340:2-3-37. Caretaker conduct review (CCR)
(a) Application.This Section applies to referrals received by the Office of Client Advocacy (OCA) that OCA refers to a facility for an internal caretaker conduct review (CCR) per Oklahoma Administrative Code (OAC) OAC 340:2-3-35 (a)(2).Allegations of caretaker misconduct regarding children are screened by the Oklahoma Department of Human Services (DHS) Abuse & Neglect Hotline (Hotline) and referred to the appropriate facility contracting and licensing entities where the incident occurred.OCA may conduct an investigation when the DHS Specialized Placement Unit, DHS Child Care Licensing Unit, or other source, determines a pattern of misconduct exists by a person responsible for the child of interest (PRFCI) or facility administration, or facility administration fails to take appropriate corrective action.This Section does not apply to allegations involving caretaker misconduct of a Hissom class member or a vulnerable adult, other than a resident of the Robert M. Greer Center (Greer).OCA continues to accept and process CCRs regarding children who are in facilities not licensed by or contracted with DHS.
(b) Assignment to a facility to conduct a CCR.
(1) When OCA receives a referral that indicates possible caretaker misconduct, in lieu of an investigation, OCA intake may refer it to the facility where it allegedly occurred for handling as a CCR when:
(A) there is no injury or evidence the client might have been exposed to a significant risk of harm;
(B) there is a minor physical injury and it is not a suspicious injury;
(C) there is a serious physical injury and the known credible information makes it unlikely the serious injury was the result of abuse or neglect; • 1 or
(D) excessive or unauthorized use of force is alleged and there is no injury or only a minor injury that is not suspicious.
(2) In addition to the referrals in subsection (b)(1) of this Section, regarding vulnerable adults at DHS operated facilities, and at Greer, a referral indicating possible maltreatment may be referred to the facility for handling as a CCR when the allegation involves a serious physical injury that occurred under unexplained or unusual circumstances.
(c) Protocol for conducting a CCR.When OCA intake assigns a facility the responsibility to conduct a CCR, the administrator or designee takes necessary steps to ensure the safety of all clients and to protect the integrity of all evidence.A facility employee designated to conduct a CCR follows the investigative procedures per OAC 340:2-3-36, with the exception of recording the interviews per OAC 340:2-3-36(j)(1), including:
(1) reviewing pertinent documentation, records, and evidence collected;
(2) viewing any injuries and photos of injuries, and obtaining photos of injuries;
(3) obtaining written statements and conducting interviews with:
(A) each alleged victim;
(B) each eyewitness;
(C) other persons with knowledge relevant to the allegation; and
(D) each accused caretaker;
(4) reviewing statutes, policies, directives, standards, rules, or practices relevant to the allegation;
(5) analyzing the accused caretaker's actions in relation to relevant statutes, policies, directives, standards, rules and practices; and
(6) determining the appropriate finding(s) per OAC 340:2-3-36(v).
(d) Returning the investigation responsibility to OCA.If at any time during the CCR information is learned that gives cause to believe a client was the victim of caretaker misconduct resulting in a serious injury, abuse, or neglect, the administrator immediately discontinues the CCR and contacts OCA intake to report the new information warranting an OCA investigation.OCA intake notes the new information and changes the disposition on Form 15GN001E, Office of Client Advocacy - Intake Referral, and the case is assigned to an OCA investigator for investigation per OAC 340:2-3-35(c).
(e) Written report of CCR.After completion of the CCR process and determination of the appropriate finding, the person conducting the CCR prepares a written report.Facilities are encouraged, but not required, to use the OCA format for CCR reports.The written report contains:
(1) the allegation(s), including the dates, times, and location of the alleged incident(s), the date the allegation was reported to OCA, and the OCA case number;
(2) a statement of any injury sustained by the alleged victim(s) and, in cases involving an injury, a statement whether photographs were taken of the injury and if so, the date they were taken;
(3) the finding(s), whether caretaker misconduct did or did not occur, based on a greater weight of the evidence standard;
(4) a list of the involved parties, their titles and roles in the matter, whether they were interviewed and, if so, when;
(5) citation to pertinent statutes, policies, directives, standards, rules, and practices, when applicable;
(6) an explanation of the basis for the finding(s);
(7) a summary of pertinent information obtained in interviews conducted during the review;
(8) a list of relevant documents and records reviewed;
(9) a list of attachments to the report;
(10) a list of areas of concern identified during the course of the investigation regarding facility or DHS practices or procedures that have implications for the safety, health, or welfare of clients, but do not rise to the level of abuse or neglect; and
(11) either on a cover memo or at the end of the report, the date and signature of the person who conducted the CCR, and the signature of the person who reviewed and approved the report.
(f) Time for completion of report.The final written report is submitted to the advocate general within 30 calendar days from the date OCA intake notified the administrator an allegation is referred for CCR.
(g) OCA processing of CCR reports.The administrator transmits the completed CCR to the advocate general.The advocate general or designee reviews the CCR report for completeness and appropriateness of the finding.When a report is incomplete or the finding is questionable, OCA contacts the administrator to request further inquiry into the allegation.OCA opens an investigation when a report indicates the need.
(h) Final CCR report.When a final CCR report is not submitted to the advocate general within 45 calendar days from the date OCA notifies the facility or provider administrator the allegation is referred for CCR, OCA notifies the appropriate state agency, office, or regulatory entity that contracts with the facility or agency for the delivery of services.
(i) Review by Developmental Disabilities Services (DDS) director.Within five business days of completion of a CCR report at the Robert M. Greer Center (Greer), the facility administrator or designee informs the client and the client's guardian or parent of the CCR result.If the client or the guardian or parent does not concur with the finding(s), the facility administrator or designee notifies the advocate general in writing by email or letter.The advocate general refers the matter to the OCA grievance coordinator to process for review by the DDS director as a contested grievance per OAC 340:2-3-46 and OAC 340:2-3-51 (g) and the client or guardian or parent who did not concur with the finding(s) is considered the grievant for purposes of the review.When the grievant does not concur with the proposed resolution of the applicabledirector or designee, the matter is reviewed by the Grievance and Abuse Review Committee (GARC) per OAC 340:2-3-62 and 340:2-3-64.
(j) State office administrator's report.The findings in a CCR are considered final when the time for requesting review pursuant to subsection (i) of this Section has expired and review has not been requested, or the review was timely requested and concluded.
(1) Within 60 calendar days of the finding becoming final, the state office administrator or designee informs the advocate general in writing of:
(A) any personnel action taken or to be taken;
(B) any corrective action taken or to be taken; and
(C) for each worker found to have engaged in caretaker misconduct, whether there was prior confirmation by OCA or the facility for client maltreatment by the worker and, if so, the basis for each finding and the personnel action taken in response.
(2) When personnel action is involved, the State Office administrator notifies the DHS Human Resources Management director.
(3) When a CCR has not resulted in a confirmed finding, no information or material pertaining to the allegation or the investigation is placed in the personnel files of any employee named in the report.
INSTRUCTIONS TO STAFF 340:2-3-37
1. Serious injuries.When an allegation involves a serious injury, the Office of Client Advocacy (OCA) intake assigns it for an OCA investigation.If known credible facts provide an explanation for the injury that makes it unlikely the injury is the result of abuse, neglect, or negligent supervision, OCA intake may refer it to the facility for handling as a Caretaker Conduct Review.For example, if a client with severe osteoporosis suffers a bone fracture (a serious injury) and the treating physician reports the fracture is consistent with the osteoporosis, and it is not otherwise a suspicious injury, an OCA investigation is not required.