Silva, Corinna C. From: Sent: Thursday, July 03, 2014 9:59 AM To: Ryan, Ann Cc: Subject: RE: Emailing: Incident Follow up? Delacare Attachments: Follow-Up Documentationpdf Good morning Ann, Attached is the retraining documentation requested for follow?up regarding the incident with M. Please contact me if you have additional questions. Have a great holiday! Message--?-- From: Sent: Wednesday: July 02, 2014 2:24 PM To: Ryan, Ann Cc: W: Subject: RE: Emailing: incident Follow up~ Delacare Sorry for the delay Ann. We got the memo out to our staff and emailed a copy of that to Erinn. a certified safety care instructor, will be retraining the 3 gentleman today and tomorrow. She will email you the signed paperwork when it has been completed. i wanted to make sure a trainer did the retraining with the 3 staff. The nks, H: B.A., Program Director St. George Academy 4185 Kirkwood St. Georges Road Bear, DE 19701 Ph: i Fx: 302.836.2516 Message??- From: Ryan, Ann [mailtozAnn.Ryan@state.de.us] Sent: Tuesday, July 01, 2014 4:10 PM To: Cc: Pizzo, Erinn Subject: FW: Emailing: incident Follow up- Delacare Good afternoon, i am following up to see if the corrective action plan for this incident was completed. Please let me know ASAP. Thank you Ann --?--0riginal From: Pizzo, Erinn Sent: Thursday, June 26, 2014 8:56 AM To: 3.0.33 Cc: Ryan, Ann Subject: RE: Emailing: . Incident Follow up? Delacare Good morning Heather, The Safety Care Manual clearly states "Do NOT place an object over the face." Holding material away above the face is acceptable but pulling a shirt over a child's face is covering the child's face/mouth. I clearly stated that "took a pillow case and folded it in half and put it over Mi '5 mouth." also stated that be adjusted the pillow case over 5 face. You yourself stated that staff" can only put a hand over the moth (not touching it), no pillow cases or towels over the face.? also stated that )Ut his hand over his mouth and nose and he couldn?t breathe. The trainers should NOT be training staff to pull the child's shirt over their mouth as the shirt would be "an object over the face." Holding a piece of material up and off of the child?s face is acceptable when you have enough staff to perform a hold as you would need a staff person that is not involved in the restraint. Per the original request on 6/10/14, the involved staff did not follow proper procedures and W. B. i and R. 1 need to have a retraining on the Safe Physical Management Practices and have them sign off on it. A memo needs to go out to all staff to clarify the procedure. Please send copies of the signed training for the three staff and a copy of the memo by 6/30/14. Thank you, Erinn -?-??0riginal Message-~? From: Heather Light [mailtozlighth@Advoserv.com] Sent: Wednesday, June 18, 2014 3:03 PM To: Pizzo, Erinn Subject: Emailing: Incident Follow up? Delacare Hi Erinn, Here are the interview notes and the page in the Safety-Care Manual that speaks to restricting breathing. The manual itself does not state any procedure to use to block spit. In speaking with some of our Safety Care Instructors, it is taught that staff can use their hands, or any other material an individual's shirt? they pull it up over the mouth, towel, etc.) as long as it's not laying over their mouth or restricting breathing in any way. By this, I don?t feel it is necessary to provide disciplinary feedback to since it acted in accordance with what he had been taught. Also, both Be and did not see Will use a pillowcase, and they might not have. During the procedure, each staff member is primarily facing away from the individual in restraint. I hope this makes things a little clearer. Had we known to interview the staff after IA did not investigate, I believe we could have gotten a better picture of what happened. We will, however, do an administrative review in the future, if IA does not accept the case. Please let me know if you have any questions or if you need futher information. Thanks! Heather Light Your message is ready to be sent with the following file or link attachments: Incident Follow up Delacare Note: To protect against computer viruses, email programs may prevent sending or receiving certain types of file attachments. Check your email security settings to determine how attachments are handled. The contents of this email message and any attachments are confidential and are intended solely for addressee. The information may also be legally privileged. 