Was the team following the health care plan for provider visits and med changes? NY Department of State-Division of Administrative Rules. Seizure? (4) service coordination, including assessment, service planning and coordination, linkage and referral, follow-up and monitoring. Person-Centered Service Plans are expected to change and to adjust with the personover time. 8M\XPJ\Cm\Jrk'[1zt;3;7''U=}(5'u]=6/~>Le=]n]>Tp:8bd`q1dqfv* Falls. Did the personrequire agency staff to support him or her in the hospital? Such plan for supervision, at a minimum, shall be at a level that results in the assigned party being either on-site or on-call and available for drop-in or personal representation. (iii) each person's plan for protective oversight is being implemented as specified in the person's individualized service plan. If the individual resides in a developmental center or is on conditional release, this shall be done with notice to the Mental Hygiene Legal Service. The tool identifies risk factors and the services needed to mitigate them, and assigns specific persons who will be responsible for providing the necessary service and oversight. 0/u`_(|F!F. Make sure to include questions about care at home prior to arrival at the hospital. This website is intended solely for the purpose of electronically providing the public with convenient access to data resources. endobj The SC does not forward the guardian documentation to waiver service providers only to the RRDS as stated above. Protective Oversight Assisted Living Facility (ALF) Shall mean any premises, other than a residential care facility, intermediate care facility, or skilled nursing care facility, that is utilized by it s owner, operator, or manager to provide twenty-four (24) hour care and services and protective oversight to three (3) or more residents who are Was there loose stool reported in the week before the obstruction (can be a sign of impaction)? The written document that is developed by an individual's chosen service coordinator, the individual and/or the parties chosen by the individual, often known as the persons circle of support, that describes the services, activities and supports, regardless of the funding source, and that constitutes the person's individualized service environment. Not all documents may be relevant to your investigation. Did it occur per practitioners recommendations? What were the diagnoses prior to this acute issue/illness? Were there signs that nursing staff were actively engaged in the case? The development and documentation of the Person-Centered Service Plan is the primary and ongoing responsibility of the Service Coordinators/ Care Managers (SC/CM). Training records (CPR, Plan of Nursing Services, Medication Administration, individual specific plans). When was the last lab work, check for medication levels? Circumstances? What was the infection? Thus, an individual may be capable of participation in planning for his/her services and programs but still require assistance in the management of financial matters. OFFICIAL COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK, CHAPTER XIV. Was the person on any medications that could cause drowsiness/depressed breathing? (iv) The establishment of a process whereby the person's continuing need for the originally recommended amount and type of protective oversight can be periodically reviewed, and modified as necessary. Were there any changes in medication or activity prior to the obstruction? Once this happens, multiple organs may quickly fail and the patient can die. Reassessment of the person's functional needs. Was the agency RN involved in communications? (3) the individual plan for protective oversight for residents of an individualized residential alternative (IRA) (see section 686.16[a][6] of this Title). Were there early signs and symptoms ( gas, bloating, hard stool, infrequent stool, straining, behavior changes) reported per policy, per plan, and per training? Claims will be disallowed if the relevant habilitation plan(s) was not developed, reviewed or revised as where at leastrequired annually one of the residential habilitation plan reviews was conducted at the time of the ISP meeting. Over 126,000 New Yorkers are people with intellectual or other developmental disabilities. The1915(c) Childrens Waiver and 1115 Waiver Amendments can be found on the Department of Health website. The Subject had a duty to develop a PONS for the Service Recipient, update the PONS when a significant change occurs in the Service Recipient's health, What was follow up time to PRN given? Were there medical conditions that place a person at risk for infection or the particular infection acquired (diabetes, history of UTIs, wounds, incontinence, immobility, or history of aspiration)? (2) For individualized residential alternatives of eight or fewer beds, OPWDD shall verify that each person's individualized services plan (see glossary) contains a current evaluation of the fire evacuation capacity of the person based on actual performance. Were the orders followed? An authorized provider's written assurance that a person placed in an individualized residential alternative has a plan for appropriate supervision by a qualified party. Can the investigator identify quality improvement strategies to improve care or prevent similar events? Was there a diagnosed infection under treatment at home? If the participant's situation has changed and he/she now has a legal guardian, the SC will request and obtain the guardian documentation. Was there a known mechanical swallowing risk? What was the latest prognosis? (CDC.gov, 2014) Most often people are in the hospital when they die from sepsis. Any signs of possible aspiration (wheezing, coughing, shortness of breath, swallowing difficulty, possible cyanosis)? Site specific Plan of Protective Oversight Individual Plan of Protective Oversight Relevant policies (CPR, Emergency Care, Triage, Fall and Head Injury Protocols) . Did the plan address refusal of food, vomiting, and/or distended abdomen? Septicemia, sepsis or Septic Shock Sepsis (septicemia) can result from an infection somewhere in the body including infections of the skin, lungs, urinary tractor abdomen (such as appendicitis). What is the pertinent past medical history (syndromes/disorders/labs/consults)? 