OLTL Critical Incidents, Including Adult Protective .
OLTL Critical Incidents, IncludingAdult Protective Services/OlderAdult Protective Services3/21/2016Click to add footer text1
Background/Purpose The purpose of this webinar is to assist OLTL Home andCommunity Based Services providers to determine:– when a critical incident has occurred,– who is responsible to report a critical incident,– when a critical incident situation needs to involve ProtectiveServices,– and how to report it all.3/21/2016Click to add footer text2
Why is it important OLTL has the following assurances in each waiver:––––––Health and WelfareFinancial AccountabilityLevel of CareQualified ProviderService PlanAdministrative Authority OLTL has a commitment to make sure that allparticipants are safe and receiving servicesappropriately.3/21/2016Click to add footer text3
Critical Incident Definitions Definitions:– Abuse – an act or omission that willfully deprives a participantof rights or human dignity, or which may cause or causes actualphysical injury or emotional harm to a participant including acritical incident and any of the following: (1) Sexual harassment of a participant. (2) Sexual contact between a staff member and aparticipant. (3) Using restraints on a participant. (4) Financial exploitation of a participant. (5) Humiliating a participant. (6) Withholding regularly scheduled meals from aparticipant.3/21/2016Click to add footer text4
Definitions, continued– Exploitation – an act of depriving, defrauding, orotherwise obtaining the personal property of a participantin an unjust or cruel manner, against one’s will, or withoutone’s consent or knowledge for the benefit of self orothers.– Investigation – to take the steps necessary to determineif a critical incident has occurred, to determine ifsuspected abuse, neglect, abandonment or exploitationrequiring the involvement of protective services isinvolved, what actions are needed to protect the healthand welfare of participants and what actions are neededto mitigate future incidents. There will be more information about critical incidentinvestigation later in the presentation.3/21/2016Click to add footer text5
Definitions, continued– Neglect – the failure to provide an individual thereasonable care that he or she requires, including butnot limited to food, clothing, shelter, medical care,personal hygiene, and protection from harm.Seclusion, which is the involuntary confinement of anindividual alone in a room or an area from which theindividual is physically prevented from having contactwith others or leaving, is a form of neglect.3/21/2016Click to add footer text6
Definitions, continued– Restraint – any physical, chemical or mechanicalintervention that is used to control acute, episodicbehavior that restricts the movement or function ofthe individual or a portion of the individual’s body.Use of restraints and seclusions are both restrictiveinterventions, which are actions or procedures thatlimit an individual’s movement, a person’s access toother individuals, locations or activities, or restrictsparticipant rights.3/21/2016Click to add footer text7
Definitions, continued– Service Interruption – any event that results in theparticipant’s inability to receive services that placeshis or her health, and or safety at risk. This includesinvoluntary termination by the provider agency andfailure of the participant’s back-up plan. If theseevents occur, the provider agency must have a planfor temporary stabilization.3/21/2016Click to add footer text8
Definitions, continued– Critical Incident – An occurrence of an event thatjeopardizes the participant’s health or welfare including: (1) Death, serious injury or hospitalization of aparticipant. (2) Provider and staff member misconduct includingdeliberate, willful, unlawful or dishonest activities. (3) Abuse, including the infliction of injury,unreasonable confinement, intimidation, punishment ormental anguish, of the participant. Abuse includes thefollowing:– (A) Physical abuse– (B) Psychological abuse3/21/2016Click to add footer text9
Definitions, continued– (C) Sexual abuse– (D) Verbal abuse (4) Neglect (5) Exploitation (6) Service interruption, which is an event thatresults in the participant’s inability to receiveservices and that places the participant’s health orwelfare at risk. (7) Medication errors that result in hospitalization,an emergency room visit or other medicalintervention.3/21/2016Click to add footer text10
Not Critical Incidents Complaints are different from critical incidents, and shouldnot be reported as critical incidents. Program fraud and financial abuse should not be reported ascritical incidents, but should be reported in accordance withthe OLTL Fraud & Financial Abuse bulletin 05-11-04, 51-1104, 52-11-04, 54-11-04, 59-11-04 issued on August 8, 2011. Pre-scheduled hospitalizations, or hospitalizations for routineillnesses should not be reported as critical incidents. A death due to natural causes should not be reported as acritical incident.3/21/2016Click to add footer text11
