Individuals can receive injuries 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:
Individuals may 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:
An individual's money, medications or property may be mismanaged or stolen by a staff person.
Money and property
In several reports received by DHS licensing, 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 Licensing Division 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.
License holders serving adults with children are required under Minnesota Statutes, section 245G.19, subdivision 3, to have a policy and schedule explaining the times and circumstances when the license holder is responsible for supervision of a child in the program and when the child's parents are responsible for supervision of a child. The policy must explain how the program will communicate its policy about the responsibility of the supervision of a child to the parents.
License holders must also have written procedures addressing the actions a staff member must take if a child is neglected or abused, including under the supervision of the child’s parent.
Safe sleeping and bathing practices as described on this page are also important. Such practices may reduce the likelihood of infant deaths and should be used in program policy and procedure development and in required staff person training.
The needs of individuals receiving services may exceed 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 re-evaluate the facility's ability to provide services to the individual.
Mandated reporters at licensed facilities have failed to report alleged or suspected maltreatment of a vulnerable adult. Frequently, facility staff people 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, states that a mandated reporter who has reason to believe that a vulnerable adult has been abused, neglected or financially exploited shall immediately report the information to the common entry point. Reason to believe includes being told by another person that an incident occurred. Facility staff people 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.
Children have received food to which they are allergic. The following may reduce the likelihood of children's exposure to such food:
Children have suffered 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:
Children's fingers can be 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:
Sexual contact can occur between children at child care centers and at children's residential facilities. The following may reduce the likelihood of such incidents:
Rough handling of children in child care centers by staff people also has been reported. The following may reduce the likelihood of such incidents:
Thorough development, training and implementation of a child care center 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:
Children have been injured on playground equipment. The following may reduce the likelihood of playground injuries:
Ensure that the playground equipment is age-appropriate for the children using the equipment. Children who are allowed to play on playground equipment designed for older children are at greater risk of injuries from falls.
Further information from the U.S. Consumer Product Safety Commission regarding playground equipment is available in the Public Playground Safety Handbook (PDF). The U.S. Consumer Product Safety Commission also warns that children’s climbing equipment should not be used indoors on wood or cement floors (PDF) even if covered by carpet. Carpet does not provide adequate protection to prevent injuries.
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, providers are reminded 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:
To prevent burns from hot water:
To prevent burns from the sun:
To prevent burns from food and drinks:
To prevent burns from bottle warmers:
Heat applications can be dangerous, especially to individuals who have decreased mobility and other health issues. Prolonged use on one area of the body can cause severe burn, even when the heal application is at a low temperature setting. To prevent burns from heat applications (electric heating pads or items warmed in a microwave, such as rice bags):
The Licensing Division 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. Individuals have developed serious medical conditions 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 911 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 911. Providers should develop and implement written policies and procedures, in conjunction with a health care professional that:
Sexual contact and nontherapeutic personal contact can occur between facility staff people and individuals receiving services in our licensed programs. To reduce the risk of such occurrences, providers should review with staff people 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 people should know how to:
While the Licensing Division recognizes that staff people function in many roles for individuals receiving services and that providing a supportive nurturing environment is an important component of quality care, staff people need to be mindful that they are compensated to provide professional services for the individuals they support and to be responsive to their own limitations; working with the individual's interdisciplinary teams and involving additional professional services as needed.
The Licensing Division 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 field trips. In addition to the provision of required supervision (Minnesota Statutes, section 245A.02, subdivision 18 and Minnesota Rules, part 9503.0045, subpart 1, item A), the following suggestions are made to reduce the likelihood of such incidents:
Vulnerable adults have been 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: