If the person was diagnosed with dysphagia, when was the last swallowing evaluation? OPWDD shall verify the accuracy of the information in each person's individualized services plan relative to fire evacuation performance. Seizure frequency? This requires that the SC/CM ensure that all required attachments (e.g. Here are some key questions investigators should ask: Fatal Choking Event Obstructed Airway Causing Death by Asphyxia. Use these questions, as appropriate. The maximum monthly amount a person can be required to contribute to the cost of care in a community residence. What is the pertinent staff training? 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. Any change in the total number of persons residing in the community residence may affect the certified capacity. % If you are not familiar with the MOLST process please see here. OPWDD assumes no responsibility for the use or application of any regulations posted here. Any history of constipation/small bowel obstruction? Were staff trained? Bowel Obstruction Most commonly, bowel obstruction is due to severe, unresolved constipation, foreign-body obstruction, obstruction due to cancerous mass, volvulus twisted bowel," or Ileus (no peristaltic movement of the bowel). 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. The PPO must be completed by the SC with the applicant during the development of the ISP. are received by service providers. As used in this Part, the term indicating the need for appropriate written guidance for staff, whether such guidance is in the form of a policy statement, a policy statement with accompanying procedures, or procedures only. Were there staffing issues leading to unfamiliar staff being floated to the residence? If there are any changes, a new PPO must be completed and signed by the participant, SC and any individuals listed as Informal Supports to the participant. OPERATION OF COMMUNITY RESIDENCES. Aspiration Pneumonia (People who are elderly are at a higher risk)? Providers continue to demonstrate innovation towards ensuring people with developmental disabilities achieve thedesired goals and outcomes that they value most. For purposes of this Part, this shall include children or adults who have applied to or have been screened for services and for whom a clinical record is maintained or possessed by such a facility. Comments: Name of RRDS Signature Date. Email: Hoffman.Lori@epa.gov. Did the person require staff assistance to stand, to walk? (CDC.gov, 2014) Most often people are in the hospital when they die from sepsis. ;yC| The PPO (refer to Appendix C - form C.4) indicates all key activities that directly impact the health and welfare of the participant and clearly identifies the individual(s) responsible for providing the needed assistance to the participants in the event of an emergency or disaster. (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. Severity? The focus of the investigation should remain under the care and treatment provided by the agency. Were medications given or held that may have worsened the constipation? OPWDD 149 signed and dated by the investigator - mandatory. 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, Did the PONS address positioning and food consistency? 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. 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)? To request a document in another language, email[emailprotected]. Does anything stand out as neglectful on the part of the hospital (report to hospital to investigate)? CFCO, authorized in the Affordable Care Act, allows states to expand access and availability of long term services and supports. (y) Payment, community residence provider. Billing, HCBS, Exhibit any behavior or pain? Any medical condition that would predispose someone to aspiration? Were staff involved trained? Plans are revised at least every six months and must be signed. Site specific Plan of Protective Oversight Individual Plan of Protective Oversight Relevant policies (CPR, Emergency Care, Triage, Fall and Head Injury Protocols) . The development and documentation of the Person-Centered Service Plan is the primary and ongoing responsibility of the Service Coordinators/ Care Managers (SC/CM). (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. Antibiotics? <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> (6 steps, in brief, see full checklist on the website). Were the orders followed? Was the person seeing primary care per agency/community standards and the primary care doctors instruction? Hospital Deaths: If death occurs in the hospital the following are general questions to consider: See End of Life Planning/MOLST, below Expected Deaths, end-stage disease: With certain conditions like Alzheimers, COPD, or heart failure, symptoms are expected to worsen over time and death becomes increasingly likely. Plan and Staff Actions? They are not diseases or causes of death, but rather circumstances. 704 0 obj <>stream Did staff decide this independently, or was it with nursing direction? The first page of the house-specific Plan of Protective Oversight will be uploaded as an attachment. Did staff follow plans in the non-traditional/community setting? Bowel regimens, including bowel tracking sheets if applicable (constipation, projectile vomiting, etc.). When was the last lab work, check for medication levels? Ensure individual's plan of care is implemented. 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. What was the course of stay and progression of disease? Were there previous episodes of choking? Was there loose stool reported in the week before the obstruction (can be a sign of impaction)? (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. Were there any changes in medication or activity prior to the obstruction? Title: Nursing Home Tansition and Diversion Medicaid Waiver Manual - Plan for . Was staff training provided on aspiration and signs and symptoms? 