,NULL),(40624,212,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40625,212,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40626,212,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40627,212,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40628,212,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40629,212,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40630,212,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40631,212,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40632,212,23,81,10,111,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40633,212,23,81,10,112,'Free_Text','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’s training was focused on medical needs rather than behavior management.',1,NULL,NULL,NULL,NULL,NULL),(40634,212,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40635,212,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40636,212,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40637,212,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40638,212,23,81,10,117,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40639,212,23,81,10,118,'Free_Text','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’s increased anxiety and the attention this was drawing from the community members nearby. Further impacting the staff’s increased anxiety was the staff’s fear of repercussions of being late to the doctor’s appointment. Further complicating the pressure on the agencies, if appointments are not made, there could be maltreatment reports made for failure to provide care.',1,NULL,NULL,NULL,NULL,NULL),(40640,212,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40641,212,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40642,212,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40643,212,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40644,212,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40645,212,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40646,212,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40647,212,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40648,212,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40649,213,23,81,10,76,'Short_Answer','KS_Rural Living Environment-SLC-2019-12',1,NULL,NULL,NULL,NULL,NULL),(40650,213,23,81,10,77,'Date','2019-12-16',1,NULL,NULL,NULL,NULL,NULL),(40651,213,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40652,213,23,81,10,79,'Multiple_Choice','Mor Vue',1,NULL,NULL,NULL,NULL,NULL),(40653,213,23,81,10,80,'Short_Answer','Rural Living Environment',1,NULL,NULL,NULL,NULL,NULL),(40654,213,23,81,10,81,'Short_Answer','Don Negley',1,NULL,NULL,NULL,NULL,NULL),(40655,213,23,81,10,82,'Short_Answer','dnegley@rurallivingmn.com',1,NULL,NULL,NULL,NULL,NULL),(40656,213,23,81,10,83,'Short_Answer','218-827-2322',1,NULL,NULL,NULL,NULL,NULL),(40657,213,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(40658,213,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40659,213,23,81,10,86,'Date','2019-11-01',1,NULL,NULL,NULL,NULL,NULL),(40660,213,23,81,10,87,'Free_Text','The reason for the service termination is: \r\n- the termination is necessary for Dominic\'s welfare and his needs cannot be met in our programs\r\n- Dominic\'s safety and that of his housemate and staff is endangered and positive support strategies that have been attempted have not achieved and effectively maintained safety for Dominic and others. \r\n- Dominic requires a minimum of 2:1 staffing which is not possible with banded rates nor does RLE have the ability to provider additional staffing for this purpose',1,NULL,NULL,NULL,NULL,NULL),(40661,213,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40662,213,23,81,10,91,'Short_Answer','Services terminated due to concerns for staff safety.',1,NULL,NULL,NULL,NULL,NULL),(40663,213,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40664,213,23,81,10,97,'Date','2020-02-04',1,NULL,NULL,NULL,NULL,NULL),(40665,213,23,81,10,98,'Free_Text','Debriefing 1 \r\nThe home was created in 2007 and licensed for 3 beds. Referrals were in from other counties; however, at the same time 2 MSOCS homes were being closed in the county and St. Louis County needed those beds. Host county concurrence from St. Louis County was denied on the 3 out of county individuals. Administration felt that they were forced into taking the three people who eventually moved in. All three had 1:1 staffing ratios when they came in. Even at that time, staff felt that the one individual should have been a 2:1; however, this was not approved by the county. He would bite himself, bite others, hit things which often resulted in daily restraints. He was on a Rule 40 program that created a plan for these restraints. Through the years adjustments were made to the home, attempting to reinforce walls, replacing toilets, industrial sheetrock, etc. \r\n\r\nIn 2017, one of the individuals in the home passed away. The home then went from 3 licensed beds to 2 licensed beds, subsequently only now having 2 staff members in the home where prior to 2017 there were 3. Through the next few years, the individual’s behaviors continued to be present but with the loss of the one staff member, it made it more difficult to intervene. This even resulted in a 60 day termination notice being issued in April 2018; however, no alternative housing option was ever found so the individual never did move from the home .The county was approached about developing a specialized home for the one individual; however, due to banding, which is when rates are locked only allowing incremental increases, they were told this couldn’t happen. In 2019, the banding was frozen so there was no slight increase they saw on their rate. They realize they could have put in 2:1 staffing, but they would have “ate the cost” for this as they would not be reimbursed for the extra staffing. \r\nThrough the years, the individual worked with one staff member who he tended to do better with. This was helpful in having to bring the individual places because they would try to schedule it with the one staff member. However, the staff member resigned in the fall of 2019. With the staff member’s departure, it appeared that the individual’s behaviors started to increase. They attempted various things, some even being quite non-conventional such as getting “gay man pheromones”. At the time of the notice, 911 was called 2 days in a row. They eventually brought him to the Duluth ER where once there, he was restrained by 8 hospital staff.\r\n\r\nWhen asked about other impacts of the situation they found themselves in, the quality of employees was quickly brought up. There continues to be a staffing shortage and it is difficult to find staff, let alone finding staff with any experience or other qualifications. There is also a concern that our state is missing a part of the continuum of care, specifically that there is little to no institutional care option that would allow individuals a longer period of stabilization. \r\n\r\nDebriefing 2 \r\nStaff members were at a point where they were no longer being effective in managing the individual’s behaviors. He went to the annual assessment meeting and saw the extremely high number of PRN’s being given. He realized they were using that as a means to control and “if we’re doing that something is wrong.” In further looking at this, he discovered that the documentation wasn’t always consistent depending on what staff member was documenting. Many behaviors were not being reported in the documentation or if they were, it wasn’t consistent amongst staff on how they were recorded. He felt that they weren’t training staff right. It was difficult to get staff to recognize what they were seeing. The house manager did not experience the same behaviors as the other staff; therefore, what he was reporting was not consistent with what staff experienced. The individual tended to treat certain staff differently, being particularly worse for women.\r\n\r\nAbout three years ago, the number of injuries that staff were sustaining started to rise consistently. Many workman’s comp claims, particularly with concerns about staff being bit. It came down to the realization that they did not have the right house for him and the concerns for staff’s safety. He felt strongly that staff did not fail the individual but rather the individual needed different suppor\r\n',1,NULL,NULL,NULL,NULL,NULL),(40666,213,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40667,213,23,81,10,100,'Free_Text','The services being terminated for a person due to concerns for staff safety were impacted by increased staff injuries. The physical aggression displayed by the person was increasing, which led to the increased staff injuries and the person damaging the house. Staff were not always able to be consistent when redirecting behavior with just one staff which impacted the increased staff injuries. The pressure from the worker’s compensation agency influenced the services terminated due to the concerns for staff safety. The number of workman’s comp claims influenced the pressure from this agency, which was impacted by the increased injuries to staff.\r\n\r\nStaff injuries was also influenced by the staff being unable to consistently redirect behaviors with one staff. One of the impacts to the inconsistency in redirecting behaviors, which included physical aggression, property distruction and self injurious, was the physical layout of the house due to narrow hallways and bathroom made it difficult to give space or intervene so the way staff chose to intervene was dependent on where the staff and individual were physically at in the home at the time of the behavior.The physical layout of the house not only impacted the consistency of redirecting these behaviors, but this also directly impacted the increased staff injuries and the requests to develop a new site around the person’s sensory needs. This request was subsequently denied by the county due to the county being unaware of available funds for modification for new development and that the county had limited foster care development. The limited foster care development was influenced by the county having a high number of foster care homes serving individuals from other counties along with a statewide moratorium on the creation of foster care beds, which in essence was a hold in developing further beds. This moratorium not only limited the foster care development in the county, but it also impacted the elimination of institutions in the state and left few alternative housing options. Other influences of the elimination of institutions was the Jensen Settlement and the Minnesota Olmstead Plan which found that individuals with disabilities were unconstitutionally secluded and the plan detailed a way to ensure that individuals with disabilities live in the most integrated setting appropriate for their needs. Another impact of staff being unable to consistently redirect behaviors with one staff was the staffing level dropped in the home in 2017 after a roommate passed away. When the person passed away, the home reduced their staff level to coincide with the reduced reimbursement that came from that person’s residence in the home. The staff attached to the roommate who passed away would often intervene in de-escalating and responding to the person’s physically aggressive behavior. When the roommate passed away, the provider inquired about adding a staff but were told that 2:1 staff couldn’t be reimbursed. This was impacted by the county not moving forward with the rate exception due to the needs of the person not changing, which in turn was influenced by the banding for the state rate allowing limited rate increase for service intensity. The Disability Waiver Rate System (DWRS) has impacted the banding requirements. The last impact to the staff being unable to consistently redirect behavior with one staff was the difficulty in matching staff to the needs of the people in the home. The difficulty in matching staff was influenced by the person tending to work best with male staff (2 particular staff) but also the low applicant pool fitting the person’s preference.  The low applicant pool was influenced by the current workforce shortage in the community and state. \r\n\r\nThe attempts and barriers to create the right service environment were also an influence to the terminating the person’s services due to concerns for staff safety. This was due to the 2:1 staff not being able to be reimbursed as previously mentioned because the staffing in the home changed but not the person’s needs. It also was influenced by county’s denial of the request to develop a new site around the person’s sensory needs. Subsequently, previous attempts to terminate service were not followed through on due to lack of providers which was impacted by the view that a part of the continuum of care for people with challenging behaviors statewide is missing. This missing part of the continuum is influenced by the lack of crisis respite providers, a lack of service availability between crisis residential services and hospitals, and few services for adults with autism. The effort to eliminate institutions and the DWRS has impacted the missing part of the continuum. The goal of the elimination of institutions to promote community living is generally seen as good; however, the lack of alternatives is what is most problematic to serve this population. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40668,213,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40669,213,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40670,213,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40671,213,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40672,213,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40673,213,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40674,213,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40675,213,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40676,213,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40677,213,23,81,10,104,'Free_Text','Staff injuries was also influenced by the staff being unable to consistently redirect behaviors with one staff. One of the impacts to the inconsistency in redirecting behaviors, which included physical aggression, property destruction and self injurious, was the physical layout of the house due to narrow hallways and bathroom made it difficult to give space or intervene so the way staff chose to intervene was dependent on where the staff and individual were physically at in the home at the time of the behavior.The physical layout of the house not only impacted the consistency of redirecting these behaviors, but this also directly impacted the increased staff injuries and the requests to develop a new site around the person’s sensory needs. \r\n\r\nThe last impact to the staff being unable to consistently redirect behavior with one staff was the difficulty in matching staff to the needs of the people in the home. The difficulty in matching staff was influenced by the person tending to work best with male staff (2 particular staff) but also the low applicant pool fitting the person’s preference.  The low applicant pool was influenced by the current workforce shortage in the community and state. ',1,NULL,NULL,NULL,NULL,NULL),(40678,213,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40679,213,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40680,213,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40681,213,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40682,213,23,81,10,109,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40683,213,23,81,10,110,'Free_Text','The examples of Demand Resource Mismatch & Prescribed Practice (policies, resource constraints, etc.) influenced the ability to have \"success\" working as a team. \r\n\r\nThis request was subsequently denied by the county due to the county being unaware of available funds for modification for new development and that the county had limited foster care development. The limited foster care development was influenced by the county having a high number of foster care homes serving individuals from other counties along with a statewide moratorium on the creation of foster care beds, which in essence was a hold in developing further beds. This moratorium not only limited the foster care development in the county, but it also impacted the elimination of institutions in the state and left few alternative housing options. Other influences of the elimination of institutions was the Jensen Settlement and the Minnesota Olmstead Plan which found that individuals with disabilities were unconstitutionally secluded and the plan detailed a way to ensure that individuals with disabilities live in the most integrated setting appropriate for their needs.\r\n\r\nWhen the roommate passed away, the provider inquired about adding a staff but were told that 2:1 staff couldn’t be reimbursed. This was impacted by the county not moving forward with the rate exception due to the needs of the person not changing, which in turn was influenced by the banding for the state rate allowing limited rate increase for service intensity. ',1,NULL,NULL,NULL,NULL,NULL),(40684,213,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40685,213,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40686,213,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40687,213,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40688,213,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40689,213,23,81,10,116,'Free_Text','The services being terminated for a person due to concerns for staff safety were impacted by increased staff injuries. The physical aggression displayed by the person was increasing, which led to the increased staff injuries and the person damaging the house. Staff were not always able to be consistent when redirecting behavior with just one staff which impacted the increased staff injuries. The pressure from the worker’s compensation agency influenced the services terminated due to the concerns for staff safety. The number of workman’s comp claims influenced the pressure from this agency, which was impacted by the increased injuries to staff.\r\n\r\nThe attempts and barriers to create the right service environment were also an influence to the terminating the person’s services due to concerns for staff safety. This was due to the 2:1 staff not being able to be reimbursed as previously mentioned because the staffing in the home changed but not the person’s needs. It also was influenced by county’s denial of the request to develop a new site around the person’s sensory needs. Subsequently, previous attempts to terminate service were not followed through on due to lack of providers which was impacted by the view that a part of the continuum of care for people with challenging behaviors statewide is missing. This missing part of the continuum is influenced by the lack of crisis respite providers, a lack of service availability between crisis residential services and hospitals, and few services for adults with autism. The effort to eliminate institutions and the DWRS has impacted the missing part of the continuum. The goal of the elimination of institutions to promote community living is generally seen as good; however, the lack of alternatives is what is most problematic to serve this population. ',1,NULL,NULL,NULL,NULL,NULL),(40690,213,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40691,213,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40692,213,23,81,10,119,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40693,213,23,81,10,120,'Free_Text','This missing part of the continuum is influenced by the lack of crisis respite providers, a lack of service availability between crisis residential services and hospitals, and few services for adults with autism. The effort to eliminate institutions and the DWRS has impacted the missing part of the continuum. The goal of the elimination of institutions to promote community living is generally seen as good; however, the lack of alternatives is what is most problematic to serve this population.',1,NULL,NULL,NULL,NULL,NULL),(40694,213,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40695,213,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40696,213,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40697,213,23,81,10,124,'Free_Text','\"Note: a key part of the example of drift stems out of this...The staff attached to the roommate who passed away would often intervene in de-escalating and responding to the person’s physically aggressive behavior...then additional system constraints with DWRS impacted not being able to change the staff ratio to 2:1.\"\r\n\r\nAnother impact of staff being unable to consistently redirect behaviors with one staff was the staffing level dropped in the home in 2017 after a roommate passed away. When the person passed away, the home reduced their staff level to coincide with the reduced reimbursement that came from that person’s residence in the home. The staff attached to the roommate who passed away would often intervene in de-escalating and responding to the person’s physically aggressive behavior. When the roommate passed away, the provider inquired about adding a staff but were told that 2:1 staff couldn’t be reimbursed. This was impacted by the county not moving forward with the rate exception due to the needs of the person not changing, which in turn was influenced by the banding for the state rate allowing limited rate increase for service intensity. ',1,NULL,NULL,NULL,NULL,NULL),(40698,213,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40699,213,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40700,213,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40701,214,23,81,10,76,'Short_Answer','201901897',1,NULL,NULL,NULL,NULL,NULL),(40702,214,23,81,10,77,'Date','2019-05-15',1,NULL,NULL,NULL,NULL,NULL),(40703,214,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40704,214,23,81,10,79,'Multiple_Choice','David Vukelich',1,NULL,NULL,NULL,NULL,NULL),(40705,214,23,81,10,80,'Short_Answer','Westview Services',1,NULL,NULL,NULL,NULL,NULL),(40706,214,23,81,10,81,'Short_Answer','David Birkhofer JR',1,NULL,NULL,NULL,NULL,NULL),(40707,214,23,81,10,82,'Short_Answer','dbirkhofer@westview-services.com',1,NULL,NULL,NULL,NULL,NULL),(40708,214,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40709,214,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(40710,214,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40711,214,23,81,10,86,'Date','2019-03-12',1,NULL,NULL,NULL,NULL,NULL),(40712,214,23,81,10,87,'Free_Text','Staff was doing shift change on overnight shift and became distracted, leaving a card of a controlled medication (lorazepam) on the counter. Isaiah saw the med card, took in and brought it to his room. In the morning it was discovered after doing controlled medication counts that a sheet of the bubble wrapped Ativan was missing. The medication card was found in Isaiah’s possession and there were 12 tablets missing. Isaiah reported that he had taken 12 tablets of the medication. Once discovered, staff called nurse immediately to report. Nurse instructed staff to bring Isaiah to the emergency room. Isaiah was able to be aroused but groggy. After the emergency room evaluation, it was determined that Isaiah could return to the foster care home. No hospitalization required.',1,NULL,NULL,NULL,NULL,NULL),(40713,214,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40714,214,23,81,10,91,'Short_Answer','Individual had access to medications.',1,NULL,NULL,NULL,NULL,NULL),(40715,214,23,81,10,94,'True_or_False','No',1,NULL,NULL,NULL,NULL,NULL),(40716,214,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40717,214,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40718,214,23,81,10,99,'Multiple_Choice','Staff No Longer Employed',1,NULL,NULL,NULL,NULL,NULL),(40719,214,23,81,10,100,'Free_Text','The individual’s access to medication was impacted by the staff’s shift change and set up of the office. Staff was focused on completing a shift change task, of medication reconciling and money reconciling. The medication reconciling and money reconciling are necessary by M.S. 245 licensing requirements and reflected the provider’s attempts to maintain compliance. The staff’s focus of attention to the tasks was impacted as the staff had limited time during shift change. Often times, overlap of staff is only a few minutes, which is why staff adapted to combine the reconciliation processes to complete it quickly. \r\n\r\nImpacting the limited amount of time for shift changes was that the provider could not schedule much overlap between staff during shift changes. Contributing to the limited time was that routine staffing patterns do not allow for staff overlap at shift change. Labor laws can influence staffing patterns by dictating the number of hours individuals can work and the requirement to receive compensation for time worked, including overtime pay. The staffing patterns are both impacted by and impacting the fiscal constraints of the provider. These patterns dictate the level of staffing required for individuals in the home and does not allow for the provider to hire additional staff.  The Rate Management Worksheet (6790) identifies the staffing need of the individual, but does not account for the needs of the provider to support the individual; therefore this impacts the staffing patterns of the home. The MnCHOICES assessment which is completed by the county influences the 6790 by determining the level of care – including staff hours – a person may need. The Rate Management System (RMS) which calculates rates based on information received in the 6790 has a reciprocating impact with the 6790 in that RMS factors in legislative constraints to rates as well as the flexible components negotiated during the 6790 process. The RMS is influenced by both the Disability Waiver Rate System (DWRS) and The Center for Medicare and Medicaid Services (CMS) defined services for indirect and direct care. Only direct service time as defined by CMS and the waiver plan can be included on a 6790 for this service, and as staff coordination is indirect time, this time cannot be added to the worksheet. Therefore, there is no compensation to the provider for overlap in staffing to allow for a shift change because this is considered to be indirect time. The Legislative decisions also impact the DWRS as the legislature creates and amends the rate components set in Minnesota statutes (256B) which directly impacts the rates providers receive to staff homes.',1,NULL,NULL,NULL,NULL,NULL),(40720,214,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40721,214,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40722,214,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40723,214,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40724,214,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40725,214,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40726,214,23,81,10,101,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40727,214,23,81,10,102,'Free_Text','Staff was focused on completing a shift change task, of medication reconciling and money reconciling. The staff’s focus of attention to the tasks was impacted as the staff had limited time during shift change.',1,NULL,NULL,NULL,NULL,NULL),(40728,214,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40729,214,23,81,10,104,'Free_Text','The staffing patterns are both impacted by and impacting the fiscal constraints of the provider. These patterns dictate the level of staffing required for individuals in the home and does not allow for the provider to hire additional staff.  ',1,NULL,NULL,NULL,NULL,NULL),(40730,214,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40731,214,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40732,214,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40733,214,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40734,214,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40735,214,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40736,214,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40737,214,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40738,214,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40739,214,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40740,214,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40741,214,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40742,214,23,81,10,117,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40743,214,23,81,10,118,'Free_Text','Often times, overlap of staff is only a few minutes, which is why staff adapted to combine the reconciliation processes to complete it quickly. ',1,NULL,NULL,NULL,NULL,NULL),(40744,214,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40745,214,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40746,214,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40747,214,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40748,214,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40749,214,23,81,10,124,'Free_Text','Often times, overlap of staff is only a few minutes, which is why staff adapted to combine the reconciliation processes to complete it quickly. ',1,NULL,NULL,NULL,NULL,NULL),(40750,214,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40751,214,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40752,214,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40753,215,23,81,10,76,'Short_Answer','KS_Westview-SLC-2021-02',1,NULL,NULL,NULL,NULL,NULL),(40754,215,23,81,10,77,'Date','2021-02-25',1,NULL,NULL,NULL,NULL,NULL),(40755,215,23,81,10,78,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(40756,215,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40757,215,23,81,10,80,'Short_Answer','Westview Services',1,NULL,NULL,NULL,NULL,NULL),(40758,215,23,81,10,81,'Short_Answer','David Birkhofer',1,NULL,NULL,NULL,NULL,NULL),(40759,215,23,81,10,82,'Short_Answer','dbirkhofer@westview-services.com',1,NULL,NULL,NULL,NULL,NULL),(40760,215,23,81,10,83,'Short_Answer','218-348-1040',1,NULL,NULL,NULL,NULL,NULL),(40761,215,23,81,10,84,'Multiple_Choice','COVID',1,NULL,NULL,NULL,NULL,NULL),(40762,215,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(40763,215,23,81,10,86,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40764,215,23,81,10,87,'Free_Text','Westview Services staff are not wearing masks while working or following the COVID-19 safety policies  put into effect by Department of Health and human services such as sanitizing every 2 hours, socially distancing clients and themselves, not sharing items and not wearing gloves during food prep. Also our water scalds us here!',1,NULL,NULL,NULL,NULL,NULL),(40765,215,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40766,215,23,81,10,91,'Short_Answer','Barriers to supporting people while implementing COVID policies/protocols.',1,NULL,NULL,NULL,NULL,NULL),(40767,215,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40768,215,23,81,10,97,'Date','2021-03-11',1,NULL,NULL,NULL,NULL,NULL),(40769,215,23,81,10,98,'Free_Text','Westview has 6 homes in total with 4 residents living at each home. The staffing patterns typically consist of two workers from 7:00 a.m. to 11:30 p.m. and one awake overnight. The homes tend to be fairly active with trying to do outings and activities such as ball games, bowling, going for drives, etc.\r\n\r\nWhen the CDC and Department of Health set out instructions for individuals to not go anywhere if they don’t have to, residents who were working were pulled back from work and remained in their home. Activities that the workers typically brought people to were pulled back as well. Consequently, there ended up being a sense of fear from the residents. Many of them watch the news and that seemed to be all they were seeing and hearing. There was some increased frustration with some residents as they were unable to do the things they typically do, particularly as these delays went on for so long.\r\n\r\nWhen a home needed to quarantine, it tended to feel like a crazy two weeks. Each time a staff member needed to quarantine or residents ended up positive, there were a core group of staff members who tended to pull together to ensure coverage was provided. While they saw some staff members leave when the $600 unemployment went into effect and people felt they could remain at home and be safe while getting paid. There were attempts made to ensure that sanitizing and safety protocols were in place to minimize risk, but when staff chose to participate in non-work activities that were outside of their work schedule which presented risks, this created a greater burden. Supervisors reminded them to keep the individuals they support in mind when they choose to do certain activities. Individual texts would get sent out to provide those reminders as well. If traveling, quarantining for 3 days (unpaid) and negative COVID test were required.\r\n\r\nThere was some concern of decompensation that was noticed in residents. Some remained fearful to the point where there was concern noted that some may be developing agoraphobia. Many residents did in fact choose to get vaccinated with only one declining. They are hopeful to get back to normal for the majority, but there remain a handful of individuals who will require work and time to get back to where they were at prior to COVID. There are some concerns that pressures will occur from social workers to work on goals where some individuals will simply need time to slowly acclimate back into society again. Some residents really struggled with the mask wearing by staff members. They were unable to recognize the staff members and this frightened them. Many staff members learned that they would need to greet the resident with their mask pulled down so the resident could identify them prior to beginning their work day. \r\n\r\nThere are some things that were identified during this that go against the work that has tried to be done. One of those is having a person centered organization. They’ve worked hard to keep people’s choices in mind, but in the last year found them minimizing these choices and at times telling someone no, they couldn’t do something. The other concern is that staff have lost confidence in making decisions as this time has created some uncertainty for them in their day to day work and the quick changes that have occurred. The impact on staff can be notable for some. Since there are not as many outings and activities happening, they have found increased down time with some staff members. They anticipate losing some staff members as the work changes because expectations will be higher and the work will inadvertently become busier as they resume activities.\r\n',1,NULL,NULL,NULL,NULL,NULL),(40770,215,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40771,215,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40772,215,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40773,215,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40774,215,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40775,215,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40776,215,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40777,215,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40778,215,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40779,215,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40780,215,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40781,215,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40782,215,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40783,215,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40784,215,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40785,215,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40786,215,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40787,215,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40788,215,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40789,215,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40790,215,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40791,215,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40792,215,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40793,215,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40794,215,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40795,215,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40796,215,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40797,215,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40798,215,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40799,215,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40800,215,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40801,215,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40802,215,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40803,215,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40804,215,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40805,216,23,81,10,76,'Short_Answer','201904881',1,NULL,NULL,NULL,NULL,NULL),(40806,216,23,81,10,77,'Date','2019-08-15',1,NULL,NULL,NULL,NULL,NULL),(40807,216,23,81,10,78,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(40808,216,23,81,10,79,'Multiple_Choice','Tim Sullivan',1,NULL,NULL,NULL,NULL,NULL),(40809,216,23,81,10,80,'Short_Answer','Accessible Spaces - Silver Lake',1,NULL,NULL,NULL,NULL,NULL),(40810,216,23,81,10,81,'Short_Answer','Stephen Vander Schaaf',1,NULL,NULL,NULL,NULL,NULL),(40811,216,23,81,10,82,'Short_Answer','svanderschaaf@accessiblespace.org',1,NULL,NULL,NULL,NULL,NULL),(40812,216,23,81,10,83,'Short_Answer','6516457271',1,NULL,NULL,NULL,NULL,NULL),(40813,216,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(40814,216,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(40815,216,23,81,10,86,'Date','2019-07-04',1,NULL,NULL,NULL,NULL,NULL),(40816,216,23,81,10,87,'Free_Text','Reporter heard from staff at VA\'s group home today that VA left sometime between mid day on 7/3/2019 and early morning 7/4/2019. VA\r\ntold one staff member on 7/3/2019, \"I\'m moving out.\" and when the staff asked where VA told him \"I\'m not going to tell you.\" and VA was\r\nnoticed gone early in the morning of 7/4/2019. VA\'s Case manager has received a voice message from VA saying that she is ok and\r\neverything is fine but has not spoken with VA yet. Reporter has tried contacting VA but after ringing a few times VA\'s phone goes to voice\r\nmail and VA\'s voice mail is currently full.',1,NULL,NULL,NULL,NULL,NULL),(40817,216,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40818,216,23,81,10,91,'Short_Answer','Staff did not report Individual\'s absence for 5 days.',1,NULL,NULL,NULL,NULL,NULL),(40819,216,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40820,216,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40821,216,23,81,10,98,'Free_Text','Incident report description\r\nIncident date:	07/04/2019\r\nIt was reported to CEP, that the individual left her group home, which was noted the early morning of 7-4-19, and has not returned for 5 days.  The reporter of the incident had been told by group home staff that the individual had told staff “I’m moving out”.   When staff asked where, the individual stated, “I’m not going to tell you”.  The individual’s case manager reportedly tried calling the individual, but her phone goes to voicemail and message states it is full.\r\n\r\nDebriefing information for Learning Point \r\nDebriefing date: November 18, 2019\r\nPerson debriefed: Home Supervisor\r\nIndividual is her own guardian and has an ongoing medical condition which requires her to attend numerous and frequent medical appointments and at times hospitalizations.  There is only one staff on site at the 4-person group home at a time.  This individual makes and attends her medical appointments by herself and is allowed to be in the community unsupervised.  \r\n\r\nDuring the time of the incident, the home supervisor was on vacation.  Several days prior to the incident, the individual reported to staff that she was moving out of the group home.  The individual reportedly stated she was not going to tell staff where.  One staff emailed the home supervisor (who was on vacation) a day after the incident asking the supervisor if she was aware the individual was moving out of the group home.  \r\n\r\nThe morning of the incident, the individual reported to early morning staff she was moving and would not say where to.  At the time she left the group home, she told a different staff she was going to the hospital.  The individual had unspecified alone time in the community, so staff did not follow her. It was typical for her to leave to do what she wanted without telling staff where she was going. Staff also believed the individual was going to the hospital and did not follow elopement protocol. \r\n\r\nThe individual did not come back to the group home the evening she left.  Staff did not follow up with trying to call the individual, or the covering supervisor, case manager of individual or 911.  Staff believed the individual had either moved out of the home or was hospitalized and due to individual being her own guardian, did not consider this an elopement.   \r\n\r\nWhen the supervisor returned from vacation, she followed up by calling case manager, individual, and reporting the incident.  The individual did go to the hospital and was hospitalized inpatient.  She returned to the group home.\r\n',1,NULL,NULL,NULL,NULL,NULL),(40822,216,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40823,216,23,81,10,100,'Free_Text','Narrative\r\nElopement\r\nDecember 12, 2019 Mapping\r\n\r\n\r\nLearning Point:  Staff did not report individual’s absence for 5 days.\r\n\r\nStaff not following-up about where the individual was for 5 days after she left the group home was influenced by the staff believing the notification policy wasn\'t applicable to this individual and situation. Several factors influenced staff believing the policy wasn\'t applicable including the staff and the individual being newer to the home and the individual being her own guardian.  The two newer staff were less familiar with the support needs of this individual.  As her own guardian, the individual made her own healthcare decisions and did not have to share the information with staff. The individual had a history of being admitted to a hospital without staff knowledge.  The individual had a history of hospitalizations lasting several days which further contributed to staff not believing the policy was applicable.  The provider did have a policy that emergency contacts should be notified if an individual who is their own guardian is hospitalized which was not followed because staff did not know the individual went to the hospital. \r\nOther contributing factors to staff believing the notification policy wasn\'t applicable was the individual was her own guardian and allowed to be in the community unsupervised for an indeterminate amount of time.  The individual’s Community Support Plan (CSP) and Community Support Service Plan (CSSP), which is completed by the individual and a county case manager, did not indicate how much time the individual could have.  Staff would have to follow the consented to CSP and CSSP.  Case Manager’s comply with 245D for how and what is written in an individual’s CSP and CSSP.  The individual approved what was included in the plans.  The individual having unspecified time in the community influenced staff\'s decision that documenting when the individual left was sufficient. The individual regularly was in the community unsupervised so staff felt like it was okay to not notify anyone beyond the logging of their activity in the individual’s logbook. It was noted that staff didn’t have much time to communicate between shifts, so communication often took place in the logbooks instead of staff communication directly with one another regarding the individual.  The individual was admitted to this home directly from a discharge from a hospital and this home was one of only two choices.\r\n\r\nAnother influencing factor affecting staff not following-up to individual’s whereabouts was the staff being worried about calling their supervisor or manager when it wasn\'t necessary due to being of a culture that deffers to authority figures.   Staff were not of the dominant culture and may have felt intimidated by calling a supervisor with questions.\r\n\r\n\r\nAdditionally, staff not following up on the individual was influenced by the house supervisor being on vacation.  At the time, the provider was short staffed and some of the shifts at this residence were covered by non-routine or fill-in staff.  A lack of cross-training on the individuals supports needs and plan of care could influence staff not reporting the individual’s whereabouts.  The provider\'s overall staff shortage, and not just this residence, contributed to having non-routine staff supporting individuals and not having enough time to train non-routine staff on all the support needs of individuals in the group home.  Staff shortage is influenced by the state and national wide direct support professional workforce shortage. \r\n\r\nStaff not following up on their individual’s whereabouts was influenced by the individual keeping an irregular schedule and would often not tell staff where she was going or would tell different information to different staff about where she was going or would be. The individual was described as having much different support needs than the three other individuals living in the group home.  The decision to place the individual in a four person home was impacted by an overall lack of community residential settings in Minnesota.  \r\n',1,NULL,NULL,NULL,NULL,NULL),(40824,216,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40825,216,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40826,216,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40827,216,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40828,216,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40829,216,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40830,216,23,81,10,101,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40831,216,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40832,216,23,81,10,103,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40833,216,23,81,10,104,'Free_Text','The individual was admitted to this home directly from a discharge from a hospital and this home was one of only two choices. The individual was admitted to this home directly from a discharge from a hospital and this home was one of only two choices.\r\n\r\nThe individual was described as having much different support needs than the three other individuals living in the group home.  The decision to place the individual in a home was impacted by an overall lack of community residential settings in Minnesota.  \r\n\r\nThe two newer staff were less familiar with the support needs of this individual.\r\n\r\nAt the time, the provider was short staffed and some of the shifts at this residence were covered by non-routine or fill-in staff.  A lack of cross-training on the individuals supports needs and plan of care could influence staff not reporting the individual’s whereabouts.  The provider\'s overall staff shortage, and not just this residence, contributed to having non-routine staff supporting individuals and not having enough time to train non-routine staff on all the support needs of individuals in the group home.  \r\n\r\n\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40834,216,23,81,10,105,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40835,216,23,81,10,106,'Free_Text','The individual’s Community Support Plan (CSP) and Community Support Service Plan (CSSP), which is completed by the individual and a county case manager, did not indicate how much time the individual could have.  Staff would have to follow the consented to CSP and CSSP.  Case Manager’s comply with 245D for how and what is written in an individual’s CSP and CSSP.  ',1,NULL,NULL,NULL,NULL,NULL),(40836,216,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40837,216,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40838,216,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40839,216,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40840,216,23,81,10,111,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40841,216,23,81,10,112,'Free_Text','Staff not following-up about where the individual was for 5 days after she left the group home was influenced by the staff believing the notification policy wasn\'t applicable to this individual and situation. Several factors influenced staff believing the policy wasn\'t applicable including the staff and the individual being newer to the home and the individual being her own guardian.  \r\n\r\nThe individual having unspecified time in the community influenced staff\'s decision that documenting when the individual left was sufficient. The individual regularly was in the community unsupervised so staff felt like it was okay to not notify anyone beyond the logging of their activity in the individual’s logbook. \r\n\r\n As her own guardian, the individual made her own healthcare decisions and did not have to share the information with staff. The individual had a history of being admitted to a hospital without staff knowledge.  The individual had a history of hospitalizations lasting several days which further contributed to staff not believing the policy was applicable. \r\n',1,NULL,NULL,NULL,NULL,NULL),(40842,216,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40843,216,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40844,216,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40845,216,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40846,216,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40847,216,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40848,216,23,81,10,119,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40849,216,23,81,10,120,'Free_Text','The individual was described as having much different support needs than the three other individuals living in the group home.  The decision to place the individual in a four person home was impacted by an overall lack of community residential settings in Minnesota.  ',1,NULL,NULL,NULL,NULL,NULL),(40850,216,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40851,216,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40852,216,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40853,216,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40854,216,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40855,216,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40856,216,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40857,217,23,81,10,76,'Short_Answer','MB_Dungarvin-HC-2020-05',1,NULL,NULL,NULL,NULL,NULL),(40858,217,23,81,10,77,'Date','2020-05-29',1,NULL,NULL,NULL,NULL,NULL),(40859,217,23,81,10,78,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(40860,217,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40861,217,23,81,10,80,'Short_Answer','Dungarvin',1,NULL,NULL,NULL,NULL,NULL),(40862,217,23,81,10,81,'Short_Answer','Shari Newgard',1,NULL,NULL,NULL,NULL,NULL),(40863,217,23,81,10,82,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40864,217,23,81,10,83,'Short_Answer','651-699-6050 (x5682)',1,NULL,NULL,NULL,NULL,NULL),(40865,217,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(40866,217,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(40867,217,23,81,10,86,'Date','2020-02-24',1,NULL,NULL,NULL,NULL,NULL),(40868,217,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40869,217,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40870,217,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40871,217,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(40872,217,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40873,217,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40874,217,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40875,217,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40876,217,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40877,217,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40878,217,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40879,217,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40880,217,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40881,217,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40882,217,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40883,217,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40884,217,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40885,217,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40886,217,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40887,217,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40888,217,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40889,217,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40890,217,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40891,217,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40892,217,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40893,217,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40894,217,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40895,217,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40896,217,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40897,217,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40898,217,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40899,217,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40900,217,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40901,217,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40902,217,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40903,217,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40904,217,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40905,217,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40906,217,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40907,217,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40908,217,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40909,218,23,81,10,76,'Short_Answer','201905859',1,NULL,NULL,NULL,NULL,NULL),(40910,218,23,81,10,77,'Date','2019-09-16',1,NULL,NULL,NULL,NULL,NULL),(40911,218,23,81,10,78,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(40912,218,23,81,10,79,'Multiple_Choice','Sara Romagnoli',1,NULL,NULL,NULL,NULL,NULL),(40913,218,23,81,10,80,'Short_Answer','Meridian Services, Inc - Kentucky',1,NULL,NULL,NULL,NULL,NULL),(40914,218,23,81,10,81,'Short_Answer','Ginny Benson',1,NULL,NULL,NULL,NULL,NULL),(40915,218,23,81,10,82,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40916,218,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40917,218,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(40918,218,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(40919,218,23,81,10,86,'Date','2019-08-09',1,NULL,NULL,NULL,NULL,NULL),(40920,218,23,81,10,87,'Free_Text','Vincent was released from the hospital on 8/9/2019 at approximately 10:30am to Meridian Services-Kentucky site.\r\nThis is a short term transition/crisis home home until permanent placement can be found. On Vincent\'s discharge orders he was\r\nprescribed Depakote 500mg each morning and 2000mg each evening for mood irritability. This order was not put on Vincent\'s medication\r\nadministration record at the Meridian site. Due to not being on the MAR, Vincent was not administered this medication. The error was\r\ndiscovered today at approximately 3:50pm. After consulting with our LPN, the medication will be started tonight as ordered. Vincent\'s last\r\ndose of administration would have been on Friday, August 9th 8:00am at the hospital before discharge.\r\n\r\nThe MAR was created by Alan Sloan, Program Manager at Kentucky. He also did the initial set-up in the medi-set. Stephanie Hughes did\r\nthe double check on the medi-set prior to being made available to staff for administration.',1,NULL,NULL,NULL,NULL,NULL),(40921,218,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40922,218,23,81,10,91,'Short_Answer','Individual\'s Medication Administration Record (MAR) listed a daily medication as a PRN (as needed) medication.',1,NULL,NULL,NULL,NULL,NULL),(40923,218,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40924,218,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40925,218,23,81,10,98,'Free_Text','Incident report description\r\nIndividual was discharged directly from the hospital to Meridian Kentucky, a Transition Home for adults.  Individual was prescribed Depakote 500 mg in the morning and 2000 mg in the evening every day for mood irritability per his discharge medication order.  Depakote was not put on the Medication Administration Record (MAR) at Meridian Kentucky as a daily medication, but as a PRN.  Due to not being on the MAR as a daily medication, the individual was not administered his medication for 8 administrations from 8/9 to 8/13.  The error was discovered mid-afternoon on 8/13 and the Meridian LPN called and who recommended medication be started again at individual’s night administration. \r\n\r\nDebriefing Information for Learning Point \r\nDebriefing date:	November 18, 2019\r\nPerson debriefed:	Program Administrator\r\nMeridian staff, including the Program Manager of Kentucky went to the hospital to pick up individual to transport to Meridian Kentucky.  The Program Manager was given the individual’s Medication Orders signed by a physician, a Discharge Summary and the individual’s medication in prescription bottles.   At Meridian Kentucky, the Program Manager then completed the Medication Administration Record from the Discharge Summary which listed all the individual’s prescribed medications.  The MAR’s is used for staff to follow when administering the individual’s medication.  Then a lead staff reviewed/checked the MARS completed by the Program Manager for accuracy.  The lead staff signed off on the correctness of MARS.  \r\n\r\nThe Program Manager who completed the MARS no longer works for Meridian, not due to this incident but leaving state and was not available to be debriefed.  The Program Administrator (PA) of Meridian Kentucky was debriefed.  PA explained there are several checks and double checks documented in the process of completing a MARS.  The first was that when an individual is admitted directly from being discharged at hospital, that the actual signed Medication Order and the prescription bottles are to be reviewed to assure they match at the hospital.  Then the Program Manager should review the Medication Orders, and prescription bottles at the group home to again insure the match and then complete the MARS.  