Critical Incident Reporting Procedures Before a critical incident is reported, measures mustbe taken immediately to safeguard the participant.This may include calling 911, contacting Adult ProtectiveServices if the situation meets the definition (participantsaged 18-59) or Older Adult Protective Services(participants aged 60 and above), law enforcement, thefire department, or other authorities as appropriate. After the health and welfare of a participant has beensafeguarded, it needs to be determined if a criticalincident is reportable or not. The health and welfare ofthe participant must be ensured at all times.3/21/2016Click to add footer text12
Reporting Procedures, continued The entity who first discovers or learns of the criticalincident (if they were not present when it occurs) isresponsible to report it. The Service Coordination or provider agency thatdiscovers or has independent knowledge of the criticalincident must submit the critical incident report within 48hours to OLTL.– If the critical incident occurs over the weekend, a written reportmust be entered the first business day after the incidentoccurred.3/21/2016Click to add footer text13
Direct Service providers for Aging WaiverAging Waiver Direct Service Providers3/21/2016Click to add footer text14
Best Practices Each critical incident report should show:– What steps were taken immediately to ensure theparticipant’s health and welfare.– what fact-finding steps were taken, and whatinformation was found.– what corrective steps were taken.– how the critical incident will be prevented fromhappening in the future.– any changes to the service plan because of thecritical incident.3/21/2016Click to add footer text15
Best Practices, Continued Remember that state entities are viewing your report, soeach critical incident report needs to account forbackground information relative to the critical incident,and explanations of who is involved/what happened. Ifyou read the critical incident report in court, would itpaint an accurate picture of the situation and theparticipant’s life? Everyone uses abbreviations differently:– Consumer: has been abbreviated as con, cons, csmr, whichcould also be different words. Con is a legal term for Certificateof Need. Cons is also a computer programming term. CSMR isthe California State Military Reserve. No one should be usingabbreviations when entering critical incidents.3/21/2016Click to add footer text16
Remember: Direct Service Providers must inform the participant’s ServiceCoordinator of the critical incident within 24 hours of anincident occurring. While a critical incident report must besubmitted within 48 hours, communication with the ServiceCoordinator about the issue must happen within 24 hours ofcritical incident discovery. All initial critical incident reports must include:––––––3/21/2016Reporter informationParticipant demographicsOLTL program informationEvent details and typeDescription of the incidentActions taken to immediately secure the participant’s health andwelfare.Click to add footer text17
Risk Mitigation All critical incident reports should show what steps weretaken to address the issue that occurred, and whatsteps will be taken to prevent the issue from happeningin the future.3/21/2016Click to add footer text18
Confidentiality When a critical incident occurs, any information relatingto the critical incident or the participant should be keptconfidential, and only necessary information should bereleased to essential personnel such as police, medicalpersonnel, Adult Protective Services/Older AdultProtective Services, crisis intervention, etc. in order toensure the participant’s health and welfare, and/orcomplete the critical incident report. 55 Pa. Code §52.29 has requirements onconfidentiality.3/21/2016Click to add footer text19
Protective Services Who is a mandated reporter?– Anyone who is part of an organization of people that uses publicfunds (including waiver funds) and is paid, in part, to providecare and support to adults in a licensed or unlicensed setting isa mandated reporter. This includes all OLTL ServiceCoordination Entity staff and direct service provider staff.– A mandated reporter is responsible to contact protectiveservices for anyone, including individuals not on the waiver, witha physical or mental impairment that substantially limits oneor more major life activities.3/21/2016Click to add footer text20
Protective Services, continued When faced with suspected abuse and neglect, the firstthing anyone should do is make sure the victim is safe.This may mean calling the police .it definitely meansmaking a report to protective services. How to involve protective services:– If anyone suspects that a participant is in imminent danger ofabuse, neglect, exploitation or abandonment, they areresponsible to make an immediate oral report to the statewideProtective Services Hotline at 1-800-490-8505. This goes to thelocal Area Agency on Aging, who will create a Report of Need(RON) that will be sent to Liberty Healthcare (the contractedAdult Protective Services agency) or Older Adult ProtectiveServices within the Area Agency on Aging to investigate.3/21/2016Click to add footer text21
