624 Regulations

1. 624 Regulations Incident Reporting & Abuse

2. What is an Incident? • OPWDD (Office of People With Developmental Disabilities)" Significant events or situations endangering a personswell-being.” • All Incidents are required to be recorded on a standardized form and are subject to OPWDD’s approval.

3. Objective: • To familiarize employees with Heaven’s Hands Community Service policy and procedures regarding incident management.

4. Training Areas: • Incident and their classifications • Distinguishing between reportable, serious reportable, sensitive situations, minor occurrence. • Define abuse, discuss prevention of abuse • Outline notification procedures and timeframes

5. Why do we report incidents? • To enhance the quality of care for our consumers. • To ensure that consumers enjoy a safe environment. • To identify possible trends and implement preventative strategies. • To increase agency-wide awareness of incidents in order to implement corrective measures.

6. Reporting Responsibilities • All staff, regardless of status are responsible for the health, safety, and welfare of those individual we serve. All staff are therefore responsible to report all incidents.

7. What constitutes an Incident? • Injury • Missing Person • Death • Restraint • Medication Error • Possible Criminal Act • Sensitive Situations • Abuse/Neglect/Mistreatment

8. Minor Occurrence: • An incident/injury which requires no more than First Aid. • Even if it is being provided by a nurse, physician or other health care professional. • Even if the person goes to the emergency room.

9. Reportable Incident: • Any suspected or confirmed harm, hurt or damage to a person receiving services, caused by an act of that person or another, whether or not by accident and whether or not the cause can be identified, which results in a persons requiring medical or dental treatment by a physician , dentist, physician’s assistant or nurse practitioner, as such treatment is more than first aid. Furthermore the treatment must revile something. i.e a break, chip, deep cut • Illness is not an injury

10. Serious Reportable: • Any injury which results in the admission of a person to a hospital or 24 hour infirmary for treatment or observation because of the injury. • A serious reportable incident is a reportable incident which because of the severity or sensitivity of the situation, it must be immediately reported to OPWDD. • Injury resulting in a hospital admission. • Illnesses are NOT reportable, including psychiatric illnesses.

11. What classification does the following incident fall under: While walking towards the kitchen John fell hitting his left knee. Carlos the staff member, helped John onto a chair and applied ice to his knee. a) Reportable b) Minor Occurrence c) Serious Reportable d) None of the above

12. What classification does the following incident fall under: While walking towards the kitchen John fell hitting his left knee. Carlos the staff member, helped John onto a chair and applied ice to his knee. After monitoring John for approximately 30 minutes, Carlos sees John knee is still swollen. Carlos escorts John to the emergency room where the doctor orders x-rays. The x-rays revile John has a chipped knee cap. a) Minor Occurrence b) Sensitive Situation c) Serious Reportable d) Reportable

13. What classification does the following incident fall under: While walking towards the kitchen John fell hitting his left knee. Carlos the staff member, helped John onto a chair and applied ice to his knee. After monitoring John for approximately 30 minutes, Carlos sees John knee is still swollen. Carlos escorts John to the emergency room where the doctor orders x-rays. After reviewing the x-rays the doctor decides John should remain in the hospital for observation…. a) Minor Occurrence b) Sensitive Situation c) Serious Reportable d) Reportable

14. Missing Person • Unauthorized/Unexpected Absence After Normal Search Procedures (911) Initiated. • Formal search must be initiated after 4 hour, reasonable judgment, considering clients habits, deficits, capabilities, health status, determines when a search procedure should be implemented. When client is in danger to themselves or others, A FORMAL SEARCH MUST START IMMEDIATELY. • Any situation that meets the definition of Missing Person will always be considered a Serious Reportable Incident.

15. Death • All Deaths are SERIOUS REPORTABLESINCIDENTS. Whether the death is Natural and/or Unnatural or Unexpected. When unrelated to known illness or disease, homicide, suicide, unexplained or accidental.

16. Restraint • Any device which prevents the free movement of both arms and/or both legs. • Physical, Mechanical or Medicinal aimed at controlling BEHAVIORS. • Immobilization of fractures, intravenous drips or other medical application are allowed as long as they are being applied/monitored in a hospital setting. • Whenever a restraint is used it is to be reported as a Serious Reportable Incident.

17. Medication Errors • Marked, Adverse Side Effects which jeopardizes the health and welfare of the consumer. • This can be identified as a result from: • Wrong dosage • Wrong form • Wrong application • Wrong patient • Wrong medication • Failing to administer medication This is classified as a Reportable incident.

18. Medication Errors • If the consumer is admitted into the hospital resulting from any of the previously mentioned infractions, the classification of the incident MUST change from a Reportable Incident to Serious Reportable Incident.

19. Medication Errors • Medication Errors which do not result in advise effects are not reportable but must be documented in a persons record.