The PA stated that this was the first time the Program Manager had completed the MARS without supervision.  Then the process is the double checker, Lead Staff in this case, who was recently promoted and was her first time being a double checker, was to compare the signed order Medication Order, with the completed MARS, then compare the MARS to the created “medi-set” of prescribed medications, then the completed medi-set back to the prescribed bottles. \r\n\r\nThe PA explained that the Program Manager was a newer employee to Meridian Services, had worked at this job for about 8 months, and again, it was the first time completing an intake and MARS independently.  The PA also stated the Program Manager developed the MARS with medication information from the Discharge Summary which also listed the prescribed medications.  The individual had an over the counter PRN listed on the Discharge Summary, and right below this PRN, Depakote was listed so it appeared it was also a PRN.  As stated previously, this was also the first time the Lead Staff, recently promoted, was responsible for double checking a MARS.  The Lead Staff noted the error around 4 days later.\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(40926,218,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40927,218,23,81,10,100,'Free_Text','The Program Manager (PM) listing the daily medication as a PRN medication in the Medication Administration Record (MAR) was influenced by it being the PM\'s first time creating a MAR for a new admission of a person that was coming from a hospital discharge. The PM was working in an unfamiliar environment coordinating a discharge from the hospital and had never completed the forms related to both a hospital discharge and new admission to the provider. Further complicating this process was that PM felt pressure from the hospital to complete the discharge quickly. In turn, the PM felt rushed to complete the discharge process which includes creating a MARS due to hospital beds are in high demand due to a very low availability of psychiatric beds. This is influenced by the state regulating the number of hospital beds that need to be available as psychiatric beds.   \r\n\r\nOn the hospital discharge summary report the medications were in a list. The daily medication was listed right below the PRN category which influenced the PM\'s decision to list it as a PRN. The confusing layout of the discharge summary was influenced by the hospital\'s lack of understanding of licensed crisis homes.\r\n\r\nAdditionally, the PM listing the daily medication as a PRN medication was influenced by it being their first time creating a MAR without the house supervisor. The PM didn\'t typically work with PRNs and when they did, the house supervisor was leading the process in creating the MAR. \r\n\r\nAfter the MAR was completed, the home’s House Supervisor double checked the MAR for accuracy. Further contributing to the daily medication being incorrectly listed in the MAR is that the House Supervisor that completed the double check didn\'t catch the error on the MAR. The House Supervisor not identifying the error was influenced by her being new to the position and it was the first time they completed a double check of a MAR after a hospital discharge.   The double checker  may have been hesitant to correct her direct supervisor.\r\n\r\nAn additional factor influencing the PM listing the daily med as a PRN was that the MAR is created by the provider. Staff felt like the provider staff are not as knowledgeable about medications as a hospital or pharmacy would be. It was the provider\'s responsibility to create the MAR when the person was discharged from the hospital. The provider had a practice of signing and preparing medication orders 24-48 hours before admission to the provider’s residence. Confirming medication regimen prior to admission was a practice developed to decrease medication errors and ensure continuity between settings. However, sometimes there are medication changes at the hospital during that 24-48 hour window and that information may not be shared or updated within the MAR. While this practice of preparing the medication order in advance wasn’t required, it was influenced by licensing and liability laws for providers and the medication administration policies the provider created.  The provider’s medication administration policies were influenced by the county assigning the responsibility to providers and 245D licensing requirements.\r\n',1,NULL,NULL,NULL,NULL,NULL),(40928,218,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40929,218,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40930,218,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40931,218,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40932,218,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40933,218,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40934,218,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40935,218,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40936,218,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40937,218,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40938,218,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40939,218,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40940,218,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(40941,218,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40942,218,23,81,10,109,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40943,218,23,81,10,110,'Free_Text','On the hospital discharge summary report the medications were in a list. The daily medication was listed right below the PRN category which influenced the PM\'s decision to list it as a PRN. The confusing layout of the discharge summary was influenced by the hospital\'s lack of understanding of licensed crisis homes.\r\n\r\nThe provider had a practice of signing and preparing medication orders 24-48 hours before admission to the provider’s residence. Confirming medication regimen prior to admission was a practice developed to decrease medication errors and ensure continuity between settings. However, sometimes there are medication changes at the hospital during that 24-48 hour window and that information may not be shared or updated within the MAR. While this practice of preparing the medication order in advance wasn’t required, it was influenced by licensing and liability laws for providers and the medication administration policies the provider created.  The provider’s medication administration policies were influenced by the county assigning the responsibility to providers and 245D licensing requirements.',1,NULL,NULL,NULL,NULL,NULL),(40944,218,23,81,10,111,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40945,218,23,81,10,112,'Free_Text','The Program Manager (PM) listing the daily medication as a PRN medication in the Medication Administration Record (MAR) was influenced by it being the PM\'s first time creating a MAR for a new admission of a person that was coming from a hospital discharge.  The PM was working in an unfamiliar environment coordinating a discharge from the hospital and had never completed the forms related to both a hospital discharge and new admission to the provider.\r\n\r\nAdditionally, the PM listing the daily medication as a PRN medication was influenced by it being their first time creating a MAR without the house supervisor. The PM didn\'t typically work with PRNs and when they did, the house supervisor was leading the process in creating the MAR. \r\n\r\nFurther contributing to the daily medication being incorrectly listed in the MAR is that the House Supervisor that completed the double check didn\'t catch the error on the MAR. The House Supervisor not identifying the error was influenced by her being new to their position and it was the first time they completed a double check of a MAR after a hospital discharge.   ',1,NULL,NULL,NULL,NULL,NULL),(40946,218,23,81,10,113,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(40947,218,23,81,10,114,'Free_Text','On the hospital discharge summary report the medications were in a list. The daily medication was listed right below the PRN category which influenced the PM\'s decision to list it as a PRN. The confusing layout of the discharge summary was influenced by the hospital\'s lack of understanding of licensed crisis homes.',1,NULL,NULL,NULL,NULL,NULL),(40948,218,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40949,218,23,81,10,116,'Free_Text','The provider had a practice of signing and preparing medication orders 24-48 hours before admission to the provider’s residence. Confirming medication regimen prior to admission was a practice developed to decrease medication errors and ensure continuity between settings. However, sometimes there are medication changes at the hospital during that 24-48 hour window and that information may not be shared or updated within the MAR. While this practice of preparing the medication order in advance wasn’t required, it was influenced by licensing and liability laws for providers and the medication administration policies the provider created.  The provider’s medication administration policies were influenced by the county assigning the responsibility to providers and 245D licensing requirements.',1,NULL,NULL,NULL,NULL,NULL),(40950,218,23,81,10,117,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(40951,218,23,81,10,118,'Free_Text','Further complicating this process was that PM felt pressure from the hospital to complete the discharge quickly. In turn, the PM felt rushed to complete the discharge process which includes creating a MARS due to hospital beds are in high demand due to a very low availability of psychiatric beds',1,NULL,NULL,NULL,NULL,NULL),(40952,218,23,81,10,119,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40953,218,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40954,218,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40955,218,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40956,218,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40957,218,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40958,218,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40959,218,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40960,218,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(40961,219,23,81,10,76,'Short_Answer','Care Manager',1,NULL,NULL,NULL,NULL,NULL),(40962,219,23,81,10,77,'Date','2020-01-28',1,NULL,NULL,NULL,NULL,NULL),(40963,219,23,81,10,78,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(40964,219,23,81,10,79,'Multiple_Choice','Kristie Pittman',1,NULL,NULL,NULL,NULL,NULL),(40965,219,23,81,10,80,'Short_Answer','Options Residential',1,NULL,NULL,NULL,NULL,NULL),(40966,219,23,81,10,81,'Short_Answer','Chantal Kraemer',1,NULL,NULL,NULL,NULL,NULL),(40967,219,23,81,10,82,'Short_Answer','CKraemer@optionsminnesota.com',1,NULL,NULL,NULL,NULL,NULL),(40968,219,23,81,10,83,'Short_Answer','952-564-3030',1,NULL,NULL,NULL,NULL,NULL),(40969,219,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(40970,219,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(40971,219,23,81,10,86,'Date','2019-11-05',1,NULL,NULL,NULL,NULL,NULL),(40972,219,23,81,10,87,'Free_Text','Individual’s DD Waiver residential services were terminated.  The provider stated that the termination was “necessary for your welfare and your needs cannot be met in this facility”, the “safety of you or others in the program is endangered and positive strategies were attempted and have not achieved and effectively maintained safety of you and others” and lastly that the “health of you and others in the program would otherwise be endangered”.  ',1,NULL,NULL,NULL,NULL,NULL),(40973,219,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(40974,219,23,81,10,91,'Short_Answer','Service Termination due to individual’s needs not being able to be met in the group home.',1,NULL,NULL,NULL,NULL,NULL),(40975,219,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(40976,219,23,81,10,97,'Date','2020-05-01',1,NULL,NULL,NULL,NULL,NULL),(40977,219,23,81,10,98,'Free_Text','The individual was admitted to this home in 2015 directly from the hospital.  He is diagnosed with Autism Spectrum Disorder and Other Intellectual Disability.  At the time of his admission the individual was described as only communicating in 2-3 word utterances and by pointing.  Those debriefed made the comment he is very smart.  The individual was admitted directly from a psychiatric hospital discharge and described as very medicated.  The individual’s parents are his guardians.\r\nAt the beginning, the individual had significant interfering behavioral issues including aggression towards others and significant property destruction.  The provider implemented positive behavioral support strategies and with a decrease in medications, notice the individual gained communication abilities.\r\nThere was a time period where the individual had a decrease in behavioral issues, was better able to express his wants and needs and advocate for himself, developed relationships with his peers in the home and became more independent and needing less support.   The provider described using the positive support strategies of using a punching bag and speed bag to provide the individual with needed physical activity he found rewarding, used white noise in his room to help with his sensitivity to sounds his housemates made and he was able to go to his favorite activity Comacon.  \r\nUnfortunately, a housemate the individual was very close to in the home, described more like a sibling, passed away.  A new resident was eventually admitted, who was smaller in stature, cognitively functioned lower and made loud verbalizations.  \r\nThe individual began aggressing towards the new peer and had an increase in behaviors, again including significant property destruction.  The provider enlisted the services of a Behavior Analyst who found clear antecedents to the individual’s interfering behaviors which were his housemates waking earlier than he would like and making noise or peers doing an activity he did not want them to do. \r\nBeing aware the antecedents couldn’t be changed; the provider advocated the individual have a Person-Centered Plan completed.  The individual was very clear that he wanted to live on his own where he could control the environment. The provider also agreed this would be an appropriate setting with supports and even offered a residential setting where this could happen.  The individual’s guardians did not agree with this plan as they felt the individual required 24 hour support.\r\nThe provider decided to demit the individual as the setting he was in was not meeting his needs, nor was it the environment the client wanted to live in. ',1,NULL,NULL,NULL,NULL,NULL),(40978,219,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40979,219,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40980,219,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(40981,219,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(40982,219,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(40983,219,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40984,219,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40985,219,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40986,219,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40987,219,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40988,219,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40989,219,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40990,219,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40991,219,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40992,219,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40993,219,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40994,219,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40995,219,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40996,219,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40997,219,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(40998,219,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(40999,219,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41000,219,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41001,219,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41002,219,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41003,219,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41004,219,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41005,219,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41006,219,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41007,219,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41008,219,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41009,219,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41010,219,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41011,219,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41012,219,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41013,220,23,81,10,76,'Short_Answer','MB_Pathways to Community-HC-2021-04',1,NULL,NULL,NULL,NULL,NULL),(41014,220,23,81,10,77,'Date','2021-04-28',1,NULL,NULL,NULL,NULL,NULL),(41015,220,23,81,10,78,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(41016,220,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41017,220,23,81,10,80,'Short_Answer','Pathways to Community',1,NULL,NULL,NULL,NULL,NULL),(41018,220,23,81,10,81,'Short_Answer','Paul McDowell',1,NULL,NULL,NULL,NULL,NULL),(41019,220,23,81,10,82,'Short_Answer','paul.mcdowell@pathwaystocommunity.com',1,NULL,NULL,NULL,NULL,NULL),(41020,220,23,81,10,83,'Short_Answer','651-641-4009',1,NULL,NULL,NULL,NULL,NULL),(41021,220,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(41022,220,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41023,220,23,81,10,86,'Date','2020-03-30',1,NULL,NULL,NULL,NULL,NULL),(41024,220,23,81,10,87,'Free_Text','Arron eloped out of sight of Pathways staff, resulting in him being missing for nearly 24 hours at the time of this report\'s submission (3/31/21, 3:00pm).  reported that staff were following Arron engaging in fast walking in the community to deescalate, that he was at a bus stop at the time staff no longer could see him, and that it is unknown whether he boarded a bus or not. \r\nEmergency services, including police departments of Minneapolis, St. Paul, and Bloomington, have reportedly been notified and are assisting in the search, and a missing person\'s report was reportedly completed as soon as supervisor was aware that he was gone from staff\'s sight. have been looking for Arron since 4:00am 3/31 and that Arron\'s mom, Linda Huber, has been looking for him all day 3/31 as well. reported the concern that if Arron liked an initial bus ride, he may have ridden several busses and now be out of range of the police departments searching for him.  \r\nArron has an autism diagnosis and a history of police-related trauma and severe aggression. He has limited verbal skills and little to no awareness of whether something is safe or dangerous, who is safe to seek assistance from, or how to keep himself safe. \r\nIt is unknown at this point if Arron is still alive, the timeline in which he will be found, if has sustained physical and/or emotional injury at this point as the result of the lack of supervision. He has for sure missed medication, supervision, access to food, and access to shelter.',1,NULL,NULL,NULL,NULL,NULL),(41025,220,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41026,220,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41027,220,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(41028,220,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41029,220,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41030,220,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41031,220,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41032,220,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41033,220,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41034,220,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41035,220,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41036,220,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41037,220,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41038,220,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41039,220,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41040,220,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41041,220,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41042,220,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41043,220,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41044,220,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41045,220,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41046,220,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41047,220,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41048,220,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41049,220,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41050,220,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41051,220,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41052,220,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41053,220,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41054,220,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41055,220,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41056,220,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41057,220,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41058,220,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41059,220,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41060,220,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41061,220,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41062,220,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41063,220,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41064,220,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41065,221,23,81,10,76,'Short_Answer','201900883',1,NULL,NULL,NULL,NULL,NULL),(41066,221,23,81,10,77,'Date','2019-05-16',1,NULL,NULL,NULL,NULL,NULL),(41067,221,23,81,10,78,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(41068,221,23,81,10,79,'Multiple_Choice','Scott Schifsky',1,NULL,NULL,NULL,NULL,NULL),(41069,221,23,81,10,80,'Short_Answer','Residential Transitions',1,NULL,NULL,NULL,NULL,NULL),(41070,221,23,81,10,81,'Short_Answer','Chrysa Reichel',1,NULL,NULL,NULL,NULL,NULL),(41071,221,23,81,10,82,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41072,221,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41073,221,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(41074,221,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41075,221,23,81,10,86,'Date','2019-02-02',1,NULL,NULL,NULL,NULL,NULL),(41076,221,23,81,10,87,'Free_Text','Individual is a 25 year old woman who lives in a 1 bedroom 245D group home in a residential area in Maple Grove.  It was reported in the CEP Intake Form that the individual was agitated around 12:00 am due to being told she could not call friends as it was too late.  An on call staff was called to help support the individual to understand it was too late to call friends.  The individual went to bed around 1:30 and locked her bedroom door.\r\n\r\nMorning staff arrived at 8:00 and knocked on individual’s door as medications needed to be administered.  Staff heard no response.  Being the door was locked, the staff obtained the key and it was then discovered the individual was not in her room.  Staff followed elopement protocol and notified on-call staff and non-emergency police.  Staff and police searched local area and found individual walking near the home and she was taken back home.\r\n\r\nIndividual stated she waited until overnight staff were in bathroom and then left the home.  She reported she walked to local Walmart, called a friend and then walked to his apartment as he was going call her an Uber.  Her friend came down to meet her, called her an Uber, she instructed the driver to drop her off at park near her group home vs her group home as she wanted to swing.  Originally the individual stated she left at 12:30 am but then stated she wasn’t sure when she left the home.\r\n\r\nIndividual complained of back and foot pain but refused to go to Urgent Care but opted to sleep.  The next morning she was willing to go and was diagnosed with First Degree Frostbite.  Doctor prescribed over the counter medication for blistering and pain.',1,NULL,NULL,NULL,NULL,NULL),(41077,221,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41078,221,23,81,10,91,'Short_Answer','The individual’s plan was to have one awake and one asleep staff on overnight shift. There was no asleep staff.',1,NULL,NULL,NULL,NULL,NULL),(41079,221,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(41080,221,23,81,10,97,'Date','2019-06-10',1,NULL,NULL,NULL,NULL,NULL),(41081,221,23,81,10,98,'Free_Text','orning staff arrived at 8:00 and knocked on individual’s door as medications needed to be administered.  Staff heard no response.  Being the door was locked, the staff obtained the key and it was then discovered the individual was not in her room.  Staff followed elopement protocol and notified on-call staff and non-emergency police.  Staff and police searched local area and found individual walking near the home and she was taken back home.\r\n\r\nIndividual stated she waited until overnight staff were in bathroom and then left the home.  She reported she walked to local Walmart, called friend and then walked to his apartment as he was going call her an Uber.  Her friend came down to meet her, called her an Uber, she instructed the driver to drop her off at park near her group home vs her group home as she wanted to swing.  Originally the individual stated she left at 12:30 am but then stated she wasn’t sure when she left the home.\r\n\r\nIndividual complained of back and foot pain but refused to go to Urgent Care but opted to sleep.  The next morning she was willing to go and was diagnosed with First Degree Frostbite.  Doctor prescribed over the counter medication for blistering and pain.',1,NULL,NULL,NULL,NULL,NULL),(41082,221,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41083,221,23,81,10,100,'Free_Text','No asleep staff for the overnight shift was influenced by the staff who was scheduled being ill and no one else available to cover the shift. Other staff were unwilling to cover this shift because the home is further away than most of the provider’s other homes. Also, the asleep shift was likely to be awake because the person was known for having challenging behaviors.  Further supporting staff’s unwillingness to cover this shift was that they would only receive $10/hour.\r\n\r\nAn additional factor that influenced the shift to go unfilled was that the provider didn’t feel pressure to fill the shift. The individual’s team, including the case manager at Hennepin County, had previously agreed that due to known staffing shortages with the provider, when an overnight asleep was not available the individual’s plan would allow for only the one awake overnight staff.\r\n\r\nMinnesota’s Rate Management System (RMS) determines a reimbursement rate for an individuals required supports (staffing pattern), which is agreed upon by the provider and case manager at the county per the DHS 6790 form.  This RMS rate then affects the provider determining they could pay overnight staff $10/hour for asleep shifts.  \r\n\r\nAnother influence was the Minnesota State Legislature, who creates laws governing provider rates, enforcing a 7% decrease in reimbursement rates to providers in July of 2018.  This impacted the provider’s ability to give an annual raises to staff and in turn influenced the provider having a staff shortage.  This was influenced by Federal (CMS) action determining Minnesota’s reimbursement rates were increased too much in recent years, and the Minnesota Department of Human Services’ decision to determine which rates needed to be cut and by how much to come into compliance with the CMS decision.',1,NULL,NULL,NULL,NULL,NULL),(41084,221,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41085,221,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41086,221,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41087,221,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41088,221,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41089,221,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41090,221,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41091,221,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41092,221,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41093,221,23,81,10,104,'Free_Text','Other staff were unwilling to cover this shift because the home is further away than most of the provider’s other homes. Also, the asleep shift was likely to be awake because the person was known for having challenging behaviors.  Further supporting staff’s unwillingness to cover this shift was that they would only receive $10/hour.\r\n\r\nThis RMS rate then affects the provider determining they could pay overnight staff $10/hour for asleep shifts.  \r\n\r\nAnother influence was the Minnesota State Legislature, who creates laws governing provider rates, enforcing a 7% decrease in reimbursement rates to providers in July of 2018.  