COMMENT DUE DATE:
September 1, 2017
August 22, 2017
Gail Wettstein, Director Adult Protective Services 405-521-3660
Dena Thayer, Programs Administrator 405-521-4326
Nancy Kelly, Policy Specialist 405-522-6703
APA WF 17-19
The proposed policy is Emergency . This proposal is subject to Administrative Procedures Act
It is important that you provide your comments regarding the draft copy of policy by the comment due date.Comments are directed to STO.LegalServices.Policy@okdhs.org.The proposed policy is emergency.
SUBJECT:CHAPTER 5. ADULT PROTECTIVE SERVICES
Subchapter 5. Investigation of Adult Protective Services
Referrals Reports [AMENDED]
340:5-5-2. Initiating investigations [AMENDED]
(Reference WF 17-19)
SUMMARY:The proposed amendments to Chapter 5, Subchapter 5 amend the rule to align deadlines in order to meet the legislative mandate of lean government.Oklahoma Administrative Code (OAC) 340:5-5-2 is amended to:(1) modify the deadline for initiating investigations from three days (72 hours) to five days (120 hours), with supervisor discretion for earlier initiations; (2) change "emergency response" with a four-hour deadline to "urgent response" with a 24-hour deadline, with supervisor discretion for earlier initiations; and (3) immediately refer emergencies to first responders, such as law enforcement or EMSA by calling 911.
EMERGENCY APPROVAL:is requestedeffective October 16, 2017, to allow APS to deploy limited existing resources to reduce the risk to as many vulnerable adults as possible because emergencies require the expertise of first responders, with APS follow-up; service planning is possible after an emergency is stabilized; and staff reductions make current deadlines impossible to meet in all cases.
LEGAL AUTHORITY:Director of Human Services; and Sections 162 and 168 of Title 56 of the Oklahoma Statutes.
Rule Impact Statement
To:Dena Thayer, Programs Administrator
Legal Services - Policy
From:Gail Wettstein, Director
Adult Protective Services
Date:August 18, 2017
Re:CHAPTER 5. ADULT PROTECTIVE SERVICES
Subchapter 5. Investigation of Adult Protective Services
Referrals Reports [AMENDED]
340:5-5-2. Initiating investigations [AMENDED]
(Reference WF 17-19)
Contact:Gail Wettstein, Director
Adult Protective Services (405) 521-3660
A.Brief description of the purpose of the proposed emergency rule:
Purpose.The proposed amendments to Chapter 5, Subchapter 5 amend the rule to align deadlines in order to meet the legislative mandate of lean government.
Strategic Plan Impact.
The proposed amendments implement the Adult Protective Services (APS) Strategic Plan outcomes to focus on core services, refer to community partners appropriately, and ensure APS specialists are safe in the field.
Oklahoma Administrative Code (OAC) 340:5-5-2 is amended to:(1) modify the deadline for initiating investigations from three days (72 hours) to five days (120 hours), with supervisor discretion for earlier initiations; (2) change "emergency response" with a four-hour deadline to "urgent response" with a 24-hour deadline, with supervisor discretion for earlier initiations; and (3) immediately refer emergencies to first responders, such as law enforcement or EMSA by calling 911.
The proposed amendments allow APS to deploy limited existing resources to reduce the risk to as many vulnerable adults as possible because emergencies require the expertise of first responders, with APS follow-up; service planning is possible after an emergency is stabilized; and staff reductions make current deadlines impossible to meet in all cases.
APS receives approximately 22,000 referrals per year, and cannot meet the current deadlines with existing staff.Failure to meet impossible deadlines exposes the state to tort liability.Extending the deadlines allows APS to comply and protects the state from tort claims.
Legal authority. Director of Human Services; Section 162 of Title 56 of the Oklahoma Statues (56 O.S. § 162).
Emergency rulemaking approval is requested.