Protective Services, continued What happens after calling the Protective ServicesHotline?– If a case involves sexual abuse, serious injury, serious bodilyinjury, or suspicious death, you must also take the followingsteps: 1. Make an immediate oral report to law enforcement 2. Make an immediate oral report to Department of HumanServices (for participants under 60) or Department of Aging (forparticipants over 60) 3. Within 48 hours of making the oral report, submit a writtenreport to law enforcement.3/21/2016Click to add footer text22
Once Protective Services is Involved Once Protective Services is involved, the ProtectiveServices agency is responsible for investigating Reportsof Need. If Protective Services becomes involved, the ServiceCoordinator should still make a contact with theparticipant to ensure the participant is safe.3/21/2016Click to add footer text23
Participant Involvement for Incidents Participant involvement in critical incident reporting:– A participant has the right to not report incidents.– A participant has the right to decline further interventions.– A participant has the right to refuse to be involved in the criticalincident investigation.– A participant has the right to have an advocate present duringany interviews or fact finding activities. If a participant chooses not to report an incident, or declines furtherintervention, the critical incident must still be reported, and theService Coordinator must still perform fact-finding activities relatingto the incident. Documentation must be kept indicating that theparticipant did not wish to report the critical incident or declinedinterventions. The Service Coordinator should also inform theparticipant that their services may be in jeopardy if they are puttingthemselves or others at risk.3/21/2016Click to add footer text24
Participant Involvement, continued– The agency staff who first reported the critical incident mustnotify the participant (and possibly their representative) of filinga critical incident report within 24 hours of filing the report. Thisnotice must be provided in a format that is easily understood bythe participant and/or their representative. If the participant’s representative is suspected of being involvedwith the critical incident, the representative should not be informed.– Within 48 hours of the conclusion of the critical incident factfinding, the Service Coordinator must inform the participant ofthe resolution and measures taken to prevent recurrence. Thismust be documented in the critical incident report.3/21/2016Click to add footer text25
Service Coordinator Fact Finding Responsibilities inRelation to Critical Incidents Service Coordinators are responsible for conducting fact finding in relationto critical incidents that they discover or have independent knowledge of,as well as incidents submitted by providers.– The Service Coordinator should first make sure that the health andwelfare of the participant have been ensured.– The Service Coordinator should contact the initial reporter forinformation. This may involve on-site fact finding. This may involve interviewing witnesses and observation of theparticipant. This may involve conducting phone interviews.– The Service Coordinator should document how risk has beenmitigated.If a critical incident involves the Service Coordinator or ServiceCoordination Entity, that entity should not conduct fact-finding, and shouldturn it over to OLTL immediately.3/21/2016Click to add footer text26
Finishing Fact Finding Activities After a Service Coordinator has completed the fact finding activitiesof the critical incident, they must enter the following information intoEnterprise Incident Management or Social Assistance ManagementSystem within 30 days of the critical incident discovery date:– Actions taken to secure the health and welfare of the participant.– Changes made to the Individual Service Plan as a result of thecritical incident.– Measures taken to prevent or mitigate recurrence of the criticalincident, including making appropriate referrals. On rare occasions where outside circumstances prevent a criticalincident from being concluded within 30 calendar days, anextension may be requested from OLTL with appropriatejustification.3/21/2016Click to add footer text27
Finishing the Critical Incident Report No further action is required when these conditions aremet:– 1. The facts and sequences of events are outlined withsufficient detail; and– 2. Preventative action through the service plan is outlined withsufficient detail; and– 3. The participant is not placed in any additional risk.3/21/2016Click to add footer text28
