340:5-5-3. Elements of an investigation
(a) Although the investigation process may vary depending on the initial allegations and other factors, all Adult Protective Services (APS) investigations include (1) through (10) of this subsection.
(1) Law enforcement notification. Law enforcement is notified of all APS investigations. ■ 1
(2) Efforts to locate and notify others. APS specialists must make every reasonable effort to locate and notify the alleged victim's (AV) caretaker, guardian, and next of kin. ■ 2
(3) Visits and interviews with the vulnerable adult. Per Section 10-105(C)(1)(a) of Title 43A of the Oklahoma Statutes (43A O.S. § 10-105(C)(1)(a)), each APS investigation includes at least one visit and private interview with the vulnerable adult. ■ 3
(4) Consultation with others. The APS specialist interviews other people who have, or can reasonably be expected to have, pertinent knowledge about the AV's circumstances during the investigation, including any alleged perpetrator (AP) of maltreatment. ■ 4 The AV's permission is not required for these contacts.
(5) Photographs. The APS specialist may take photographs or video recordings to document injuries to the vulnerable adult or conditions in the adult's residential environment that resulted in, or may result in, an injury or serious harm.
(6) Other relevant data. The APS specialist collects data relevant to the situation being investigated including records to arrive at a finding. When the APS specialist is denied access to pertinent records, documentation, or other information relevant to the investigation, Oklahoma Human Services (OKDHS) may petition the court for an order allowing access.
(7) Determining decision-making capacity. OKDHS is mandated by 43A O.S. § 10-106(C) to determine a vulnerable adult's risk and needs and the vulnerable adult's capacity to consent to receive services, especially with regard to the need for involuntary services. Each investigation includes an evaluation of the vulnerable adult's decision-making capabilities in personal, medical, and financial management.
(A) The APS specialist's assessment of a vulnerable adult's mental capacity to consent to protective services takes into account the vulnerable adult's awareness of the:
(i) limitations and deficiencies in the physical environment;
(ii) vulnerable adult's own physical or mental limitations;
(iii) resources available to assist in meeting the vulnerable adult's needs; and
(iv) consequences to the vulnerable adult if nothing is done to improve the situation.
(B) When a vulnerable adult lacks capacity and an imminent risk to health or estate exists, legal intervention may be appropriate.
(8) Evaluation to determine the need for protective services. The evaluation consists of the APS specialist's analysis and consultation with the APS specialist IV, or designee, of all evidence gathered during the initial phases of the investigation. The evaluation includes consideration of whether the:
(A) vulnerable adult needs protective services. When so, the need for protective services is documented to include the least restrictive services to meet the person's needs;
(B) services that are identified as needed are available through OKDHS or in the community, and the sources and manner in which they can be provided. Options are explored with the vulnerable adult;
(C) vulnerable adult is capable and willing to obtain services for himself or herself;
(D) vulnerable adult can pay for needed services or is eligible for public assistance programs;
(E) caretaker or guardian is willing to provide or agree to the provision of needed services; ■ 10 through 12 and
(F) vulnerable adult wants the services. ■ 5
(9) Completion of investigative report. From the date an APS referral is received, the APS specialist completes the investigative report within 60-calendar days. To complete the investigation, the APS specialist:
(A) completes necessary interviews and assessments including identification of any immediate service needs;
(B) completes all final documentation;
(C) submits a report to the local district attorney;
(D) submits a report to the court of jurisdiction, when the alleged victim is currently under guardianship or conservatorship; and
(E) makes a determination of substantiated, unsubstantiated, or inconclusive based on the definitions of terms in Oklahoma Administrative Code (OAC) 340:5-1-6. ■ 6
(10) Findings. The APS specialist, in conjunction with the APS specialist IV or designee, makes a final determination of the investigative process on each allegation contained in the APS report. Each allegation is determined to be substantiated, unsubstantiated, or inconclusive and the investigation is documented, per OAC 340:5-5-5.
(11) Follow-up. The APS specialist, in consultation with the APS specialist IV or designee, determines needed follow-up in each case.
(A) On cases not requiring court-ordered involuntary services, follow-up needs are determined on a case-by-case basis. ■ 7
(B) For reports that result in a vulnerable adult receiving involuntary services, OKDHS ensures basic needs for safety and security are met as required by the court. The APS specialist monitors the delivery of court-ordered protective services and continues to assess the need for additional services determined by the vulnerable adult's changing needs. ■ 8
INSTRUCTIONS TO STAFF 340:5-5-3
1. Each Adult Protective Services (APS) specialist IV or designee is responsible for determining, in conjunction with each APS district director or designee and local law enforcement agencies, the method to notify law enforcement agencies of APS investigations within their jurisdictions.