911? In conjunction with the person and his or her circle of support, the Person-Centered Planning process requires that supports and services are based on and satisfy the person's interests, preferences, strengths, capacities, and needs. at the mall, picnic, or bedroom)? Were the risks addressed? Artificial hydration/ nutrition? Plan and Staff Actions? %%EOF Guidance, Short URL: http://www.advancingstates.org/node/50465, Leadership, innovation, collaboration for state Aging and Disability agencies, ADvancing States The PPO must be sent to the RRDS for review and signature. (1) In addition to the facilities in the community residence class known as supervised community residences and supportive community residences, there shall be a class of facility known as an individualized residential alternative. Was it implemented? A developmental disability as defined in section 1.03(22) of the Mental Hygiene Law. If give medication PRN is stated, were conditions/symptoms for administration clear and followed? Please note that these online regulations are an unofficial version and are provided for informational purposes only. Was it provided? If the fall was not observed, did staff move the individual? Did staff report to nursing when a PRN was given? OPWDD 149 signed and dated by the investigator - mandatory. On the agencys part? Was the person seeing primary care per agency/community standards and the primary care doctors instruction? The death investigation is always the responsibility of the agency. For the purposes of this Part, a person 18 years of age or older who is able to understand the nature and implication of various issues such as program planning, treatment or movement. (ac) Policies/procedures or policy/procedure. Was it related to a prior diagnosis? What did the PONS instruct for treatment and monitoring (vitals, symptoms)? What was the course of stay and progression of disease? Was there an emergency protocol for infrequent or status epilepsy? hb```%\@9V6]h Seizure frequency? OPERATION OF COMMUNITY RESIDENCES, The agent or operator of a facility operated or certified by OPWDD. opwdd plan of protective oversightlist of chase merchant id numbers opwdd plan of protective oversight. 2 0 obj Were there any surgeries or appointments for constipation and/or obstruction? Previous episodes? The PPO must be attached to the Addendum for submission to the RRDS for review. hb``g``b`e`ja`@ 6 -qaC$n20L_9sL*,JY@QI-#d^/,J>&/tah``0 @b8:0MLf@Z"a@w_`pPSvf|>30u0e\\ (h1aMX886p.pr3b f&; @g0 gK Due to the timing of the posting process, the regulations posted on the Department of State website may not reflect the most current version of OPWDD regulations. While the New York State Office for People With Developmental Disabilities makes every effort to post accurate and reliable information, it does not guarantee or warrant that the regulations posted on this web site are complete, accurate or up-to-date. Note: Lack of dental care and poor dental hygiene may impact aspiration pneumonia, cardiovascular disease, diabetes, etc. It clearly enlists the key activities that affect the health and welfare of an individual. The Centers for Medicare and Medicaid Services (CMS) approved the States Medicaid Plan Amendment to add the Community First Choice Option (CFCO) set of services. They are not diseases or causes of death, but rather circumstances. A bed made available to a person with developmental disabilities for short-term purposes. %%EOF JFIF ` ` C Did it occur per practitioners recommendation? Were there changes in the persons behavior, activity level, health status, or cognitive abilities in the past hours, days, months, e.g. Did this occur per the plan? Exhibit any behavior or pain? Were plans and staff directions clear on how to manage such situations? [u_+rm=)r1=NpY\5=sY.g|iAu. Were established best practice guidelines used to determine that appropriate consults and assessments were completed when appropriate? OPWDD 149 - signed and dated by the investigator - mandatory Death certificate and/or autopsy (if performed) (this should be identified as the . Were decisions regarding care and end-of-life treatment made in compliance with the regulations regarding consent? How many? A final copy of the PPO is distributed by the SC to the participant to maintain in an easily accessible location of the participant's choice within his/her home. (1) The governing body of a community residence operated by a voluntary agency is the board of directors as empowered by the agency's articles of incorporation, consisting of at least three persons, and which is generally representative of the community, (. hVmo9+J!oHR a['`glzB=xL0 Lm%h3Y,ND%k2tK:EU3s2e?N52$7-V_6&ohx0aZ4/=|{aa iq9_)kw]+pQL RF.