| Regulation | LIS Non-Compliance Area | Correction Required | Plans of Correction | Correction Date | POC Status |
| 6400.22(d)(1) | Individual #1 requires assistance to manage daily funds. According to the daily service notes, on two occasions, Individual #1 was in the community and handled their funds independently. Once on 4/8/23 and once on 4/15/23. Staff did not document the transactions for either day. | The home shall keep an up-to-date financial and property record for each individual that includes the following: Personal possessions and funds received by or deposited with the home. | The transactions referenced above were documented on the individual's shift note but not on the individual funds record "Cash-On-Hand Report". This was because the money for the transactions was not from the individual's funds at the home and staff could not ascertain where the money came from. Individual #1 was employed in April 2023. On 4/8/23 and 4/15/23 when staff picked the Individual up from work, it was observed that they had money and/or new items which they had purchased while at work. Staff inquire where the individual got the money to purchase the items. They reported that they used a bank card which they had with them. The individual's representative payee was contacted regarding the use of a bank card. Later, it was discovered through contact with the individual's workplace that they had stolen money on multiple occasions while at work. Transactions such as the above (done independently by the individual while out of program with money of unknown origin) cannot be mixed with the transactions completed with individual funds kept at the home. However, to ensure proper monitoring of such situations should they occur again, staff have been trained on 11/14/23 to document such transactions on a separate cash-on-hand form as well as notify the program manager or specialist immediately. The program manager or specialist would then investigate to gather more information about such transactions including the origins of the money used. Any incidents of stealing would be documented as well. Currently, the individual does not use a bank card. This provider's policy pertaining to individual funds has been updated as of 11/10/23 to reflect how bank cards and gift cards would be handled (see page 3 and 4 of Attachment 1). The program manager and staff were trained on the updated policy on 11/14/23. |
11/14/2023
| Implemented |
| 6400.22(e)(2) | On 5/11/23 Staff #1 documented Individual #1 cashed their check and refused to give the money to Staff #1, so Individual #1 kept it on their person. Individual #1's financial transaction record does not document that Individual #1 was given the money, how much money they were given, but documents that $28 from their check was deposited into the individual's house funds that the home is to manage.
During the 10/31/23 inspection, it was reported to the Department that Individual #1 kept the $28 from their check on their person, and this wasn't deposited into their house account. Record of the individual keeping the $28 wasn't documented. | If the home assumes the responsibility of maintaining an individual's financial resources, the following shall be maintained for each individual: For a withdrawal when the individual is given the money directly, the record shall indicate that funds were given directly to the individual. | Usually when Individual #1 receives a check, they are taken to the Fulton Bank to cash it. At the bank, they complete all the transactional process (including endorsing the back of the check, handing it to the Teller and receiving the cash) independently. Most often they would hand the money to staff after they leave the bank. However, there are times the individual would insist on keeping the money in their wallet. 5/11/23 was one such day. At the home, the transaction was recorded as a deposit in the individual funds at the house instead of as money handed to the individual. There was another entry on 5/13/23 indicating that the individual used the fund on 5/13/23 at Walmart for which there is receipt. The money was thus accounted for. The correct way for documenting this would have been to enter the amount as a deposit (to account for the fact that the check was cashed) and then make another entry as disbursement (to account for the fact that individual kept the cash) as well as have individual sign a receipt for keeping the cash. The individual fund policy for this provider has been updated to include this procedure and the program team has been trained on the updated policy as of 11/14/23 (See page 2 of Attachment 1). |
11/14/2023
| Implemented |
| 6400.143(a) | Since Individual #1's date of admission, 2/12/23, staff have documented that the individual continually refuses to shower either morning or evening. They are witnessed to be completely dry after they state they have showered. They refuse to clean themselves after enuresis. They refuse to wear clean clothes and adult briefs. They refuse to brush their teeth regularly. They refuse to take medications and refuse routine and as needed medical appointments. The training and assistance provided to the individual during each documented refusal is not in the individual's record. The home does not have any plans to implement when the individual refuses all the above items, with the exception of refusal plans for medical appointments, psychiatric appointments, and medications that were not created until July 2023 or after. | If an individual refuses routine medical or dental examination or treatment, the refusal and continued attempts to train the individual about the need for health care shall be documented in the individual's record. | Individual #1 had refusal plans for medical appointments, psychiatric appointments, and medications. A personal hygiene protocol and refusal documentation have been created (See attachment # 2). Program manager and specialist are currently working on hygiene related social story and checklist to help educate and guide Individual #1 in developing a daily personal hygiene routine. Program specialist would review the protocol with the individual and all staff members by 11/21/23. Program specialist would communicate with the individual's support coordinator to update the ISP to reflect the new protocol and changes related to how the individual would be supported with regards to personal hygiene. |
11/30/2023
| Implemented |
| 6400.144 | On 4/21/23, Staff #1 took Individual #1 to be examined by the individual's primary care physician. Individual #1 had a sore throat, was constipated, and their physician stated if the individual is unable to have a bowel movement in the next few days call the physician. The individual was prescribed MiraLAX, 17gm mixed with 8 ounces of liquid and drink daily for constipation for 3 days, and can continue to take benefiber, prunes, or prune juice.