686.16 Certification of the facility class known as individualized residential alternative. Circumstances? OPWDD DDRO Manual for the Children's Waiver, DD/MF and DD in Foster Care - August 2019 updated May 2021 (PDF) OPWDD Collaborative Eligibility Process for the Children's Waiver, DD/MF and DD in Foster Care - PDF | Recording (YouTube) - May 2021 Initiating and Maintaining OPWDD ICF/IID LCED Policy #CW0010 - Updated May 2021 (PDF) Transfer of Oversight/Service Provision Between Programs. 690 0 obj <>/Filter/FlateDecode/ID[<59ED846B642C84478C9F98D6F6215179>]/Index[665 40]/Info 664 0 R/Length 110/Prev 246535/Root 666 0 R/Size 705/Type/XRef/W[1 3 1]>>stream Were the vitals taken as directed, were the findings within the parameters given? What did the bowel records show? Did staff follow orders/report as directed? Artificial hydration/ nutrition? %PDF-1.5 % Diet orders and swallow evaluation, if relevant. January 9, 2023 . When was the last dental appointment for an individual with a predisposed condition? Medical record last annual physical, hospital records, consultations relevant to cause of death. ",#(7),01444'9=82. Any changes in medications prior to the acute incident? Was there a known mechanical swallowing risk? Certify notifications made and no objections. This document may be known by a different name but it must comprise the elements described in this definition. A designation for individuals in a supportive community residence who have attained independent living skills but who remain in the facility while they demonstrate their proficiency in these skills and/or make provisions for moving to independent living. 20 6WiyH9XBAOwSQpyv4(v[l|rt~/[ <3t>MW_KG7;b7AVTW'`YW z 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. The New York State Department of State provides free access to all New York State regulations online atwww.dos.ny.gov. What to expect; First visit; FAQ; OPWDD 149 - signed and dated by the investigator - mandatory Death certificate and/or autopsy (if performed) (this should be identified as the . 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 4 0 obj W t|C'TCT3W0 `A-][-|xA;f!Z}gV42`C!M_dgeLvkZeE~2 h240W0P04P0TtvvJ,NMQ04;. What were the prior diagnoses? Future hospitalizations? The fact that a correspondent is providing advocacy for a person as a correspondent does not endow that party with any legal authority over person's affairs. If diagnosed with seizures, frequency? food-stuffing, talking while eatingor rapid eating? Were there any diagnoses requiring follow up? Did the person receive any medications that could cause drowsiness? The PPO must be signed and dated by the applicant and SC and all individuals listed as Informal Supports to the waiver applicant. (s) Funds, Mental Hygiene Law, section 41. 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. How many? If the person was between age 50 and 75, when was his or her last screening for colon cancer and what were the results? Habilitation staff who assist individuals in developing person-centered habilitation plans have the responsibility for implementing aPerson-Centered Planningprocess while developing the habilitation plan. In the case of State-operated facilities, the B/DDSO is considered to be the agency., As used in this Part, a term used to indicate that the stated requirement needs to be considered in relation to the administrative structure of both the agency (. Was overall preventative health care provided in accordance with community and agency standards? 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 diagnosis? P3T{$0\C-yA8|}xE OX 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)? OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES, PART 686. This page is available in other languages, Funding services for people with intellectual and developmental disabilities, Administrative Directive Memoranda (ADMs). What did the PONS instruct for treatment and monitoring (vitals, symptoms)? This plan for Protective Oversight must be readily accessible to all staff and natural supports. Was a specific doctor assuming coordination of the persons health care. DNI? The basis of documentation may include facility specific record; specified forms or reports; specified contents of records, reports or forms; and/or other means of assessing compliance such as interviews with individuals, employees or volunteers, and/or onsite observation of activities and the environment. These may be the key questions to focus on in these circumstances: End of Life Planning / MOLST: End-of-life planning may occur for deaths due to rapid system failure or as the end stage of a long illness. When was his or her last EKG? The PPO must be attached to the Addendum for submission to the RRDS for review. Were staff aware of the risks/ plan? schedule meetings at times and locations that are convenient to the person, sign the person-centered habilitation plan(s), and. Available? 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. 