2. (a) To accomplish this mandate, the APS specialist reviews existing Oklahoma Human Services (OKDHS) records. The reporter, when known, other professionals involved with the vulnerable adult, and involved friends, neighbors, or service providers may provide information to identify the vulnerable adult's caretaker, guardian, and next of kin. For purposes of this requirement:
(1) "caretaker" means the vulnerable adult's primary caretaker;
(2) "guardian" means a guardian, limited guardian, or conservator appointed per Title 30 of the Oklahoma Statutes. Persons holding power of attorney or similar surrogate decision-making documents are not guardians; and
(3) "next of kin" means the closest living relative by blood or marriage and includes any relative active in care or service planning.
(b) When the vulnerable adult retains the capacity to consent to voluntary services, and does not want a caretaker or next of kin to receive notification of the investigation, OKDHS abides by the vulnerable adult's decision.
(c) When the caretaker, guardian, and next of kin are identified, a copy of OKDHS Publication No. 15-13 "Frequently Asked Questions Adult Protective Services," is provided to each of them and to the vulnerable adult.
3. (a) Visits with the vulnerable adult may include as many visits as are necessary to reach a conclusion and determine if the adult meets the definition of a vulnerable adult and what, if any, protective services are needed.
(b) When the adult is determined to not be a vulnerable adult, the Investigation or service case is concluded. The APS specialist refers the adult to more appropriate services. When the APS specialist and the APS specialist IV or designee determine that the alleged victim (AV) is not a vulnerable adult, the APS specialist documents the findings as unsubstantiated.
(c) All contacts are documented in the APS Computer System Interview Section.
(d) When there are two or more counties involved, refer to Oklahoma Administrative Code (OAC) 340:5-5-4(b).
(e) When the APS specialist is unable to locate the AV for the initial interview, per OAC 340:5-5-2, the APS specialist staffs with the APS specialist IV or designee to determine if another attempt to locate must be made.
(1) When, at the first attempt, the AV does not answer the door, the APS specialist follows the protocol in (A) through (D) of this paragraph prior to leaving the residence.
(A) The APS specialist attempts to contact the AV by phone.
(B) When no one answers the phone, the APS specialist calls the reporter to verify correct information.
(C) When the reporter does not have additional information regarding the AV's whereabouts, the APS specialist contacts collaterals, such as neighbors, doctors, and family to attempt to locate the AV.
(D) When the first attempt to locate the AV is unsuccessful, the APS specialist leaves a business card and OKDHS Publication No. 17-33, "APS Door Hanger."
(2) When the first attempt was unsuccessful, the APS specialist makes a second attempt to contact the AV within five-business days at a different time of the day, when directed to do so by the APS specialist IV or designee. When contact is unsuccessful, the APS specialist follows the protocol in (A) through (E) of this paragraph.
(A) The APS specialist mails a contact letter on OKDHS letterhead to the last known address requesting the AV contact the APS specialist within seven-calendar days.
(B) When the letter is returned undeliverable or there is no response within seven-calendar days, the APS specialist staffs the report with the APS specialist IV or designee regarding further options and documents in the APS Computer System Notes Section, what further action is planned.
(C) When the APS specialist and the APS specialist IV or designee decide that all reasonable efforts to locate the AV were made, the APS specialist documents the referral as unsubstantiated based on "unable to locate."
(D) When the reporter is from a law enforcement agency and the APS specialist is unable to locate the AV, the APS specialist notifies the reporter.
(E) When the reporter is from another state or entity and the APS specialist is unable to locate the AV, the APS specialist notifies the other state or entity and local law enforcement.
(F) When a service case is assigned and the APS specialist is unable to contact the vulnerable adult by phone, it is at the discretion of the APS supervisor or designee to conduct a home visit. The APS supervisor or designee takes into consideration:
(i) how many phone calls were attempted;
(ii) the vulnerable adult's risk factors and diagnoses, including health conditions and cognitive impairment;
(iii) the severity of the allegations being reported;
(iv) the vulnerable adult's history; and
(v) if collaterals were contacted.
4. Interviews with collateral contacts are extremely important in helping the APS specialist determine the AV's current circumstances, expressed wants and needs, habitual practices, and recent changes. Consultation includes medical, psychiatric, or other evaluations, as necessary to assist in the determination of a vulnerable adult's decision-making capacity and need for services. The APS specialist documents all interviews with collaterals, alleged perpetrators (AP), family members, next of kin, caretakers, legal guardians, or service providers in the APS Computer System Interview Section.
(1) The AV's caretaker, guardian, next of kin, and the reporter are considered collateral contacts when they are identified.
(2) Any collateral contacts the APS specialist is unsure about are staffed with the APS specialist IV or designee before the APS specialist interviews the collateral contacts.
(3) The AP is interviewed in all reports in which an AP is identified.
(4) The APS specialist coordinates with appropriate law enforcement officials regarding interviewing APs, who are or may be the subject of a criminal investigation.
(5) An investigation is considered complete when a finding is reached, Adult Protective Services Report of Investigation is submitted to the district attorney (DA), and the computer documentation of the finding is done. A Service Case assignment is complete when the APS Specialist IV or designee submits and approves the case conclusion.
(6) At any time when it appears that criminal wrongdoing may have occurred, the APS specialist discusses the case with the APS specialist IV or designee, law enforcement, the DA, or all three parties before interviewing the AP.
(7) The APS specialist documents all collateral contact attempts in the APS Computer System Interview Section.
5. (a) Information is obtained from medical or psychiatric sources, when available, to assist in the capacity determination. In making the determination, the APS specialist assesses and considers the vulnerable adult's:
(1) short - and long-term memory;
(2) executive functioning by his or her ability to plan and execute a plan;
(3) ability to recognize risk factors;
(4) or caretaker's denial of problems;
(5) executive functioning by his or her ability to understand and follow directions; and
(6) indicators of:
(A) affective disorders, such as depression or bipolar disorder;
(B) substance use or abuse;
(F) traumatic brain injury;
(G) uncharacteristic, socially-inappropriate behaviors;
(H) impaired decision-making; and
(I) other factors.
(b) When a vulnerable adult is deficient in all or most of the areas described, he or she may lack the capacity to consent to protective services, and it may be appropriate to petition the district court for an order authorizing the provision of needed services.
(c) When a vulnerable adult expresses awareness of all four areas described in (i) through (iv) of OAC 340:5-5-3(a)(7)(A), it is likely that the present circumstances are the vulnerable adult's choice, though in some cases a vulnerable adult might express awareness in these areas and still lack the capacity to consent to provision of services.
6. APS specialists in each county office develop a coordinated working relationship with the local Oklahoma State Department of Health, mental health facilities, DA's office, law enforcement agencies, and other public or private staff that may help facilitate the investigation process or provide needed services to vulnerable adults.
7. It may be in the vulnerable adult's best interest to delay finalizing the report in order to allow the APS specialist more time to visit with the vulnerable adult to establish rapport before the vulnerable adult makes a decision about accepting available services.
8. (a) Steps in (1) through (6) of this subsection determine if a report is substantiated, unsubstantiated, or inconclusive and to develop an individualized service plan for the vulnerable adult.
(1) The APS specialist reviews all evidence gathered during the investigation including all collateral contacts made and all records reviewed, to assess their usefulness in making a finding on the referral.
(2) When more than half of the evidence indicates maltreatment likely occurred and the AV is a vulnerable adult, a finding of substantiated is entered in the APS Computer System Allegations Section.
(3) When less than half of the evidence indicates maltreatment likely occurred and the AV is a vulnerable adult, a finding of unsubstantiated is entered in the APS Computer System Allegations Section.
(4) When there is insufficient information to either support or not support the allegation of maltreatment but there is a reason to suspect maltreatment, a finding of Inconclusive is entered in the APS Computer System Allegations Section.
(5) Although professional judgment plays a large part in the investigative process, it has no part in the case finding. A very strong feeling that maltreatment occurred, when not supported by sufficient evidence, results in a finding of unsubstantiated or inconclusive.
(6) A service plan is developed with the vulnerable adult and involved family and caretakers in all cases where service needs are indicated.
(b) The APS district director or designee is responsible for monitoring completion of APS investigations within 60-calendar days and regularly discussing reports with investigations pending over 90-calendar days with the APS specialist IV or designee.
(c) Service provision and follow-up activities often extend beyond 60-calendar days based on the individual vulnerable adult's needs and service plan. These ongoing activities are not considered in determining if the investigation was timely, as long as a substantiation decision was reached and Adult Protective Services Report of Investigation was submitted to the DA's office within 10-calendar days of completing the investigation.
9. The APS specialist documents follow-up activities in the APS Computer System when entering the date and time of the contact and information about the visit in the Interview Section.
(1) When the APS specialist IV or designee and APS specialist determine follow-up is not necessary, the decision and the reasons for it are documented in the APS Computer System Service Plan Monitoring Notes Section.
(2) When the APS specialist IV or designee and APS specialist determine follow-up is necessary, the APS specialist documents why follow-up is necessary and the plan for completing follow-up in the APS Computer System Service Plan Monitoring Notes Section.