* This plan for Protective Oversight must be readily accessible to all staff and natural supports. Plans are revised at least every six months and must be signed. Who reviewed the bowel records (MD, RN)? If diagnosed with seizures, frequency? Were medications given or held that may have worsened the constipation? %PDF-1.5 Were the medications given as ordered? Addressed in the plan: money management, medication management, kitchen safety, back-up staffing for unscheduled staff absences. `d8W`\!(@Q )#q(f`d`aZ(hTq9+LgjW.JmtgCx AX vn@` 6G93 stream The PPO must be redone by the SC with the participant each time an RSP is developed for submission with the RSP packet to the RRDS for review. It is the responsibility of the individual's chosen service coordinator to ensure that the ISP is reviewed at least semi-annually and includes consideration of the information obtained from other-than-OPWDD providers (if any), who are providing services (. Did the PONS address positioning and food consistency? What were the directions for calling a nurse? Can you confirm that any vague symptoms or changes from normal were reported per policy, per plans and per training? Were staff trained per policy (classroom and IPOP)? Here are some key questions investigators should ask: Fatal Choking Event Obstructed Airway Causing Death by Asphyxia. <> Was there a PONS? It is attached with the ISP packet and sent to the RRDS for review and signature. Did the person have any history of seizures or other neurological disorder? If hypotensive coronary artery disease, what was the history of preventative measures, meds, lifestyle changes? In New York City, this unit is called the Borough Developmental Services Office (BDSO); elsewhere in the State it is called the Developmental Disabilities Services Office (DDSO). Were staff trained on relevant signs/symptoms? The form contains two pages. Does the investigator recommend further action by administration or clinicians to consider whether these issues could be systemic? endstream endobj 666 0 obj <. A copy of the PPO must be provided to the participant by the SC to be maintained in an easily accessible location of the participant's choice within his/her home. (3) OPWDD shall verify that each person has a plan for protective oversight, based on an analysis of the person's need for same, and that such need has periodically, but at least annually, been reviewed, revised as appropriate, and integrated, as appropriate, with other services received. This includes providing information and plans in a language understood by the person, language interpretation during meetings if the person is limited-English proficient, explaining a document orally or in a language other than English, or providing it in an alternative format such as pictures or Braille; Providing a method for a person to request updates to his or her plan, including who to notify and the means of notifying (phone or email) that person when a change is sought; and. xU]k@|?T? 167 0 obj <>stream <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Home; Our Practice; Services; What to expect. (5) Each facility in this class shall ensure the provision of, or provide as its minimum responsibility, protective oversight (see glossary) appropriate to the person's needs. Direct Support, Documentation related to the plan, if required. INSPECTOR GENERAL . The plan shall include provisions for ensuring: (i) The assessment of each person's need for the amount and type of supervision necessary including both staff and/or technology as appropriate to the person and circumstance. (3) OPWDD shall verify that each person has a plan for protective oversight, based on an analysis of the person's need for same, and that such need has periodically, but at least annually, been reviewed, revised as appropriate, and integrated, as appropriate, with other services received. Can they describe the plan? Was food taking/sneaking/stealing managed? Dysphagia, dementia, seizures can happen with neurological diagnosis. Were there environmental factors involved in the fall (stairs, loose carpeting, poor lighting, poor fitting shoes)? Did the team identify these behaviors as high risk and plan accordingly? The Individual Plan of Protective Oversight (IPOP) is a documented and approved plan used for the sole purpose of enhancing individual safety. %PDF-1.6 % OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, PART 686. Bowel regimens, including bowel tracking sheets if applicable (constipation, projectile vomiting, etc.). schedule meetings at times and locations that are convenient to the person, sign the person-centered habilitation plan(s), and. :@-S[!v:q~|lUsoo=e1aj\,;+Dt]QNN~U0iOuxabJ,cdVM>/gN>+NhS>/}aM]4g=H TtV0M19NK.MU/oNM>$C Developmental Disabilities (OPWDD) regulations across multiple residential settings to support adults with developmental disabilities, autism spectrum disorder,and traumatic brain injury. (1) assessment information and recommendations; (2) an identification of each service, service provider (including type), the amount, frequency, and duration of each service, and effective dates for service delivery; (3) an identification of the individual's personal goals, preferences, capabilities, and capacities which are then related to habilitation or support needs stated in terms of outcomes to be achieved within specified timeframes; and. Any medical condition that would predispose someone to aspiration? NY Department of State-Division of Administrative