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. Phone: 202-309-7504 . stream :@-S[!v:q~|lUsoo=e1aj\,;+Dt]QNN~U0iOuxabJ,cdVM>/gN>+NhS>/}aM]4g=H TtV0M19NK.MU/oNM>$C (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. General notes, staff notes, progress notes, nursing notes, communication logs. Can they describe the plan? Start or increase another medication that can cause constipation? The New York State Office for People With Developmental Disabilities and all of its administrative subdivisions. (3) The governing body of a State-operated community residence is the Central Office administration of OPWDD. What was the person's level of supervision? It clearly enlists the key activities that affect the health and welfare of an individual. <> (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. Were staff trained on the PONS? Is it known whether the person lost consciousness prior to the fall? the person and/or entity responsible for monitoring the plan. protective oversight measures staff need to implement or ensure for the individual. Was the PONS followed? The B/DDSO is responsible for coordinating the service delivery system within a particular service area, planning with community and provider agencies, and ensuring that specific placement and program plans and provider training programs are implemented. 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. This Inventory is a tool that can help to generate meaningful conversations with a person regarding the possible risk areas in his/her life. For purposes of this Part, a bed in a designated bedroom that is not occupied or encumbered by a person living in the residence and is immediately available for use by a person with developmental disabilities who is in need of short-term relocation. (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. ADMS, (1) all relevant habilitation plans (for individuals receiving habilitation services); (2) all relevant plans or documents pursuant to subdivisions 636-1.4(c) and (d) of this Title that support modification to an individuals rights specified in paragraphs 636-1.4(b)(1)-(4) of this Title; and. endobj It is attached with the ISP packet and sent to the RRDS for review and signature. Was there a plan for provider follow-up? Once this happens, multiple organs may quickly fail and the patient can die. Office of Inspector General FY 2023 Oversight Plan | 3 . Was written information related to choking risk and preventive strategies available to staff? Was the person receiving any medications related to this diagnosis? Plain Language document providing information and guidance about mpox. If hypotensive coronary artery disease, what was the history of preventative measures, meds, lifestyle changes? The death investigation is always the responsibility of the agency. Call us at (858) 263-7716. . 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. A vacant certified bed is counted in determining the facility's certified capacity. 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. %PDF-1.6 % EMS report, 911 call transcript, ER/hospital report, ambulance report if relevant. Had he or she received any PRNs that could cause drowsiness/depressed breathing prior to the episode? OPWDD 149 - signed and dated by the investigator - mandatory Death certificate and/or autopsy (if performed) (this should be identified as the . endstream endobj startxref $.' 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. EPA Office of Inspector General issues Fiscal Year 2023 Oversight Plan This page is available in other languages, Office for People With Developmental Disabilities. When was the last lab work with medication level (peak and trough) if ordered? Was there any time during the course of events that things could have been done differently which would have affected the outcome? 6. What were the symptoms which sent the person to the hospital? The local administrative unit, responsible to the Division of Program Operations of OPWDD, that has major responsibility for the planning and development of community residential and other program services. OFFICIAL COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK, CHAPTER XIV. 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. <>/Metadata 102 0 R/ViewerPreferences 103 0 R>> OPERATION OF COMMUNITY RESIDENCES, The agent or operator of a facility operated or certified by OPWDD. endstream endobj 200 0 obj <> endobj 201 0 obj <> endobj 202 0 obj <>stream Were decisions regarding care and end-of-life treatment made in compliance with the regulations regarding consent? Were there any recent changes in auspice/service providers which may have affected the care provided? What was the diagnosis at admission? If monitoring urine output report what amount, or qualities? It is a means of providing relief from the responsibilities of daily caregiving. Furthermore, OPWDD cannot provide individual legal advice or counseling. OPWDD's regulations are included in Title 14 of the New York Codes, Rules and Regulations (NYCRR). Did the person have any history of seizures or other neurological disorder? The information provided in this Plan for Protective Oversight summarizes alternatives so that the participant's health and welfare can be maintained in the community and that he/she is not at risk for nursing home placement. Was there a diagnosed infection under treatment at home? Whenever there is doubt on the part of any other party interested in the welfare of the individual as to that person's ability to make decisions, as ascertained by the program planning team, a determination of capability is to be made by an external capability review board, designated by the commissioner. Person-Centered Service Plans are expected to change and to adjust with the person over time. Were appointments attended per practitioners recommendations? Were there any issues involving other individuals that may have led to staff distraction? Written statements (expected for all death investigations). Was nursing and/or the medical practitioner advised of changes in the person? hbbd```b``f3@$S*X2tA0HY``0&I30KD_@# .l2Xm8_)I`W10RP ^` Contact: Lori Hoffman . Specialist care, per recommendations? The maximum number of beds available to be occupied by people with developmental disabilities for respite purposes, as indicated on the operating certificate issued by the commissioner. There are several