Staff #1 documented Individual #1 refused to go to the store to pick up MiraLAX on 4/21/23, so the home didn't obtain the medication.
Staff #1 documented Individual #1 did not go to work on 4/22/23 because they didn't feel well and refused to take MiraLAX. They didn't go to work on 4/23/23 because they didn't feel well. They were upset on 4/25/23 and on 4/26/23 woke staff up crying saying their stomach hurt and they had shoulder pain. The home was not monitoring for bowel movements. they did not call the individual's physician after not having a bowel movement in a few days. They did not obtain MiraLAX immediately and there are no records the home offered the individual Benefiber, prunes, or prune juice or the individual's refusal to the additional treatment recommendations. On 4/26/23, Individual #1 was evaluated at the emergency room and an x-ray indicated large amounts of fecal matter in their bowels.
On 4/26/23, the emergency room offered instructions for caring for constipation at home. These instructions indicated to drink additional fluids, move your body, increase their intake of fiber or probiotic, and obtain a stool to assist with the bowel positioning when sitting on a toilet. There are no records the home offered the additional recommendations to the individual, or if they chose not to utilize the recommendations.
Staff documented Individual #1 reported stomach pains on the following occasions: in the morning on 5/13/23 and in the morning on 5/14/23 and could not go to work. There are no records the home attempted to contact the individual's physician or offer the individual any additional fiber or prunes.
On 9/28/23, Individual #1 was examined by their physician for constipation and prescribed the individual Metamucil 1 packet daily and Florastor 250mg probiotic daily for constipation. The home did not attempt to offer the medications until 10/1/23, of which the individual refused to take the Metamucil.
The home did not implement any bowel tracking charts until 10/1/23. At the time of the 10/31/23 inspection, the home did not have a bowel protocol to implement if the individual goes any number of days without having a bowel movement. In October 2023 staff document that the individual only had bowel movements on the 7th, 14th, and 28th.
On 4/21/23 and 5/12/23 the individual's physician indicated staff are to continue to encourage the individual to increase their fiber intake, eat prunes, and drink prune juice in attempts to assist with their constipation. The home had the items available in the home, but no records of offering the items to the individual or encouraging the individual to follow through with physician's recommendations. | Health services, such as medical, nursing, pharmaceutical, dental, dietary and psychological services that are planned or prescribed for the individual shall be arranged for or provided.
| Individual moved into their home run by Provider on 2/12/23. Not long after moving in, staff noticed that the individual struggles with constipation. Prunes were obtained and were incorporated in the individual's diet as snack. With the exception of 2/23/23, when Staff #1 documented that the individual ate 2 prunes, it was usually not documented when the individual was offered prunes. The individual initially did not refuse prunes. However, in May during one of their team meetings, a team member made a passing comment that prune and prune juice taste nasty. The individual has since stopped taken prunes even though they are provided at the house. During their appointment on 4/21/23, the PCP added prunes to the recommendation because at that point the individual was already taking them.
