1. Welcome! Apd To Today’s presentation of Reporting & Writing UIR’s
(Unusual Incident Report)
Sponsored By
Apd
Agency for persons with disabilities
State of Florida
Area 14
Revised November 8, 2014

2. Apd Welcome! To Today’s presentation of Reporting & Writing UIR’s
(Unusual Incident Report)
Sponsored By
Apd
Agency for persons with disabilities
State of Florida
Area 14
Revised November 8, 2014

3. Purpose. Operations APD OPERATING PROCEDURE STATE OF FLORIDA
No AGENCY FOR PERSONS
WITH DISABILITIES
TALLASSEE, September 19, 2005
Operations
INCIDENT REPORTING AND RISK PREVENTION FOR CONSUMERS LIVING IN THE COMMUNITY OR IN ICF/DDs
Purpose.
This operating procedure established APD Procedures and guidelines for identifying, reporting and analyzing information related to critical and reportable incidents and risk prevention involving APD consumers living in the community or in Intermediate Care Facilities for the Developmentally Disabled (ICF/DDs).

4. APD OPERATING PROCEDURENO
September 19, 2005
Incident Reporting and Risk Prevention For Persons Living In the Community or In ICF/DDs

5. Module 2 Medical UIR’s & Med Error Reports (Group Breakouts) Performance-Based Exercise: Writing an EBI & UIR Report Module 3 What Happens To Your UIR? APD UIR Databases .

6. APD OP September19,2005
2.Scope
c. This operating procedure also applies to APD employees initiating or responding to incident reporting and risk prevention involving APD consumers in the community or in ICF/DDs.
d. This operating procedure does not replace the abuse, neglect and exploitation reporting required by the by law and rule. Regardless of the reporting requirements provided in this operating procedure, allegations of abuse, neglect or exploitation must always be reported IMMEDIAATELY to the Florida Abuse Hotline

7. APD OP September19,2005
2. Scope
b. This operating procedure, therefore, applies to incident reporting and risk prevention in APD community programs, in APD contracted and licensed residential facilities, in any other community setting, and in private ICF/DDs in which consumers of APD services are receiving either state general revenue funded or Medicaid funded services. Incident reporting and risk prevention in APD developmental disabilities institution will be governed by a separate procedure.

8. APD OP September19,2005
2. Scope
a. In accordance with the requirements outlined in the PD Standard Contract, the Core Assurances for Medicaid developmental disabilities waiver providers, and the rules regulating licensed residential facilities and ICFR/DDs, it is the responsibility of all APD operated, contracted, and their subcontractors, and ICF/DDs licensed and regulated by the Agency for Health Care Administration, to report incidents to ASD in accordance with this operation procedure.

9. APD OP 10-oo September19,2005
(2) The oral report must be followed by an APD Incident Reporting Form (Appendix 1), submitted to the APD Area Office at the earliest opportunity but no later than the next business day. Whenever possible, the form should be completed electronically and submitted as an attachment to the area office. If handwritten, it must be legible. The first page of the form must be completed in its entirely by the person who initiated the original report.
(3) The APD Area Office Administrator or designee will immediately inform APD’s Deputy Director for Operation or designee at the Central Office in Tallahassee of the critical incident.

10. 3.REPORTING PROCEDDURES CRITICAL INCIDENTS.
APD OP September19,2005
3.REPORTING PROCEDDURES
CRITICAL INCIDENTS.
(1) Critical incidents must be reported to the appropriate APD Area Office by telephone or in person within one hour of becoming aware of the incident. If this occurs after normal business hours or on the weekend or holiday the person reporting the incident shall call the APD after-hours designee. If the incident occurs between the hours of 8:00 pm and 8 am and 9 am of the following day. It shall be within the provider’s discretion and judgment to determine the appropriate of waiting until the following morning.

11. REPORTING PROCEDURES a. CRITICAL INCIDENTS.
APD OP September19,2005
REPORTING PROCEDURES
a. CRITICAL INCIDENTS.

12. APD OP September19,2005
(6) CRITICAL INCIDENTS INCLUDE:
***(a) Consumer Death – The death of a person who is receiving services from an APD operated, licensed or contracted provider, Medicaid waiver provider, or ICF/DD that occurs due to or allegedly due to an accident, act of abuse, neglect, or other unexpected incident.