B.A description of the classes of persons who most likely will be affected by the proposed rule, including classes that will bear the costs of the proposed rule, and any information on cost impacts received by the Agency from any private or public entities:The role of APS is to connect vulnerable adults at risk to services available in the community.Vulnerable adults at imminent risk for serious bodily harm will receive a more effective two-step response:first responders are followed by APS service planning when the emergency is stabilized.Each vulnerable adult will receive a more complete response from APS, when APS has more time in which to initiate the next investigation.
C.A description of the classes of persons who will benefit from the proposed rule:Vulnerable adults will receive services more efficiently and thoroughly.
D.A description of the probable economic impact of the proposed rule upon the affected classes of persons or political subdivisions, including a listing of all fee changes and, whenever possible, a separate justification for each fee change:The revised rules do not have an economic impact on the affected entities.There are no fee changes associated with the revised rules.
E.The probable costs and benefits to the Agency and to any other agency of the implementation and enforcement of the proposed rule, the source of revenue to be used for implementation and enforcement of the proposed rule and any anticipated effect on state revenues, including a projected net loss or gain in such revenues if it can be projected by the Agency:The benefit to the Oklahoma Department of Human Services (DHS) is that APS specialists can address the needs of vulnerable adults at the lowest manpower cost possible, and proactively avoid citizen complaints asserting that DHS is not timely in responding to their needs.The proposed amendments are driven by cuts to staff required to meet the legislative mandate of lean government, and do not require additional revenue.The proposed amendments have no impact on the generation of state revenues.
F.A determination whether implementation of the proposed rule will have an impact on any political subdivisions or require their cooperation in implementing or enforcing the rule:APS has always cooperated with law enforcement and other first responders.No new efforts in this regard are anticipated.
G.A determination whether implementation of the proposed rule will have an adverse economic effect on small business as provided by the Oklahoma Small Business Regulatory Flexibility Act:No anticipated impact.
H.An explanation of the measures the Agency has taken to minimize compliance costs and a determination whether there are less costly or nonregulatory methods or less intrusive methods for achieving the purpose of the proposed rule:APS requires accurate rules in order to have the authority to perform its governmental function.The proposed amendments implement the Protective Services for Vulnerable Adults Act; there is not a non-regulatory or less intrusive method of implementation.
I.A determination of the effect of the proposed rule on the public health, safety, and environment and, if the proposed rule is designed to reduce significant risks to the public health, safety, and environment, an explanation of the nature of the risk and to what extent the proposed rule will reduce the risk:Vulnerable adults in Oklahoma are at risk for abuse, neglect by caretakers, self-neglect, and exploitation.The proposed amendments allow APS to triage limited resources to reduce and address this risk timely.Risk is reduced by discovery during home visits and/or investigation, and the delivery/acceptance of social services.The proposed amendments allow APS to partner compassionately with vulnerable adults to reduce their risk and allow them to age in place.
J.A determination of any detrimental effect on the public health, safety, and environment if the proposed rule is not implemented:Failure to implement the proposed amendments will create inefficiencies in the ability of APS to reduce risk to vulnerable adults.Failure to implement the amendments will keep impossible deadlines in place that demoralize and defeat professional social workers committed to the protection of vulnerable adults.
K.The date the rule impact statement was prepared and, if modified, the date modified:Prepared August 18, 2017.
CHAPTER 5. ADULT PROTECTIVE SERVICES
Subchapter 5. Investigation of Adult Protective Services
340:5-5-2. Initiating investigations
An Adult Protective Services (APS) specialist initiates an investigation by a visit to the vulnerable adult who is the alleged victim (AV) at the adult's
home or other place of location or residence.¢ 1
(1) Time frame for initiating investigations.
(A) The APS specialist initiates the maltreatment investigation of referrals of maltreatment as soon as possible within three working five-business days, not to exceed 72 120 hours from the time of the receipt of APS received the report in the Oklahoma Department of Human Services (OKDHS), excluding weekends and official OKDHS state holidays.An APS specialist IV or designee may determine that a more prompt initiation is required.¢ 2
the case of an emergency urgent situation, when immediate prompt action may be required, the APS specialist initiates the investigation as soon as possible within four 24 hours of receipt, or sooner at the discretion of the APS specialist IV or designee.¢ 3
(2) Denial of access to the AV.