Provider is a new agency and Staff #1 was the only staff available to work as of 4/21/23. After the individual's appointment with the PCP on 4/21/23 evening, staff had suggested taking the individual to the pharmacy to get the recommended medication. Individual #1 protested and threatened to be unsafe in the vehicle. Staff thus drove them to the house and as a last resort called their parents who live about 10 to 15 minutes away to pick up the medication and deliver it to the house. Unfortunately, they could not do that in the evening. They however picked up the medication early the next morning and delivered it to the house. Miralax was thus available for administration on the morning of 4/22/23. Individual refused to take the medication throughout the period it was prescribed. The suggestions by the ER doctor on 4/26/23 were followed with the exception of using a stool in the bathroom. The senna laxative was obtained and administered as prescribed. Individual initially did not like drinking water because, "they were told that their issues with incontinence was due to drinking too much fluid". Staff educated the individual regarding the body's need for fluid and why it was important to get plenty of fluid. The individual is encouraged during grocery shopping to select the kind of fluid they want. Individual #1 seems to have settled on ICE flavored sparkling water which is what they currently drink all the time. Their fluid intake is not monitored since they drink freely now. Individual was encouraged to exercise. Their parents bought them a bicycle which they ride around in their neighborhood. They were also assisted to enroll in the UDS Challenger program where they played flag football till the end of October when the session ended. They are currently signed up for Special Olympics and is waiting for the PCP to complete the necessary physical form so that they can join. They also meet regularly with their classmates for various games and activities as well as goes on walks with staff (particularly with CPS as part of their sessions). As of 11/12/23, a step stool has been obtained for use in the bathroom (see attachment # 3). Staff explained and modeled how to use the step stool for individual #1. The prescription on 9/28/23 was started on 10/1/23 because the pharmacy had to order it. This medication has however been discontinued as of 11/8/23 since the individual refused to take it. Individual's bowel protocol has been updated as of 11/14/2023 (See attached # 4) and the program team have been trained on the new protocol. |
11/21/2023
| Implemented |
| 6400.32(c) | On 5/15/23, Staff #2 documented on Individual #1's daily notes that they witnessed bruises on the inner part of Individual #1's right wrist. Individual #1 reported to Staff #2 the bruises have always been there. Staff #2 documented they see Individual #1's wrist every time they administer medications to the individual and the bruises were never there. At the time of the 11/1/23 inspection, the home did not report the bruises to any oversight agency, or internally investigate how the individual received bruises on their right wrist.
On 5/21/23, Staff #2 recorded a note in Individual #1's record stating, Staff #2 received information that Individual #1 was potentially threatening to contact law enforcement alleging sexual incident(s) occurred with a target. The record was not detailed of the incident(s). There are no other records about this incident(s) in the individual's record at the home. At the time of the 10/31/23 inspection, it is unknown if the individual consented to, or did not consent to, any alleged sexual incident(s), the alleged sexual incident(s), or target(s). | An individual may not be abused, neglected, mistreated, exploited, abandoned or subjected to corporal punishment. | What staff #2 reported on 5/15/23 as bruises were small cut marks made by the individual using a shaving stick that they picked up when they visited their mom on the evening of 5/14/23. In talking with the Program specialist, individual #1 had indicated that they made them because they were frustrated that their then boyfriend did not want to talk with them and was trying to break up with them. Around the same period, they had also shaved their hair overnight. Following the conversation with the program specialist, they agreed to keep their shaving sticks in the staff office for safety. Since then, the shaving sticks have remained in the staff office. When needed, Individual #1 requests a shaving stick to use and then returns it to the staff for disposal. It must be added that Individual #1 was receiving mobile therapy services at the period this incident happened and did receive support from the therapist and the nurse on the team to help them process the breakup with their boyfriend. As of 11/14/23, an injury report form (Attachment #5) has been developed for use at the home to document observations such as above. The program team have been trained on how to use the form and are aware to provide the needed support (i.e. arrange for individual to be seen by a health provider or apply first aid) in the event of an injury and then inform program specialist or manager about the discovered upon injury. Program manager or specialist would follow up and initiate an investigation and EIM report (if applicable). Also, a behavioral support specialist is currently working on a behavioral support plan for Individual #1 which would include the above practice of keeping the shaving sticks in the staff office.