This impacted the provider’s ability to give an annual raises to staff and in turn influenced the provider having a staff shortage.  ',1,NULL,NULL,NULL,NULL,NULL),(41094,221,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41095,221,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41096,221,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41097,221,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41098,221,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41099,221,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41100,221,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41101,221,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41102,221,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41103,221,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41104,221,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41105,221,23,81,10,116,'Free_Text','An additional factor that influenced the shift to go unfilled was that the provider didn’t feel pressure to fill the shift. The individual’s team, including the case manager at Hennepin County, had previously agreed that due to known staffing shortages with the provider, when an overnight asleep was not available the individual’s plan would allow for only the one awake overnight staff.',1,NULL,NULL,NULL,NULL,NULL),(41106,221,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41107,221,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41108,221,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41109,221,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41110,221,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41111,221,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41112,221,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41113,221,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41114,221,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41115,221,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41116,221,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(41117,222,23,81,10,76,'Short_Answer','201909221',1,NULL,NULL,NULL,NULL,NULL),(41118,222,23,81,10,77,'Date','2020-01-28',1,NULL,NULL,NULL,NULL,NULL),(41119,222,23,81,10,78,'Multiple_Choice','Sara Romagnoli',1,NULL,NULL,NULL,NULL,NULL),(41120,222,23,81,10,79,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(41121,222,23,81,10,80,'Short_Answer','NHS-Northstar Specialized Services',1,NULL,NULL,NULL,NULL,NULL),(41122,222,23,81,10,81,'Short_Answer','John Briski',1,NULL,NULL,NULL,NULL,NULL),(41123,222,23,81,10,82,'Short_Answer','j.briski@nhs-nss.com',1,NULL,NULL,NULL,NULL,NULL),(41124,222,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41125,222,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(41126,222,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(41127,222,23,81,10,86,'Date','2019-12-18',1,NULL,NULL,NULL,NULL,NULL),(41128,222,23,81,10,87,'Free_Text','IMPACT/EFFECTS ON VA:\r\nDescription of Caregivers Behavior Creating a Health or Safety Risk for the VA: AP refused to administer medication to VA due to\r\nbehavior, AP told other Staff to not give VA medications\r\nImpact of Caregivers Behavior: VA not receive medication',1,NULL,NULL,NULL,NULL,NULL),(41129,222,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41130,222,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41131,222,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(41132,222,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41133,222,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41134,222,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41135,222,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41136,222,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41137,222,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41138,222,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41139,222,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41140,222,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41141,222,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41142,222,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41143,222,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41144,222,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41145,222,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41146,222,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41147,222,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41148,222,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41149,222,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41150,222,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41151,222,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41152,222,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41153,222,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41154,222,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41155,222,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41156,222,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41157,222,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41158,222,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41159,222,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41160,222,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41161,222,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41162,222,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41163,222,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41164,222,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41165,222,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41166,222,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41167,222,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41168,222,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41169,223,23,81,10,76,'Short_Answer','2019-08-SLC-SR',1,NULL,NULL,NULL,NULL,NULL),(41170,223,23,81,10,77,'Date','2019-08-15',1,NULL,NULL,NULL,NULL,NULL),(41171,223,23,81,10,78,'Multiple_Choice','Sara Romagnoli',1,NULL,NULL,NULL,NULL,NULL),(41172,223,23,81,10,79,'Multiple_Choice','Kelly Sather',1,NULL,NULL,NULL,NULL,NULL),(41173,223,23,81,10,80,'Short_Answer','Northland AFC',1,NULL,NULL,NULL,NULL,NULL),(41174,223,23,81,10,81,'Short_Answer','Lindsay Nash',1,NULL,NULL,NULL,NULL,NULL),(41175,223,23,81,10,82,'Short_Answer','Lindsay Nash ',1,NULL,NULL,NULL,NULL,NULL),(41176,223,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41177,223,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(41178,223,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(41179,223,23,81,10,86,'Date','2019-07-21',1,NULL,NULL,NULL,NULL,NULL),(41180,223,23,81,10,87,'Free_Text','Person had confirmed plans with staff to go to the metro area and see a friend. Due to staffing constraints, there was a change resulting in the cancellation or postponement of the trip. \r\n\r\nOn 7/21/19 the person went out for a cigarette at 2am and then allegedly went back to his room. That was the last time he was seen. It was during this time he eloped to Burnsville and MSP. Staff called 911 on or around 5:00 pm the next day once they noticed he was not in his bedroom. \r\n',1,NULL,NULL,NULL,NULL,NULL),(41181,223,23,81,10,96,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41182,223,23,81,10,91,'Short_Answer','Provider cancelled a person\'s planned trip',1,NULL,NULL,NULL,NULL,NULL),(41183,223,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(41184,223,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41185,223,23,81,10,98,'Free_Text','Person had been living at this house only months but had been with the same provider in a different home previously. He wanted to visit a friend near the metro area. Staff conveyed because of the distance and time for the trip it made sense that someone who was working a double shift would make the drive with him. Person followed usual and proper channels to schedule the out of town social activity.\r\nStaff felt that scheduling had become complicated at the time due to employees utilizing vacation time and also during that time the agency was very short staffed. The staff who was scheduled to take him on the trip during a double shift ended up not working the double shift because of how vacation was utilized. When the team saw this schedule conflict, the person was informed they couldn’t go on that weekend. He was initially disappointed, but he seemed to handle the news well after the initial disappointment. \r\nThe house manager usually has an assistant who arranges trips for residents. They work hard to prioritize social outings for people, trips and activities are accommodated. That assistant position was vacant and the house manager was feeling the “burn” of long hours and covering duties outside of her position. The staffing shortage made it hard to be sure residents were able to participate in desired activities.\r\nThe day they noticed person had eloped, staff had assumed he was sleeping in. He usually wakes by 9:00 but since he wasn’t utilizing a job coach during that time, there was no regular asleep/awake schedule. Also, there were no required checks in his plan. During counts, they noticed the bedroom door locked, but saw the window was open and that’s when they discovered he wasn’t there. Some of the staff were aware of his schedule change and that he was originally upset but had seemed to be fine with the change. \r\nPerson has history of elopement. He has a hard time making and keeping friends.  All of his housemates have girlfriends. When he elopes, they believe it is to see a female. Some of his housemates take trips together which he can’t attend due to his inability to afford the trips they take. \r\nHis adoptive mother/guardian is seen as unsupportive. There’s an impression among staff his adoptive mom and him bring out the worst in each other. They believe she expects the worst in him, affecting how he sees himself. They believe their relationship impacts his decisions in a negative way. \r\n',1,NULL,NULL,NULL,NULL,NULL),(41186,223,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41187,223,23,81,10,100,'Free_Text','The provider cancelling a planned trip for a person they served had a number of influences. On the morning the person was going to go on the trip, the provider was short staffed. Originally, the overnight staff was going to work a double shift by staying on for the morning shift. This staff ended up unable to work the morning shift, leaving the home with 2 staff instead of the typical 3. The provider agency was short staffed in general and did not fill the 3rd staff position for this day. The home served 4 people, 2 of which frequently exhibited challenging behavior. This level of need impacted the assignation of 3 staff to the day shifts. Also, the person’s CSSP addendum approved by the county required that the person be staffed at least 1:1 for trips, so due to short staffing it was not possible to send another staff on the trip. A factor into why 1:1 was necessary for trips was that the person had a history of abuse and because of this the guardian usually did not allow the person to meet people they met online without the 1:1 supervision required by the CSSP. Playing into the staffing requirements of the home too was the negotiation process between the county and the provider facilitated by DHS Form 6790 which determines staffing levels. This negotiation is impacted by each person in the home’s MnCHOICES assessment of need completed by the lead agency, as well as the Disability Waiver Rate Setting System which calculates service rates based on staffing needs. The Minnesota Legislature created both MnCHOICES and DWRS requirements. \r\nThis specific staff who couldn’t work the morning shift was the staff the person wanted to take him on the trip and he did not want to go with the other available staff. The person did not want the friend he was going to see to know he lived at the group home, and reportedly felt more comfortable going with the staff who was unable to work the morning shift. \r\nAnother influence to cancelling the trip was that the house manager felt burned out. The influences to the manager feeling burned out included the fact that the provider was – as noted above - short staffed as an agency, the scheduler position who typically takes care of trips was also vacant, a number of staff were taking vacations at this time and the manager was filling a number of shifts themselves. Low unemployment rates in Minnesota and the region contributed to the provider’s short staff issue. Also, this specific trip required a staff to work more than 8 hours due to the distance of trip: driving from Duluth to the Twin Cities required 5-6 hours of drive time alone. This is why the overnight staff who was going to work the double was going to take the person. There was not any staff who could work an extra shift to take this person on the trip, let alone a staff the person wanted to go with. Typical policy was that the provider required 2 weeks notice before long trips to accommodate obtaining a guardian’s permission, case manager agreement and putting together the staffing needs, which made accommodating unexpected staff shortages difficult.  \r\nThe last of the influences identified was that this trip wasn’t a top priority for the staff. The person wanted to see a friend they met online in the metro area, but this person had a history of misusing social media. Specifically, when using social media, the person had a history of pretending to be someone else (known as catfishing) and, as mentioned above, had a history of being abused by people they met online. Partly due to this history, the staff wasn’t sure that the person their client wanted to visit was fully aware of who he was. Due to the vulnerability of the person and their history, the spontaneous trip didn’t meet the needs of the person. \r\n',1,NULL,NULL,NULL,NULL,NULL),(41188,223,23,81,10,127,'Short_Answer','Staff did not perform visual checks between 2am and 5pm',1,NULL,NULL,NULL,NULL,NULL),(41189,223,23,81,10,128,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(41190,223,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41191,223,23,81,10,130,'Free_Text','Person had been living at this house only months but had been with the same provider in a different home previously. He wanted to visit a friend near the metro area. Staff conveyed because of the distance and time for the trip it made sense that someone who was working a double shift would make the drive with him. Person followed usual and proper channels to schedule the out of town social activity.\r\nStaff felt that scheduling had become complicated at the time due to employees utilizing vacation time and also during that time the agency was very short staffed. The staff who was scheduled to take him on the trip during a double shift ended up not working the double shift because of how vacation was utilized. When the team saw this schedule conflict, the person was informed they couldn’t go on that weekend. He was initially disappointed, but he seemed to handle the news well after the initial disappointment. \r\nThe house manager usually has an assistant who arranges trips for residents. They work hard to prioritize social outings for people, trips and activities are accommodated. That assistant position was vacant and the house manager was feeling the “burn” of long hours and covering duties outside of her position. The staffing shortage made it hard to be sure residents were able to participate in desired activities.\r\nThe day they noticed person had eloped, staff had assumed he was sleeping in. He usually wakes by 9:00 but since he wasn’t utilizing a job coach during that time, there was no regular asleep/awake schedule. Also, there were no required checks in his plan. During counts, they noticed the bedroom door locked, but saw the window was open and that’s when they discovered he wasn’t there. Some of the staff were aware of his schedule change and that he was originally upset but had seemed to be fine with the change. \r\nPerson has history of elopement. He has a hard time making and keeping friends.  All of his housemates have girlfriends. When he elopes, they believe it is to see a female. Some of his housemates take trips together which he can’t attend due to his inability to afford the trips they take. \r\nHis adoptive mother/guardian is seen as unsupportive. There’s an impression among staff his adoptive mom and him bring out the worst in each other. They believe she expects the worst in him, affecting how he sees himself. They believe their relationship impacts his decisions in a negative way. \r\n',1,NULL,NULL,NULL,NULL,NULL),(41192,223,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41193,223,23,81,10,132,'Free_Text','Staff not performing visual checks on a person between 2am and 5pm had a number of influences. On the day the checks were not performed, the staff did not have any reason to believe that the person had eloped. While the person did have a history of elopement, he usually exhibited telltale signs of leaving the house such as telling staff they were leaving and/or taking a bag with him. These typical signs were not present this day. Instead the person left without telling anyone or taking a bag with him. Adding to the lack of reason to believe the person eloped was that the person often slept in, had an inconsistent sleep schedule, and refused to eat breakfast on the weekends, so sleeping in on Saturdays was a norm . This person also did not like to be bothered and often wanted his privacy while in his room. Due to cultural norms to allow privacy to people in their bedrooms along with the provider’s licensing statute – MS 245D – guaranteeing a person the right to privacy, this was wish was respected. \r\nAn additional influence to why checks weren’t performed was that the morning shift was short staffed. The house typically required 3 staff to be on in the morning. The overnight staff was going to work a double shift by staying on for the morning shift, but was unable to work. This left the provider with only 2 staff working in the morning shift. It was a norm at the house that they were comfortable only having 2 staff on if both staff were veteran staff, which was the case this day. Although the veteran staff were comfortable working short staffed, this did mean that the two staff had more responsibilities and were thus somewhat overworked and busy that day . \r\n The last influence identified by the mapping team into why staff did not perform checks was that the person’s plan did not require visual checks when he was at home. The provider typically does not perform visual checks on any person while they are in their own home. This practice is impacted by cultural norms to allow people privacy in their bedroom, an emphasis on person-centered planning and thinking and 245D rights to privacy. The provider noted that the only scenario in which they provide visual checks on a person when they were at home was if the person’s Coordinated Service and Support Plan (CSSP), created by the person’s case manager at the lead agency, indicated a need for them and assigned the provider responsibility for it. But considering the person’s history and his desire for privacy, the CSSP did not identify this as a need for this person at the time . The CSSP is created after a MnCHOICES assessment of the person’s needs is completed and neither the assessment nor the plan identified this level of need. Levels of need identified in the CSSP are reflected in the negotiation between the lead agency and the provider facilitated by the DHS-6790 Form. This form is influenced by the provider’s needs, the lead agency’s identification of the person’s needs and the Disability Waiver Rates System which provides a calculation for the person’s service rates. It was the final 6790 which ultimately allowed for the home to sometimes have 3 staff working the morning shift. \r\n',1,NULL,NULL,NULL,NULL,NULL),(41194,223,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41195,223,23,81,10,102,'Free_Text','On the day the checks were not performed, the staff did not have any reason to believe that the person had eloped. While the person did have a history of elopement, he usually exhibited telltale signs of leaving the house such as telling staff they were leaving and/or taking a bag with him. These typical signs were not present this day.',1,NULL,NULL,NULL,NULL,NULL),(41196,223,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41197,223,23,81,10,104,'Free_Text','On the morning the person was going to go on the trip, the provider was short staffed. The provider agency was short staffed in general and did not fill the 3rd staff position for this day.',1,NULL,NULL,NULL,NULL,NULL),(41198,223,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41199,223,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41200,223,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41201,223,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41202,223,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41203,223,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41204,223,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41205,223,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41206,223,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41207,223,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41208,223,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41209,223,23,81,10,116,'Free_Text','Typical policy was that the provider required 2 weeks notice before long trips to accommodate obtaining a guardian’s permission, case manager agreement and putting together the staffing needs, which made accommodating unexpected staff shortages difficult.\r\n\r\nThe last influence identified by the mapping team into why staff did not perform checks was that the person’s plan did not require visual checks when he was at home.',1,NULL,NULL,NULL,NULL,NULL),(41210,223,23,81,10,117,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41211,223,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41212,223,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41213,223,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41214,223,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41215,223,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41216,223,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41217,223,23,81,10,124,'Free_Text','The house typically required 3 staff to be on in the morning. The overnight staff was going to work a double shift by staying on for the morning shift, but was unable to work. This left the provider with only 2 staff working in the morning shift. It was a norm at the house that they were comfortable only having 2 staff on if both staff were veteran staff, which was the case this day.',1,NULL,NULL,NULL,NULL,NULL),(41218,223,23,81,10,125,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41219,223,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41220,223,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(41221,224,23,81,10,76,'Short_Answer','SR_Northland AFC-SLC-2020-08',1,NULL,NULL,NULL,NULL,NULL),(41222,224,23,81,10,77,'Date','2020-08-26',1,NULL,NULL,NULL,NULL,NULL),(41223,224,23,81,10,78,'Multiple_Choice','Sara Romagnoli',1,NULL,NULL,NULL,NULL,NULL),(41224,224,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41225,224,23,81,10,80,'Short_Answer','Northland AFC',1,NULL,NULL,NULL,NULL,NULL),(41226,224,23,81,10,81,'Short_Answer','Lindsay Nash',1,NULL,NULL,NULL,NULL,NULL),(41227,224,23,81,10,82,'Short_Answer','lindsay@northlandafc.com',1,NULL,NULL,NULL,NULL,NULL),(41228,224,23,81,10,83,'Short_Answer','218-464-3864',1,NULL,NULL,NULL,NULL,NULL),(41229,224,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(41230,224,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(41231,224,23,81,10,86,'Date','2020-07-17',1,NULL,NULL,NULL,NULL,NULL),(41232,224,23,81,10,87,'Free_Text','VA went to his room at 6:45 p.m. Was known to be missing at 8:00 p.m. VA was to be quarantining due to COVID-19 guidelines. ',1,NULL,NULL,NULL,NULL,NULL),(41233,224,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41234,224,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41235,224,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(41236,224,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41237,224,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41238,224,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41239,224,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41240,224,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41241,224,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41242,224,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41243,224,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41244,224,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41245,224,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41246,224,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41247,224,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41248,224,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41249,224,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41250,224,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41251,224,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41252,224,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41253,224,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41254,224,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41255,224,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41256,224,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41257,224,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41258,224,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41259,224,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41260,224,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41261,224,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41262,224,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41263,224,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41264,224,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41265,224,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41266,224,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41267,224,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41268,224,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41269,224,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41270,224,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41271,224,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41272,224,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41273,225,23,81,10,76,'Short_Answer','201900095',1,NULL,NULL,NULL,NULL,NULL),(41274,225,23,81,10,77,'Date','2019-05-15',1,NULL,NULL,NULL,NULL,NULL),(41275,225,23,81,10,78,'Multiple_Choice','Sara Romagnoli',1,NULL,NULL,NULL,NULL,NULL),(41276,225,23,81,10,79,'Multiple_Choice','Charles Young',1,NULL,NULL,NULL,NULL,NULL),(41277,225,23,81,10,80,'Short_Answer','REM Arrowhead',1,NULL,NULL,NULL,NULL,NULL),(41278,225,23,81,10,81,'Short_Answer','Corey Labissoniere',1,NULL,NULL,NULL,NULL,NULL),(41279,225,23,81,10,82,'Short_Answer','Corey.LaBissoniere@thementornetwork.com',1,NULL,NULL,NULL,NULL,NULL),(41280,225,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41281,225,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(41282,225,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(41283,225,23,81,10,86,'Date','2019-10-02',1,NULL,NULL,NULL,NULL,NULL),(41284,225,23,81,10,87,'Free_Text','Several staff administered more than one dose of PRN on several occasions to a person who had been prescribed several PRNs.',1,NULL,NULL,NULL,NULL,NULL),(41285,225,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41286,225,23,81,10,91,'Short_Answer','Staff administered more than one dose of PRN on several days in October 2018.',1,NULL,NULL,NULL,NULL,NULL),(41287,225,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(41288,225,23,81,10,97,'Date','2019-06-25',1,NULL,NULL,NULL,NULL,NULL),(41289,225,23,81,10,98,'Free_Text','Several workers administered the medication in the same way resulting in the error. Their decision to administer the medication in the way they did was driven by the instructions on the MAR which they all interpreted the same way, and which was also the incorrect interpretation. The staff interpreted the instruction of “daily” to mean he could have it daily instead it meant a maximum daily (meant once a day and must be 4-6 hours after the last medication and only once a day, not every 4-6 hours daily), thus the over administration. The instructions were on the MAR and not on the med label, which was common practice. The staff followed the policy to check the label and MAR 3x any time there’s a med pass. All staff had received the required training and followed the signature and other MAR review requirements.