13. APD OP September19,2005
(5) Follow-up measures taken by provider (or APD staff as appropriate) to project consumers, gain control or manage the situation must be noted on the second page of the incident reporting from which may be completed at a later date. The measures must specify what actions will be taken to mitigate a recurrence of a similar incident.

14. APD OP September19,2005 (4) The reporter must also provide immediate notification to the person’s support coordinator, and to a child’s or incompetent adult’s parents or guardian. If the child is in the custody of the Department of Children and Family Services, the child's family services counselor (or DCF after hours on-call staff) must be immediately notified.

15. APD OP September19,2005
(d) MEDIA-An unusual occurrence or circumstance that may initiate unfavorable media attention.

16. APD OF September19,2005
Missing Child or Adult Who Has Been Adjudicated Incompetent- The unauthorized absence or unknown whereabouts of a minor or an adult who has been adjudicated incompetent who is receiving services from APD operated, licensed or contracted provider, Medicaid waiver provider, or ICF/DD (see additional procedures below).

17. APD OF ` September19,2005
*** (b) Sexual Misconduct – Any sexual activity, as described in ,F.S., between a provider and a consumer, regardless of the consent of the consumer, or incident of nonconsensual sexual activity between consumers. A provider is an paid staff member, volunteer, or intern; any person under contract with APD; or any person providing care or support to a consumer on behalf of APD.

18. (7) Reportable Incidents:
APD OF September19,2005
(7) Reportable Incidents:
Other rep0ortable incidents that are not critical incidents must be reported within one business day to the appropriate APD Area Office through the completion of an APD Incident Reporting Form (Appendix 1).
The form may be faxed, electronically mailed, or personally delivered to the Area Office. If handwritten, it must be legible. The first page must be completed in its entirety by the person who is initiating the repot.

19. Reportable Incidents (24 Hours)

20. Arrest
If any individual being served by APD is arrested for any reason, this is now a critical UIR as of November 3,2010 per a change in APD statewide policy.

21. (7) Reportable Incidents:
APD OF September19,2005
(7) Reportable Incidents:
***(a) Altercations-a physical confrontation occurring between a consumer and a member of the community, a consumer and provider, or tow consumers at the time that services are rendered and that results in law enforcement contact. If the altercation results in consumer injury care, emergency room or physician office setting, it is to be reported as a Consumer Injury. If the altercation results in consumer arrest, it is to be reported as a Consumer Arrest.

22. APD OF September19,2005
(5) These incidents will be managed at the area level, and only aggregate data on such incidents will be reported to APD’S Deputy Director for operations.

23. APD OF September19,2005
(3) Follow-up measures taken by the provider (or APD staff as appropriate) to protect consumers, gain control or manage the situation must be note on the second page of the Incident Reporting Form which may be completed at a later date. The measures must be specify what actions will be taken to mitigate recurrence of the same type of incident.
(4) The reporter must also provide immediate notification to the person’s support coordinator, and to a child’s or incompetent adult’s parent or guardian. If the child is in the custody of the Department of Children and Family Services, the child’s family services counselor (or DCF after hours on-call staff) MUST BE Immediately notified.

24. APD OF September19,2005
(e) Suicide Attempt-An act which clearly reflects the physical attempt by a consumer to cause his or her own death while receiving services from an APD operated, licensed or contracted provider. Medicaid waiver provider, or ICF/DD.

25. APD OF September 19,2005
(d) Missing Competent Adult- The unauthorized absence or un known whereabouts beyond eight hours (or less time if the person is known to lack capacity to make safe decisions) of a legally competent adult who is receiving services from a APD operated, licensed or contracted provider. Medicaid waiver provider, or ICF/DD. Local providers should refer to their Area Office Procedures to determine if they are required to report missing persons sooner than the time frame stated above.

26. APD OP September 19, 2005
***(b) Consumer Injury- Any injury sustained or allegedly sustained due to an accident, act of abuse, neglect or other incident occurring while receiving services from an APD operated, licensed or contracted provider. Medicaid waiver provider, or ICF/ DD that requires medical attention in a urgent care center, emergency room, or physician office setting.

27. Take a report of the missing child or incompetent adult.
APD OP September 19,2005
(a) Immediately call local law enforcement and ask the officer to:
Take a report of the missing child or incompetent adult.
Assign a case number and provide the number to the person reporting the child incompetent adult as missing.