The text message referenced on 5/21/23 was also sent around the same period when the individual was breaking up with their boyfriend. A follow up was made but a formal investigation was not made. During the inspection, when Provider was made aware a formal investigation was needed, an investigation was initiated, and a report was made in EIM (ID#: 9307340). A certified investigator is currently investigating what happened. |
11/30/2023
| Implemented |
| 6400.46(d) | Staff #1 was the only staff providing care to Individual #1 in the home and community and transportation in the community. They received training in first aid and cardiopulmonary resuscitation and Heimlich techniques on 10/15/21 and not again until 7/19/23. The agency was unable to produce records that the staff's training on 10/15/21 met standards applicable for a certification every two years, therefore, the training completed on 7/19/23 was late. | Program specialists, direct service workers and drivers of and aides in vehicles shall be trained within 6 months after the day of initial employment and annually thereafter, by an individual certified as a training by a hospital or other recognized health care organization, in first aid, Heimlich techniques and cardio-pulmonary resuscitation. | Staff #1 completed the Red Cross First Aid CPR training on 10/15/21 while working for another agency. Training records from that previous agency for staff #1 indicated that training was completed. However, Staff #1 was not issued the wallet size card with the training expiration date. Staff #1 was retrained on 7/19/23. The records for all staff currently working for provider have been reviewed and it has been determined that each staff has received the required training and has the required documentation on file. |
11/14/2023
| Implemented |
| 6400.163(b) | During the 10/31/23 inspection, Staff #1 reported to the Department that on Sunday, staff and Individual #1 placed all Individual #1's daily medications in a weekly pill container. They do this by removing them from their original labeled container for the week. Individual #1 is not able to self-administer their medications and staff must administer the medications to the individual. | A prescription medication may not be removed from its original labeled container in advance of the scheduled administration, except for the purpose of packaging the medication for the individual to take with the individual to a community activity for administration the same day the medication is removed from its original container. | Prepacking the medication into the weekly pill container was an activity that individual was doing prior to their admission to the home run by this provider. Upon admission, individual was adamant to stop and would not take medication they had not prepacked. Provider thus used the prepacking as an opportunity to educate the individual about the medications. The weekly pill container was kept in the staff office and staff were administering the medication (even when individual prepacked). Program specialist met with the individual on 11/05/23 and informed them about ending the prepacking of the medication as well as the reason why. With the individual being currently familiar with the staff and also having been involved in the medication change decision making they were okay with not prepacking. The practice has been stopped and all staff working with the individual have been informed of the changes as of 11/14/23. Individual no longer prepacks the medications. Individual is currently not able to self-administer the medications and as such staff will continue to administer the medications while helping them to learn and work towards self-administration. |
11/14/2023
| Implemented |
| 6400.165(c) | Individual #1's pharmacy issued medication label on their Mupirocin ointment at the home states to administer a small amount three times a day as directed. The home never administered this medication to individual from February 2023 to 11/1/23. | A prescription medication shall be administered as prescribed. | Following an appointment with Individual #1's PCP on 11/8/23, Mupirocin has been discontinued. For the individual's other medications, PCP is sending new scripts to the pharmacy to correct all labels identified as missing some required information as per agency regulation. Also, the PCP is working on updating the individual's records kept on file by this practice to reflect the medications the individual is currently taken as well as instructions as to how medication is to be administered. |
11/30/2023
| Implemented |
| 6400.165(f) | Individual #1's 3/22/23, 6/28/23, 7/12/23, 8/23/23, and 10/11/23 psychiatric medication reviews with their psychiatrist do not clarify which Aripiprazole medication they are prescribed. The physician signs the record reviews that Aripiprazole 15mg is prescribed daily and there is an attached medication list, that documents Aripiprazole ODT is prescribed. The records do not clarify which form of the medication is ordered.