20. Possible Criminal Act • Actions by a person receiving services which are or appear to be a crime. • A crime is defined as “an act that is forbidden by law that makes the offender liable to punishment pursuant to the law. In New York State, the Penal Law defines a crime as a Misdemeanor or a Felony, but does not include a traffic infraction.” • This falls under the classification of Serious Reportable Incidents.

21. Sensitive Situations • A Reportable Sensitive Situation Incident are situations involving a person receiving services which are not described previously, which may be of a delicate nature to the agency, and which are reported to the administration to ensure awareness.

22. Sensitive Situations • A Serious Reportable Sensitive Situation Incident are those situations which in the judgment of the chief executive officer, needs to be brought to the attention of OPWDD, through the DDSO as expeditiously as possible.

23. ABUSE • The definition of ABUSE under 624 Regulations is as follows: • The maltreatment or mishandling of a person receiving services which would endanger the physical or emotional well being of the person through the action or inaction on the part of anyone, including an employee, intern, volunteer, consultant, contractor, visitor, or others, whether or not the person is or appears to be injured or harmed.

24. ABUSE • Failure to exercise one’s duty to intercede on behalf of a person receiving services also constitutes abuse. • Employees must realize that, should they fail to intervene in a situation in which they consider a consumer is being abused, they may be considered as contributing to the abuse. This includes failing to interrupt an actual act of abuse or failing to report such abuse.

25. Mishandling/Maltreatment • Mishandling: is to manage wrongly or ignorantly. • Maltreatment: is cruel or rough treatment (or handling) of a consumer.

26. WHO REPORTS ABUSE? • Everyone and anyone who observes abuse, discovers signs of abuse or who hears an allegation. • Allegation: a claim that somebody has done something illegal, wrong, or undesirable.

27. WHEN SHOULD YOU REPORTABUSE? • Immediately. Even if you are not sure it is abuse, report what you observed, heard, etc. so that it can be investigated. It is not up to the reporter to judge whether it was abuse or not.

28. What Should be Reported? • Report the facts. (i.e. what you saw and/or heard). • Do not draw your own conclusions.

29. How Should I Report the Abuse? • Verbally, to your supervisor. • DO NOT leave a message.

30. How Can We Prevent Abuse? • Identifying the signs of stress and burnout. • Learning coping solutions and how to reframe situations. • Seeking support when needed. • Know your consumer. Recognizing antecedents, early warning signs. • Be flexible, avoid power struggles.

31. CATEGORIES OF ABUSE • Physical • Sexual • Psychological • Seclusion • Violation of Civil Rights • Mistreatment • Neglect

32. CATEGORIES OF ABUSE UNAUTHORIZED OR INAPPROPIATE USE OF: • Restraints • Aversive Conditioning • Time Out

33. PHYSCIAL ABUSE • Physical contact which may include, but not limited to such obvious physical actions as hitting, slapping, pinching, kicking, hurling, strangling, shoving, unauthorized or unnecessary use of personal intervention. • Physical contact which is not necessary for the safety of the person and/or causes discomfort to the person may also be considered to be physical abuse.

34. PHYSICAL ABUSE • Any intentional hitting, slapping, pinching, kicking, hurling, strangling or shoving of an individual receiving services by a staff member, intern, contractor, consultant or volunteer of a DDSO or provider entity, except for those instances in which the action was taken to prevent injury to the individual receiving services or any other person, whether or not such action causes injury, may be a crime and must be reported to law enforcement.

35. PHYSICAL ABUSE • Any intentional hitting, slapping, pinching, kicking, hurling, strangling or shoving of an individual receiving services by another individual receiving services, where the individual who performs the abusive action intends to cause physical injury to the other individual and causes such physical injury, may be a crime and must be reported to law enforcement. Physical injury is defined as impairment of physical condition or substantial pain.

36. PHYSICAL ABUSE • Any unauthorized or unnecessary use of restrictive personal intervention techniques, including the use of more physical force than is necessary for the safety of the individual receiving services, by a staff member, intern, contractor, consultant or volunteer, where the staff member, intern, contractor, consultant or volunteer knowingly acts in a manner likely to cause injury to the physical or mental welfare of the person receiving services, may be a crime and must be reported to law enforcement

37. PHYSICAL ABUSE • Physically forcing a person, who refuses to take a medication would be considered physical abuse. • Any unauthorized or unnecessary use of restrictive personal intervention techniques, including the use of more physical force than is necessary for the safety of the individual receiving services, by a staff member, intern, contractor, consultant or volunteer, where the staff member, intern, contractor, consultant or volunteer knowingly acts in a manner likely to cause injury to the physical or mental welfare of the person receiving services, may be a crime and must be reported to law enforcement. .

