The Division of Licensing receives reports regarding injuries to individuals related to the use of wheelchairs, van/bus lifts, and safety restraints during transportation. Providers are required to have a transportation safety policy and procedures as identified under the Home and Community-Based Services Standards. In addition, the following may reduce the likelihood of injuries involving transportation:
An individual's coordinated service and support plan addendum (CSSPA) includes assessments used to identify an individual's needs, vulnerabilities, and risks in multiple areas. Inadequately written and improperly implemented CSSPA's could result in harm to individuals receiving services. The following may reduce the likelihood of harm and incidents related to an individual's needs, vulnerabilities, and risks identified in the CSSPA:
The Division of Licensing receives reports regarding individuals who sustain injuries while using a wheelchair. It is the provider's responsibility to assess the individual's risk when using a wheelchair. This assessment includes:
Incidents where individuals fall or slip out of mechanical lift slings or wheelchairs occur because safety belts or straps are not utilized, either while in a mechanical lift or a wheelchair, prior to having either the mechanical lift or wheelchair in the proper position to transfer the individual safely. To reduce the likelihood of incidents, providers should:
The Division of Licensing receives reports where an individual's money, medications, or property was mismanaged or stolen by a staff person.
Money and property:
In several of these reports, a supervisory staff person was responsible for the mismanagement and was the sole person responsible to audit the individual's finances-allowing the exploitation to continue over a number of months or years. To reduce the likelihood of such incidents, providers should:
Many individuals are prescribed psychotropic and Schedule II medications. The Division of Licensing receives reports when these medications are missing or thought to be stolen. Providers should:
In addition, you can seek information from your pharmacist or call your city or county government to find out if a drug take-back program is available in your community.
The Division of Licensing received reports of two infant deaths resulting from unsafe sleeping and bathing practices. The following information may reduce the likelihood of such incidents and should be used in program policy and procedure development and in required staff person training.
License holders serving adults with children are required under Minnesota Rules, part 9530.6490, subpart 3, item A, to have a policy and schedule delineating the times and circumstances under which the license holder is responsible for supervision of children in the program and when the child's parents are responsible for child supervision. The policy must explain how the program will communicate it's policy about child supervision responsibility to the parents and include all circumstances under which the license holder will be responsible for the supervision of children in the program that includes at a minimum:
Minnesota Rules, part 9530.6490, subpart 3, item B requires that license holders must have written procedures addressing the actions to be taken by staff persons if children are neglected or abused including while the children are under the supervision of their parents.
In addition to the reporting of maltreatment requirements, these written procedures must also include the immediate actions that will be taken by staff persons to protect the health and safety of all children in the program.
*It is recommended that each provider immediately develops and implements a plan that includes an assessment of each parent's capacity to meet the health and safety needs of their children while at the program. The plan should include a statement of measures that will be taken to minimize the risk of harm presented to children for each risk identified.
The Division of Licensing receives reports in which the needs of individuals receiving services exceeded the licensed facility's capacity to provide services. These situations can and often do result in harm to the individual receiving services. When an individual's physical and/or mental health changes, providers should reevaluate the facility's ability to provide services to the individual.
The Division of Licensing receives reports where mandated reporters at the facility failed to report alleged or suspected maltreatment of a vulnerable adult. Frequently, facility staff persons stated that they did not report the alleged or suspected maltreatment because they did not know whether the alleged incidents of maltreatment occurred.
Minnesota Statues, section 626.557, subdivision 3, stated that a mandated reporter who has reason to believe that a vulnerable adult has been abused, neglected, or financially exploited shall immediately report the suspected maltreatment to the Common Entry Point of the county where the maltreatment allegedly occurred. Reason to believe includes being told by another person that an incident occurred. Facility staff persons must ensure the safety of the vulnerable adult upon learning of the alleged maltreatment, but no further investigation is necessary prior to reporting the suspected maltreatment to the Common Entry Point.
Minnesota Statutes, section 245A.65, subdivision 1, states that providers must establish and maintain policies and procedures to ensure that an internal review is completed within 30 calendar days and that corrective action is taken as necessary to protect the health and safety of vulnerable adults when the facility has reason to know that an internal or external report of alleged or suspected maltreatment has been made. This review must include an evaluation of whether related policies and procedures (relating to the incident, not the reporting policy) were followed before, during, and after the incident; whether the policies and procedures were adequate; whether there is a need for additional staff training; whether the reported event is similar to past events with the vulnerable adult(s) or services involved; and whether there is a need for corrective action by the license holder to protect the health and safety of vulnerable adults.