Individual #1's 10/11/23 medication review does not include the reason for prescribing their medications. | If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a written protocol as part of the individual plan to address the social, emotional and environmental needs of the individual related to the symptoms of the psychiatric illness. | The prescribed medication for Individual #1 is Aripiprazole ODT 15mg Tab ALE and it is prescribed for mood stabilization as shown in the attached medication label and MAR (See attachment # 5b & 6). When filling the psychiatric medication form, staff had written Aripiprazole 15mg since the space provided on the form was a bit smaller and had attached the medication list to provide the full name, reason and instructions for each of the psychotropic medications. Not writing the reason on the form for the 10/11/23 review was an oversight. All the previous reviews forms from 3/22/23, 6/28/23, 7/12/23 and 8/23/23 had the reason included for all the psychotropic medications. The attention of all staff members have been drawn to this as of 11/14/23. A sample medication review form has been created to guide staff members as to how to fill form correctly for future appointments. |
11/14/2023
| Implemented |
| 6400.166(a)(4) | Individual #1 is being administered over the counter, kids' melatonin gummies once daily. Staff are documenting on the individual's February 2023 to current, 11/2/23, medication administration records (mars), that they are administering Melatonin 1mg. The MAR does not include the name, frequency, or dose of the kids' melatonin gummies. | A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Name of medication. | The MAR has been updated as of 11/08/23 (see attachment #6) to reflect that individual is taking Netrol kids Melatonin 1mg gummies which the PCP had given prior approval for. Program manager and specialist have reviewed all current medications and MAR for individual supported by this Provider to ensure that all the required information (such medication name, form, dosage, time, route and prescriber information) is included. When necessary written approvals would be obtained from individual's PCP for each over the counter medication. |
11/14/2023
| Implemented |
| 6400.166(a)(6) | Individual #1's October 2023 and November 2023 mars don't include the dosage form for Metamucil. The mars state 1 packet daily. However, the instructions on the medication box indicate the packet must be mixed with 8 or more ounces of cold liquid and drank immediately. | A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Dosage form. | Metamucil is an over-the-counter medication and the entry on the MAR was based on the written instruction provided by the PCP on the appointment form when the medication was suggested. Individual's PCP discontinued Metamucil during the appointment on 11/8/23 due to continual refusal to take it. Program manager and specialist have reviewed all current medications including (over-the-counter meds) and MAR for individual supported by this Provider to ensure that medications are entered correctly. For over-the-counter medications, entry would be reflective of the instruction provided on the medication box or container and would include all the required information such as medication name, form, dosage, time and route. Written approvals would be kept on file for each over the counter medication. |
11/14/2023
| Implemented |
| 6400.166(a)(7) | Individual #1's medication administration records (mars) from October 2023 and November 2023 do not include the dosage or frequency of Florastor medication prescribed and administered to them. The records state, take as directed.
Individual #1 is prescribed acetaminophen 325mg tablets, take 1-2 tablets by mouth every 6 hours as needed. The individual was administered acetaminophen on the following occasions but the dose that was administered was never documented: 8pm on 9/4/23, 8am on 9/30/23, 3:02pm on 7/13/23, and 7am on 6/28/23. | A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Dose of medication. | The home was of the view that the instruction on the MAR needed to be an exact match of the pharmacy label. This was why "Florastor 250mg. Take as directed" was entered on the MAR since it was the pharmacy label on the medication and pharmacy had refused to give a new label with the needed details upon request. The home had copies of the appointment form with the doctor's original written instruction attached to the October and November MAR to guide staff as of the time of the licensing. That instruction included the dosage (250mg) and frequency (daily). Following conversation with the licensor, it was clarified that Provider should enter the medication on the MAR according to the pharmacy label and in addition provider is able to enter the missing required information as well on the MAR as long as there was a written documentation from the prescriber with that information. The medication of concern has been discontinued by the individual's PCP as of 11/08/23.
Regarding the documentation for acetaminophen (PRN), the program team members for the home have been retrained as of 11/14/23 on the fact that the notes for each PRN administered should include the dose of the medication given. |
11/14/2023
| Implemented |
| 6400.166(a)(11) | Individual #1's medication administration records (mars) from December 2022 to current, 11/1/23, do not include the reason for prescribing and administering Senna, Melatonin, Vitamin D3, Acetaminophen, Mupirocin, or Divalproex.