If When the APS specialist is denied entry into the AV's residence of the AV, or is denied a private interview with the AV, OKDHS staff may petition the Oklahoma Department of Human Services petitions the court for an order allowing entry or access.¢ 4
INSTRUCTIONS TO STAFF 340:5-5-2
Prior to the Adult Protective Services (APS) specialist making the initial visit to the alleged victim (AV), the The Oklahoma Department of Human Services (DHS) Adult Protective Services (APS) specialist IV or designee discusses with the APS specialist any safety issues identified in the acceptance and during screening of the report, and together they make arrangements for safety concerns to be addressed both before and during the visit with the APS specialist prior to the initial visit.The APS specialist and the APS specialist IV or designee:
and the APS specialist IV staffs staffs the report and case record information to determine whether there are any risk factors associated with the family, the home, or the neighborhood.; and
When the APS specialist believes determine if the home visit cannot can be made safely, he or she consults with the APS specialist IV to and what precautions are taken , they determine how a safe home visit can be made.When necessary, the APS specialist contacts law enforcement for assistance; follows:
(A) hazard protocol using program resources;
(B) warning protocol, including law enforcement; or
(C) stop-authority protocol and refers the situation to law enforcement, when the specialist cannot enter the home after first considering (A) and (B)
(2) prior to petitioning the court for an order of entry, staffs the situation with the APS specialist IV and documents the situation in the Notes Section of the APS Computer System; (3) provides documentation of planned field contact per local human service center (HSC) procedures.If there are major changes in the schedule, the APS specialist informs the HSC staff or the APS specialist IV of the changes; (4) arranges the work schedule in order to make new or questionable visits early in the day; (5) notifies HSC staff when he or she leaves and returns.If the APS specialist plans to go home after the last field visit, he or she notifies the APS specialist IV after the last visit is finished even if it is an after hours visit; and (6) is aware of the areas in the neighborhood where help may be obtained when an emergency occurs.
(b) After safety concerns are addressed, the APS specialist plans the home visit and:
(1) provides documentation of planned field contact to the APS specialist IV or designee.When there are major changes in the schedule the APS specialist informs the APS specialist IV or designee of the changes; and
(2) notifies the APS specialist IV or designee when the APS specialist leaves and returns.When the APS specialist plans to go home after the last field visit, he or she notifies the APS specialist IV or designee after the last visit is finished even if it is an afterhours visit.
(b)(c) HSCs APS specialists keep supplies of basic safety personal protective equipment items for the APS specialist to keep in the car (PPE) for use when making home visits.
(1) Program-issued PPE consists of:
(A) a respiratory mask;
(B) a lab coat;
(C) surgical gloves;
(D) boots and boot covers;
(E) shoe covers;
(F) a head cover;
(G) vehicle seat covers;
(H) disinfectant; and
(I) disposal bags.