(3) The APS specialist may complete a follow-up contact by phone rather than face-to-face with someone other than the vulnerable adult or the AP after receiving APS specialist IV or designee approval. The APS specialist documents in the APS Computer System Interview Section:
(A) the means of contact;
(B) why the contact was made by phone rather than face-to-face; and
(C) what information was obtained.
10. At least one follow-up visit is made within a month, regardless of whether OKDHS continues to hold temporary guardianship. A follow-up is completed within two weeks of any hearing unless the vulnerable adult was personally served or seen by APS. A follow-up is completed within two weeks of placement in a nursing home and required monthly thereafter for the duration of placement. For guardianship follow-ups, the APS specialist documents follow-up activities in the APS Computer System by completing a Monthly Guardianship Assessment, entering the date and time of the contact and information about the visit.
(1) The APS specialist may complete a follow-up contact by phone rather than face-to-face with someone other than the vulnerable adult or the AP after receiving APS specialist IV or designee approval. The APS specialist IV or designee also documents this approval. The APS specialist documents in the Monthly Guardianship Assessment:
(A) the means of contact;
(B) why the contact was made by phone rather than face-to-face; and
(C) what information was obtained.
(2) When the district court dismisses a guardianship, the APS specialist submits the case for internal review and closure.
11. The assigned APS specialist IV or designee enters case notes regarding any closure decision and his or her review of all supporting documents; reconciliation of bank accounts; staffing of any ongoing or outstanding issues, such as pending Medicaid; review of the monthly guardianship assessment; decision to assign further follow up tasks and if they need to be face-to-face based on review and staffing. The APS specialist IV or designee may assign a face-to-face follow-up any time a dismissal is considered.
(1) When OKDHS continues to hold guardianship after 30-calendar days, follow-up contact with the vulnerable adult is required at least once each month. A face-to-face visit is required within two weeks of any hearing unless the vulnerable adult is personally served or was already seen by APS within the two week timeframe. This requirement continues for the duration of the temporary guardianship.
(A) When the vulnerable adult's situation is deteriorating at any time during the follow-up period, the service plan is reassessed and changed as needed with the concurrence of the court.
(B) Follow-up contact may be made as often as needed to comply with APS specialist guardianship responsibilities and to monitor the vulnerable adult's situation.
(C) In medical facilities, such as geriatric psychiatric units or a medical hospital, the worker follows-up with the vulnerable adult's assigned social worker or the individual assigned at the APS specialist IV's or designee's discretion.
(D) In group homes, residential care facilities, and assisted living centers through involuntary services, the face-to-face follow-up is completed each month until the first 180-Day Order is obtained. After the 180-day order is obtained, monthly follow-up is required, and the APS specialist IV or designee has the discretion to determine if the follow-up must be face-to-face. However, a monthly follow-up must be documented and may include an interview with the vulnerable adult, staff, and any family or collateral involved. Supporting documentation is obtained, scanned into the APS Computer System, and listed in the Files Section. The APS specialist may contact other professionals not associated with the facility who provide treatment or services to the vulnerable adult for follow-up information every month, or more often as indicated.
(E) In any type of nursing home, the APS specialist visits the vulnerable adult, at least once within two weeks of initial placement to check for changes in the vulnerable adult's condition, such as injuries, signs of over-medication, and cognitive state. This follow-up includes; admit to the facility, inventory, resident trust fund, payment considerations, the vulnerable adult's adjustments to the facility, incidents, pharmacy or medical issues, visitation issues, how to contact the APS specialist, back-up specialist, and APS specialist IV or designee and intentional relationship building with staff. All computer-related tasks must be completed. The face-to-face follow-up is completed each month until the first 180-Day Order is obtained. Face-to-face monthly visits are at the discretion of the APS specialist IV or designee after the initial 180-Day Order. However, a monthly follow-up must be documented. Supporting documentation is obtained, scanned into the APS Computer System, and listed in the Files Section. The APS specialist discusses concerns with the nursing home administrator or director of nursing, and the APS specialist IV or designee. After the first month, the APS specialist completes a follow-up with the vulnerable adult at least once every month, reviews the nursing home charts and incident reports, and discusses care needs with the staff and vulnerable adult's family, if available. This follow-up may be completed by phone with APS specialist IV or designee approval.