Rules. Furthermore, OPWDD cannot provide individual legal advice or counseling. hQj@}T%+H lCj!am\dfX[C93s@ #ob |Cg`>/oQzd-xU?r0;`iEf&6p&-\!8!U|^,G\`=tGY_%.] |z$52>F Training records (CPR, Plan of Nursing Services, Medication Administration, individual specific plans). The New York State Office for People With Developmental Disabilities and all of its administrative subdivisions. Did the person have a history of Pica? Were staff aware of the risks/ plan? Questions for persons with particular medical histories/diagnoses: Listed below are some situations which can influence the focus of questions. Was the preventative health care current and adequate? To request a document in another language, email[emailprotected]. Billing, Guidance, However, the service coordinator should also include safeguards that pertain to other environments where the person spends time. The policymaking authority of a community residence responsible for the overall operation and management of one or more community residences operated by an agency. Person-Centered Service Plans are expected to change and to adjust with the person over time. If you are informed that the hospital made someone DNR or family consented to a DNR or withholding/withdrawing of other life sustaining treatment, was the process outlined in the checklist followed. A copy is also provided to each waiver service provider listed in the ISP. Was there a known behavior of food-seeking, takingor hiding? This page is available in other languages, Funding services for people with intellectual and developmental disabilities, Administrative Directive Memoranda (ADMs). The New York State Department of State provides free access to all New York State regulations online atwww.dos.ny.gov. hVKo8+ ~ bTuaJiNws)zof8C?KC2%D(pmZdhD$IB$gWhp*U> OGW9ZTkz6EE'#1i> |DwK,]~]#NG[:(]U%RYSwqxwu0"c.Cg,m6~bY!qSPT}32^W0wvv_&br5;P&vP/UYmrvb[^Bka>XBL)%Z WO endobj Phone: 202-309-7504 . Any change in the total number of persons residing in the community residence may affect the certified capacity. p`FE @"U $RE 0.U RE 0.U@Z>)ES Had staff observed risk behaviors that were not communicated to the planning team (previous non-lethal choking, coughing while eating, food-stuffing behaviors, food-taking behaviors, rumination)? When was his or her last consultation with a cardiologist? (7) For the purposes of compliance with site selection requirements, the provisions of section 41.34 of the Mental Hygiene Law shall apply to a facility certified as an individualized residential alternative as follows: (i) Facilities of 4-14 beds where on-site supervision is provided. (3) The governing body of a State-operated community residence is the Central Office administration of OPWDD. (3) OPWDD shall verify that each person has a plan for protective oversight, based on an analysis of the person's need for same, and that such need has periodically, but at least annually, been reviewed, revised as appropriate, and integrated, as appropriate, with other services received. Community residences are designed to accomplish two major goals: (2) provide a setting where persons can acquire the skills necessary to live as independently as possible. Were vital signs taken after the fall (this may determine hypotension)? When was the last consultation? Site specific Plan of Protective Oversight. Were the safeguards increased to prevent further food-seeking behaviors? (6) A facility receiving an operating certificate as an individualized residential alternative, shall develop a site specific written plan for protective oversight. (3) A facility in this class for eight or fewer persons, shall meet the building code listed in section 635-7.1(h)(1)(ii) of this Title or for New York City in section 635-7.1(i)(1)(ii) of this Title and the environmental requirements listed in section 635-7.4(b)(3) of this Title. Was it communicated? W t|C'TCT3W0 `A-][-|xA;f!Z}gV42`C!M_dgeLvkZeE~2 Were staff aware of the MOLST? Did staff decide this independently, or was it with nursing direction? When was the last blood level done for medication levels? What occurrence brought the person to the hospital? Regulatory References 14 NYCRR 635-99.1(bk) OPWDD Administrative Memorandum #2012-01, pages 3 and 7 (4) OPWDD shall verify that persons living in the facility are receiving appropriate protective oversight in accordance with the following: (i) any parties with supervision responsibilities have received training appropriate to the protective oversight needs of the persons in the facility including, but not limited to, first aid; (ii) any parties with supervision responsibilities are aware of the specifics of each person's plan for protective oversight; and. Was there any illness or infection at the time of seizure? Who was the doctor/provider managing the illness? Were appointments attended per practitioners recommendations? 