resources to support the planning process and the delivery of exceptional care in the most integrated community settings. Was there a PONS for dysphagia/dementia/seizures? On the agencys part? Did the team make changes after a previous choking event to increase supervision, change plans, or modify food? Did it occur per practitioners recommendation? What were the directions for calling a nurse? (4) service coordination, including assessment, service planning and coordination, linkage and referral, follow-up and monitoring. Did staff understand and follow dining/feeding requirements? Was the fall observed? OPWDD assumes no responsibility for any error, omissions or other discrepancies between the electronic and printed versions of documents. If the fall was not observed, did staff move the individual? A designation for those persons (such as an individuals spouse, children or other family members) residing at the certified supportive community residence, and who have not been admitted to the supportive community residence. A copy is also provided by the SC to each waiver service provider listed in the RSP. When was his or her last lab work (especially if acute event)? xU]k@|?T? Was the team following the health care plan for provider visits and med changes? Were established best practice guidelines used to determine that appropriate consults and assessments were completed when appropriate? Phone: (202) 898-2578 | Fax: (202) 898-2583 | info@advancingstates.org. Was there a known behavior of food-seeking, takingor hiding? Were appointments attended per practitioners recommendations? Short URL: http://www.advancingstates.org/node/50465, Leadership, innovation, collaboration for state Aging and Disability agencies, ADvancing States What is the pertinent past medical history (syndromes/disorders/labs/consults)? endstream endobj 168 0 obj <>stream A Plan of Nursing S ervices (PONS) is required by OPWDD and addresses a service recipient's individual medical needs. Washington, D.C. Was there a specific plan? What communication occurred between OPWDD service provider and hospital? When was the last GYN consult? hb```%\@9V6]h about ADM #2015-02 Service Documentation for Community Transition Services, about ADM #2018-06R2 Transition to People First Care Coordination, about ADM #2022-05 Medication Administration Training Curriculum for Direct Support Staff, Office for People With Developmental Disabilities, Title 14 of the New York Codes, Rules andRegulations (NYCRR), 1915(c) Childrens Waiver and 1115 Waiver Amendments, Management of Communicable Respiratory Diseases. Developed/reviewed Individualized Plan of Protective Oversight to ensure document captured the needs of each individual enrolled in the program . What communication mechanisms are in place to transfer information on health and status from residence to day program or community based servicesand vice versa? 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. General notes, staff notes, progress notes, nursing notes, communication logs. If you are seeking specific legal advice in relation to these regulations, you should contact a licensed attorney in your local community. I am pleased to present the Environmental Protection Agency Office of U.S. Did staff report to nursing when a PRN was given? Documentation related to the plan, if required. Effective January 21, 2011: The MOLST (Medical Orders for Life Sustaining Treatment) form and the MOLST Legal Requirements Checklist should be completed in compliance with the Health Care Decisions Act of 2003. What PONS were in effect and were staff trained? The SC, participant, and all individuals listed as Informal Supports to the participant must sign the PPO. Individualized Plan of Protective Oversight. Individual Plan of Protective Oversight. endstream about ADM#2021-04R Crisis Services for Individuals with Intellectualand/or Developmental Disabilities (CSIDD) Service Requirements and Billing Standards. What are the pertinent agency policies and procedures? (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. When was the last consultation? Was it communicated? What were the PONS in place at the time? habilitation plans, Individualized Plan of Protective Oversight (IPOP), documentation to support rights modifications, nursing plans, etc.) Did the person have an injury or illness that impaired mobility? Did plan address Pica as a choking risk? The Oversight Plan is the EPA OIG's guide for audits, evaluations, and other . However, the service coordinator should also include safeguards that pertain to other environments where the person spends time. 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 What was the bowel management regimen e.g. Was there a PONS? Was this reported? Was there a written bowel management regimen? New York, NY. Were the risks addressed? 665 0 obj <> endobj DNR? (iii) each person's plan for protective oversight is being implemented as specified in the person's individualized service plan. (ii) Facilities of 1-3 beds where on-site 24-hour per day supervision is provided. Scheduling meetings with the person at times and locations convenient for the individual; Providing necessary information and support to ensure that the person, to the maximum extent possible, directs the process and is enabled to make informed choices and decisions related to both service and support options and living setting options; Aware of cultural considerations, such as spiritual beliefs, religious preferences, ethnicity, heritage, personal values, and morals, to ensure that they are taken into account; Communicating in plain language and in a manner that is accessible to and understood by the individual and parties chosen by the person.
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