\r\nThere were four people who signed off as over-administering the PRN. Two were DSPs, one area manager and one program director. The area manager and program director were covering for DSP hours due to a staffing shortage. The DSPs there were new to the agency, as was the program supervisor and the person. It was also noted the person subjected to the overmedication was a new client to the provider. It was conveyed that in a perfect world the provider wouldn’t take new service recipients until all staff were trained specific to a person. He came into a house that was already short-staffed. \r\n\r\nThe person had a high level of care, high needs, compared to others served at the home and was a newer resident of the home, moved there in September and incidents occurred in October. He began receiving services from this home after being in a hospital long after he required a hospital level of care. The transition from the hospital was described as hard: hospital social worker and care team communications were strained and confusing, and the med orders were also described as confusing. When a person with controlled meds transfers from a hospital to a provider, that time was described as being filled with angst. The sense of urgency leads to added stress. He was at the hospital for almost a year and there was extreme pressure to move him out of the hospital. The transition and care planning for this person were complicated by the fact that his guardian and contracted case manager were from Ramsey County. \r\n\r\nHe had multiple controlled meds and overlapping PRNs. For example, one PRN can only be taken X# of hours after another PRN, and there were several of these time lines and instructions to monitor. There was also one other man at the home who had a high contingent of medications. \r\n\r\nThe decision to administer the PRNs was also driven by the prescriber’s instruction to “give him the PRN if he asks for it.” Person had been asking for many PRNs frequently. It was common for him to have more than one agitation a day. He had a diagnosis that included schizophrenia, delusional behavior. He had a long history of chemical abuse. Some of his PRNs included an inhaler, med to reduce nausea, ointment for gums. Staff describe his as having high seeking behavior and describe him as liking to be in control of his medications. He was seen by the staff as being very anxious and demanding. He occasionally raised his voice, swore, used power moves, his thoughts could get “out of control” and turn delusional. It was difficult for staff who had no experience with that. \r\nStaff attribute staffing of the house as a challenge. The house was very short staffed. The provider was not receiving exception rates for the people at this home. They attempted to increase the wage. The location of the home may have been a barrier to keeping it staffed. \r\nThe incident on 11/20/2018, the omission of a medication on the MAR, was influenced by a staffing shortage. The medication was not added to the MAR and it would have been a supervisor’s role to ensure the MAR was correct. The supervisor in charge of the MAR at that time is no longer with the company and was not debriefed. The person who attended the appointment, which was likely the same supervisor, also had a duty to ensure the correct instructions were passed along but that did not happen. ',1,NULL,NULL,NULL,NULL,NULL),(41290,225,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41291,225,23,81,10,100,'Free_Text','Several staff were involved in administering more than one dose of PRN to a person on several dates. This was influenced by a misinterpretation of instructions on the Medication Administration Report (MAR) which is created by the pharmacy. The instructions on the MAR, on the medication bottle and on the referral form for this person were all different. Although the instructions were different enough in wording and readability to create misinterpretation, they were not directly conflicting. For example, the dosage and timing in relation to other PRNs and possible interactions were not fully outlined on each in the same way.  This explains why the confusion may not have been caught despite staff triple checking the instructions each time they administered medications.\r\n\r\nAdding to the potential confusion was that the PRN medication was also prescribed as part of the person’s daily regimen, meaning that in addition to the instructions that it was a daily medication, the PRN was also instructed to be given as needed, but instructions did not specify a timeframe for administering after the daily dose was administered.\r\n\r\nWhile the MAR and other medical instructions are typically reviewed and clarified at intake and then communicated with staff, this transition and intake was perceived as rushed, even urgent. The med instructions were reviewed, but the confusing nature of the instructions along with the rushed intake explain the eventual misinterpretation by staff.There are circumstances that can make a typical intake feel rushed and urgent, which is what happened here. In this case, prior to moving into the home, this person had been in the hospital for a year beyond when he was assessed to no longer require hospital level of care. Hospital administrators feel a high level of pressure to release people. Case managers, in turn, feel that high level of pressure from the hospital. Logically, the provider feels that urgency with which the transition is needed to occur. Since the hospital had been providing services for a year after the person no longer required hospital level of care, staff sensed urgency around the release. Once a provider is found, the timeline for release is nearly immediate. The federal rate structure does not allow for hospitals to bill for services to people who do not require hospital level of care. The length of time the person remained at the hospital was impacted, likely directly caused, by a statewide shortage of community placement options for people with complex needs. \r\nEven under the very best of circumstances, working under an urgent timeline to transition a person with a complex medication schedule, and the fact the residential program was very understaffed, increases the likelihood an incident can occur. The confusing nature of the medication instructions, along with an expedited or “rushed” transition, explains how an error or misunderstanding could occur even if a manager conducted a med review during the transition and intake process. \r\n\r\nAnother factor that contributed to the administration of more than one dose of PRN was staff felt pressure to administer PRNs. The person’s history and diagnosis along with staff wanting to avoid a behavior incident added to the pressure to administer. The person asked for PRNs frequently and it was also the prescriber’s instruction to give the person the PRN when he asked for it. Additional dynamics contributing to the staff feeling a pressure to administer are that the person was new to the home; there were new staff recently hired, not necessarily fully trained for the exact unique needs of the person; and, the management staff covering for a staff shortage were just newly acquainted with the person.\r\n\r\nThe provider desired to make the placement successful, which also added to a perceived pressure to administer. There was a belief that administering PRNs as prescribed and when asked for would be one way to assist in a successful placement. Adding to the desire to facilitate a successful placement was the provider who has incentive to fill open beds which is directly impacted by the Disability Waiver Rates System, whose payment structure is determined by the number of people in a home.',1,NULL,NULL,NULL,NULL,NULL),(41292,225,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41293,225,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41294,225,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41295,225,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41296,225,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41297,225,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41298,225,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41299,225,23,81,10,102,'Free_Text','The person’s history and diagnosis along with staff wanting to avoid a behavior incident added to the pressure to administer. The person asked for PRNs frequently and it was also the prescriber’s instruction to give the person the PRN when he asked for it.',1,NULL,NULL,NULL,NULL,NULL),(41300,225,23,81,10,103,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41301,225,23,81,10,104,'Free_Text','Additional dynamics contributing to the staff feeling a pressure to administer are that the person was new to the home; there were new staff recently hired, not necessarily fully trained for the exact unique needs of the person; and, the management staff covering for a staff shortage were just newly acquainted with the person.',1,NULL,NULL,NULL,NULL,NULL),(41302,225,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41303,225,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41304,225,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41305,225,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41306,225,23,81,10,109,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41307,225,23,81,10,110,'Free_Text','Since the hospital had been providing services for a year after the person no longer required hospital level of care, staff sensed urgency around the release. Once a provider is found, the timeline for release is nearly immediate. Even under the very best of circumstances, working under an urgent timeline to transition a person with a complex medication schedule, and the fact the residential program was very understaffed, increases the likelihood an incident can occur. The confusing nature of the medication instructions, along with an expedited or “rushed” transition, explains how an error or misunderstanding could occur even if a manager conducted a med review during the transition and intake process. ',1,NULL,NULL,NULL,NULL,NULL),(41308,225,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41309,225,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41310,225,23,81,10,113,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41311,225,23,81,10,114,'Free_Text','The instructions on the MAR, on the medication bottle and on the referral form for this person were all different. Although the instructions were different enough in wording and readability to create misinterpretation, they were not directly conflicting. For example, the dosage and timing in relation to other PRNs and possible interactions were not fully outlined on each in the same way.  This explains why the confusion may not have been caught despite staff triple checking the instructions each time they administered medications.\r\n\r\nAdding to the potential confusion was that the PRN medication was also prescribed as part of the person’s daily regimen, meaning that in addition to the instructions that it was a daily medication, the PRN was also instructed to be given as needed, but instructions did not specify a timeframe for administering after the daily dose was administered.',1,NULL,NULL,NULL,NULL,NULL),(41312,225,23,81,10,115,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41313,225,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41314,225,23,81,10,117,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41315,225,23,81,10,118,'Free_Text','While the MAR and other medical instructions are typically reviewed and clarified at intake and then communicated with staff, this transition and intake was perceived as rushed, even urgent. The med instructions were reviewed, but the confusing nature of the instructions along with the rushed intake explain the eventual misinterpretation by staff. There are circumstances that can make a typical intake feel more urgent or even rushed, which is what happened here. In this case, prior to moving into the home, this person had been in the hospital for a year beyond when he was assessed to no longer require hospital level of care. Hospital administrators feel a high level of pressure to release people. Case managers, in turn, feel that high level of pressure from the hospital. Logically, the provider feels that urgency with which the transition is needed to occur. Since the hospital had been providing services for a year after the person no longer required hospital level of care, staff sensed urgency around the release. Once a provider is found, the timeline for release is nearly immediate. The federal rate structure does not allow for hospitals to bill for services to people who do not require hospital level of care. The length of time the person remained at the hospital was impacted, likely directly caused, by a statewide shortage of community placement options for people with complex needs. \r\n\r\nThe provider desired to make the placement successful, which also added to a perceived pressure to administer. There was a belief that administering PRNs as prescribed and when asked for would be one way to assist in a successful placement. Adding to the desire to facilitate a successful placement was the provider who has incentive to fill open beds which is directly impacted by the Disability Waiver Rates System, whose payment structure is determined by the number of people in a home.',1,NULL,NULL,NULL,NULL,NULL),(41316,225,23,81,10,119,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41317,225,23,81,10,120,'Free_Text','The length of time the person remained at the hospital was impacted, likely directly caused, by a statewide shortage of community placement options for people with complex needs.',1,NULL,NULL,NULL,NULL,NULL),(41318,225,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41319,225,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41320,225,23,81,10,123,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41321,225,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41322,225,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41323,225,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41324,225,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(41325,226,23,81,10,76,'Short_Answer','201906864',1,NULL,NULL,NULL,NULL,NULL),(41326,226,23,81,10,77,'Date','2019-10-15',1,NULL,NULL,NULL,NULL,NULL),(41327,226,23,81,10,78,'Multiple_Choice','Sara Romagnoli',1,NULL,NULL,NULL,NULL,NULL),(41328,226,23,81,10,79,'Multiple_Choice','Tony Gantenbein',1,NULL,NULL,NULL,NULL,NULL),(41329,226,23,81,10,80,'Short_Answer','Stepping Stones for Living',1,NULL,NULL,NULL,NULL,NULL),(41330,226,23,81,10,81,'Short_Answer','Laura Flynn',1,NULL,NULL,NULL,NULL,NULL),(41331,226,23,81,10,82,'Short_Answer','laura.flynn@sslduluth.com',1,NULL,NULL,NULL,NULL,NULL),(41332,226,23,81,10,83,'Short_Answer','218-336-6413',1,NULL,NULL,NULL,NULL,NULL),(41333,226,23,81,10,84,'Multiple_Choice','Staff Sleeping on Duty',1,NULL,NULL,NULL,NULL,NULL),(41334,226,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(41335,226,23,81,10,86,'Date','2019-09-19',1,NULL,NULL,NULL,NULL,NULL),(41336,226,23,81,10,87,'Free_Text','On 09/19/2019, it was reported that AP was found sleeping during their shift when they were to be supervising VA. At this time it is undetermined how long AP was asleep for. No harm came to VA during this time.',1,NULL,NULL,NULL,NULL,NULL),(41337,226,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41338,226,23,81,10,91,'Short_Answer','One staff fell asleep during the day shift.',1,NULL,NULL,NULL,NULL,NULL),(41339,226,23,81,10,94,'True_or_False','No',1,NULL,NULL,NULL,NULL,NULL),(41340,226,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41341,226,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41342,226,23,81,10,99,'Multiple_Choice','Staff No Longer Employed',1,NULL,NULL,NULL,NULL,NULL),(41343,226,23,81,10,100,'Free_Text','St. Louis County (Provider-Stepping Stones for Living)\r\nNarrative-Staff Sleeping\r\n\r\nLearning point: One staff fell asleep during the day shift. \r\n\r\nA DSP was found sleeping during the day shift while supervising two VAs. No harm came to VAs as a result. The staff sleeping was influenced by environmental factors in the home as well as outside factors. \r\n\r\nOne environmental factor in the home the day of the incident was that there were less people for the DSP to supervise than normal. There is usually an additional person to supervise, as the staffing ratio was 1:3. The third person was at an activity at the time. Due to this, the house was more quiet than usual which allowed for a more relaxed environment that lent itself to rest. For residents of the home, their needs are defined by assessment results and outlined in a Community Services and Support Plan. The level of staffing needed to address these needs is agreed to by provider and lead agency via a rate management worksheet called a 6790. The rates for the services which take into account shared and individual staffing are then entered into and set by the Disability Waiver Rates System (DWRS). \r\nAnother environmental factor in the home was the daily program consisted of unstructured home time and TV watching. That day, the house was quiet and there was unstructured TV watching time. Programs or daily schedules for residents are outlined in their CSSP and supported by policies that emphasize and protect personal preference. Personal preference and control over one’s schedule is a tenant of the federal Home and Community Based Services Rule which governs HCBS providers. Additionally, residential providers are required to carry a 245D license which secures a person’s right to choose activities they prefer and have a say in their daily schedule. This unstructured time was an additional factor that led to a quiet house in which the staff experienced down time, leading to sleep. \r\nOutside factors that contributed to staff sleeping were also present. One outside factor is that the DSP was experiencing homelessness and was exhausted from that life stressor. It is not uncommon for DSPs to experience intermittent homelessness. In the Northeast MN region, there is a lack of affordable housing, housing resources and coordination. The governmental body that oversees housing and distribution of housing resources is Housing and Urban Development. \r\nAnother outside factor is the DSP was working extra shifts as the provider had unfilled shifts available. In doing so, the DSP’s basic needs such as having a roof over his head were met. He picked up extra shifts also because the provider was offering overtime pay. The fact the provider had unfilled shifts is due to the well-known and highly publicized state and national workforce shortage. \r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(41344,226,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41345,226,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41346,226,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41347,226,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41348,226,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41349,226,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41350,226,23,81,10,101,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41351,226,23,81,10,102,'Free_Text','One environmental factor in the home the day of the incident was that there were less people for the DSP to supervise than normal. There is usually an additional person to supervise, as the staffing ratio was 1:3. The third person was at an activity at the time. Due to this, the house was more quiet than usual which allowed for a more relaxed environment that lent itself to rest. For residents of the home, their needs are defined by assessment results and outlined in a Community Services and Support Plan. The level of staffing needed to address these needs is agreed to by provider and lead agency via a rate management worksheet called a 6790. The rates for the services which take into account shared and individual staffing are then entered into and set by the Disability Waiver Rates System (DWRS). \r\nAnother environmental factor in the home was the daily program consisted of unstructured home time and TV watching. That day, the house was quiet and there was unstructured TV watching time. Programs or daily schedules for residents are outlined in their CSSP and supported by policies that emphasize and protect personal preference. Personal preference and control over one’s schedule is a tenant of the federal Home and Community Based Services Rule which governs HCBS providers. Additionally, residential providers are required to carry a 245D license which secures a person’s right to choose activities they prefer and have a say in their daily schedule. This unstructured time was an additional factor that led to a quiet house in which the staff experienced down time, leading to sleep. \r\n',1,NULL,NULL,NULL,NULL,NULL),(41352,226,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41353,226,23,81,10,104,'Free_Text','Outside factors that contributed to staff sleeping were also present. One outside factor is that the DSP was experiencing homelessness and was exhausted from that life stressor. It is not uncommon for DSPs to experience intermittent homelessness. In the Northeast MN region, there is a lack of affordable housing, housing resources and coordination. The governmental body that oversees housing and distribution of housing resources is Housing and Urban Development. \r\nAnother outside factor is the DSP was working extra shifts as the provider had unfilled shifts available. In doing so, the DSP’s basic needs such as having a roof over his head were met. He picked up extra shifts also because the provider was offering overtime pay. The fact the provider had unfilled shifts is due to the well-known and highly publicized state and national workforce shortage. \r\n',1,NULL,NULL,NULL,NULL,NULL),(41354,226,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41355,226,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41356,226,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41357,226,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41358,226,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41359,226,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41360,226,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41361,226,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41362,226,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41363,226,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41364,226,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41365,226,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41366,226,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41367,226,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41368,226,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41369,226,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41370,226,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41371,226,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41372,226,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41373,226,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41374,226,23,81,10,125,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41375,226,23,81,10,126,'Free_Text','Outside factors that contributed to staff sleeping were also present. One outside factor is that the DSP was experiencing homelessness and was exhausted from that life stressor. It is not uncommon for DSPs to experience intermittent homelessness. In the Northeast MN region, there is a lack of affordable housing, housing resources and coordination. The governmental body that oversees housing and distribution of housing resources is Housing and Urban Development. \r\nAnother outside factor is the DSP was working extra shifts as the provider had unfilled shifts available. In doing so, the DSP’s basic needs such as having a roof over his head were met. He picked up extra shifts also because the provider was offering overtime pay. The fact the provider had unfilled shifts is due to the well-known and highly publicized state and national workforce shortage. \r\n',1,NULL,NULL,NULL,NULL,NULL),(41376,226,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(41377,227,23,81,10,76,'Short_Answer','SS_BridgesMN-HC-2020-08',1,NULL,NULL,NULL,NULL,NULL),(41378,227,23,81,10,77,'Date','2020-08-26',1,NULL,NULL,NULL,NULL,NULL),(41379,227,23,81,10,78,'Multiple_Choice','Scott Schifsky',1,NULL,NULL,NULL,NULL,NULL),(41380,227,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41381,227,23,81,10,80,'Short_Answer','Bridges MN',1,NULL,NULL,NULL,NULL,NULL),(41382,227,23,81,10,81,'Short_Answer','Kelsey Traynor (completed the BIRF)',1,NULL,NULL,NULL,NULL,NULL),(41383,227,23,81,10,82,'Short_Answer','kelseyt@bridgesmn.com',1,NULL,NULL,NULL,NULL,NULL),(41384,227,23,81,10,83,'Short_Answer','651-334-9629',1,NULL,NULL,NULL,NULL,NULL),(41385,227,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(41386,227,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41387,227,23,81,10,86,'Date','2020-06-29',1,NULL,NULL,NULL,NULL,NULL),(41388,227,23,81,10,87,'Free_Text','On 06/29/2020 VA packed up his belongings at approximately 6:00 pm and left the home, stating he was going to\r\nChicago to visit his sister. VA then proceeded to walk towards the bus stop and waited. Staff followed the bus once VA got on the bus. Staff\r\ncontacted Metro Transit Police for assistance, who then intervened. The officer called the Supervisor, who then called in the Community\r\nLiving Director (CLD) as well, via phone, to discuss the situation. The CLD explained VA\'s situation and that he is on a commitment and\r\nprovisional discharge, and requested assistance in getting the VA back to the residence. The officer informed the CLD and supervisor that\r\ndue to VA being their own guardian and not being a danger to himself or others, they could not do anything except encourage VA to go with\r\nstaff. The CLD then met VA and staff at the Greyhound Bus Station in Minneapolis a little before 8:00 pm, just as VA was purchasing a bus\r\nticket to Chicago. Staff and CLD attempted every approach they could think of to get VA to reconsider leaving the state, but VA still planned\r\nto get on the bus. VA reported having connections in Chicago and has a plan, but would not share any further details. VA recently\r\npurchased a cell phone, but refused to give staff the phone number to the new phone. The CLD called Fairview Hospital to discuss the\r\nsituation, but they also stated \"our hands are tied\" since VA is his own guardian. Staff remained with VA at the bus station until 1:00 am on\r\n06/30/2020, when VA left on the greyhound bus to Chicago. The CLD filed a missing persons report with the Minneapolis Police\r\nDepartment, who stated they would pass this report along to the Chicago Police Department as well. The CLD attempted to contact VA\'s\r\nmother, but the mother\'s phone was disconnected. The CLD also attempted to call VA\'s grandmother, who did not answer or respond to\r\nthe CLD\'s voicemails.\r\nStaff followed all care plans and attempted to redirect VA into not going on the bus, but VA made the choice to leave. VA did not have any\r\nmedications packed and is due for an injection on 07/08/2020. VA is prescribed multiple psychotropic medications, including an injection.\r\nVA has a history of attempting to ',1,NULL,NULL,NULL,NULL,NULL),(41389,227,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41390,227,23,81,10,91,'Short_Answer','Staff did not follow person’s plan that said the person should not have alone time.',1,NULL,NULL,NULL,NULL,NULL),(41391,227,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(41392,227,23,81,10,97,'Date','2020-10-06',1,NULL,NULL,NULL,NULL,NULL),(41393,227,23,81,10,98,'Free_Text','Two night staff from Bridges were de-briefed.  They relieved two second shift staff who followed the person to the bus station and worked to help attempt to help the person return home.  \r\n\r\nThe staff worked by relieving each other in the bus station as there was not adequate parking at the bus station so they had to park on the street and one person needed to remain in the car to assure it did not get towed.   They both stated the person would not talk to them and the bus station was very busy.  The person smoked frequently outside the bus station while waiting for departure.   Staff also had one mask to share while switching spots from the car to inside the bus station next to the person.  Staff would use their shirt as a mask while switching.   The person spent most of their time listening to music and ignoring staff.   Staff attempted several times to have a conversation in an effort to persuade the person to return back to the home.   At about 1:00 AM the person departed on the bus and staff returned back to the home.   Staff were in frequent contact with the home manager for guidance. Staff were instructed to remain with the person at the bus station, however, they were instructed that he was his own guardian and could leave.\r\n',1,NULL,NULL,NULL,NULL,NULL),(41394,227,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41395,227,23,81,10,100,'Free_Text','Learning Point:  Staff were unable to redirect a person from departing on a bus to Chicago.  \r\n\r\nStaff 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’t communicate with staff present.  All efforts to redirect the person were unsuccessful while exhausting all other safe alternatives. The person was earlier hospitalized regarding mental health and aggression and the staff was hesitant at the moment and didn’t want to anger the person further. Another contributing factor was that the person received a COVID stimulus 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’s risk management plan and it was affirmed. Contributing factors that further influenced the staffs’ 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 hesitant to anger the person. This was further supported by the person having a history of aggressive behavior. The person wouldn’t communicate with the staff present and they were hesitant to coerce 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 lent to the person was the agency’s 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’s 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’s stay at home order also influenced the person’s decision to leave as his routine was limited to low activity. This elopement influenced the agency, team, and staff present to honor the person’s 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.    \r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(41396,227,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41397,227,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41398,227,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41399,227,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41400,227,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41401,227,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41402,227,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41403,227,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41404,227,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41405,227,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41406,227,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41407,227,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41408,227,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41409,227,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41410,227,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41411,227,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41412,227,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41413,227,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41414,227,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41415,227,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41416,227,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41417,227,23,81,10,116,'Free_Text','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’t communicate with staff present.  All efforts to redirect the person were unsuccessful while exhausting all other safe alternatives. The person was earlier hospitalized regarding mental health and aggression and the staff was hesitant at the moment and didn’t want to anger the person further. Another contributing factor was that the person received a COVID stimulus 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’s risk management plan and it was affirmed. Contributing factors that further influenced the staffs’ 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 hesitant to anger the person. This was further supported by the person having a history of aggressive behavior. The person wouldn’t communicate with the staff present and they were hesitant to coerce 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 lent to the person was the agency’s 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’s 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’s stay at home order also influenced the person’s decision to leave as his routine was limited to low activity. This elopement influenced the agency, team, and staff present to honor the person’s 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. ',1,NULL,NULL,NULL,NULL,NULL),(41418,227,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41419,227,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41420,227,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41421,227,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41422,227,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41423,227,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41424,227,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41425,227,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41426,227,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41427,227,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41428,227,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(41429,228,23,81,10,76,'Short_Answer','201908690',1,NULL,NULL,NULL,NULL,NULL),(41430,228,23,81,10,77,'Date','2019-12-16',1,NULL,NULL,NULL,NULL,NULL),(41431,228,23,81,10,78,'Multiple_Choice','Scott Schifsky',1,NULL,NULL,NULL,NULL,NULL),(41432,228,23,81,10,79,'Multiple_Choice','Sara Romagnoli',1,NULL,NULL,NULL,NULL,NULL),(41433,228,23,81,10,80,'Short_Answer','JEC Miller',1,NULL,NULL,NULL,NULL,NULL),(41434,228,23,81,10,81,'Short_Answer','Adam Gregg',1,NULL,NULL,NULL,NULL,NULL),(41435,228,23,81,10,82,'Short_Answer','adam@jecmiller.com',1,NULL,NULL,NULL,NULL,NULL),(41436,228,23,81,10,83,'Short_Answer','952-303-1614',1,NULL,NULL,NULL,NULL,NULL),(41437,228,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(41438,228,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41439,228,23,81,10,86,'Date','2019-11-23',1,NULL,NULL,NULL,NULL,NULL),(41440,228,23,81,10,87,'Free_Text','Peter walked to the store down the road from his home. He was gone for roughly 30 minutes. Peter does not have alone time.',1,NULL,NULL,NULL,NULL,NULL),(41441,228,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41442,228,23,81,10,91,'Short_Answer','Staff did not follow person’s plan that said the person should not have alone time',1,NULL,NULL,NULL,NULL,NULL),(41443,228,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(41444,228,23,81,10,97,'Date','2020-02-12',1,NULL,NULL,NULL,NULL,NULL),(41445,228,23,81,10,98,'Free_Text','Staff did not follow person’s plan that said the person should not have alone time',1,NULL,NULL,NULL,NULL,NULL),(41446,228,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41447,228,23,81,10,100,'Free_Text','Staff not following the person’s plan that said they should not have alone time was influenced by the unfamiliarity the staff had at the home as they were transferred to cover appropriate shifts as the provider was short staffed. This required the provider to train the staff quickly to become familiar with the home and the people who lived there. When a staff trains at a new home, they have to read multiple plans for each person who lives in the home. The staff present the day of the incident worked at multiple homes to help fill shifts as the provider was short staffed. Low unemployment rates in the region and the state contributed to low unemployment rates, which in turn contributed the provider being short staffed. Adding to the unfamiliarity the staff had with the home, the person who eloped was difficult to understand and was noted to often test boundaries with staff which made it difficult for staff to understand that the person was not supposed to be alone.\r\n\r\nThe staff’s understanding of the difference between alone and community time further influenced the staff not following the person’s plan.  There was also another person in the home that did not have alone time which was contrary to the house norm which implied that each person had some alone time.  Furthermore, the two staff’s roles were not clearly communicated to them and the second staff didn’t counter the support staff’s understanding and may not have been aware.   The person’s plan stated they did have 10 minutes of home time alone but no unsupervised time in the community.  This created confusion for the staff who was new working in the home and had to train fast. \r\n\r\nThe basis for alone time according to the provider can be difficult to manage as staff have to read multiple plans for a person.  There was also pressure due to the staff shortage that is directly tied to regional and statewide staff shortages and overall low unemployment rates.  The CSSP no longer has a line to state whether a person has alone time hence creating confusion and vagueness.  The DWRS further influences the 6790 which connects to provider resources and their need to share a van with multiple locations that support people with disabilities.   \r\n',1,NULL,NULL,NULL,NULL,NULL),(41448,228,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41449,228,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41450,228,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41451,228,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41452,228,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41453,228,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41454,228,23,81,10,101,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41455,228,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41456,228,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41457,228,23,81,10,104,'Free_Text','Staff not following the person’s plan that said they should not have alone time was influenced by the unfamiliarity the staff had at the home as they were transferred to cover appropriate shifts as the provider was short staffed. This required the provider to train the staff quickly to become familiar with the home and the people who lived there. When a staff trains at a new home, they have to read multiple plans for each person who lives in the home. The staff present the day of the incident worked at multiple homes to help fill shifts as the provider was short staffed. The basis for alone time according to the provider can be difficult to manage as staff have to read multiple plans for a person.   The CSSP no longer has a line to state whether a person has alone time hence creating confusion and vagueness.  The DWRS further influences the 6790 which connects to provider resources and their need to share a van with multiple locations that support people with disabilities.   ',1,NULL,NULL,NULL,NULL,NULL),(41458,228,23,81,10,105,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41459,228,23,81,10,106,'Free_Text','The CSSP no longer has a line to state whether a person has alone time hence creating confusion and vagueness.  ',1,NULL,NULL,NULL,NULL,NULL),(41460,228,23,81,10,107,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41461,228,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41462,228,23,81,10,109,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41463,228,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41464,228,23,81,10,111,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41465,228,23,81,10,112,'Free_Text','Staff not following the person’s plan that said they should not have alone time was influenced by the unfamiliarity the staff had at the home as they were transferred to cover appropriate shifts as the provider was short staffed. This required the provider to train the staff quickly to become familiar with the home and the people who lived there. When a staff trains at a new home, they have to read multiple plans for each person who lives in the home. The staff present the day of the incident worked at multiple homes to help fill shifts as the provider was short staffed. Low unemployment rates in the region and the state contributed to low unemployment rates, which in turn contributed the provider being short staffed. Adding to the unfamiliarity the staff had with the home, the person who eloped was difficult to understand and was noted to often test boundaries with staff which made it difficult for staff to understand that the person was not supposed to be alone.',1,NULL,NULL,NULL,NULL,NULL),(41466,228,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41467,228,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41468,228,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41469,228,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41470,228,23,81,10,117,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41471,228,23,81,10,118,'Free_Text','Staff not following the person’s plan that said they should not have alone time was influenced by the unfamiliarity the staff had at the home as they were transferred to cover appropriate shifts as the provider was short staffed. This required the provider to train the staff quickly to become familiar with the home and the people who lived there. ',1,NULL,NULL,NULL,NULL,NULL),(41472,228,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41473,228,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41474,228,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41475,228,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41476,228,23,81,10,123,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41477,228,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41478,228,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41479,228,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41480,228,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(41481,229,23,81,10,76,'Short_Answer','SS_Merdian-HC-2021-02',1,NULL,NULL,NULL,NULL,NULL),(41482,229,23,81,10,77,'Date','2021-02-25',1,NULL,NULL,NULL,NULL,NULL),(41483,229,23,81,10,78,'Multiple_Choice','Scott Schifsky',1,NULL,NULL,NULL,NULL,NULL),(41484,229,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41485,229,23,81,10,80,'Short_Answer','Meridian Services - Timber Crest',1,NULL,NULL,NULL,NULL,NULL),(41486,229,23,81,10,81,'Short_Answer','Rebecca Hage-Thomley',1,NULL,NULL,NULL,NULL,NULL),(41487,229,23,81,10,82,'Short_Answer','rthomley@orionassoc.net',1,NULL,NULL,NULL,NULL,NULL),(41488,229,23,81,10,83,'Short_Answer','763-450-5045',1,NULL,NULL,NULL,NULL,NULL),(41489,229,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(41490,229,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41491,229,23,81,10,86,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41492,229,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41493,229,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41494,229,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41495,229,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(41496,229,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41497,229,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41498,229,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41499,229,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41500,229,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41501,229,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41502,229,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41503,229,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41504,229,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41505,229,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41506,229,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41507,229,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41508,229,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41509,229,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41510,229,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41511,229,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41512,229,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41513,229,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41514,229,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41515,229,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41516,229,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41517,229,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41518,229,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41519,229,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41520,229,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41521,229,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41522,229,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41523,229,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41524,229,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41525,229,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41526,229,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41527,229,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41528,229,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41529,229,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41530,229,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41531,229,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41532,229,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41533,230,23,81,10,76,'Short_Answer','201906129',1,NULL,NULL,NULL,NULL,NULL),(41534,230,23,81,10,77,'Date','2019-09-16',1,NULL,NULL,NULL,NULL,NULL),(41535,230,23,81,10,78,'Multiple_Choice','Scott Schifsky',1,NULL,NULL,NULL,NULL,NULL),(41536,230,23,81,10,79,'Multiple_Choice','Aric Gregg',1,NULL,NULL,NULL,NULL,NULL),(41537,230,23,81,10,80,'Short_Answer','Opportunity Partners - Keith\'s Place',1,NULL,NULL,NULL,NULL,NULL),(41538,230,23,81,10,81,'Short_Answer','Jay McKibbins',1,NULL,NULL,NULL,NULL,NULL),(41539,230,23,81,10,82,'Short_Answer','jmckibbins@opportunities.org',1,NULL,NULL,NULL,NULL,NULL),(41540,230,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41541,230,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(41542,230,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41543,230,23,81,10,86,'Date','2019-08-24',1,NULL,NULL,NULL,NULL,NULL),(41544,230,23,81,10,87,'Free_Text','VA, Housemate and AP were at food court in Eden Prairie mall. VA needed to go to the bathroom. Bathroom was at sight so AP let VA walk\r\nto the bathroom by himself. AP observed VA walk in to the bathroom but did not observe VA come out. After about 10 minutes, AP went to\r\ncheck the bathroom with Housemate but VA was not there. AP talked to an unknown cleaning lady about contacting the security. AP\r\ncontacted security and also called Nurse and Reporter. Nurse contacted Coordinator.',1,NULL,NULL,NULL,NULL,NULL),(41545,230,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41546,230,23,81,10,91,'Short_Answer','Staff did not continuously monitor a public restroom door a person with dementia was using.',1,NULL,NULL,NULL,NULL,NULL),(41547,230,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(41548,230,23,81,10,97,'Date','2020-10-13',1,NULL,NULL,NULL,NULL,NULL),(41549,230,23,81,10,98,'Free_Text','Staff drove two housemates to the Eden Prairie mall. The staff and housemates frequent the mall and are very familiar with the area. They parked in the back of the mall parking lot as they prefer the walk into the mall for some exercise. After shopping in the mall they stopped at the food court for lunch. The person who went missing brought his own lunch and after eating needed to use the restroom. This person had never used the restroom at this mall before. Staff stayed with the other person while he walked to the restroom. The restroom sign was in line of sight for the staff and staff saw the person enter the hallway that led to the restroom. There was only one entrance to the restroom area.  \r\n\r\nWhile the person was using the restroom, the staff reported the other person was experiencing anxiety. Staff is trained in positive behavior approaches and did help the person by talking to them while they used a paper bag to take some deep breaths. After about 10 minutes, staff and the person she was supporting went to the restroom area to check on the person as they did not see him exit. While she was assisting the person, she did have line of sight on the exit to her best knowledge. Staff checked the family and womens restroom, while the other person checked the mens restroom. The person was not present. Staff then spoke with a cleaning attendant and she helped contact the mall security.   \r\n\r\nMall security searched for the person while the staff and other person searched around the food court. Mall security then asked the staff to remain at the food court and that they would contact the police to assist.  Staff then called the Opportunity Partners nurse as the typical program manager was on vacation.  \r\n\r\nAt about 12:45 the mall security found the person standing by the staff’s vehicle. Mall security then reunited the staff with the person.  \r\n',1,NULL,NULL,NULL,NULL,NULL),(41550,230,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41551,230,23,81,10,100,'Free_Text','Staff did not continuously monitor a public restroom door a person with dementia was using. This was influenced by staff’s 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’d 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’s 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’s definition. While the person’s CSSP required 24/7 supervision, it did not require “direct line of sight” 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 “direct line of sight” supervision would require 1:1 staffing, which was not supported in the person’s 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’s DWRS system. The person’s MNCHOICES assessment was not up for renewal for several months which creates more complexity while the person’s 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’s dementia had just recently developed. The provider had not sought out additional staff or funding for the person yet because they weren’t 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.\r\n',1,NULL,NULL,NULL,NULL,NULL),(41552,230,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41553,230,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41554,230,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41555,230,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41556,230,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41557,230,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41558,230,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41559,230,23,81,10,102,'Free_Text','This was influenced by staff’s 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.',1,NULL,NULL,NULL,NULL,NULL),(41560,230,23,81,10,103,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41561,230,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41562,230,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41563,230,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41564,230,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41565,230,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41566,230,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41567,230,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41568,230,23,81,10,111,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41569,230,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41570,230,23,81,10,113,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41571,230,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41572,230,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41573,230,23,81,10,116,'Free_Text','This situation was further complicated as the definition of the need of support was not synonymous with the agency’s definition. While the person’s CSSP required 24/7 supervision, it did not require “direct line of sight” 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 “direct line of sight” supervision would require 1:1 staffing, which was not supported in the person’s CSSP or 6790 rate form. ',1,NULL,NULL,NULL,NULL,NULL),(41574,230,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41575,230,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41576,230,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41577,230,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41578,230,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41579,230,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41580,230,23,81,10,123,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41581,230,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41582,230,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41583,230,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41584,230,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(41585,231,23,81,10,76,'Short_Answer','SS_Success Homes-HC-2021-04',1,NULL,NULL,NULL,NULL,NULL),(41586,231,23,81,10,77,'Date','2021-04-28',1,NULL,NULL,NULL,NULL,NULL),(41587,231,23,81,10,78,'Multiple_Choice','Scott Schifsky',1,NULL,NULL,NULL,NULL,NULL),(41588,231,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41589,231,23,81,10,80,'Short_Answer','Success Homes',1,NULL,NULL,NULL,NULL,NULL),(41590,231,23,81,10,81,'Short_Answer','Amy R or P',1,NULL,NULL,NULL,NULL,NULL),(41591,231,23,81,10,82,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41592,231,23,81,10,83,'Short_Answer','763-533-628 (main line)',1,NULL,NULL,NULL,NULL,NULL),(41593,231,23,81,10,84,'Multiple_Choice','Termination of Services',1,NULL,NULL,NULL,NULL,NULL),(41594,231,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41595,231,23,81,10,86,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41596,231,23,81,10,87,'Free_Text','\"Termination is necessary for person\'s welfare and needs can\'t be met; safety of others is endangered and positive support strategies were unsuccessful\r\n\r\nSuccess Homes, Inc. has made attempts to allow person to remain in the home by meeting with the team to find positive support approaches to minimize the behaviors that cause the outbursts that he has displayed. He has become physically aggressive with peers, staff and himself and destroyed property that has resulted in him being transferred to the hospital for assessment. Medication changes have been unsuccessful and attempts to manage these behaviors have been unsuccessful. Success Homes, Inc. feels that the behaviors require a more secure setting and structured placement. He has now displayed behaviors that pose a threat to his peers and staff that cause them to feel endangered and unsafe in their current placement. He has worked with crisis facilities that were unsuccessful in the past. Attempts have been made with medication changes and behavior supports that have been unsuccessful for staff and him. We feel he\'s a threat to his peers and the staff are immanent enough at this point to terminate services.\"',1,NULL,NULL,NULL,NULL,NULL),(41597,231,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41598,231,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41599,231,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(41600,231,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41601,231,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41602,231,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41603,231,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41604,231,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41605,231,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41606,231,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41607,231,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41608,231,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41609,231,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41610,231,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41611,231,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41612,231,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41613,231,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41614,231,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41615,231,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41616,231,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41617,231,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41618,231,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41619,231,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41620,231,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41621,231,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41622,231,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41623,231,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41624,231,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41625,231,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41626,231,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41627,231,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41628,231,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41629,231,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41630,231,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41631,231,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41632,231,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41633,231,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41634,231,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41635,231,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41636,231,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41637,232,23,81,10,76,'Short_Answer','201902151',1,NULL,NULL,NULL,NULL,NULL),(41638,232,23,81,10,77,'Date','2019-06-18',1,NULL,NULL,NULL,NULL,NULL),(41639,232,23,81,10,78,'Multiple_Choice','Scott Schifsky',1,NULL,NULL,NULL,NULL,NULL),(41640,232,23,81,10,79,'Multiple_Choice','Sara Romagnoli',1,NULL,NULL,NULL,NULL,NULL),(41641,232,23,81,10,80,'Short_Answer','Taylor SLS',1,NULL,NULL,NULL,NULL,NULL),(41642,232,23,81,10,81,'Short_Answer','Michael Taylor',1,NULL,NULL,NULL,NULL,NULL),(41643,232,23,81,10,82,'Short_Answer','miket.sls@charter.net',1,NULL,NULL,NULL,NULL,NULL),(41644,232,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41645,232,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(41646,232,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(41647,232,23,81,10,86,'Date','2019-03-22',1,NULL,NULL,NULL,NULL,NULL),(41648,232,23,81,10,87,'Free_Text','Staff 1 administered the person another roommates’ medication at 8:15pm on 3/22/19. Immediately following, Staff 1 notified the facility\'s RN Consultant, the person\'s primary physician, poison control, and the home\'s Associate Director. Poison Control suggested that the person be transported to a local emergency room for treatment. The Staff 1 immediately dialed 9-1-1and activated EMS. EMS arrived and brought the person to St. Mary\'s Medical Center ER in Duluth via Gold Cross Ambulance. VA was brought into an ER room and assessment began. The Associate Director met the person at the hospital. The person was given IV fluids as a precaution. Blood was drawn and x-rays were taken. ER MD planned on transferring person from the ER to a regular room for overnight observation. In the interim, the person had a seizure in the ER and the ER MD\'s plan was changed to have him transferred to an ICU bed for monitoring. The person was moved from the ICU to a regular hospital room on 4 East the next day. The person was discharged from the hospital on 3/24 at 1:30pm as he returned to baseline without any adverse effects per Hospitalist.',1,NULL,NULL,NULL,NULL,NULL),(41649,232,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41650,232,23,81,10,91,'Short_Answer','Agency staff administered incorrect medication to a person living in the home.',1,NULL,NULL,NULL,NULL,NULL),(41651,232,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(41652,232,23,81,10,97,'Date','2019-08-01',1,NULL,NULL,NULL,NULL,NULL),(41653,232,23,81,10,98,'Free_Text','Staff 1 arrived at work at 2:00pm and described it as a normal day.  The person 1 who received the incorrect medication was picked up by his Mother around 3:00pm and staff was told they would be back at 6:00pm.   Staff 1 stated that the person receives seizure medications and it is important to administer at specific times per doctors’ orders.   Missing medications or being untimely can trigger seizures.   Evening medication pass is at 7:00pm and as of 7:30pm the person 1 did not arrive home.  Staff 1 stated they felt anxious about not being able to pass medications, however, there is a one hour window on each side of medication passes.   Therefore, medications could be passed between 6:00pm and 8:00pm.   As of 8:30pm, the person 1 did not arrive and staff 2’s shift ended. Staff 2 asked staff 1 if he could administer all medications to the people who lived there.  Staff 1 agreed and continued to feel anxious given the person was not home and was not able to administer medications.     \r\n\r\nStaff 1 began the process of a blood check that is routine for person 2 who lives in the home.   Person 2 receives sleep medication (Trazadone 300mg).   Staff 1 described that person 2 needed a lot of time to prepare for his blood check and taking his medications which required significant attention.  Person 2 was watching TV and required a lot of reminders to eventually transition to the kitchen area to take medications.  Staff 1 was eventually at the kitchen table with person 2 and began the blood check. At about 9pm, person 1 arrived home and staff 1 went to lock the medication cabinet that he had left open.  Staff 1 had already prepared person 1 and 2’s medications.  Staff 1 put both sets of medications on the table in apple sauce and then quickly passed medications to person 1.   Person 1 proceeded to eat a snack while staff 1 was finishing the blood check with person 2.   \r\n\r\nShortly after the medication was passed, staff 1 realized he gave person 1 the incorrect medication and proceeded to contact the house LPN and director.',1,NULL,NULL,NULL,NULL,NULL),(41654,232,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41655,232,23,81,10,100,'Free_Text','Agency staff administering the incorrect medication was influenced by passing medications in apple sauce to two people at the same time. Staff punched out medications for two people from pre-packaged bubble packs at the same time, placed them both in apple sauce but then could not differientiate between the medications in apple sauce.   An additional factor influencing giving the incorrect medication to the person was that the provider had one less staff working than they typically did during medication administration. The provider typically had a 2 staff to 4 person ratio until 8pm, so that two staff would be on during the 6p-8p med administration window. On this day, the person’s mother kept him out past the medication window, so that when he returned the second staff had left, leaving one staff on to administer the person’s meds when he arrived. The provider\'s staff ratio and schedule is influenced by the county’s service agreement with the provider to deliver services. MNCHOICES also influences how the county determines how many staffing hours to include in their service agreement and what medication administration responsibility they assign to the provider.    \r\n\r\nStaff had further constraints on their attention while assisting another person in the home with a blood check. This was further supported by staff worrying about the adverse effects of not passing seizure medications within the window of the medication protocol.  The pressure to pass timely seizure medications is based on the provider’s medication protocol. 245D licensing and nursing protocols further complicated the medication protocol which connects to the person’s physician who established specific times and dosages. Medications for both people were in apple sauce and when the person arrived staff felt pressure to pass medications and did pass the incorrect nighttime medications to the person.  \r\n\r\nThe DWRS, MNCHOICES assessment, and county service agreement also impacted the staff schedule and further complicated the medication protocol.   ',1,NULL,NULL,NULL,NULL,NULL),(41656,232,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41657,232,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41658,232,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41659,232,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41660,232,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41661,232,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41662,232,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41663,232,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41664,232,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41665,232,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41666,232,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41667,232,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41668,232,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41669,232,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41670,232,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41671,232,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41672,232,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41673,232,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41674,232,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41675,232,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41676,232,23,81,10,115,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41677,232,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41678,232,23,81,10,117,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41679,232,23,81,10,118,'Free_Text','Staff had further constraints on their attention while assisting another person in the home with a blood check. This was further supported by staff worrying about the adverse effects of not passing seizure medications within the window of the medication protocol.  The pressure to pass timely seizure medications is based on the provider’s medication protocol. 245D licensing and nursing protocols further complicated the medication protocol which connects to the person’s physician who established specific times and dosages. Medications for both people were in apple sauce and when the person arrived staff felt pressure to pass medications and did pass the incorrect nighttime medications to the person.  ',1,NULL,NULL,NULL,NULL,NULL),(41680,232,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41681,232,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41682,232,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41683,232,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41684,232,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41685,232,23,81,10,124,'Free_Text','Agency staff administering the incorrect medication was influenced by passing medications in apple sauce to two people at the same time. Staff punched out medications for two people from pre-packaged bubble packs at the same time, placed them both in apple sauce but then could not differentiate between the medications in apple sauce.   ',1,NULL,NULL,NULL,NULL,NULL),(41686,232,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41687,232,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41688,232,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(41689,233,23,81,10,76,'Short_Answer','201904741',1,NULL,NULL,NULL,NULL,NULL),(41690,233,23,81,10,77,'Date','2019-07-24',1,NULL,NULL,NULL,NULL,NULL),(41691,233,23,81,10,78,'Multiple_Choice','Scott Schifsky',1,NULL,NULL,NULL,NULL,NULL),(41692,233,23,81,10,79,'Multiple_Choice','Marilee Bengtson',1,NULL,NULL,NULL,NULL,NULL),(41693,233,23,81,10,80,'Short_Answer','Thomas Allen',1,NULL,NULL,NULL,NULL,NULL),(41694,233,23,81,10,81,'Short_Answer','Chet Whitmore',1,NULL,NULL,NULL,NULL,NULL),(41695,233,23,81,10,82,'Short_Answer','chet.whitmore@thomasalleninc.com',1,NULL,NULL,NULL,NULL,NULL),(41696,233,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41697,233,23,81,10,84,'Multiple_Choice','Wheelchair Safety',1,NULL,NULL,NULL,NULL,NULL),(41698,233,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41699,233,23,81,10,86,'Date','2019-06-27',1,NULL,NULL,NULL,NULL,NULL),(41700,233,23,81,10,87,'Free_Text','On 6/27/2019 between 8:00am and 9:30am, Staff 1 was driving person in their electronic wheelchair.  Staff 1 ran into door way, and the person’s leg got caught. The person’s leg looked swollen, so Reporter told Program Manager to bring VA to an Urgent Care (unknown information.) Reporter notified Guardian, Case Manager (unknown information,) and County Licensor. Urgent Care Physician (unknown information) told Program Manager to bring VA to an ER. Program Manager brought VA to an ER (unknown information,) and VA has a hairline fracture in VAs\' foot (unknown information.) VA was admitted to Hospital (unknown information.) Reporter is waiting to hear back to see what plan of action Hospital plans to take. Reporter will train AP on how to drive VAs\' wheelchair.',1,NULL,NULL,NULL,NULL,NULL),(41701,233,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41702,233,23,81,10,91,'Short_Answer','Staff did not have foot pedals on person’s wheelchair while driving the person to the restroom.',1,NULL,NULL,NULL,NULL,NULL),(41703,233,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(41704,233,23,81,10,97,'Date','2019-09-05',1,NULL,NULL,NULL,NULL,NULL),(41705,233,23,81,10,98,'Free_Text','Staff arrived at 6:00am and described the morning as a typical shift.  Staff took a Benadryl for allergy relief at 5:00am and described that the medication did not make her sleepy.  Staff then assisted the person with their morning routine by helping them use the restroom, bathing, and then going to the kitchen for breakfast.  The person has difficulty swallowing food and requires assistance eating and reminders to swallow twice.  Staff was doing a variety of household tasks and was helping people get ready between 6:00am and 8:00am.  There were three staff on duty that morning. \r\n\r\nAfter breakfast staff then assisted the person by driving her electric chair from the kitchen to the restroom without foot pedals.  The person does not like their foot pedals on the chair.  The person has a lot of rigidity in her muscles and her legs were sticking out the sides of the chair.  Staff stopped shortly before the doorway to do a task and then proceeded driving the person in their chair.  The person’s leg broke when their foot got caught on a cupboard door jam.    ',1,NULL,NULL,NULL,NULL,NULL),(41706,233,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41707,233,23,81,10,100,'Free_Text','Agency staff not having foot pedals on while driving the person’s wheelchair was influenced by the staffs’ divided attention.  Staff could not recall the specific task that divided her attention while being midway through the kitchen. The person had a preference against using foot pedals and communicates their preference by their rigidity and loud vocalizations.  This was further complicated by typical morning routine that resembles the practice of most busy group homes.  Additionally the staff pushing the wheelchair had a number of years of experience working with the person and felt more comfortable pushing the person without foot pedals. Furthermore, there were policies and plans that were conflicting related to wheel chair. The provider had a policy to always use foot pedals with wheelchairs for safety, but had also been pushing person-centered practices to support people they serve to have more control of daily decisions. \r\n\r\nThe CSSP and risk management plan followed standard wheelchair safety and practice related to the wheelchair manufacturer guidelines.  The general practice for wheel chair use conflicted with the agency’s practice. Team conversations about how this person wanted to live did not have consistency with the person’s plan and guidelines related to wheelchair use. There was a practice of the home not to use foot pedals and given the numerous tasks in the morning, staff could not account for everything.',1,NULL,NULL,NULL,NULL,NULL),(41708,233,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41709,233,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41710,233,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41711,233,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41712,233,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41713,233,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41714,233,23,81,10,101,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41715,233,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41716,233,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41717,233,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41718,233,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41719,233,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41720,233,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41721,233,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41722,233,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41723,233,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41724,233,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41725,233,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41726,233,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41727,233,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41728,233,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41729,233,23,81,10,116,'Free_Text','Agency staff not having foot pedals on while driving the person’s wheelchair was influenced by the staffs’ divided attention.  Additionally the staff pushing the wheelchair had a number of years of experience working with the person and felt more comfortable pushing the person without foot pedals. Furthermore, there were policies and plans that were conflicting related to wheel chair. The provider had a policy to always use foot pedals with wheelchairs for safety, but had also been pushing person-centered practices to support people they serve to have more control of daily decisions. \r\n\r\nThe general practice for wheel chair use conflicted with the agency’s practice.',1,NULL,NULL,NULL,NULL,NULL),(41730,233,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41731,233,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41732,233,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41733,233,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41734,233,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41735,233,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41736,233,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41737,233,23,81,10,124,'Free_Text','Team conversations about how this person wanted to live did not have consistency with the person’s plan and guidelines related to wheelchair use. There was a practice of the home not to use foot pedals and given the numerous tasks in the morning, staff could not account for everything.',1,NULL,NULL,NULL,NULL,NULL),(41738,233,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41739,233,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41740,233,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(41741,234,23,81,10,76,'Short_Answer','201906219',1,NULL,NULL,NULL,NULL,NULL),(41742,234,23,81,10,77,'Date','2019-09-16',1,NULL,NULL,NULL,NULL,NULL),(41743,234,23,81,10,78,'Multiple_Choice','Tony Gantenbein',1,NULL,NULL,NULL,NULL,NULL),(41744,234,23,81,10,79,'Multiple_Choice','Jill Tilbury',1,NULL,NULL,NULL,NULL,NULL),(41745,234,23,81,10,80,'Short_Answer','Dungarvin - Brooklyn Park',1,NULL,NULL,NULL,NULL,NULL),(41746,234,23,81,10,81,'Short_Answer','Heather Golden',1,NULL,NULL,NULL,NULL,NULL),(41747,234,23,81,10,82,'Short_Answer','hgolden@dungarvin.com',1,NULL,NULL,NULL,NULL,NULL),(41748,234,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41749,234,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(41750,234,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41751,234,23,81,10,86,'Date','2019-08-24',1,NULL,NULL,NULL,NULL,NULL),(41752,234,23,81,10,87,'Free_Text','On 8/24/2019, VA and AP went to the Minnesota State Fair. An unknown event occurred between 12:30 PM and 5:30 PM wile VA was\r\nunsupervised. VA was unsupervised for approximately thirty minutes.\r\n\r\nReporter found out 8/26/2019. VA had appointment with Psychologist at 3:30 PM. Behavior Specialist accompanied VA to appointment. VA\r\ntold Psychologist \"while at the Minnesota State Fair on Saturday, I was alone for about thirty minutes.\" VA said AP walked away from VA. VA\r\ncould not find AP. AP found VA.\r\n\r\nReporter asked AP to explain. AP said VA had a rental scooter while at the Minnesota State Fair. VA told AP she was going to the bathroom\r\non scooter, and took off. AP could not keep up with scooter and soon lost VA. AP continued to search for VA. Approximately thirty minutes\r\nlater AP found VA near a bathroom.\r\n\r\nReporter noted that VA has a previous history of false reporting.',1,NULL,NULL,NULL,NULL,NULL),(41753,234,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41754,234,23,81,10,91,'Short_Answer','Staff lost sight of a person at the State Fair',1,NULL,NULL,NULL,NULL,NULL),(41755,234,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(41756,234,23,81,10,97,'Date','2019-10-25',1,NULL,NULL,NULL,NULL,NULL),(41757,234,23,81,10,98,'Free_Text','Collaborative Safety – Systems Mapping \r\nCase Summary\r\nOctober 14, 2019\r\nHennepin County\r\n\r\n\r\nLearning Point #1: Staff lost sight of a person at the State Fair.\r\n\r\nLearning Point #2: Staff brought his son along on this community outing. \r\n\r\nIncident report description\r\n•	Incident date: 8/24/2019, between 12:30 PM and 5:30 PM\r\n•	Report date: 8/27/2019 4:11PM\r\n\r\nStaff and person went to the Minnesota State Fair on a Saturday afternoon. During this outing, the person was unsupervised for approximately thirty minutes. The person had a rental scooter and took off on it to go to use the bathroom. The staff could not keep up with the scooter and lost sight of the person. Approximately 30 minutes later, staff found the person near the bathroom. \r\n\r\nTwo days later, the reporter found out about the incident during an appointment between the person and a Psychologist when the person told the Psychologist \"while at the Minnesota State Fair on Saturday, I was alone for about thirty minutes.\" \r\n\r\nDebriefing information for learning Point #1, October 25, 2019\r\n\r\nStaff participated in a human factors debriefing, led by a Safety Analyst, on October 25, 2019.\r\n\r\nUpon arrival at the State Fair, the person rented an electric mobility scooter for people with disabilities. The staff brought his 10 year old son along to the event. The staff’s attention was influenced by the person’s behavior as they began walking into the Fair, when the person said she wanted to go to the beer garden and drink beer. This action triggered the staff to wonder if this was a good idea. \r\n\r\nShortly after arriving, the staff and his son sat down to eat some food while the person used the scooter to go and browse at a souvenir stand within eyesight. The crowd at the Fair impacted the staff’s focus when he lost sight of the person on the scooter during the outing. Staff reported he was not distracted by his son’s presence. \r\n\r\nDebriefing information for learning Point #2, October 25, 2019\r\n\r\nDuring the debriefing session for Learning Point #1, Staff shared he brought his son along to the outing after the VA told him she thought it was fine. He explained it was a last minute decision because of issues around child care coverage.\r\n\r\nResult of Incident\r\nStaff reported going to the beer garden to search for the person. She was not there, so he called her on her cell phone. She answered his call, but could not tell staff exactly where she was. This phone call went on for about 30 minutes until staff located the person.\r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(41758,234,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41759,234,23,81,10,100,'Free_Text','The crowd size, unfamiliarity with the State Fair and the person, impacted staff losing sight of the individual. When the staff lost sight of the person, his attention was divided between his 10-year-old son and the person. Staff brought their son along on the outing because the person offered for him to come along. The person likely offered because if staff was unable to work the person would be unable to go to the fair as the person overheard a conversation the staff had about his son not having childcare on the day of the Fair. The provider was experiencing a staff shortage and would not have been able to find another staff to go to the fair with the person. \r\n\r\nAnother contributing factor to losing sight of the person was that staff did not perceive a risk of losing the person because there was no elopement history. Therefore, staff felt comfortable bringing their son. Staff also knew the person’s high level abilities to be independent and capabilities to navigate the scooter, which further supported their decision to have divided attention between the person and their son.  The provider has a policy that allows staff to use judgment/interpretation of the Coordinated Services & Support Plan (CSSP) as long as staff is attentive to the persons needs without direct line of sight. The provider allows this room for staff judgment because it gives staff the space and ability to support each person as they need and choose. \r\n\r\nThe Case Manager approved the decision not to require a line of sight on the person while out in the community. The person’s history of challenging behaviors influenced the Guardian’s directive to the Case Manager not to include any alone time in the CSSP and the Case Manager\'s decision to include a 1:1 staffing ratio on public outings in the CSSP. This requirement was an influence on how the provider selected staff for the outing. An industry wide staffing shortage impacted the providers’ ability to hire and retain part-time, intermittent, 1:1 activities staff. The HCBS Rule on Community Inclusion and Person Centered Planning and Person Centered Thinking influenced the Case Manager and provider roles to meet these standards when staffing for outings in the community.\r\n',1,NULL,NULL,NULL,NULL,NULL),(41760,234,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41761,234,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41762,234,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41763,234,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41764,234,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41765,234,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41766,234,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41767,234,23,81,10,102,'Free_Text','The crowd size, unfamiliarity with the State Fair and the person, impacted staff losing sight of the individual. When the staff lost sight of the person, his attention was divided between his 10-year-old son and the person. \r\n\r\nAnother contributing factor to losing sight of the person was that staff did not perceive a risk of losing the person because there was no elopement history. Therefore, staff felt comfortable bringing their son. Staff also knew the person’s high level abilities to be independent and capabilities to navigate the scooter, which further supported their decision to have divided attention between the person and their son.',1,NULL,NULL,NULL,NULL,NULL),(41768,234,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41769,234,23,81,10,104,'Free_Text','The provider was experiencing a staff shortage and would not have been able to find another staff to go to the fair with the person.  \r\n\r\nAn industry wide staffing shortage impacted the providers’ ability to hire and retain part-time, intermittent, 1:1 activities staff. The HCBS Rule on Community Inclusion and Person Centered Planning and Person Centered Thinking influenced the Case Manager and provider roles to meet these standards when staffing for outings in the community.',1,NULL,NULL,NULL,NULL,NULL),(41770,234,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41771,234,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41772,234,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41773,234,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41774,234,23,81,10,109,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41775,234,23,81,10,110,'Free_Text','The Case Manager approved the decision not to require a line of sight on the person while out in the community. The person’s history of challenging behaviors influenced the Guardian’s directive to the Case Manager not to include any alone time in the CSSP and the Case Manager\'s decision to include a 1:1 staffing ratio on public outings in the CSSP. This requirement was an influence on how the provider selected staff for the outing .',1,NULL,NULL,NULL,NULL,NULL),(41776,234,23,81,10,111,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41777,234,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41778,234,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41779,234,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41780,234,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41781,234,23,81,10,116,'Free_Text','The provider has a policy that allows staff to use judgment/interpretation of the Coordinated Services & Support Plan (CSSP) as long as staff is attentive to the persons needs without direct line of sight. The provider allows this room for staff judgment because it gives staff the space and ability to support each person as they need and choose.  ',1,NULL,NULL,NULL,NULL,NULL),(41782,234,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41783,234,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41784,234,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41785,234,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41786,234,23,81,10,121,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41787,234,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41788,234,23,81,10,123,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41789,234,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41790,234,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41791,234,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41792,234,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(41793,235,23,81,10,76,'Short_Answer','TG_DungarvinBryant-H-2020-09',1,NULL,NULL,NULL,NULL,NULL),(41794,235,23,81,10,77,'Date','2020-10-12',1,NULL,NULL,NULL,NULL,NULL),(41795,235,23,81,10,78,'Multiple_Choice','Tony Gantenbein',1,NULL,NULL,NULL,NULL,NULL),(41796,235,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41797,235,23,81,10,80,'Short_Answer','Dungarvin',1,NULL,NULL,NULL,NULL,NULL),(41798,235,23,81,10,81,'Short_Answer','Caimon Kollie',1,NULL,NULL,NULL,NULL,NULL),(41799,235,23,81,10,82,'Short_Answer','ckollie@dungarvin.com',1,NULL,NULL,NULL,NULL,NULL),(41800,235,23,81,10,83,'Short_Answer','651-699-6050 ext 5761',1,NULL,NULL,NULL,NULL,NULL),(41801,235,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(41802,235,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41803,235,23,81,10,86,'Date','2020-08-09',1,NULL,NULL,NULL,NULL,NULL),(41804,235,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41805,235,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41806,235,23,81,10,91,'Short_Answer','Medication was stole from a residential facility without staff knowledge.',1,NULL,NULL,NULL,NULL,NULL),(41807,235,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(41808,235,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41809,235,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41810,235,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41811,235,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41812,235,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41813,235,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41814,235,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41815,235,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41816,235,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41817,235,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41818,235,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41819,235,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41820,235,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41821,235,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41822,235,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41823,235,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41824,235,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41825,235,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41826,235,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41827,235,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41828,235,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41829,235,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41830,235,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41831,235,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41832,235,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41833,235,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41834,235,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41835,235,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41836,235,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41837,235,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41838,235,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41839,235,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41840,235,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41841,235,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41842,235,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41843,235,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41844,235,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41845,236,23,81,10,76,'Short_Answer','TG_MSOCS-HC-2021-01',1,NULL,NULL,NULL,NULL,NULL),(41846,236,23,81,10,77,'Date','2021-01-29',1,NULL,NULL,NULL,NULL,NULL),(41847,236,23,81,10,78,'Multiple_Choice','Tony Gantenbein',1,NULL,NULL,NULL,NULL,NULL),(41848,236,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41849,236,23,81,10,80,'Short_Answer','MSOCS - West Metro Community Resources',1,NULL,NULL,NULL,NULL,NULL),(41850,236,23,81,10,81,'Short_Answer','Donovan Chandler',1,NULL,NULL,NULL,NULL,NULL),(41851,236,23,81,10,82,'Short_Answer','donovan.chandler@state.mn.us',1,NULL,NULL,NULL,NULL,NULL),(41852,236,23,81,10,83,'Short_Answer','218-831-5409',1,NULL,NULL,NULL,NULL,NULL),(41853,236,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(41854,236,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41855,236,23,81,10,86,'Date','2020-11-09',1,NULL,NULL,NULL,NULL,NULL),(41856,236,23,81,10,87,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41857,236,23,81,10,96,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41858,236,23,81,10,91,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41859,236,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(41860,236,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41861,236,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41862,236,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41863,236,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41864,236,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41865,236,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41866,236,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41867,236,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41868,236,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41869,236,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41870,236,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41871,236,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41872,236,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41873,236,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41874,236,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41875,236,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41876,236,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41877,236,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41878,236,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41879,236,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41880,236,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41881,236,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41882,236,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41883,236,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41884,236,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41885,236,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41886,236,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41887,236,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41888,236,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41889,236,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41890,236,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41891,236,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41892,236,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41893,236,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41894,236,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41895,236,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41896,236,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41897,237,23,81,10,76,'Short_Answer','201904039',1,NULL,NULL,NULL,NULL,NULL),(41898,237,23,81,10,77,'Date','2019-07-24',1,NULL,NULL,NULL,NULL,NULL),(41899,237,23,81,10,78,'Multiple_Choice','Tony Gantenbein',1,NULL,NULL,NULL,NULL,NULL),(41900,237,23,81,10,79,'Multiple_Choice','Tim Sullivan',1,NULL,NULL,NULL,NULL,NULL),(41901,237,23,81,10,80,'Short_Answer','Mary T. Inc.',1,NULL,NULL,NULL,NULL,NULL),(41902,237,23,81,10,81,'Short_Answer','Gordon Clark',1,NULL,NULL,NULL,NULL,NULL),(41903,237,23,81,10,82,'Short_Answer','gordonc@marytinc.com',1,NULL,NULL,NULL,NULL,NULL),(41904,237,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41905,237,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(41906,237,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(41907,237,23,81,10,86,'Date','2019-06-01',1,NULL,NULL,NULL,NULL,NULL),(41908,237,23,81,10,87,'Free_Text','Staff brought four housemates to the Como Park Zoo on a summer Saturday afternoon. After spending some time walking around the crowed zoo looking at animals, one person wandered away from the group. Staff was not sure what to do so he brought the other guys back to the van, leaving the windows down, to keep them together. He went back to look for the missing person with the help of zoo staff.',1,NULL,NULL,NULL,NULL,NULL),(41909,237,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41910,237,23,81,10,91,'Short_Answer','Staff lost sight of person at Como Zoo',1,NULL,NULL,NULL,NULL,NULL),(41911,237,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(41912,237,23,81,10,97,'Date','2019-08-27',1,NULL,NULL,NULL,NULL,NULL),(41913,237,23,81,10,98,'Free_Text','Staff participated in a human factors debriefing, led by a Safety Analyst, on August 27, 2019 at the group home in Richfield where the VA resides.\r\n\r\nThe slow pace of one of the people on the outing impacted the staff persons focus during the outing and he lost sight of one the housemates. The staff placed importance on the safety of the other people in the group when he made the decision to place them in the van while he sought help in locating the missing person. He did not want to lose other people. This decision was further influenced by fact, he was the only staff person on the outing and he had never been to Como Park before so he was not familiar with the park or available resources.\r\n',1,NULL,NULL,NULL,NULL,NULL),(41914,237,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41915,237,23,81,10,100,'Free_Text','Losing sight of a person was influenced by staff being distracted while holding the hand of a slow walker in the group and watching their footing. This was further influenced by the crowded zoo and the varying needs of each of the four people in the group. Also this was the staffs first time at Como Park Zoo and he was unfamiliar with the park and available resources. He wanted to do an activity the group enjoyed and was not afraid to take risks by going to a new place for an outing. It was known that the people living in the home enjoyed seeing animals, and considering that Como Zoo was a free activity, this outing was selected. The staff’s willingness to take risk was likely impacted by the disability advocacy community’s emphasis on allowing people with disabilities the dignity of risk. \r\nAdditional factors that influenced the Como Park outing and staff decision making were the community inclusion goals developed by the provider. These goals are outlined in the CSP/CSSP for each person in the group based on the MN Choices Assessment and the Person Centered/Informed Choice protocols. \r\n\r\nThe staffing pattern on the day of the outing to Como Zoo was impacted by the provider’s budget and the hours allocated to the home during the negotiation process facilitated by DHS Form 6790. This process is impacted by the individual needs of each person in the home, assessed by MnCHOICES and developed into each person’s Coordinated Services and Support Plan. The hours and rate are further impacted by the Disability Waiver Rate System created by the Minnesota Legislature. \r\n\r\nThe staff training established in 245D statute and the Positive Supports Rule influenced the provider required training to prepare staff for community based outings and discretion for decision making. Staff demonstrated competency in this area when he was able to describe the clothing worn by the missing person and share “the book” with details about the person.',1,NULL,NULL,NULL,NULL,NULL),(41916,237,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41917,237,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41918,237,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41919,237,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41920,237,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41921,237,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41922,237,23,81,10,101,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41923,237,23,81,10,102,'Free_Text','Losing sight of a person was influenced by staff being distracted while holding the hand of a slow walker in the group and watching their footing. This was further influenced by the crowded zoo and the varying needs of each of the four people in the group.',1,NULL,NULL,NULL,NULL,NULL),(41924,237,23,81,10,103,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41925,237,23,81,10,104,'Free_Text','The staffing pattern on the day of the outing to Como Zoo was impacted by the provider’s budget and the hours allocated to the home during the negotiation process facilitated by DHS Form 6790. This process is impacted by the individual needs of each person in the home, assessed by MnCHOICES and developed into each person’s Coordinated Services and Support Plan. The hours and rate are further impacted by the Disability Waiver Rate System created by the Minnesota Legislature.',1,NULL,NULL,NULL,NULL,NULL),(41926,237,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41927,237,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41928,237,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41929,237,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41930,237,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41931,237,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41932,237,23,81,10,111,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41933,237,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41934,237,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41935,237,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41936,237,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41937,237,23,81,10,116,'Free_Text','We may need to edit the narrative and this example to emphasize the conflict between the \"health, safety, and well-being\" and community inclusion\r\n\r\nIt was known that the people living in the home enjoyed seeing animals, and considering that Como Zoo was a free activity, this outing was selected. The staff’s willingness to take risk was likely impacted by the disability advocacy community’s emphasis on allowing people with disabilities the dignity of risk. \r\nAdditional factors that influenced the Como Park outing and staff decision making were the community inclusion goals developed by the provider. \r\n',1,NULL,NULL,NULL,NULL,NULL),(41938,237,23,81,10,117,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41939,237,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41940,237,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41941,237,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41942,237,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41943,237,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41944,237,23,81,10,123,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41945,237,23,81,10,124,'Free_Text','The staff’s willingness to take risk was likely impacted by the disability advocacy community’s emphasis on allowing people with disabilities the dignity of risk.',1,NULL,NULL,NULL,NULL,NULL),(41946,237,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41947,237,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41948,237,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(41949,238,23,81,10,76,'Short_Answer','TG_TBI Residential-SLC-2020-05',1,NULL,NULL,NULL,NULL,NULL),(41950,238,23,81,10,77,'Date','2020-05-28',1,NULL,NULL,NULL,NULL,NULL),(41951,238,23,81,10,78,'Multiple_Choice','Tony Gantenbein',1,NULL,NULL,NULL,NULL,NULL),(41952,238,23,81,10,79,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41953,238,23,81,10,80,'Short_Answer','TBI Residential & Community Services',1,NULL,NULL,NULL,NULL,NULL),(41954,238,23,81,10,81,'Short_Answer','Keith Comstock',1,NULL,NULL,NULL,NULL,NULL),(41955,238,23,81,10,82,'Short_Answer','k.comstock@tbiduluthmn.com',1,NULL,NULL,NULL,NULL,NULL),(41956,238,23,81,10,83,'Short_Answer','218-733-1331',1,NULL,NULL,NULL,NULL,NULL),(41957,238,23,81,10,84,'Multiple_Choice','Elopement',1,NULL,NULL,NULL,NULL,NULL),(41958,238,23,81,10,85,'Multiple_Choice','St. Louis County',1,NULL,NULL,NULL,NULL,NULL),(41959,238,23,81,10,86,'Date','2019-03-20',1,NULL,NULL,NULL,NULL,NULL),(41960,238,23,81,10,87,'Free_Text','TBI Crisis Float was at the Alder home at 5:45pm on Friday, March 20th talking with Dwayne. Crisis Float and\r\nDwayne were outside during the conversation. Dwayne asked if he was able to get his hair done soon and Crisis Float explained that due\r\nto the pandemic the salon was closed until further notice. Dwayne was disappointed that he could not get his hair done. After the\r\nconversation Dwayne walked inside and Crisis Float left the Alder home. At 6:00pm Khun (staff) went to check on Dwayne and he was not\r\nin his bedroom. Khun checked the inside of the house then walked around the outside of the house and could not locate Dwayne. Khun\r\nthen called the Crisis Float to notify them of the situation. Crisis Float began driving around the area looking for Dwayne. At 7:00pm Crisis\r\nFloat notified the Sheriff and completed an Attempt to Locate for Dwayne. Crisis Float continued to search for Dwayne. At 8:30pm the Crisis\r\nFloat asked that the Attempt to Locate be changed to a Missing Persons report. At 4:00am on Saturday, March 21st the TBI Crisis Float\r\nreceived a call from the Duluth Police Department saying that Dwayne had approached them looking for a ride home. Dwayne reported to\r\nthe police and TBI Crisis Float that he eloped from the Alder house and walked to the Kwik Trip where he was able to catch a bus to\r\ndowntown Duluth. Dwayne reported he walked around downtown for several hours before finding a police officer at CVS Pharmacy in\r\ndowntown Duluth. Dwayne returned home at 5:00am and went to bed.',1,NULL,NULL,NULL,NULL,NULL),(41961,238,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41962,238,23,81,10,91,'Short_Answer','Float staff waited four hours to contact their supervisor about an elopement',1,NULL,NULL,NULL,NULL,NULL),(41963,238,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(41964,238,23,81,10,97,'Date','2020-08-27',1,NULL,NULL,NULL,NULL,NULL),(41965,238,23,81,10,98,'Free_Text','Person was talking with (Alder House staff) about going downtown Duluth to get a haircut. The salons were closed due to the Governor’s 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: “If two staff were working this elopement could have been avoided because the other staff could drive person downtown Duluth”.\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.\r\n',1,NULL,NULL,NULL,NULL,NULL),(41966,238,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41967,238,23,81,10,100,'Free_Text','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’d be able to find them. The float staff’s 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’s Stay at Home order. The Governor’s 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’s 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’s 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’s 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 . \r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(41968,238,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(41969,238,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(41970,238,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(41971,238,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41972,238,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(41973,238,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41974,238,23,81,10,101,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(41975,238,23,81,10,102,'Free_Text','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’s 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 . \r\n\r\n',1,NULL,NULL,NULL,NULL,NULL),(41976,238,23,81,10,103,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41977,238,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41978,238,23,81,10,105,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41979,238,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41980,238,23,81,10,107,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41981,238,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41982,238,23,81,10,109,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41983,238,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41984,238,23,81,10,111,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41985,238,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41986,238,23,81,10,113,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41987,238,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41988,238,23,81,10,115,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(41989,238,23,81,10,116,'Free_Text','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 .  ',1,NULL,NULL,NULL,NULL,NULL),(41990,238,23,81,10,117,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41991,238,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41992,238,23,81,10,119,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41993,238,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41994,238,23,81,10,121,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41995,238,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41996,238,23,81,10,123,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(41997,238,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(41998,238,23,81,10,125,'Multiple_Choice','0',1,NULL,NULL,NULL,NULL,NULL),(41999,238,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42000,238,23,81,10,432,'Yes_or_No','Yes',1,NULL,NULL,NULL,NULL,NULL),(42001,239,23,81,10,76,'Short_Answer','201900069',1,NULL,NULL,NULL,NULL,NULL),(42002,239,23,81,10,77,'Date','2019-05-15',1,NULL,NULL,NULL,NULL,NULL),(42003,239,23,81,10,78,'Multiple_Choice','Tim Sullivan',1,NULL,NULL,NULL,NULL,NULL),(42004,239,23,81,10,79,'Multiple_Choice','Tony Gantenbein',1,NULL,NULL,NULL,NULL,NULL),(42005,239,23,81,10,80,'Short_Answer','Howry Southside',1,NULL,NULL,NULL,NULL,NULL),(42006,239,23,81,10,81,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(42007,239,23,81,10,82,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(42008,239,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(42009,239,23,81,10,84,'Multiple_Choice','Staff Sleeping on Duty',1,NULL,NULL,NULL,NULL,NULL),(42010,239,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(42011,239,23,81,10,86,'Date','2019-01-02',1,NULL,NULL,NULL,NULL,NULL),(42012,239,23,81,10,87,'Free_Text','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. ',1,NULL,NULL,NULL,NULL,NULL),(42013,239,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(42014,239,23,81,10,91,'Short_Answer','Staff did not hear person call for assistance after falling',1,NULL,NULL,NULL,NULL,NULL),(42015,239,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(42016,239,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(42017,239,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42018,239,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42019,239,23,81,10,100,'Free_Text','The overnight asleep direct service provider’s ability to hear the vulnerable adult’s calls for assistance was impacted by the VA being a soft spoken individual and the existence of routine overnight “white” noise in the home from roommates (TV, radio, electronics, etc.).  \r\nThe direct service provider’s ability to hear the vulnerable adult’s 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’s 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.\r\n',1,NULL,NULL,NULL,NULL,NULL),(42020,239,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(42021,239,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(42022,239,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(42023,239,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42024,239,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42025,239,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42026,239,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42027,239,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42028,239,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42029,239,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42030,239,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42031,239,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42032,239,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42033,239,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42034,239,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42035,239,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42036,239,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42037,239,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42038,239,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42039,239,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42040,239,23,81,10,115,'Multiple_Choice','3',1,NULL,NULL,NULL,NULL,NULL),(42041,239,23,81,10,116,'Free_Text','The direct service provider’s ability to hear the vulnerable adult’s 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’s CM before admission.\r\n',1,NULL,NULL,NULL,NULL,NULL),(42042,239,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42043,239,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42044,239,23,81,10,119,'Multiple_Choice','2',1,NULL,NULL,NULL,NULL,NULL),(42045,239,23,81,10,120,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(42046,239,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42047,239,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42048,239,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42049,239,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42050,239,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42051,239,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42052,239,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(42053,240,23,81,10,76,'Short_Answer','201904508',1,NULL,NULL,NULL,NULL,NULL),(42054,240,23,81,10,77,'Date','2019-07-15',1,NULL,NULL,NULL,NULL,NULL),(42055,240,23,81,10,78,'Multiple_Choice','Tim Sullivan',1,NULL,NULL,NULL,NULL,NULL),(42056,240,23,81,10,79,'Multiple_Choice','Tony Gantenbein',1,NULL,NULL,NULL,NULL,NULL),(42057,240,23,81,10,80,'Short_Answer','Meridian Services, Inc - Logan',1,NULL,NULL,NULL,NULL,NULL),(42058,240,23,81,10,81,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(42059,240,23,81,10,82,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(42060,240,23,81,10,83,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(42061,240,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(42062,240,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(42063,240,23,81,10,86,'Date','2019-06-19',1,NULL,NULL,NULL,NULL,NULL),(42064,240,23,81,10,87,'Free_Text','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.',1,NULL,NULL,NULL,NULL,NULL),(42065,240,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(42066,240,23,81,10,91,'Short_Answer','Staff administered wrong medication to the person',1,NULL,NULL,NULL,NULL,NULL),(42067,240,23,81,10,94,'True_or_False','',1,NULL,NULL,NULL,NULL,NULL),(42068,240,23,81,10,97,'Date','',1,NULL,NULL,NULL,NULL,NULL),(42069,240,23,81,10,98,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42070,240,23,81,10,99,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42071,240,23,81,10,100,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42072,240,23,81,10,127,'Short_Answer','',1,NULL,NULL,NULL,NULL,NULL),(42073,240,23,81,10,128,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(42074,240,23,81,10,129,'Date','',1,NULL,NULL,NULL,NULL,NULL),(42075,240,23,81,10,130,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42076,240,23,81,10,131,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42077,240,23,81,10,132,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42078,240,23,81,10,101,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42079,240,23,81,10,102,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42080,240,23,81,10,103,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42081,240,23,81,10,104,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42082,240,23,81,10,105,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42083,240,23,81,10,106,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42084,240,23,81,10,107,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42085,240,23,81,10,108,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42086,240,23,81,10,109,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42087,240,23,81,10,110,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42088,240,23,81,10,111,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42089,240,23,81,10,112,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42090,240,23,81,10,113,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42091,240,23,81,10,114,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42092,240,23,81,10,115,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42093,240,23,81,10,116,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42094,240,23,81,10,117,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42095,240,23,81,10,118,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42096,240,23,81,10,119,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42097,240,23,81,10,120,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42098,240,23,81,10,121,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42099,240,23,81,10,122,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42100,240,23,81,10,123,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42101,240,23,81,10,124,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42102,240,23,81,10,125,'Multiple_Choice','',1,NULL,NULL,NULL,NULL,NULL),(42103,240,23,81,10,126,'Free_Text','',1,NULL,NULL,NULL,NULL,NULL),(42104,240,23,81,10,432,'Yes_or_No','',1,NULL,NULL,NULL,NULL,NULL),(42105,241,23,81,10,76,'Short_Answer','201907105',1,NULL,NULL,NULL,NULL,NULL),(42106,241,23,81,10,77,'Date','2019-10-15',1,NULL,NULL,NULL,NULL,NULL),(42107,241,23,81,10,78,'Multiple_Choice','Tim Sullivan',1,NULL,NULL,NULL,NULL,NULL),(42108,241,23,81,10,79,'Multiple_Choice','Scott Schifsky',1,NULL,NULL,NULL,NULL,NULL),(42109,241,23,81,10,80,'Short_Answer','REM Hennepin - Columbus',1,NULL,NULL,NULL,NULL,NULL),(42110,241,23,81,10,81,'Short_Answer','Kris Wainwright-Tadych',1,NULL,NULL,NULL,NULL,NULL),(42111,241,23,81,10,82,'Short_Answer','kris.wainwright-tadych@thementornetwork.com',1,NULL,NULL,NULL,NULL,NULL),(42112,241,23,81,10,83,'Short_Answer','(952) 945-4947',1,NULL,NULL,NULL,NULL,NULL),(42113,241,23,81,10,84,'Multiple_Choice','Medication Error',1,NULL,NULL,NULL,NULL,NULL),(42114,241,23,81,10,85,'Multiple_Choice','Hennepin County',1,NULL,NULL,NULL,NULL,NULL),(42115,241,23,81,10,86,'Date','2019-08-23',1,NULL,NULL,NULL,NULL,NULL),(42116,241,23,81,10,87,'Free_Text','On 8/16/19 the house nurse, Terri Abrahamson requested a refill of Carbamazepine 200 mg ER twice a day. 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.',1,NULL,NULL,NULL,NULL,NULL),(42117,241,23,81,10,96,'Multiple_Choice','1',1,NULL,NULL,NULL,NULL,NULL),(42118,241,23,81,10,91,'Short_Answer','The DSP initialed the med log but did not administer the med.',1,NULL,NULL,NULL,NULL,NULL),(42119,241,23,81,10,94,'True_or_False','Yes',1,NULL,NULL,NULL,NULL,NULL),(42120,241,23,81,10,97,'Date','2020-01-30',1,NULL,NULL,NULL,NULL,NULL),(42121,241,23,81,10,98,'Free_Text','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 “busy”, 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 “overflow” 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’s “overflow” 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.  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