The individual's October 2023 and November 2023 mars do not include the reason for prescribing Florastor or Metamucil. | A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Diagnosis or purpose for the medication, including pro re nata. | For all the medication the individual is currently taking, the MAR has been updated to include the missing required information as of 11/14/23 (See attachment #6). |
11/14/2023
| Implemented |
| 6400.169(a) | Staff #1 administers medications to Individual #1. Staff #1 is a certified medication administration trainer. However, they have not completed the Department's initial or annual medication administration training course to maintain qualifications to be able to administer medications. | A staff person who has successfully completed a Department-approved medications administration course, including the course renewal requirements may administer medications, injections, procedures and treatments as specified in § 6400.162 (relating to medication administration). | Staff #1 is currently the only medication trainer / observer for this Provider. Staff #1 will not administer medications until they complete the medication administration training. To recertify the above violation, another employee has been enrolled in the practicum observer trainer course as of 11/14/23 (Attachment #7). Once employee completes the practicum observation course, they would be able to complete the required reviews and observation for staff #1. |
12/20/2023
| Implemented |
| 6400.181(f) | There are no records that Individual #1's 4/11/23 assessment or 7/20/23 assessment was provided to them. | The program specialist shall provide the assessment to the individual plan team members at least 30 calendar days prior to an individual plan meeting. | A printed copy of the most recent assessment has been provided to the Individual #1 as of 11/20/23. The assessment was re-reviewed with the individual. Additionally, the individual was educated with respect to the individual's right to receive copies of records generated including annual and updated assessments. The education also highlighted the risks of the individual carrying their records with them into the community and of sharing information contained in their records with others. |
11/30/2023
| Implemented |
| 6400.186 | Individual #1 has a past history of trauma and a 3/23/23 behavior support plan that included trauma informed instructions for staff to implement in the home. The plan identifies target behaviors as stealing, emotional outbursts, and unsafe behaviors, and includes lengthy details about crisis plans, and positive approaches and strategies to assist Individual #1 through behaviors. The plan states staff are to refrain from challenging Individual #1's actions or giving the individual demands. This will only escalate them further. According to daily notes in the individual's record and referenced in this report, staff have documented giving Individual #1 demands, challenging the individual's reporting, or lack thereof, of defecating and urination in their bedroom, challenging the individual's reporting, or lack thereof, of showering habits, and told the individual there are rules in the house to follow.
The behavior support plan outlines positive approaches staff are to use. For all the daily documentation of incidents, behaviors, or emotional outbursts, there are no records that staff are using any of the positive approaches outlined in the individual's plan to support them. The plan of support wasn't used in any incident where staff give direct orders to the individual. They did not assist the individual with support when an incident involving feces and urination occurred in the home. They instructed the individual to throw away their personal belongings and contested the individual's responses for why they do things in the home.
According to daily notes, on 4/2/23 Staff #1 documented finding feces in Individual #1's bedroom, in a basket and in their closet. Staff #1 documented when the feces was discovered they "gave (the individual) a direct instruction to get ready and take it to the dumpster. (The individual) complied after numerous protests. (The individual) also had to hand wash their clothes that had the feces wrapped in it before washing them in the washers."
During the 10/31/23 inspection, Individual #1 was home and playing their play station 4 and listening to music around 3:15pm. Individual #1 was singing along to the song. When singing, Staff #2 yelled from the living room, telling Individual #1 to watch their language when they were singing. This intervention is not a technique to be used with Individual #1. | The home shall implement the individual plan, including revisions. | Individual #1's behavior support plan was created on 3/23/23 and the then specialist reviewed it with them on 4/17/23. Staff members working with the individual were trained on the plan by the behavioral specialist on 5/16/23. Not long after that, the behavioral support agency decided to discharge the individual from services because of continuous refusal of individual to meet with behavioral specialist and other members of the mobile therapy team. This provider currently has an internal behavioral specialist who is working with the individual and the team. The specialist is working on updating the existing plan to include recent changes in behavior. In the meantime, while waiting for the new plan to be completed and approved by a Human Rights Team, the behavioral support specialist would be visiting the home on different days and at different times to meet, observe and coach the staff members working with the individual on the use of positive approaches and trauma informed care practices as recommended in the existing plan. The existing plan has been re-reviewed with all staff as of 11/14/23. Also, the HCQU has been contacted to arrange for trauma informed training for all provider staff (see attachment # 8). |
11/30/2023
| Implemented |
| 6400.193(a) | On 3/11/23 Staff #1 restricted Individual #1's access to the home's internet, inadvertently not allowing them to operate their play station 4, because the individual didn't want to accompany staff to the hardware store. Individual #1's plans do not include an approved restrictive procedure plan.
Individual #1 has a cell phone and does not have any approved restrictive procedures regarding the use of the phone, where they store the phone, or what staff are allowed to do with the phone. Their individual support plan (isp) states the individual agrees to keep their phone downstairs to charge at night and gives permission for staff to go through their browsing history, messages, and information on the individual's personal phone. There are no records that Individual #1 consented to having staff go through the individual's phone and content on the phone.
On 5/1/23 Staff started documenting in daily notes, if Individual #1 agreed to charge their phone downstairs overnight and the number of prompts staff used to get Individual #1 to say yes. There are multiple times where staff indicated they prompted Individual #1, 1-5 times at night before the individual agreed to charge their phone in the kitchen, out of their possession overnight.