38. PHYSICAL ABUSE • Any unauthorized or inappropriate use of restraint where the staff member, intern, contractor, consultant or volunteer knowingly acts in a manner likely to cause injury to the physical or mental welfare of the person receiving services may be a crime and must be reported to law enforcement. This includes the use of mechanical restraining devices or medication to control a person’s behavior without the necessary permissions

39. SEXUAL ABUSE • Any sexual abuse, as defined by 14 NYCRR Part 624.4(c)(2), between a person receiving services and an employee, intern, consultant, contractor or volunteer of an agency may be a crime and must be reported to law enforcement. • Sexual contact is defined as the touching or fondling of the sexual or other intimate parts of a persons for the purpose of gratifying the sexual desire of either party, whether directly or through clothing. • Any sexual contact between two persons receiving services in which one person receiving services uses force or coercion may be a crime and must be reported to law enforcement.

40. PSYCHOLOGICAL ABUSE • The use of verbal or non-verbal expression, or other actions in the presence of one or more persons receiving services that subjects the person (s) to ridicule, humiliation, or scorn, contempt or dehumanization. In addition to the language and/or gestures, the tone of voice, such as that used in screaming or shouting at the presence of persons receiving services, may in certain circumstances, constitute psychological abuse.

41. SECLUSION • The placement of a person in a secured room or area from which he or she cannot leave at will. • Note: This does not include TIME OUT as part of a behavior management plan.

42. UNAUTHORIZED OR INAPPROPRIATE USE OF RESTRAINTS • Use of mechanical restraining devices without the written prior physicians authorization without it being specified in a plan of service, or used for medical purposes without a physician's order. • The intentional use of a medication to control a persons behavior that has not been prescribed by a physician.

43. UNAUTHORIZED OR INAPPROPRIATE USE OF Aversive Conditioning • The use of adverse conditioning without appropriate permission is the unauthorized use of aversive conditioning. Inappropriate use of aversive conditioning shall include, but not limited to, the use of the technique for convenience, as a substitute for programming, or for disciplinary (punishment) purpose.

44. UNAUTHORIZED OR INAPPROPRIATE USE OF TIME OUT • The use of Time Out without appropriate permission is the unauthorized use of Time Out. Inappropriate use of Time Out shall include, but not limited to, the use of the technique for convenience, as a substitute for programming, or for disciplinary (punishment) purpose. • Time out should not be confused with seclusion.

45. VIOLATION OF A PERSONS CIVIL RIGHTS • Any action or inaction which deprives a person of the ability to exercise his or her legal rights. • Civil rights are those rights stipulated in State or Federal law for all persons in the United States, as such but not limited to the right to be free from discrimination, the right to vote, the right of children to education, and the right of disabled person to access public buildings.

46. MISTREATMENT • The deliberate and willful determination of an agency or staff to follow treatment practices contraindicated a person’s plan of service, which violates a person’s human rights or does not follow accepted treatment practices and standards in the field of developmental disabilities. • The denial of programming, socialization, recreation, etc. might be categorized as abuse in the form of mistreatment.

47. NEGLECT • A condition of deprivation in which persons receiving insufficient, inconsistent or inappropriate services, treatment, or care to meet their needs. • Failure to provide appropriate and/or safe environments for persons receiving services. • Failure to provide appropriate services, treatment, or care by gross error in judgment, inattention, or ignoring may be considered a form of neglect.

48. IS THIS ABUSE? • It’s 9:00 pm and Maria, DCC assist her consumers with their showers and puts two residents to bed in the room they share and shuts the door. The consumers keep getting up from their beds and opening the door. Maria decides to put a chair in front of the door and holds the door shut to prevent the consumers from leaving their room. • Is this abuse, and if so what kind? • Thirty five year old Janet has been trying to make her own sandwich for months. One afternoon she successfully completes the task and proudly approaches a staff who says “Big deal” and throws the sandwich in the garbage and walks away. • Is this abuse, and if so what kind?

49. IS THIS ABUSE? • While Roseanne, a twelve year old consumer is watching T.V., Tom, the DCC begins to tickle her. Roseanne doesn't like it and repeatedly asks Tom to stop. Tom says “ You’ve been so quiet today”, and continues to tickle Roseanne. • Is this abuse, and if so what kind? • Tom is a consumer who enjoys going to church every Sunday. This particular Sunday it is raining outside and staff tells Tom he would not be going to church today because it is raining. • Is this abuse, and if so what kind?

50. Carmella McDonald, Dir. of Clinical Services 646-919-8890 Kimberlyn James, Program Manager 917-682-9819 Daniel Rodriguez, Dir. Of Day Hab Services 347-756-8851 Marie Saintelmy Dir. Of QA & Corp Comp. 718-809-0721 Arlene Rado, Deputy. Ex Dir. of Pro Oper. 718-864-0228 Child Abuse Hotline 800-635-1522 REPORTING AN INCIDENT CHAIN OF COMMAND