28. APD OP September 19,2005
4. Procedures for Missing Children or Incompetent Adults:
Upon discovering that a minor or adult who has been adjudicated incompetent is missing, staff of an APD operated, licensed or contracted provider. Medicaid waiver provider, or ICF/DD who is responsible for the consumer’s care, shall:

29. APD OP September 19,2005
(f) Other- Any event not listed above that jeopardizes a consumer’s health, safety or welfare. Examples may include but not restricted to severe weather condition damage (e.g. tornadoes or hurricanes), criminal activity by providers or employees, fires or other hazardous events or conditions, etc. If the event may generate unfavorable media attention, it is to be reported as a critical incident (see ‘Media’ above).

30. 5. APD Area Office Responsibilities:
APD OF September 19,2005
5. APD Area Office Responsibilities:
(a) Each APD Area Administrator shall ensure that all APD operated, licensed or contracted providers. Medicaid waiver providers, and all ICF/DDs are informed about and provided with:

31. APD OF September 19,2005
(b) The person will immediately notify the APD’s Area Office Administrator (or after-hours designee and provide all the information listed above, including the case number. If the law enforcement officer refused to take the missing person report, the staff person shall inform the area Office Administrator or designee and the Administrator will contact the law enforcement agency to request assistance filing the report.

32. APD OF September 19, Procedures for Missing Children or Incompetent Adults (continued): (3) If the responding law enforcement missing person report, when it is available. (4) If the responding law enforcement officer refuses to take a missing person report, for any reason, the person making the report will document the name of the officer’s and the responding local law enforcement agency and request to speak to the appropriate Watch Commander.

33. Medicaid Waiver Core Assurances AHCA (Federal Requirements) Reportable Events

34. 7. References-(SEE HARD COPY OF POLICY)
APD OF September 19,2005
6. Risk prevention-APD Procedure APD Procedures (SEE HARD COPY OF POLICY0)
7. References-(SEE HARD COPY OF POLICY)

35. APD OF September 19, 2005
5. APD Area Office Responsibilities:
Each APD Area Administrator shall ensure that all APD operated, licensed or contracted providers, Medicaid waiver providers, and all ICF/DDs are informed about and provided with:
(1) This operating procedure
(2) The most current contact reporting incidents to the APD Area Office (Appendix 2)
(3) The after-hours contact home number of the APD Area Administrator or Designee (Appendix 2)
(4) A description of and more stringent procedures required at the local level

36. b. Recipient Death. A person whose life ends due to or allegedly due to an accident, act of abuse, neglect or other incident occurring while in the presence of an employee, in a Department of Children and Families operated or contracted facility or service center; while in the physical custody of the Department; or when a death review is required.

37. a. Altercation. A physical confrontation occurring between a beneficiary and employee or two more beneficiaries at the time services are being rendered, or when a beneficiary is in the physical custody of the department, which results in one or more beneficiaries or employees receiving medical treatment by a licensed health care professional

38. Reportable Events are any of the following events, which must be reported to the District.

39. e. Escape. The unauthorized absence as defined by statute, departmental operating procedure or manual, of a recipient committed to, or securely detained in, a Department of Children and Families mental health or developmental services forensic facility covered-by Chapters 393, 394 or 916, F.S.

40. d. Elopement. The unauthorized absence beyond eight hours, or other time frames as defined by a specific program operating procedure or manual, or a child or adult who is in the physical custody of the Department.

41. c. Recipient Injury or Illness
c. Recipient Injury or Illness. A Medical condition or a recipient requiring medical treatment by a licensed health care professional sustained or allegedly sustained due to an accident, act or abuse, neglect or other incident occurring while in the presence of an employee, in a Department of Children and Families or contracted facility or services center, or who is in they physical custody of the department.

42. h. Suicide Attempt: An act which clearly reflects the physical attempt by a recipient to cause his own death while in the physical custody of the Department or a Departmental contracted or certified provider and which results in bodily injury requiring medical treatment by a licensed health care professional.

43. g. Sexual Battery. An allegation of sexual battery by a recipient of a recipient, employee on a recipient, or recipient on an employee as indicated by medical evidence or law enforcement involvement.