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This transmission is sent in trust, for the sole purpose of delivery to the intended recipient. lf you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly prohibited. if you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this message and its attachments, if any. The contents of this email message and any attachments are confidential and are intended solely for addressee. The information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended recipient. if you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly prohibited. if you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this message and its attachments, if any. Safe Physical Management Practices include: Physical management is used only for safety? never for convenience, coercion, punishment, denigration, of because Clea?escalation id taking "too long?. Apply no pressure to the head, neck, or torso. Do not restrict breathing, block the airway, place the object over the face, or put pressure on the diaphragm. Do not use joint locks or pressure points. Do not twist or hyper~extend joints. Do not place the person into an uncomfortable or awkward physical posture. Not used to inflict pain. Do not use more force that necessary for safety and stability. Do not push the person against a wall or over an object such as a chair or table. Do not straddle the person?s torso, buttocks, neck, or head. Do not require the person to sit or lie down on rough or unsafe surfaces. Do not attempt to escort the person on unsteady footing such as stairs, debris, or ice. Do not continue longer than necessary for safety. have had the opportunity to review the above and have a full understanding of safe physical management practices. Staff (Print Name) Authorized Trainer (Print Name) Vl db}! 4' (39 g; Signature Date ?(/2le i Signature Date- Safe Physicai Management Practices inciude: Physicai management is used for safety never for convenience, coercion, punishment, denigration, of because de?escaiation id taking ?too long?. a Appiy no pressure to the head, neck, or torso. I Do not restrict breathing, block the airway, piece the object over the face, or put pressure on the diaphragm. 0 Do not use joint iocks or pressure points. Do not twist or hyper-extend joints. - Do not piece the person into an uncomfortabie or awkward physicai posture. Not used to in?ict pain. a Do not use more force that necessary for safety and stability. 0 Do not push the person against a waii or over an object such as a chair or tabie. a Do not straddle the person?s torso, buttocks, neck, or head. Do not require the person to sit or lie down on rough or unsafe surfaces. 0 Do not attempt to escort the person on unsteady footing soch as stairs, debris, or ice. 0 Do not continue longer than necessary for safety. i have had the opportunity to review the above and i haye a fuii understanding of safe physicai .. *4 Staff (Fi? Name) Signature Date Gm? Authorized Trainer (Print Name) Signature Date management practices. a Safe Physical Manaeement Practices inciode: 0 Physical management is used only for safety? never for convenience, coercion, punishment, denigration, of because tie-escalation id taking "too long". 4! Apply no pressure to the head, neck, or torso. a Do not restrict breathing, block the airway, place the object over the face, or put pressure on the diaphragm. I Do not use joint locks or pressure points. - Do not twist or hyper?extend joints. a Do not place the person into an uncomfortable or awkward physical posture. a Not used to inflict pain. 0 Do not use more force that necessary for safety and stability. 0 Do not push the person against a wall or over an object such as a chair or table. 0 Do not straddie the person?s torso, buttocks, neck, or head. - Do not require the person to sit or lie on rough or unsafe surfaces. Do not attempt to escort the person on unsteady footing such as stairs, debris, or ice. Do not continue longer than necessary for safety. 1 have had the opportunity to review the above and i have a full understanding of safe physical management practices. Staff (Print Name) 5 Signature Date Authorized Trainer (Print Name) - Signature Date Silva, Corinna C. From: Sawyer, Cara Sent: Monday, May 19, 2014 11:11 PM To: Ranji, Jennifer Subject: AdvoServ outline Attachments: Corrective Action Plan for AdvoServ.docx Hi Jennifer, Attached is an outline of the requirements of AdvoSe-rv's compliance plan as well as an outline of what they are pledging to do to make improvements to their program. Bottom line is that they are pretty similar. There are not major differences in what they said they would do better and what they were asked to do better. They focus mainly on oversight of staff and ensuring there is no wrongdoing there rather than supporting them. Thanks, Cara Vita33; olzuiiwgeo conndenua: and intended om; 15 Corrective Action Plan for AdvoServ based on the incident involving MT 9 All AdvoServ staff will receive a review of approved Safety Care behavior management techniques at their April Shift Meetings 0 OCCL is still waiting for the list of all staff who attended the training. a All AdvoServ staff will receive and sign a policy on False Reporting and Falsification or Destruction of Documentation 0 OCCL is still waiting for this list. 0 All AdvoServ staff will be trained on the new AdvoServ Abuse and Neglect Policy 0 AdvoServ has updated the policy to reflect the Delaware Code but OCCL is still waiting for verification from AdvoServ that ail employees have completed it. All medications (in this particular case it was was at issue) must be accounted for via documentation 0 AdvoServ has placed in bubble packs and the staff member must initial the Medication Administration record and the bubble pack that the has been given. 0 Proper monitoring and supervision of employees and volunteers through adoption and implementation of a chain of command 0 AdvoServ has provided OCCL with a Table of Organization which delineates the chain of command. Random, unannounced monitoring will be provided by administrative and clinical staff during daytime, evening, night and weekend hours. 