Employee Suspension A critical incident may entail suspending an employee orremoving the employee from all OLTL Home andCommunity Based Services programs. If this happens,the employee should not have contact with theparticipant during incident fact finding. Agencies shouldfollow their own policies about whether the suspensionis with or without pay until critical incident fact findingactivities are complete. If the critical incident involves a participant-directedemployee, the suspension must be without pay, and theparticipant’s back-up plan should be enacted, or analternate paid employee should be used.3/21/2016Click to add footer text29
Agency Training Responsibilities All provider and Service Coordination agencies areresponsible to train their staff and have supportingdocumentation that standard training occurred Prevention of abuse and exploitation of participants.Reporting critical incidents.Participant complaint resolution.Department-issued policies and procedures.Provider’s quality management plan.Fraud and financial abuse prevention.Click to add footer text30
How do I get Information from OLTL? Anyone who likes can sign up for a ListServ. Go to http://listserv.dpw.state.pa.us/ and pick whichones you would like to be added to!3/21/2016Click to add footer text31
Resource Information Act 70 for Adult Protective Services sCheck.cfm?yr 2010&sessInd 0&act 70 Older Adults Protective Services Act: ap15toc.html Report Of Need cuments/document/c 167248.pdf Local Area Agencies on s/AAA.aspx Office of Long Term Living tinsearch/bulletinsearchresults/index.htm?po OLTL 55 Pa. Code Chapter 52 chapter52/chap52toc.html Enterprise Incident Management:https://www.hhsapps.state.pa.us/eim/ Adult Protective Services t/documents/document/c 199869.pdf3/21/2016Click to add footer text32
Questions? Questions relating to this webinar can be submittedusing the Subject Line “Critical Incidents webinar” to:RA-oltlstreamlining@pa.gov3/21/2016Click to add footer text33
released to essential personnel such as police, medical personnel, Adult Protective Services/Older Adult Protective Services, crisis intervention, etc. in order to ensure the participant’s health and welfare, and/or complete the critical incident report. 55 Pa. Code §52.29 has requirements on confidentiality.
PA Department of Human Services-Office of Long-Term Living-CommCare Page 4 Information and updates were provided to the LTC Sub-MAAC on August 11, 2015 and October 13, 2015. Additionally, OLTL Service Coordinators and direct service providers were asked to share information with Waiver participants.
language skills and exercise their critical thinking." Critical incidents, also used in teacher training, provide opportunities for teachers to reflect on and modify their own teaching. The writers of this article and other trainers at Spring Institute have incorporated critical incidents into language lessons for limited English speakers.
Adult Coloring Book: Stress Relieving Animal Designs Volume 2 Adult Coloring Book: Stress Relieving Dolphin Patterns Adult Coloring Book: Stress Relieving Flower Patterns Adult Coloring Book: Stress Relieving Paisley Patterns Adult Coloring Book: Stress Relieving Patterns, Volume 2 Adult Coloring Book: Stress Relieving Peacocks Adult Coloring Book: Stress Relieving Tropical Travel Patterns .
Alireza Pakdel Iran Adult 3 E-mail . Alireza Zakeri Iran Adult 1 E-mail Aloisio De Souza Andrade Brazil Adult 1 E-mail Altan Ozeskici Turkey Adult 1 Postal Ameen Alhabarah Saudi Arabia Adult 3 E-mail . Majid Salehi Iran Adult 2 E-mail Makhmud Eshonqulov Uzbekistan Adult 3 E-mail Manoj Chopr
The Alchemist Jonson, Ben English Project Gutenberg Ebook 4/08/2010 Adult, Juvenile, Young adult Alchemy Mahy, Margaret 9780007406760 English HarperCollins Publishers Young Adult Fiction Fantasy, Young Adult Fiction Ebook 27/03/2014 Adult, Young adult Alexander Altmann A10567 Zail, Suzy 9781925081169 English Walker Books Australia Young Adult .
JoPllen Bruce, Salinas Adult School Peter Bulza, Valley Vocational Adult School Shirley cutler, Pomona Adult School. Alice Chlite, Clovis Adult School. Kathy Crete, Lodi Adult Schco1 Lloyd Downing, El Centro Jr/Sr High School Pat Duran, Napa College Clare Eckhart, Claremont Adult School Richard Furlong, Placer Adult School Wilma Henry, Clovis .
incidents reported to the CERT Coordination Center are soaring. Incidents rose 2,099 percent from 1998 through 2002 – an average annual compounded rate of 116 percent. Incidents reported during January through June of 2003 already totaled 93 percent of incidents for all of 2
alimentaire à la quantité de cet additif qui peut être ingérée quotidiennement tout au long d’une vie sans risque pour la santé : elle est donc valable pour l’enfant comme pour l’adulte. Etablie par des scientifiques compétents, la DJA est fondée sur une évaluation des données toxicologiques disponibles. Deux cas se présentent. Soit après des séries d’études, les experts .