44. f. Other Incident. An unusual occurrence or circumstance initiated by something other that natural causes or out of the ordinary such as a tornado, kidnapping, riot or hostage situation, which jeopardizes the health, safety and welfare or recipients who are in the physical custody of the Department.

45. The only person(s) qualified to determine if abuse exists is an Adult Protective Services Investigator, or Child Protective Investigator

46. NO! You are a mandated reporter regarding allegations of or suspected abuse, neglect, exploitation or sexual abuse including that of a person receiving services on person receiving services suspected sexual abuse.

47. Can your agency/supervisor instruct or require you to report any or all abuse allegations to them directly or prior to making a report to the Central Abuse Registry?

48. Criminal charges and fines can be imposed upon a person for the false reporting abuse up to the amount of $10,000

49. The reporting procedures do not replace the abuse, neglect and exploitation reporting system. Regardless of their status as an event in beneficiary risk prevention, allegations of abuse, neglect or exploitation must always be reported immediately to the Florida Abuse Hotline and appropriate district human rights advocacy committees as required by law.

50. You DO NOT have to give your name as a reporter
You DO NOT have to give your name as a reporter. If you do, it is kept confidential and against the law for an investigator or the Central Abuse Hotline or reveal your name. Your agency is required to submit a UIR regarding allegations of abuse but DO NOT need to know who reported it.

51. Criminal and administrative penalties will be pursued.
Continued:
If it is determined that administrators, owners or operators of a provider agency are considered to be culpable for the abuse through negligence or failure to report the incidence(s), their waiver enrollment status will be terminated.
Criminal and administrative penalties will be pursued.

52. Zero Tolerance
Penalties for Sexual Abuse: Confirmed cases of sexual abuse by service providers will result in immediate termination of the waiver enrollment status of the individual who committed the abuse as well as the imposition of legal penalties.

53. ABUSE

54. Continued: Pursuant to Section 415. 1034, F. S
Continued: Pursuant to Section , F.S., any service provider with knowledge of, or having reasonable cause to suspect that a vulnerable adult has been or is being abused, neglected or exploited shall immediately report such knowledge or suspicion to the Department’s Central Abuse Hotline At:

55. ABUSE

56. Mandatory Reporting Requirements
A person with knowledge of, or having reasonable cause to suspect that a child is being sexually abused by a parent, legal custodian, caregiver, or other person responsible for the child’s welfare, as defined n section , F.S, is required to report such knowledge or suspicion to the Department’s Central Abuse Hotline at:

57. Person on Person Sexual Abuse (Person’s Receiving Services) Known or suspected sexual abuse between two individuals with developmental disabilities must also be reported immediately to the Central Abuse Hotline at:

58. Failure to report known or suspected cases of sexual abuse represents an offense that will be cause for termination of waiver enrollment status. Criminal and administrative penalties will be pursued.

59. ABUSE

60. Copy ALL UIR’s To The persons Support Coordinator Immediately!

61. immediately to the Area or Regional APD Program Office to ensure the
Continued:
The incident must also be reported
immediately to the Area or Regional
APD Program Office to ensure the
continued health and safety of the
individuals involved.

62. 1-800-96-ABUSE …. So that an investigation will
occur in order to determine
whether or not the sexual abuse
was the result if inadequate
supervision or neglect on the part
of a service provider or caregiver.

63. An Emergency Behavioral Intervention Report MUST be submitted within 24 hours- if any of the following occur: Reactive Strategies-(including Redirection, Exclusion, Isolation, Social Disapproval, Planned Ignoring, etc..) Manual Restraint, Mechanical Restraint or Chemical Restraint _

64. Agency for Persons with Disabilities Emergency Behavioral Intervention(EBI Report) I e: Alternatives for Behavioral Crises (ABC) Professional Crisis Management (PCM)

65. Medicaid Waiver C ore Assurances Section 2
Medicaid Waiver C ore Assurances Section 2.2: Department Notification B. Immediate notification to the Area office of an emergency or of an unusual occurrence or circumstance. Said notification of an unusual occurrence or : -1. Hospitalization of a recipient -2. Involvement of law enforcement agency -Concerns about abuse, and reportable events -Death of recipient