On 5/8/23 Staff #2 documented Individual #1 agreed to charge their phone downstairs in the kitchen overnight, after 5 prompts, and staff telling Individual #1 to "follow the rules in order to sleep sufficiently enough to be able to focus in school tomorrow."
Individual #1 would not normally engage in the behavior to leave their phone in the kitchen overnight but has been continually prompted by staff to do so, until they agreed. | A restrictive procedure may not be used as retribution, for the convenience of staff persons, as a substitute for the program or in a way that interferes with the individual's developmental program. | Turning the internet off on 3/11/23 was a temporary situation to mitigate an immediate health and safety risk. 3/11/23 was a Saturday. Prior to the incident referenced above, individual was operating the PS4 play station on the first floor of the home while staff was on the second floor. At some point the whole house started smelling like feces so staff came down to the first floor to find out what had happened. It was noted that the toilet on the first floor got clogged after individual #1 used it and by flushing several times in an attempt to unclog it, the whole bathroom and the kitchen floors were flooded. The water mixed with feces was also seeping into the carpet in the dining area where the individual had the game system set up. Part of the carpet was already wet from individual walking in the flooded floor and then on the carpet. The clog could not be cleared with a plunger. Staff could not get a hold of any maintenance person since the leasing office for the apartment complex was closed. Staff and the individual reached out to their father, but the father was not able to stop by to help. Staff #1 was the only provider staff available at that time and there was no one else to call. Having an electronic equipment (PS4 with extension cord) on a wet carpet is a safety risk. Also, having the clogged toilet at the house with the fecal smell is a health risk. Based on these, staff prompted the individual to move the game system away from where they had it due to portions of the carpet being wet and the water seeping into the rest. Individual was also asked to get ready (put on appropriate clothes and changed wet sock) to accompany staff to the hardware store to obtain equipment that could be used to unclog the toilet. Staff at this point was mopping the kitchen and bathroom floors. The mopping lasted about 30 minutes. During this period, individual did not remove the game nor get ready for the store. Individual was sitting next to the game; any attempt by staff to disconnect and remove the system to another location would have resulted in a physical alteration. To avoid this, the internet was turned off temporarily. Individual walked away from the game to get ready allowing staff to relocate the game to the living room area where individual played the game after returning from the hardware store until staff finished unclogging the toilet, cleaned the floor, and the dining area dried up. Since the individual struggles with constipation and frequently clogs the toilet after having a bowel movement, the home has equipment on site to help with the unclogging process. The individual has also been educated to alert staff before flushing (after they have finished using the toilet and cleaned up) should the individual think the BM is likely to clog the toilet. This practice seems to be working well and seems to have prevented the home toilet clogging or overflowing to flood the home.
Phone: Individual #1 goes to a school-to-work program on weekdays. In one of the team meetings with the school, it was reported that the individual was sleeping a lot during school hours. The teacher also reported getting complaints from other students that Individual #1 was calling them late at night while they were sleeping. In brainstorming ideas, it was suggested and individual #1 agreed to charge the phone in the living room area overnight. The ISP was updated to reflect that. At night, the individual usually prefers to talk with their boyfriend in the privacy of their room before going to bed. And the practice was for staff to prompt / remind them between 10pm and 11pm to charge the phone downstairs after they are done talking to their boyfriend. Staff never physically take the phone from the individual and on days individual refuses to keep phone downstairs, staff just document the refusal. Prompting the individual about 5 times however is excessive. Over prompting is not an effective strategy to use. A behavior support specialist is working with the individual and the team at this time to update the individual's plan. In the meantime, staff members working with the individual were retrained on 11/14/23 on the individual's current plan which emphasizes less prompting and the use of trauma informed care practices. Staff are now aware to first offer the individual an opportunity to choose the time they would prefer to complete a task and help set alarm reminders. Staff are expected to prompt only after the chosen time has elapsed and individual fails to initiate the task. After the first prompt, staff would allow some time for the individual to initiate the task. Should the individual refuse, staff would provide education and encourage individual to complete the task. This would be the second and last prompt. Staff would document the refusal on the appropriate form together with the education provided. Staff now know not to prompt more than 2 times and to use the strategy outlined above. |
11/30/2023
| Implemented |