(1)(2) The APS specialist also carries:
cellular DHS-issued cell phone , whenever possible;
(B) one change of clothing; and
(C) clean towels for
clean-up or self-decontamination ; (D) surgical gloves for handling adults that may be injured or exposed to methamphetamine; (E) disinfectant hand wipes; (F) plastic trash bags for covering car seats and floorboards, and carrying clothes that may need decontamination; and (G) dust masks to limit breathing of chemical or other fumes. (2)(d) When preparing to park and leave the vehicle used for making the home visit, the APS specialist:
(A) programs the phone so that a 911 call can be made;
(A)(B) parks in an open area and near a light source that offers the safest walking route to the home; (B)(C) locates the AV's alleged victim's (AV) building, when possible before exiting the car when the AV's residence is in an apartment complex , whenever possible; (C)(D) parks on the street rather than in a driveway , and in the direction in which the APS specialist plans to leave; and (D)(E) takes only the items necessary to complete the home visit.Purses or wallets and personal items are concealed if when left in a parked and the locked car. (3)(e) When approaching the residence, the APS specialist: (A) looks and listens for signs of someone in the residence and assesses whether if there is any indication of danger involving the occupants of the residence;
(B) is aware of any smells associated with substance use or abuse;
(C) observes the outside of the residence, the surrounding homes, and any animals or suspicious vehicles; and
carrying a cellular phone, programs the phone so that a 911 call can be easily made newly discovered risk factors indicate warning protocol, the specialist leaves and staffs with the APS specialist IV or designee. (4)(f) In order to make a safe entrance into the residence, the APS specialist:
(A) goes only to the door that is in plain sight of the street and stands to the side of the door when knocking;
(B) as the door is opened, looks quickly inside to determine if there are any safety threats
(C) does not enter the home
if when an unseen person calls for the APS specialist to come in; and
(D) quickly evaluates the AV's attitude and demeanor to determine if there are warning signs of aggression, violence, substance use, or suspicious behavior
;. (E) secures an entry order from the court if needed to obtain permission for law enforcement to enter the home;
(g) When the specialist is accompanied by law enforcement on a home visit
(F) does not enter the home law enforcement accompanies the APS specialist for the home visit.If law enforcement: (i) makes the decision to enter, the APS specialist he or she remains outside of the residence in order to ensure the APS specialist's physical safety; or until law enforcement determines it is safe to enter. (ii) requests the assistance of the APS specialist in the residence due to an emergency with the adult, the APS specialist does not enter the residence until it has been secured by law enforcement and is determined safe to enter;
(h) When the APS specialist is denied entry into the home he or she
(G) does not attempt to aggressively persuade the AV if he or she refuses to allow access to the home. If When denied, the APS specialist leaves the residence and consults with an APS specialist IV ; and (H) leaves the residence if the APS specialist does not feel safe entering the home, and consults with an APS specialist IV. (5)(i) When in the AV's residence, the APS specialist is particularly aware of any signs of risk to safety.The APS specialist once inside the AV's residence:
(A) stays near an exit and remains alert and observant;
(B) pays attention to any unusual sights or
smells odors, particularly those associated with the manufacture or use of drugs;
(C) remains aware of the possibility of any other persons in the residence and inquires about anyone that may appear to be in another room; and
(D) leaves immediately if there is risk to safety.
(6)(j) When leaving the AV's residence, the APS specialist remains alert to safety risks by:
(A) observing any activity or persons near the residence or in the neighborhood;
(B) having the car keys in hand when walking to the
parked car; and
(C) not lingering to make phone calls or notes
, but instead and leaves the neighborhood immediately. (6)(k) If When an APS specialist has an ongoing APS case where there have been were or are new allegations of methamphetamine use or manufacture, the same precautions are taken as in an investigation the initial visit. (c)(l) APS staff maintain regular contact with law enforcement to stay specialist IVs and designees stay informed about the most current indicators of methamphetamine production and provide the information to staff. The Oklahoma Bureau of Narcotics and Dangerous Drugs Control (OBNDDC) information flyers are kept in supply in each HSC DHS county offices.
(1) Outbuildings, hotel and motel rooms, apartments, storage sheds, garages, and vacant buildings are all common places where methamphetamine is produced.Some of the indicators of methamphetamine use and production identified by
the OBNDDC are:
(A) a strong odor
that resembles of urine or unusual chemicals, such as ether, ammonia, or acetone;
(B) little or no traffic around the home during the day
, but significant activity during very late hours;
(C) extra efforts made to cover windows or to reinforce doors;
(D) trash not put out for collection;
(E) a significant accumulation of items, such as cooking dishes, coffee filters, or bottles that do not appear to be for regular household use;
(F) the presence of unusual quantities of chemicals; and
(G) vehicles loaded with laboratory materials or chemicals.
(2) The APS specialist, in initiating an investigation alleging use or production of methamphetamine:
(A) requests law enforcement to accompany him or her;
(B) remains in the car until law enforcement
has determined that determines the residence is safe to enter; and
(C) does not enter the residence under any circumstances when there is evidence of a methamphetamine laboratory.