0 AdvoServ implemented a web?based timekeeping system on 11/21/13 that requires staff and supervisors to punch in using a biometric finger scanner whenever they transfer locations throughout the shift. 0 AdvoServ is in the process of installing video recording systems in the public areas of the residences, they will record continuously and keep the info for 14 days. 0 Cnow is AdvoServ?s existing live interactive video and audio system which they are working on expanding and modifying to monitor and facilitate staff training and clinical oversight. They have not yet finished this expansion into McCoy residence as there were issues regarding bandwidth. 0 All AdvoServ employees are to be trained on the State of Delaware Child Protection Accountability Commission's How to Identify and Report Child Abuse and Neglect in Delaware training 0 AdvoServ will train this in Pre?Service for all new employees. OCCL has not received any lists of new staff who have attended this training. AdvoServ?s actions as reported in a letter addressed to Secretary Ranji, in a letter dated 4/15/14. AdvoServ laid out a few areas in which they were working toward improvements. The notable points are summarized below: lnterpreting Data AdvoServ states (incorrectly) that the report given to them in the meetings between you and they indicate that AdvoServ reports more frequent and more serious incidents than other providers. Actually, the opposite is true. They report less than others which is precisely the cause for concern. 0 Internal Policies and Procedures - AdvoServ states that they employ methods and strategies that often go beyond the background checks and screenings that are required by licensing. For example, they require 80 hours of new employee pre?service training. They also point to the many external monitors that review them and when those reviews took place: OCCL 11/19/13; Delaware DOE?unannounced visit on 8/27/13 and announced on 4/11/14; Delaware school districts in conjunction with meeting 4/7/14; Delaware quarterly meetings last one was 2/3/14; annual licensing reviews with on 3/27/14; Maryland DOE 8/24/12; Maryland Department of Human Resources 10/22/13; New Jersey Division of Developmental Disabilities on 2/27/13; New Jersey Department of Children Youth and Families on 7/8/13. 0 Improve Compliance Monitoring?~Fidelity of monitoring compliance will be reviewed and published weekly. The distribution and use of this data will be reviewed to ensure that it has a functional impact on staff and program performance, by reinforcing appropriate actions and correcting problematic findings. (included in this is the report above about using the Cnow system and expanding it as well as installing a digital recording system). - Reallocation of Leadership time time and resources of the administrative and senior leadership team is reallocated to provide more direct supervision on evening, night and weekend shifts. AdvoServ did not include how this was going to be done or what actions steps were to be taken to implement this. - Revision of policies and procedures AdvoServ states that all protocols and policies reflecting these changes will be revised as appropriate. Here they reference that they have updated their policy on Abuse and Neglect to be in full compliance with the Delaware code sections governing the reporting and communication of allegations. They also state that they are presently ensuring that all clinical and administrative staff have completed their mandatory training in How to Identify and Report Child Abuse and Neglect in Delaware. They have not provided this to OCCL. (Greg Harrison reported to OCCL on 5/15/14 that about half of the staff have completed this). 0 Time on Demand System~AdvoServ is now able to track via biometric fingerprinting where their staff are in different locations during their shift. - Medical/Nursing improvements?~AdvoServ reports that smartphones and Cnow will be utilized by medical and nursing staff to improve our triage capabilities and ensure proper and timely treatment of injuries. A few points from the letter to you regarding all the strides they are taking to make improvements: - The improvements have a focus on oversight or supervision of staff?~making sure they are not doing anything ?had? rather than working with staff and providing useful training aimed at preventing situations when staff may lose their cool, or how to a situation. Additionally, the new trainings and policies they have developed also have a punishment/supervision slant, as in now all personnel will be trained on what will happen to them if they falsify or destroy documents. The above bullets reflect their stance that the that happened to MT was caused solely by a few bad actors. These individuals were subsequently fired. After being fired, they told authorities that the behaviors they engaged in were typical of AdvoServ. AdvoServ states in their letter that these individuals? statements lack all credibility. They then go onto outline all of the steps they are taking to better watch and monitor their staff to prevent this from happening again.