66. UIR Follow UP
When Do You Follow UP?

67. Electronic Incident Reporting Form (UIR) Training
Incident Scenario
Trina Bated (SS#: ) Lives in her own apartment in Lakeland, FI. She receives supported living Services from My Way INCD., located at 1048 Marjorie place, Telephone(863)
Here’s what happened: Today(11/27/2005) is Trina’s birthday (she is 39) and she decided that she (with assistance from her supported living coach, Ann Lee P.M.) As soon as Ann left, Trina found a the bag of charcoal that they had purchased several months a go Trina decided that she would start the grill on her own.
Well, Trina did not realize that the grill was too close to the large over hanging tree in her back yard. When Trina lit the grill, the flame burst ignited several branches that quickly engulfed the entire tree.
When Ann returned, She was greeted by Trina, firemen, police officers and EMS WORKERS. Everyone was safe and the fire had been put out. Trina stated” IT’S A GOOG THING I KNOW HOW TO 911,HUH”

68. Writing a UIR and EBI Report

69. Submit URI & MER form to APD-Area14-IR @apd. State. Fl. us

70. AFTER – HOURS REPORTING OF MAJOR INCIDENTS IN AREA 14 THIS ORDER:
CASE MANAGER OR SUPPRT COORDINATOR:
IF NO RESPONSE CALL, PLEASE CALL:
Jennette Estes, Area 14 Deuty Adminstrator
Office (863)
Home: (863)
Cell: (863)
3) IF NO RESPONSE, PLEASE CALL :
Connle Miller, Iluman Service Program Adminsitrator
Officer: (863)
Home: (863)
Cell: (863)
4) IF NO RESPONSE PLEASE CALL:
Linda Gibson Human Services program Specialist
officer: (863)
Home: (863)
Cell: (863)

71. Please Take Out The UIR Follow UP Form From your Training Folder

72. If Needed As A LAST Resort………. Fax (863) 413-3388
If Needed As A LAST Resort………. . Fax (863) Or Mail to: Agency for persons with Disabilities 200 North Kentucky Ave suite 422 Lakeland, Florida 3381 Phone (864)

73. Secure All containing Consumer information must be sent in ZIX mail (secure Encrypted

74. Trina Bates [SS#: ] Lives in her own apartment in Lakeland, FI. She receives Supported living Services from My Dreams, My Way, INC., located at Marjorie Place, Lakeland Telephone: (863) Here’s what happened: Today (11/27/2005) is Trina’s birthday (she is 39) and she decided that she (with assistance from her supported living coach, Ann Lee) would have a BBQ and invite friends over to celebrate. (approx. 2:55 P.M.) As soon as Ann left, Trina found a the bag of charcoal that they had purchased several months ago. Trina decided that she would start the grill on her own. Well, Trina did not realize that the grill was too close to the large over hanging tree in her back yard. When Trina lilt the grill, the flame burst ignited several branches that quickly engulfed the entire tree. When Ann returned, She was greeted by Trina firemen, police officers and EMS workers, Everyone was safe and the fire had been put out. Trina sated “ It’s A GOOD THING I KNOW HOW TO CALL 911, HUH”

75. Electronic Incident reporting From (UIR) Training
Incident Senario

76. Trina asked “Do you think he will kick me out cause I burnt up his pretty tree.” I again told her that I don’t believe that he would do that but no matter what; we would work on it together. Mr. Rivers was very understanding about the situation. He stated to Trina and also to me (Trina asked me to talk to him too so that I would know what they had agreed to do.}; he would plant another tree nest week. He just glad that no one was hurt. Trina that she would pay for the tree. She stated “It’s only fair, I burnt the tree so I have to get him another one” Mr. Rivers stated he was able to get Trina to agree to splitting the cost and that she could pay10.00 extra a month until she has paid her half. He stated her share would be He later stated t o me that he would never had asked Trina to pay anything to replace the tree. The only reason he agreed on was because of Trina’s insistence the tree.

77. Once I completed all notification/documentation
Once I completed all notification/documentation. Trina and I discussed the importance of fire safety again. Trina started that she was really afraid that her support coordinator would say that she had to move into a group home because (in Trina’s own words: “I burnt the tree up”). I reassured her that would not be the case. I told her that everyone makes mistakes at times, our job is to learn from them. She agreed then asked if I would teach her how to “BBQ” food the right way”. I told her that I would but due to the possible dangers, I would like to do it with a formal program. Trina stated “That’s fine by me and I promise I won’t try that again until you teach me everything I need to know.” I then informed her that she