(3) When evidence of a methamphetamine laboratory either outside or inside the residence is encountered, the APS specialist:
(A) does not enter any residence where there is any evidence of methamphetamine laboratory materials or chemicals on the property;
(B) discreetly, but immediately leaves the residence
if when he or she unknowingly enters a home in which there is evidence of a methamphetamine laboratory, and drives to a safe location to contact law enforcement; and
(C) follows self-decontamination procedures,
as described in paragraph (4) per (b)(2) of this Instruction.
If When there is any exposure to a methamphetamine laboratory, self-decontamination procedures are followed.The APS specialist:
(A) covers car seats and floorboards with plastic covering and wipes his or her hands with disinfectant wipes before touching the steering wheel
(B) goes to a safe location to change clothes and place the dirty clothes in a
plastic trash sack disposal bag.All exposed skin surfaces are cleaned with disinfectant wipes .Wash any items carried into the home with soap and water; and
makes every effort not to touch any surface until the skin has been wiped with disinfectant wipes or washes any items washed carried into the home with soap and water. (d)(m) The APS specialist coordinates with law enforcement to handle decontamination procedures and ensure the safety of any vulnerable adult who has was likely been exposed to a methamphetamine laboratory.
of for the vulnerable adult is arranged by the APS specialist in cooperation and coordination with law enforcement.
Whenever possible, the The vulnerable adult is taken immediately for a medical examination. If it is not possible to obtain a medical examination the same day, arrangements for a medical examination are made as soon as possible. (e)(n) If When the vulnerable adult is in the hospital or other temporary residence at the time of the referral, the initial visit is made to that location. (f)(o) The initial home visit is not preceded by a telephone phone call or appointment and is made unannounced. (g)(p) If When the AV cannot be located, the APS specialist documents efforts to locate the AV in the Interview Section of the APS Computer System Interview Section by checking the "Initial Visit" on the APS Computer System, marking the "attempted face-to-face" on the drop down box, and documenting the specifics in the Interview tab Section.
(q) When the AV cannot be located, the APS specialist IV or designee, at his or her discretion may direct one or two more attempts to locate.
If When the APS specialist does not receive the referral timely, the APS specialist is responsible for making the face-to-face visit or phone initiation as soon as possible and documents the reason for delay in the Notes Section of the APS computer system Computer System Notes Section.
(a) An emergency urgent situation is determined by the APS specialist IV or designee at the time of screening and immediately communicated to the assigned APS specialist. (b) If When an investigation is not initiated in a timely manner, the reasons for the lack of timeliness are documented in the Notes Section of the APS Computer System Notes Section.
If When the APS specialist is denied access to the AV, the APS specialist notifies the AV or the AV's caretaker that an investigation must be completed. If When the AV continues to deny entrance or the caretaker continues to deny access to the AV, the APS specialist, in consultation with the APS specialist IV , or designee documents the situation in the Notes Section and makes a decision to:
(1) contact law enforcement to assist in gaining access to the AV;
(2) contact other persons who may be able to assist in gaining access to the AV; or
(3) petition the court for an entry order.
(b) To petition the court for an entry order, the APS specialist contacts the local district attorney or
OKDHS Office of General Counsel DHS Legal Services for assistance.
(1) When the court grants the entry order, the APS specialist notifies law enforcement to enforce the entry order.Law enforcement is responsible for gaining access to the AV.The APS specialist requests law enforcement
to remain with the APS specialist him or her for the duration of the interview and home assessment.
(2) When the court denies the entry order, the APS specialist consults with the APS specialist IV or designee to develop a plan to complete the investigation, when possible.The APS specialist IV or designee may consult with the
area district program field representative (PFR) and Family Support Service Division (FSSD) APS Unit district director or State Office staff as needed.
(c) The APS specialist documents all activities in
the Interview tab of the APS Computer System Interview Section and scans copies of any court orders in the W drive.