(F) The APS specialist makes frequent contact with vulnerable adults remaining at home, or at a relative's home, caretaker or any non-facility placement in temporary guardianship at a minimum of every month to ensure the established service plan meets the vulnerable adult's safety and needs. The APS specialist:
(i) makes modifications, as needed, to the service plan and provision of services by providers;
(ii) evaluates the quality of care and the method of contact on a case-by-case basis depending on the individual needs of the specific vulnerable adult including a face-to-face visit every month; and
(iii) ensures all computer-related tasks are completed. A monthly follow-up must be documented and includes an interview with the vulnerable adult, family, and any other collateral involved. Supporting documentation is obtained when available, scanned in to the APS Computer System, and listed in the Files Section.
(I) The APS specialist may determine, as a result of follow-up contacts, that further placement options need exploring. This may be the result of inappropriate action on the part of the provider, current information about the facility's ability to provide care for the vulnerable adult, a request by the family, or the facility's request to relocate the vulnerable adult.
(II) Placement alternatives are determined in accordance with this Section and approved by the APS specialist IV or designee, the APS district director, or district program field representative.
(III) The court-appointed attorney for the vulnerable adult and the family are notified of the problems and the alternatives that were developed.
(IV) The APS specialist submits a written report of the change of placement to the court, with a copy of the motion to the vulnerable adult's family and attorney of record.
(G) The follow-up on estate only guardianships does not require a mandatory face-to-face visit, and may be completed by phone with APS specialist IV or designee approval. The follow-up is assigned at the APS specialist IV's or designee's discretion, but must be completed monthly and documented in the Monthly Guardianship Assessment. Supporting documentation is scanned into the APS Computer System and listed in the Files Section. Case notes reflect the APS specialist IV's or designee's review of all supporting documents, reconciliation of bank accounts, staffing of any ongoing or outstanding issues, such as pending Medicaid, review of the Monthly Guardianship Assessment, and a decision if the APS specialist IV or designee wants to assign an immediate face-to-face visit based on review and staffing and how the follow-up is to be conducted and when for future months.
(i) In the event the vulnerable adult is placed in a facility out-of-county, the APS specialist IV or designee immediately contacts the APS specialist IV or designee in the county of placement to notify the receiving county of the placement and that follow-up activities must be completed by the receiving county.
(ii) The APS specialist in the county where the vulnerable adult is residing is the specialist designated to provide follow-up services for temporary guardianship cases.
(2) The APS specialist IV or designee assigns Medicaid follow-ups when:
(A) there is a new application for Long-Term Care (LTC) benefits, either nursing home or ADvantage Waiver services, and whether or not the application was made by APS;
(B) there is a recent closure or denial of LTC benefits; or
(C) a review for LTC benefits is due within the month.
(3) The Medicaid process must be monitored monthly until a satisfactory decision to certify or deny has been documented in the APS Computer System Service Plan Monitoring Notes. Medicaid follow-ups must continue on dismissed guardianship cases until the issue is resolved.
(4) A Medicaid follow-up may consist of: checking Information Management System (IMS), Family Assistance and Client Services (FACS), or workflow or contact with the client, AFS, or other collaterals. The APS specialist documents all Medicaid follow up activities in the APS Computer System Service Plan Items. The APS specialist documents in the Service Plan Monitoring Notes:
(A) the means of contact;
(B) what information was obtained; and
(C) what remains unresolved.
12. The APS specialist IV or designee notifies the appropriate APS district director or designee immediately of substantiated referrals in which an OKDHS employee is named as the AP.
13. The assigned APS specialist and APS specialist IV or designee enters notes in Service Plan Monitoring Notes regarding any decision to change placement location, the APS specialist IV's or designee's review of all supporting documents, and a decision if the APS specialist IV or designee wants to assign further follow-up tasks.
14. In the event the vulnerable adult is placed in a facility out-of-county, the APS specialist IV or designee adds the APS specialist in the placement county to the APS Computer System as a back-up worker. The APS specialist IV or designee documents all contacts, Monthly Guardianship Assessments, supporting documents, and Service Plan Monitoring Notes on the APS Computer System as soon as the contacts are made. All actions are discussed with the APS specialist in the county of jurisdiction and documented in the APS Computer System Notes Section.
(1) The resident county APS specialist or APS specialist in the county of court jurisdiction are responsible for all issues that require written consent, other problems or concerns, and acts in coordination for reporting to the court as required by the court order.
(2) The APS specialists and specialist IVs or designees from both counties discuss and determine the best course of action for temporary guardianship continuations.
(A) The decision takes into account the vulnerable adult's specific situation, the family and their desires, the availability of the courts in the two counties, and the advice of the vulnerable adult's court-appointed attorney, and the attorney(s) representing OKDHS in the matter.
(B) The APS district director, district program field representative, State Office, and OKDHS Legal Services attorneys are consulted for assistance in determining the best course of action