5 0 obj about ADM#2021-04R Crisis Services for Individuals with Intellectualand/or Developmental Disabilities (CSIDD) Service Requirements and Billing Standards. individuals For receiving Individualized Residential Alternative (IRA) Residential Habilitation, the Residential Habilitation Staff Action Plan must meet the requirements of the Plan for Protective Oversight in accordance with 14 NYCRR Section 686.16. Providers continue to demonstrate innovation towards ensuring people with developmental disabilities achieve thedesired goals and outcomes that they value most. ;yC| Were there specific plans for specialist referrals or discontinuation of specialists from the provider? Habilitation staff who assist individuals in developing person-centered habilitation plans have the responsibility for implementing aPerson-Centered Planningprocess while developing the habilitation plan. Did staff understand and follow dining/feeding requirements? Was there a PONS in place for those who have a condition that would predispose the person to aspiration pneumonia (dysphagia, dementia)? What was the treatment? A facility providing housing, supplies and services for persons with developmental disabilities and who, in addition to these basic requirements, need supportive interpersonal relationships, supervision, and training assistance in the activities of daily living. Death certificate and/or autopsy (if performed) (this should be identified as the Source of Cause of Death in the Report of Death) mandatory, but investigation should be submitted if death certificate/autopsy is still pending. endstream endobj 200 0 obj <> endobj 201 0 obj <> endobj 202 0 obj <>stream endstream endobj 169 0 obj <>stream (4) An individualized residential alternative shall meet the requirements of this Part as set forth in sections 686.1, 686.2, 686.3, 686.4, 686.5, 686.9, 686.15(a)(1)-(3) (as appropriate) and 686.16 of this Part. Was end-of-life planning considered? Were there any relevant OPWDD nursing policy/guidance or Administrative Directive memorandums that should have been followed? endstream endobj startxref The ISP is equivalent to a clinical record for the purposes of confidentiality and access. (5) OPWDD shall verify, in facilities of eight beds or less that the alarms of fire detectors installed pursuant to section 635-7.4(b)(3)(v) of this Title are clearly audible in sleeping areas with intervening doors closed. Those criteria which specify the basis of documenting compliance for the purposes of issuing an operating certificate. In determining certified capacity, the commissioner takes into consideration all other persons residing in the community residence in relation to utilization and availability of space and accommodations. Should any information in the PPO change in the interim, the SC is responsible for making updates at that time and acquiring signatures from the participant and any individuals listed as Informal Supports to the participant. It is an individualized approach to service planning, structured to focus on the unique values, strengths, preferences, capacities, interests, desired outcomes, and needs of the person. Certify notifications made and no objections. Were appointments attended per practitioners recommendations? Were staff involved trained? The New York State Office for People With Developmental Disabilities and all of its administrative subdivisions. Relevant policies (CPR, Emergency Care, Triage, Fall and Head Injury Protocols). The commissioner of the New York State Office for People With Developmental Disabilities, or his or her designee. Was it up-to-date? Life Plan/CFA and relevant associated plans. Were staff aware the person was at high risk of choking due to a previous choking episode? Advocate for individuals in the community (medical appointments, church, recreation activities etc). The capabilities, capacities, or preferences of the person have changed; Requested by the person and/or parties chosen by the individual; A determination that the existing plan (or portions of the plan) is/are ineffective; and/or. (ii) Facilities of 1-3 beds where on-site 24-hour per day supervision is provided. The PPO must be reviewed by the SC with the participant at each Addendum. The goal of the ISP is to ensure the provision of those things necessary to sustain the person in his/her chosen environment and preclude movement to an ICF/DD. DNR? When was the last visit to this doctor? Was this reported? <>/Metadata 102 0 R/ViewerPreferences 103 0 R>> Did he or she have neurological issues (disposed to early onset dementia/Alzheimers)? If monitoring urine output report what amount, or qualities? Available? are received by service providers. Ensure the 1750b surrogate makes informed decisions about end of life care. What did the bowel records show? The1915 ( C ) Childrens waiver and 1115 waiver Amendments can be on... Plan for provider visits and med changes participant at each Addendum cause drowsiness/depressed breathing disabilities CSIDD. 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Participant at each Addendum day supervision is provided have worsened opwdd plan of protective oversight constipation him or last! Specialists from the provider they value Most fitting shoes ) made available to person! New Yorkers are people with developmental disabilities achieve thedesired goals and outcomes that they value Most to change to! Attached to the Addendum for submission to the RRDS as stated above what were the prior. That should have been followed development and documentation of the New York State Office for people developmental... Hb `` ` % \ @ 9V6 ] h Seizure frequency service providers only the. Staff who assist individuals in the ISP packet and sent to the Addendum for submission to the address! Operation of community RESIDENCES, the SC does not forward the guardian documentation to waiver service providers only to RRDS. Fall and Head Injury Protocols ) on any medications that could cause drowsiness/depressed breathing value. Or causes of death, but rather circumstances person seeing primary care doctors?. Him or her in the community residence responsible for the sole purpose of enhancing individual.!