The Division of Licensing receives reports regarding children receiving food to which they are allergic. The following may reduce the likelihood of children's exposure to such food:
The Division of Licensing receives reports of children suffering elbow injuries at child care centers. The most common injury is referred to as "nursemaid's elbow," partial dislocation, or radial head subluxation. The most common cause of such an injury is staff persons lifting or pulling children by the wrist or hand. Examples of incidents involving children suffering "nursemaid's elbow" include the following:
In addition to increased awareness of this safety concern, the following might help prevent these injuries:
The Division of Licensing receives reports of children suffering fingers pinched in doors at child care centers. Children are at risk of their finger(s) being caught in a closing door; resulting injuries have included severing of a fingertip and permanent loss of a fingernail. There have also been incidents where children's fingers were pinched in cabinet doors. The following may reduce the likelihood of this type of incident from occurring:
The Division of Licensing receives reports of sexual contact between children at child care centers and at children's residential facilities. The following may reduce the likelihood of such incidents:
The Division of Licensing receives reports regarding rough handling of children by staff persons. The following may reduce the likelihood of such incidents:
Thorough development, training, and implementation of the Risk Reduction Plan required by Minnesota Statutes, section 245A.66, subdivision 2, may help reduce the likelihood of incidents of known risk to children including:
Minnesota Statutes, section 245A.66, states that providers must establish and maintain policies and procedures to ensure that an internal review is completed (except for family child care settings and foster care for children in the license holder's residence) within 30 calendar days and that corrective action is taken if necessary to protect the health and safety of children in care when the facility has reason to know that an internal or external report of alleged or suspected maltreatment has been made. The review must include an evaluation of whether related policies and procedures were followed before, during, and after the incident; whether the policies and procedures were adequate; whether there is a need for additional staff training; whether the report is similar to past events with the children or the services involved; and whether there is a need for corrective action by the license holder to protect the health and safety of the children in care.
Due to the severity and preventability of incidents regarding hot water, sun, and heat application burns, the Division of Licensing is reminding providers of this danger. In addition, information is provided regarding burns from hot food and drink. The following information may reduce the likelihood of such incidents:
The Division of Licensing receives reports each year where an individual was not provided with necessary and timely first aid and/or cardiopulmonary resuscitation after an incident or injury occurred. The Division of Licensing also receives reports where an individual developed a serious medical condition and/or died prior to receiving emergency medical treatment.
Not providing first aid to an individual or moving an individual has resulted in more serious injuries than the initial injury presented. To prevent an individual's injury from worsening, the provider should develop and implement written policies and procedures, in conjunction with a health care professional, that:
In many cases, a staff person attending to the individual did not telephone 9-1-1 because they minimized the individual's condition, assumed the individual's symptoms were behavioral, or believed that they needed permission from a parent, guardian, or a supervisory staff person prior to telephoning 9-1-1. Providers should develop and implement written policies and procedures, in conjunction with a health care professional that:
The Division of Licensing receives reports involving sexual contact and nontherapeutic personal contact between facility staff persons and individuals receiving services in our licensed programs. To reduce the risk of such occurrences, providers should review with staff persons the importance of maintaining professional boundaries with the individuals who receive services at their facility. Failing to maintain healthy boundaries is not therapeutic and might be maltreatment or a licensing violation. The following list is not all encompassing but provides areas for consideration in staff training and policy and procedure development.
Staff persons should know how to:
While the Division of Licensing recognizes that staff persons function in many roles for individuals receiving services and that providing a supportive nurturing environment is an important component of quality care, staff persons need to be mindful that they are compensated to provide professional services for the individuals they support and be responsive to their own limitations; working with the individual's interdisciplinary teams and involving additional professional services as needed.
The Division of Licensing receives reports involving children leaving child care centers without staff persons' knowledge; children left without supervision on playgrounds or in classrooms; children left behind in community settings; and children leaving the group during outings or fieldtrips. In addition to the provision of required supervision (Minnesota Statutes, section 245A.02, subdivision 18), the following suggestions are made to reduce the likelihood of such incidents:
The Division of Licensing also receives reports involving adults being left without supervision at residential, work, and community settings. In addition, reports are received that involve individuals leaving facilities without supervision. The following suggestions are made to reduce the likelihood of such incidents: