COMMENT DUE DATE:
February 16, 2012
DATE:
January 11, 2012
Laura Brown FSSD (405) 521-4396
Dena Thayer OIRP Programs Administrator (405) 521-4326
Pat McCracken OIRP (405) 522-1017
RE:
APA WF 11-16
The proposed policy is Permanent . This proposal will go to the Commission meeting on
CHAPTER 5. ADULT PROTECTIVE SERVICES
Subchapter 3. Reports of Maltreatment of Vulnerable Adults
OAC 340:5-3-2 [INSTRUCTIONS TO STAFF REVISED]
OAC 340:5-3-4 [AMENDED]
Subchapter 5. Investigation of Adult Protective Services Referrals
OAC 340:5-5-4 [AMENDED]
OAC 340:5-5-5 [INSTRUCTIONS TO STAFF REVISED]
SUMMARY: The proposed revisions to Subchapter 3 of Chapter 5 amend the rules to add: (1) additional types of reports of maltreatment Adult Protective Services staff refer to the Oklahoma Department of Human Services (OKDHS) Office of Client Advocacy (OCA) including reports involving persons subject to the Community Services Worker Registry (CSWR); and (2) clarifying information.
The proposed revisions to Subchapter 5 of Chapter 5 amend the rules to: (1) remove rules regarding APS staff investigating reports of maltreatment by persons subject to the CSWR; and (2) add clarifying language.
340:5-3-2 Instructions to Staff only is revised to: (1) instruct hotline staff when to make a the report to the Oklahoma Department of Human Services (OKDHS) Office of Client Advocacy (OCA), the Oklahoma State Department of Health, or the Oklahoma Department of Mental Health and Substance Abuse Services; and (2) rearranging information for greater clarity.
340:5-3-4 is revised to add: (1) additional types of reports of maltreatment APS staff refer to the OCA including reports involving persons subject to the Community Services Worker Registry (CSWR); and (2) clarifying information.
340:5-5-4 is amended to: (1) remove rules regarding APS staff investigating reports of maltreatment by persons subject to the CSWR; and (2) add clarifying language
340:5-5-5 Instructions to staff only is revised to: (1) differentiate time frames for documenting investigations involving self neglect and those that involve an alleged perpetrator; and (2) remove documentation requirements involving alleged perpetrators subject to the CSWR.
PERMANENT RULEMAKING APPROVAL IS REQUESTED.
LEGAL AUTHORITY:Commission for Human Services, Article XXV, Sections 2, 3, and 4 of the Oklahoma Constitution; and Sections 10-105 and 10-108 of Title 43A of the Oklahoma Statutes.
Rule Impact Statement
To:Dena Thayer, Programs Administrator
Office of Intergovernmental Relations and Policy (OIRP)
From:Mary Stalnaker
Family Support Services Division Director
Date:January 18, 2012
Re:CHAPTER 5. ADULT PROTECTIVE SERVICES
Subchapter 3. Reports of Maltreatment of Vulnerable Adults
OAC 340:5-3-4 [AMENDED]
Subchapter 5. Investigation of Adult Protective Services Referrals
OAC 340:5-5-4 [AMENDED]
(Reference APA WF 11-16)
Contact:Laura Brown 405-521-4396
A.Brief description of the purpose of the proposed rule:
Purpose.The proposed revisions to Subchapter 3 of Chapter 5 amend the rules to add: (1) additional types of reports of maltreatment Adult Protective Services staff refer to the Oklahoma Department of Human Services (OKDHS) Office of Client Advocacy (OCA) including reports involving persons subject to the Community Services Worker Registry (CSWR); and (2) clarifying information.
The proposed revisions to Subchapter 5 of Chapter 5 amend the rules to: (1) remove rules regarding APS staff investigating reports of maltreatment by persons subject to the CSWR; and (2) add clarifying language.
Strategic Plan impact. The proposed rule change will continue to achieve the OKDHS goals by protecting vulnerable adults from abuse, neglect, and exploitation.
Substantive changes.
OAC 340:5-3-4 is revised to add: (1) additional types of reports of maltreatment APS staff refer to the OKDHS OCA including reports involving persons subject to the CSWR; and (2) clarifying information.
OAC 340:5-5-4 is amended to: (1) remove rules regarding APS staff investigating reports of maltreatment by persons subject to the CSWR; and (2) add clarifying language.
Reasons. The proposed revisions eliminate duplicate investigations of caregivers subject to the CSW Registry by APS and OCA.Eliminating duplicate work improves the APS specialist’s ability to provide timely and appropriate protective services to other vulnerable adults and reduces the time period for placing caretakers found to have abused, neglected, or exploited a vulnerable adult on the CSWR.
Repercussions. Removing APS specialist’s responsibility to investigate reports of maltreatment by caretakers subject to the CSWR does not negatively impact vulnerable adults as OCA staff retain this responsibility.Failure to implement these rules will continue to require duplicate investigations of the same caretaker and delay placing an unsafe caretaker on the CSWR.
Legal authority. Commission for Human Services, Article XXV, Sections 2, 3, and 4 of the Oklahoma Constitution; and Sections 10-105 and 10-108 of Title 43A of the Oklahoma Statutes.
Permanent approval. Permanent 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 classes of persons most likely to be affected by the proposed rules are Oklahoma’s vulnerable adults and OKDHS staff. The affected classes of persons will bear no costs associated with implementation of the rules.
C.A description of the classes of persons who will benefit from the proposed rule: The classes of persons who will benefit are Oklahoma’s vulnerable adults and OKDHS staff.
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 probable cost to OKDHS includes the cost of printing and distributing the rules, which is estimated to be less than $20 and is within the current budget.
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: The proposed rules do not have an economic impact on any political subdivision, nor will the cooperation of any political subdivisions be required in implementation or enforcement of the rules.
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: There are no anticipated adverse effects on small business as provided by the Oklahoma Small Business Regulatory Flexibility Act .
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: There are no less costly or nonregulatory methods or less intrusive methods for complying with.
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: Implementation of the proposed rules eliminates duplicate investigations which improves the APS specialist’s ability to provide timely and appropriate protective services to other vulnerable adults and decreases the time it takes to place an unsafe caretaker on the CSWR.Improving timeliness of investigations will reduce safety risks to vulnerable adults.
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 rules, may affect the APS specialist’s ability to provide the most appropriate protective services and delay placing an unsafe caretaker on the CSWR.A delay in placing a caretaker on the CSWR may expose vulnerable adults to an unsafe caretaker longer.
K.The date the rule impact statement was prepared and, if modified, the date modified: Prepared November 8, 2011.Modified January 3, 2012.
SUBCHAPTER 3. REPORTS OF MALTREATMENT OF VULNERABLE ADULTS
340:5-3-2. Abuse hotline 1-800-522-3511 [INSTRUCTIONS TO STAFF ONLY REVISED]
Issued 6-1-03
The Oklahoma Department of Human Services maintains a statewide, toll free hotline for the purpose of receiving reports of abuse, neglect, or exploitation of children and adults.The hotline operates 24 hours a day, seven days a week.The hotline is staffed by Children and Family Services Division personnel who are trained in Adult Protective Services reporting procedures.¢ 1
INSTRUCTIONS TO STAFF 340:5-3-2
Revised 6-1-10 6-1-12
1.(a) Reports.The hotline staff accepts all information and records it, in the Intake Section of the Adult Protective Services (APS) Computer System, including the name of the reporter, if possible.Anonymous reports are handled in the same manner as those made by a person who identifies himself or herself.
(b) Guidelines for hotline staff.When a report falls within the Emergency Guidelines for hotline staff in (c) of this Instruction, hotline staff refers to the latest contact list provided by the Family Support Services Division (FSSD) APS Unit and immediately telephones the appropriate APS specialist IV staff.Hotline staff who receive APS calls after hours always call the APS specialist IV when:
(1) the reported allegations fall within the emergency guidelines in (c) of this Instruction;
(2) the situation does not fall within the emergency guidelines, but information given by the reporter indicates immediate action may be necessary; or
(3) hotline staff is unable to decide whether the situation reported falls within the emergency guidelines.
(c)(b) Emergency report guidelines for hotline staff.When hotline staff receives a call that meets the emergency guidelines in (1) through (17) of this Instruction, hotline staff asks the reporter if 911 or the local emergency services number has been called.If local emergency services have not been called and immediate help is needed, hotline staff tells the reporter to call 911 or other local emergency numbers.Hotline staff tells the APS specialist IV whether the reporter called local emergency services or was asked to call.APS situations are considered A report meets emergency reports report guidelines when:
(1) abuse is occurring at the time of the report;
(2) immediate medical attention is needed to treat conditions that could result in irreversible physical damage or death, such as unconsciousness, acute pain, severe respiratory distress, or suspected gangrene;
(3) there is threat of suicide of the alleged victim (AV);
(4) there is threat of homicide to the AV;
(5) there is reason to believe the AV or alleged perpetrator (AP) is exhibiting psychotic or bizarre behavior which places the AV in immediate danger;
(6) sexual, physical, or the threat of such abuse is reported and the AP currently has access to the AV;
(7) the report indicates sexual abuse that occurred within the last 72 hours;
(8) the caregiver refers self for fear he or she may harm AV;
(9) there is reason to believe the AP may flee the investigation and move AV to an unknown location;
(10) the AV needs total care and has been left without a caregiver.Examples include: the caregiver is hospitalized, deceased, or abandons the AV;
(11) the AV lacks basic physical necessities severe enough to result in freezing, serious heat stress, or starvation;
(12) there is neglect or self-neglect whether and the AV is without essentials for daily living or critically needed supervision, and AV's impaired judgment or physical condition places AV in immediate danger;
(13) there are visible injuries, bruising to vital areas, or other possible life threatening conditions;
(14) there is sudden deterioration in AV's condition, and AV may be in imminent danger;
(15) there is an environmental hazard or condition that places AV in immediate danger;
(16) there is punishment or confinement of AV, such as locking the AV in a closet or tying him or her to a bed; or
(17) there are any other factors, such as repeated incidents or reports, that are believed to indicate imminent danger.
(c) Report procedures.Hotline and APS staff follow report procedures in (1) through (5).
(1) When hotline staff receives an emergency report, hotline staff:
(A) asks the reporter if 911 or the local emergency services number has been called.If local emergency services have not been called and immediate help is needed, hotline staff tells the reporter to call 911 or other local emergency numbers; and
(B) refers to the latest contact list provided by the Family Support Services Division (FSSD) APS Unit and immediately telephones the appropriate APS specialist IV.Hotline staff tells the APS specialist IV whether the reporter called local emergency services or was asked to call;
(2) Hotline staff who receive APS calls after hours always call the APS specialist IV when:
(A) the reported allegations meet emergency report guidelines in (b) of this Instruction;
(B) the situation does not fall within the emergency report guidelines, but information given by the reporter indicates immediate action may be necessary; or
(C) hotline staff is unable to decide whether the situation reported falls within the emergency report guidelines.
(3) During regular business hours, hotline staff electronically submits the report through the APS Computer System to the human services center (HSC) in which the alleged victim resides.
(d)(4) If a report from the When hotline is made staff makes a report to the incorrect human services center (HSC), the APS specialist receiving the report is responsible for notifying notifies the appropriate APS staff and transfers the report to the appropriate HSC through the APS Computer System.
(e)(5) Hotline staff do not screen APS reports.Some Hotline staff send some APS reports are sent to investigative bodies other than local APS, as indicated in (1)(A) through (4)(G) of this Instruction.
(1)(A) If the AV is a resident of Northern Oklahoma Resource Center of Enid (NORCE), the Greer Center, or Southern Oklahoma Resource Center (SORC) of Pauls Valley, or is known to be a Hissom Class member, hotline staff make the report is made to the Office of Client Advocacy (OCA) at 405-525-4850 or fax 405-525-4855 405-525-4885 or, after regular business hours, the OCA on-call ombudsman at 405-203-6056.
(B) If the report alleges that the AP is an employee of a community services provider, a community services worker, or a paid Medicaid personal care assistant, as those terms are defined in Sections 1025.1 of Title 56 of the Oklahoma Statutes, hotline staff makes the report to OCA at 405-525-4850 or fax 405-525-4885.
(2)(C) If the AV is a resident of a licensed nursing facility, and the alleged perpetrator is a facility employee, hotline staff make the report is made to the FSSD APS Unit, Long Term Care Investigations (LTCI) Section, 405-521-3440.
(3)(D) If the hotline staff determines that the AV is deceased, hotline staff refer the caller is referred to the local district attorney's or medical examiner's office.
(4)(E) If the AV is presently incarcerated in a city, county, state, or federal jail or prison, or is a resident of a state or federal hospital, hotline staff refer the caller is referred to the internal advocates for the agency that regulates the facility.If the caller is resistant to being referred elsewhere, the report is accepted and forwarded to the FSSD APS Unit.
(F) If the report alleges maltreatment of the AV by staff of a medical hospital, rehabilitation facility, or private psychiatric hospital while the AV is receiving services, hotline staff refer the caller to the Medical Facilities Service of the Oklahoma State Department of Health, Protective Health Services at 405-271-6576.
(G) If the report alleges maltreatment of the AV by staff of a public or private community mental health agency, hotline staff refer the caller to the Advocacy Division of the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) at 405-573-6605 or toll free, 1‑866-699-6605.
340:5-3-4.Reports under the jurisdiction of agencies other than local Adult Protective Services (APS)
Revised 6-7-04 6-1-12
Some reports of alleged maltreatment of vulnerable adults are not investigated by local Adult Protective Services (APS) staff.
(1) Reports of alleged victims who are residents of Northern Oklahoma Resource Center of Enid (NORCE), Greer Center, or Southern Oklahoma Resource Center (SORC) of Pauls Valley, or former residents of Hissom Memorial Center.Reports which APS staff refer reports that allege a current resident of NORCE, Greer Center, or SORC has suffered maltreatment by an employee of the facility, as well as reports which allege or maltreatment of a former resident of Hissom Memorial Center by a current caretaker, are referred to the Oklahoma Department of Human Services (OKDHS) Office of Client Advocacy (OCA).¢ 1
(2) Reports of maltreatment by persons providing services to alleged victims receiving services from a community services worker, a community services provider, a SoonerCare (Medicaid) person care services provider, a Medicaid personal care assistant (MPCA).APS staff refer reports to the OKDHS OCA when the alleged victim receives services from a community services worker, a community services provider, a SoonerCare (Medicaid) personal care services provider, or a MPCA, as those terms are defined in Section 1025.1 of Title 56 of the Oklahoma Statutes.¢ 2
(2)(3) Alleged victims of maltreatment in hospital settings.Reports APS staff refer reports of alleged maltreatment of vulnerable adults who are receiving services in medical hospitals, rehabilitation facilities, or private psychiatric hospitals by staff of the facility are referred to the Oklahoma State Department of Health (OSDH), Protective Health Services, Medical Facilities Service.¢ 23
(3)(4) Alleged victims of maltreatment by staff of the Oklahoma Department of Mental Health and Substance Abuse Services (DMHSAS ODMHSAS) and its contracted providers.Reports APS staff refer reports of alleged maltreatment of a vulnerable adult by staff of a public or private community mental health agency are referred to the Advocacy Division of DMHSAS.If DMHSAS declines to conduct an investigation, the report may be referred back to the local APS office.¢ 34
(4)(5) Reports alleging maltreatment of residents by staff of nursing facilities.Reports APS staff send reports of alleged maltreatment of nursing facility residents are sent to the Family Support Services Division, APS Unit, Long Term Care Investigations Section.These reports are also sent to the Oklahoma State Department of Health OSDH, Protective Health Services.¢ 45
(5)(6) Reports involving local, state, or federal correctional facilities.Reports APS staff refer reports of abuse, neglect, or exploitation of residents by staff of state or federal public hospitals, jails, prisons, or similar facilities are referred to the facility's regulatory department for investigation and to the local district attorney.
(6)(7) Reports involving deceased alleged victims.Reports of maltreatment of persons who are already deceased at the time the report is made are not accepted by APS.Reporters are referred to the state or local Office of the Medical Examiner, local law enforcement, or, if the death occurred in a nursing facility, to the Medicaid Fraud Control Unit in the Office of the Attorney General.¢ 56
INSTRUCTIONS TO STAFF 340:5-3-4
Revised 11-1-11 6-1-12
1.(a) When the Adult Protective Services (APS) specialist receives a report regarding current residents of Northern Oklahoma Resource Center of Enid (NORCE), 580-213-2700, the Greer Center, 580-213-2700, Southern Oklahoma Resource Center (SORC), 405-238-6400, or a former resident of Hissom, he or she enters all pertinent information in the Intake Section of the APS computer system and immediately refers the report to the Office of Client Advocacy (OCA), by fax 405‑525‑4855 405-525-4885 or email *oca.intake@OKDHS.org.If the APS specialist receives a report after regular business hours, he or she refers the complaint to the OCA on-call ombudsman, 405-203-6056.The APS specialist sends a copy of the report to Developmental Disabilities Services Division.
(b) In some instances of self-neglect involving Hissom class members, the OCA may return the complaint to the local APS staff for the human services center (HSC) where the alleged victim (AV) resides.
2. (a) APS specialists refer reports of maltreatment when the AV receives services from a community services worker, a community services provider, a SoonerCare (Medicaid) personal care services provider, or a Medicaid personal care assistant, by entering all pertinent information in the Intake Section of the APS computer system and submits the report to the appropriate APS specialist IV for screening.
(b) After screening, the APS specialist IV immediately refers the report to OCA by:
(1) faxing it to 405-525-4885; or
(2) emailing a computer screenshot of the intake report to *oca.intake@okdhs.org.
23.Hospital reports are telephoned to The APS specialist IV calls the Oklahoma State Department of Health (OSDH), Protective Health Services, Medical Facilities Service, at 405-271-6576 to report maltreatment of vulnerable adults in hospital settings.The APS specialist IV documents the referral was made to OSDH in the IR Notes section of the APS computer system.
34.Reports involving The APS specialist IV calls the Oklahoma Department of Mental Health and Substance Abuse Services (DMHSAS ODMHSAS) operated or contracted facilities or providers are telephoned to the DMHSAS Advocacy Division at 405-573-6605 or toll free, 1‑866-699-6605 to report alleged maltreatment of the vulnerable adult by staff of a facility operated by or contracted from ODMHSAS.The APS specialist IV documents the referral was made to ODMHSAS in the IR Notes section of the APS computer system.
45.Nursing facility reports are submitted by completingWhen HSC staff receives a report of maltreatment of a nursing facility resident, he or she enters all pertinent information in the Intake Section on the APS Computer System and marking marks it as a facility investigation.The report is The system automatically submitted by the computer submits the report to the Long Term Care Investigations (LTCI) Unit for screening.The LTCI telephone number is 405-521-3440; fax 405-522-3463.
56.If the alleged victim (AV) dies during the investigation and When the APS specialist conducted a face-to-face interview was conducted with the AV and the AV dies during the investigation, the APS specialist continues with the elements of the investigation to complete the investigation.
SUBCHAPTER 5. INVESTIGATION OF ADULT PROTECTIVE SERVICES REFERRALS
340:5-5-4. Special considerations during investigations
Revised 6-1-10 6-1-12
(a) Referrals regarding members of Indian tribes.Referrals are accepted for an alleged victim (AV) who is a tribal member according to the Protective Services for Vulnerable Adults Act as set forth in Sections 10-101 through 10-110 of Title 43A of the Oklahoma Statutes (43A O.S. § 10-101 through 10-111).The Adult Protective Services (APS) specialist provides or arranges voluntary or involuntary services as indicated for a vulnerable adult regardless of whether the adult resides on tribal land.¢ 1
(b) Referrals involving two or more counties.If a referral involves two or more counties, as when the AV lives in one county and the alleged perpetrator (AP) in another or when the AV moves either temporarily or permanently to another county before the investigation has been completed, local APS staff from both human services centers (HSCs) are involved in the investigation.¢ 2
(c) Referrals involving Soonercare (Medicaid) fraud.When an APS investigation indicates fraud by a provider receiving Medicaid funds, APS staff immediately notifies the Medicaid Fraud Control Unit (MFCU) in the Office of the Oklahoma Attorney General.APS cooperates with any investigation by MFCU.If MFCU declines to investigate, APS staff completes the investigation and sends a summary report to MFCU upon completion of the investigation.
(d) Referrals involving persons and provider agency employees.APS investigations of maltreatment of vulnerable adults may include all persons in a relationship of caretaker, regardless of organizational affiliation, and non-caretaker provider agency employees except those noted in Subchapter 3 of this Chapter.Care providers who may be subject to APS investigation include, but are not limited to, home health providers, community services workers for persons with developmental disabilities, personal care assistants, adult foster homes, adult day care centers, independent living centers, residential care facilities, and assisted living centers.
(1) These agency investigations include all the elements of an APS investigation, with special emphasis placed on:
(A) interviewing agency staff and other residents or participants who may have knowledge of the reported incident;
(B) obtaining copies of applicable charts and records;
(C) reviewing medication lists and schedules;
(D) taking photographs;
(E) examining habilitation or other care plans;
(F) examining financial records and other money management documentation;
(G) reviewing time schedules and time sheets; and
(H) requesting any other information needed to complete the investigation.
(2) If assistance is needed in assessing medical issues in these cases, involvement of the OKDHS long-term care nurse may be requested.¢ 3
(3) APS staff submits findings of substantiated referrals of maltreatment by persons who are personal care assistants, Medicaid personal care attendants (MPCA), and community services workers subject to the requirements of the Community Services Worker (CSW) Registry maintained by Developmental Disabilities Services Division (DDSD) pursuant to 56 O.S. § 1025.3 of the Oklahoma Statutes within three working days to the OKDHS Office of Client Advocacy for consideration of placement of the worker's name on the statewide CSW Registry.Persons whose names are on the CSW Registry must not be employed by providers for direct care services to persons with developmental disabilities or as personal care attendants (PCA) paid through the Medicaid ADvantage Waiver.¢ 4
(4)(3) For provider agency employees who are not subject to the CSW Registry requirements, such as program coordinators, job coaches, bus drivers, or administrative personnel, APS staff notifies the agency director or board of any substantiated elements of the investigation.Any corrective action plan on the part of the provider agency becomes a part of the APS case record.If the provider agency fails to cooperate in addressing the substantiated elements of the investigation, APS staff notifies the licensing agency, any appropriate governing board, and the district attorney's (DA's) office of the failure to cooperate.
(e) Referrals involving other licensed or certified persons.APS staff sends findings to any state agency with concurrent jurisdiction over persons or issues identified in the investigation, including, where appropriate, the Oklahoma State Department of Health (OSDH), the Oklahoma Board of Nursing, and any other appropriate state licensure or certification board, agency, or registry.¢ 54
(f) Referrals alleging exploitation.Referrals involving exploitation are complex.To assist in handling some of these When referrals, the OKDHS Office of Inspector General (OIG) may accept for investigation referrals of exploitation involving involve large amounts of funds or the need to access complex records regarding financial transactions, the APS specialist is authorized to request assistance from the OKDHS Office of Inspector General (OIG).¢ 65If OIG declines to investigate, the APS specialist completes the investigation.Protective services that may be provided in cases of exploitation include:
(1) changing the representative payee; ¢ 76
(2) freezing all assets of the vulnerable adult;
(3) petitioning the court for an order allowing access to records;
(4) redirecting or stopping the flow of the vulnerable adult's assets into the alleged perpetrator's accounts; and
(5) stopping perpetrator access to the alleged victim's account(s).
(g) Persons referred to OKDHS by the courts.Courts are not authorized to remand criminal defendants to OKDHS based on a finding of lack of competency. Courts are authorized to refer the alleged incompetent defendant to OKDHS for consideration of voluntary assistance or conditionally release the incompetent defendant according to 22 O.S. § 1175.6(b)(B).In order to qualify for such findings disposition, the court must make findings described in (1) or (2) of this subsection.
(1) Referral for voluntary services or conditional release occurs when the court finds that the person is incompetent for reasons other than the AV is a person requiring treatment under 43A O.S. and is found not to be dangerous.
(2) When a court, the DA, or the attorney for a criminal defendant notifies the APS specialist that a referral for voluntary APS OKDHS services or conditional release has been made, the APS specialist obtains a copy of the order from the person making the referral.If, after evaluation, it appears to the APS specialist the AV may also be developmentally disabled, the APS specialist immediately contacts the Developmental Disability Services Division (DDSD) Area Intake office and requests their involvement in the process of determining what in consultation with the Office of General Counsel if voluntary services are available and adequate or whether to propose a plan of services for conditional release.This is a joint effort between the APS specialist and the DDSD case manager.¢ 87
(h) AV receiving services from DDSD.When an AV is receiving or may be eligible for services from DDSD, the APS specialist contacts the appropriate DDSD Area Intake office to coordinate activities to enhance the AV's safety.22 O.S. § 1175.3(D)(1)(b) authorizes a court to call for DDSD to conduct a competency evaluation to determine whether mental retardation or other developmental disability may be involved.¢ 98
(i) Referrals involving residents of residential care facilities, assisted living facilities, and continuum of care facilities.A The APS specialist sends a copy of the final investigative report is sent to OSDH.¢ 109
INSTRUCTIONS TO STAFF 340:5-5-4
Revised 11-1-11 6-1-12
1.Adult Protective Services (APS) staff is encouraged to continue the established working relationships with tribal social services to provide services for Native American clients, but are not required to contact tribal APS prior to initiating and completing an APS investigation.APS staff may contact the United States Marshal for assistance on restricted land, as appropriate.Information from an APS investigation may be shared with the Bureau of Indian Affairs (BIA) and tribal governments.
2.APS staff in the county of residence of the alleged victim (AV) has primary responsibility for the investigation.APS specialists in other counties involved cooperate fully and as quickly as possible in attempting to obtain information needed for the investigation.All requested information is forwarded to the human services center (HSC) in the AV's county of residence for completion of the case.This includes, but is not limited to, interviews with collateral contacts such as family members, alleged perpetrators (APs), or other persons determined to have knowledge pertinent to the investigation andconducting property searches, obtaining bank records, or other material pertinent to the investigation.
(1) Staff in the HSC of the county of residence may request staff in the HSC of the county in which the AP lives to conduct the interview with the AP.All efforts to involve the AP with the APS staff in the county of residence are exhausted before this option is exercised.The same APS specialist interviews the AV and the AP if possible.When the back-up APS specialist interviews the AP, the back-up APS specialist documents the interview in the Interview tab of the APS Computer System within five working days.
(2) When the AV is temporarily housed in another county, the APS specialist IV in the resident county where the AV normally resides may request that the back-up specialist in the temporary county completes and documents the initial face-to-face interview as quickly as possible, completes and documents the Capacity Assessment, initiates and documents the Risk and Needs Assessments, and contacts and documents any available collaterals.Staff in the resident county is responsible for completing the investigation and takes into consideration the input from the temporary county's APS specialist.The time frame for initiating the investigation remains the same per OAC 340:5-5-2.
(3) If it is determined that the AV relocated to another county prior to the conclusion of the investigation, the referral may be transferred to the new county.The APS specialist IV of the initial county contacts the APS specialist IV of the receiving county as soon as this determination is known in order to complete the investigation in a timely manner.
(4) When problems with coordination occur between APS staff in different HSCs or there are delays in documenting information, HSC APS staff contact the area APS program field representative(s) (PFR) for resolution.
3.(a) The APS specialist may request the involvement of an Oklahoma Department of Human Services (OKDHS) long-term care (LTC) nurse in investigations involving agency providers or when a nursing assessment is needed.The role of the nurse in APS cases is to:
(1) act as a resource in the interpretation of physical observations made by the APS specialist;
(2) accompany the APS specialist to visit the vulnerable adult if approved by the area nurse;
(3) assist the APS specialist in determining a course of action on the vulnerable adult's behalf; and
(4) assist in the follow-up of the vulnerable adult in the home, as appropriate.
(b) In order to involve the OKDHS LTC nurse in an APS investigation, the APS specialist must determine that the need exists for an in-home medical assessment.This conclusion may be reached after discussion with the APS specialist IV and the OKDHS LTC nurse, or both.
(1) If the OKDHS LTC nurse is not available, the specialist may call the area nurse.
(2) If a nurse cannot be reached or is geographically unavailable for immediate response, the APS specialist determines whether other nursing resources are available.Examples of other nursing resources include the Developmental Disabilities Services Division (DDSD) nurse or nurse at the local Oklahoma State Department of Health (OSDH).
(3) If the situation demands immediate attention and a nursing resource is unavailable, the APS specialist initiates the home visit immediately.
(c) If assistance from the OKDHS LTC nurse is appropriate either at the initial home visit or follow-up visits, the APS specialist accompanies the nurse to visit the vulnerable adult.If the OKDHS LTC nurse accompanies the APS specialist on the initial home visit, the specialist and OKDHS LTC nurse together assess the need for further action.After a visit to the vulnerable adult, the OKDHS nurse completes all items on Form 08AP003E, Adult Protective Services Nursing Assessment, and submits the original to the APS specialist for scanning and inclusion in the Nursing Assessment Section of the APS Computer System.
4.(a) The APS specialist submits to the Office of Client Advocacy (OCA) by fax 405-525-4885 or email *OCA.Intake@okdhs.org:
(1) Form 08AP015E, Transmittal to Client Advocacy;
(2) copies of the Intake Section and any pertinent sections from the APS Computer System;
(3) Form 08AP002E, Adult Protective Services Report of Investigation; and
(4) relevant documentation.
(b) If any supporting documentation is not available in electronic format, the APS specialist sends it to OCA Intake by interagency mail, with the APS case number clearly identified on the supporting documentation.
(c) For substantiated findings against a community services worker (CSW), the:
(1) finding substantiates physical, sexual, or verbal abuse, neglect, or financial exploitation by a caretaker.Self neglect is not included;
(2) vulnerable adult named as a victim is a person with developmental disabilities; and
(3) maltreatment was committed by a caretaker employed as a habitation training specialist (HTS) by a vocational, residential, or in-home supports provider.
(d) For substantiated findings against a personal care attendant (PCA), the:
(1) finding substantiates physical, sexual, or verbal abuse, neglect, or financial exploitation of a vulnerable adult by a caretaker.Self neglect is not included; and
(2) maltreatment was committed by an adult caretaker employed as a Medicaid PCA (MPCA) privately or through the ADvantage Waiver program.
(e) OCA screens APS reports to ensure they involve a matter subject to the CSW Registry.Within two working days of receiving a report, OCA decides whether to open an investigation.OCA Intake Unit notifies the APS specialist and or APS specialist IV by email of the decision.If OCA does not open an investigation, that does not change the APS substantiated finding.
(f) The process established for consideration of placement of a person's name on the CSW Registry must be followed.
(1) APS uses the greater weight of the evidence standard to substantiate maltreatment of a vulnerable adult.The CSW Registry process requires clear and convincing evidence which is a higher standard of proof.Some APS substantiated findings do not meet this higher burden of proof.OCA reviews APS findings to determine whether the cases merit further review.
(2) If the case appears to merit further review, OCA completes an independent investigation.If the OCA investigation results in a substantiated finding on a CSW or MPCA, OCA submits its report to OKDHS Office of General Counsel for review.If the Office of General Counsel determines that placement of the person's name on the CSW Registry may be warranted, the CSW or MPCA is notified of due process rights, including the right to an administrative hearing.
(g) When the APS specialist has any question about whether to send a particular report to OCA, the APS specialist contacts OCA Intake for guidance at 405-525-4850 or 800-522-8014.
54.(a) Contact information for OSDH includes:
(1) mailing address, 1000 N.E. 10th Street, Oklahoma City, Oklahoma (OK) 73111;
(2) local telephone number, 405-271-6868; toll-free number, 1‑800‑747-8419; fax number, 405-271-4172; and toll-free fax, 1‑866-239-7553; or
(3) email address, LTCComplaints@health.state.ok.gov.
(b) Contact information for the Oklahoma State Board of Nursing includes:
(1) mailing address, 2915 N. Classen Blvd., OKC, OK 73106; and
(2) telephone number, 405-962-1800.
65.A The APS specialist makes the referral to OKDHS Office of Inspector General (OIG) is made on Form 19MP001E, Referral Form, or its electronic equivalent,. An sends an email referral is sent to oigfraud@okdhs.org.
76.A vulnerable adult's benefits may be suspended pending appointment of a payee or change of payee.
87.When an AV in a criminal defendant case is referred to OKDHS, the assigned APS specialist makes periodic reports to the court regarding the status, activities, and well-being of the AV in accordance with Section 1175.6b of Title 22 of the Oklahoma Statutes (22 O.S. § 1175.6(b)).Periodic reports are made annually, or more often when court ordered.
(1) Original HSC staff in the vulnerable adult's county of residence maintain the original paper case records on vulnerable adults previously remanded to OKDHS under Title 22 of the Oklahoma Statutes are maintained in the HSC of the vulnerable adult's residence.Copies including copies of all reports and evaluations are kept in the original case record.New The APS specialist enters new reports are entered in the Intake Section of the APS Computer System with references to existing paper files.
(2) If the county of the vulnerable adult's residence is different from the county of court jurisdiction, an APS specialist in the county of residence is assigned as back-up for the purpose of seeing the vulnerable adult, documenting the contact, and preparing reports as needed.The reports are maintained in the specified W drive and may be printed as needed by the APS specialist.
(3) If, in the opinion of the APS specialist or the DDSD case manager, the AV appears to have achieved competency, the APS specialist reports this opinion in writing to the court.The court then sets another hearing for the purpose of determining competency.
98.(a) APS staff provides information to DDSD staff to assist in evaluation of a vulnerable adult known or suspected to have a developmental disability.The case manager for a vulnerable adult receiving DDSD services facilitates and cooperates with the APS investigation by providing requested information and accompanying the APS specialist on home visits when needed.
(1) When APS staff is assisted by DDSD staff on a case, a copy of Form 08AP002E is routed to the appropriate DDSD case manager upon completion of the investigation.
(2) An example of a situation when APS and DDSD staff coordinate activities is when the AV has developmental disabilities and is facing criminal charges.
(b) When a vulnerable adult receiving APS services appears to have developmental disabilities, but does not receive DDSD services, DDSD Intake staff or other appropriate staff may accompany the APS specialist, when necessary, on home visits and assist in making application for DDSD services.When DDSD staff assist APS staff on a case, APS staff route a copy of Form 08AP002E to the appropriate DDSD case manager upon completion of the investigation.
(c) If the APS specialist suspects the AV has developmental disabilities, the APS specialist calls the DDSD Area Intake office to determine whether the vulnerable adult receives DDSD waiver services or is on the waiting list.To make a referral for DDSD waiver services or DDSD state funded services, the APS specialist contacts the appropriate DDSD Area Intake office.
(1) DDSD has three Area Intake offices:
(A) Area I includes Oklahoma City and Enid and the toll-free number is 1‑800-522-1064;
(B) Area II includes Tulsa and the toll-free number is 1-800-522-1075; and
(C) Area III includes Pauls Valley and the toll-free number is 1‑800‑522‑1086.
(2) The APS specialist describes the situation and gives details to the DDSD intake worker regarding the person who may be in need of DDSD services.Details include the AV's:
(A) name;
(B) Social Security number;
(C) date of birth;
(D) address;
(E) phone number;
(F) diagnosis;
(G) medical information;
(H) name of responsible party or legal guardian; and
(I) any other pertinent information.
(3) The DDSD intake worker explains to the APS specialist the DDSD services available, if any, and how to access services and/or make application for DDSD services.
(d) If, after consultation with DDSD staff, it appears the AV may be eligible for DDSD waiver services but is not yet receiving them, the APS specialist informs the AV and/or the AV's responsible party or legal guardian that the AV may be eligible for DDSD waiver services.The APS specialist advises how to apply for services and offers to assist in completing and signing the DDSD waiver application and obtaining all required documents, such as physical and psychological reports.
(1) If the family does not want or need the APS specialist's help in applying for DDSD waiver services, the APS specialist may provide the family the appropriate DDSD Area Intake number so they can apply.In this case the APS specialist informs the local DDSD staff that the family was referred to the DDSD Area Intake office and may need services.If there is no family, responsible party, or legal guardian, or these persons are the alleged perpetrators, the APS specialist may assist the DDSD intake worker with the application.
(2) DDSD maintains a waiting list of clients when resources are unavailable for persons to be added to services funded through the Home and Community-Based Services Waiver.The waiting waiver request list is maintained in chronological order based on the date of receipt of a written request for services.For emergency situations, exceptions to the chronological order may be made, per OAC 317:40-1-1(g).
(e) The APS specialist routes a copy of Form 08AP002E to DDSD Quality Assurance upon completion of the APS investigation involving vulnerable adults receiving DDSD services.
(f) When a complaint alleges abuse, neglect, or exploitation of a person with developmental disabilities by an OKDHS employee, refer to OAC 340:5-3-6(c).
(g) If, in the course of an investigation, the APS specialist discovers the vulnerable adult is a Hissom class member, the APS specialist immediately routes the report to OCA. because OCA has the right of first refusal on investigations involving former residents of the Hissom Memorial Center. and OCA may investigate or return the report to APS for investigation.
109.The APS specialist faxes, mails, or emails final investigative findings in summary form to OSDH.See Refer to Instruction # 5 for OSDH contact information.
340:5-5-5. Documentation of APS cases
Revised 6-1-10 [INSTRUCTIONS TO STAFF ONLY REVISED]
The Adult Protective Services (APS) specialist documents the referral, all interviews, record reviews, other evidence, and findings of all investigations in the APS case.¢ 1
(1) Upon completion of the investigation, the identified caretaker, legal guardian, and next of kin receives a letter from the Oklahoma Department of Human Services (OKDHS) pursuant to Section 10-105.1(C)(6) of Title 43A of the Oklahoma Statutes.
(2) When the vulnerable adult has a court-appointed guardian, the APS specialist notifies the court of jurisdiction of the findings as mandated by 43A O.S. § 10-105.1(C)(6).
INSTRUCTIONS TO STAFF 340:5-5-5
Revised 6-1-10 6-1-12
1.(a) The APS specialist documents investigations on Form 08AP002E, Adult Protective Services Report of Investigation, or its electronic equivalent within 30 calendar days for self-neglect cases and 60 calendar days for cases involving alleged perpetrators after the receipt of the report in the human services center (HSC).The APS specialist files the original is filed Form 08AP002E or its electronic equivalent in the W drive and routes copies are routed to the local district attorney's office.
(b) Form 08AP002E is intended as a summary of the investigation and is not used as a tool to complete the investigation.The full case documentation on the APS Computer System provides a detailed chronological account of the entire investigation process, including:
(1) specific circumstances of the report;
(2) date and time of the home visit;
(3) persons present during the home visit;
(4) condition of the vulnerable adult and the vulnerable adult's environment;
(5) information from collateral contacts, including date and time;
(6) APS specialist's evaluation of vulnerable adult's capacity to consent to services;
(7) assessment of risk;
(8) APS specialist's determination of whether the report is substantiated or unsubstantiated;
(9) results of follow-up visits including date and time;
(10) assessment of vulnerable adult's needs;
(11) proposed service plan for substantiated investigations;
(12) circumstances of vulnerable adult's acceptance or refusal of services offered;
(13) information concerning the actual delivery of services; and
(14) detailed descriptions of all legal actions and follow-up activities for vulnerable adults receiving involuntary services.
(c) The APS specialist must document each new APS referral in the Intake Section of the APS Computer System.If there is no existing APS case number for the alleged victim, a new case must be opened.For all APS referrals, the APS specialist must enter into the computer system the relevant information, including receipt of referral, case findings of substantiated or unsubstantiated, and services actually provided, including any legal actions initiated.
(d) The APS specialist III and IV must successfully complete the APS Specialist III and IV Academy to be able to provide adequate supervisory support for an APS specialist.
(e) APS cases require documentation of a review by an APS specialist IV or staffing in the Notes Section of the APS Computer System at:
(1) intake;
(2) risk, needs, and capacity assessments;
(3) the determination of findings;
(4) legal action determinations;
(5) service planning;
(6) extension requests;
(7) appropriate follow-up; and
(8) closure.
(f) At the conclusion of the investigation, the APS specialist routes Form 08AP002E to the local district attorney.A summarized report is sent to any appropriate licensing agency.In substantiated investigations, the APS specialist works closely with the facility to develop a plan that addresses substantiated elements of the investigation.
(g) The APS specialist submits a summary of the investigation, omitting the reporter's identity, to the Nurse Aide Registry at the Oklahoma State Department of Health for all substantiated referrals against certified nurse aides.For substantiated referrals against licensed nurses, information is submitted to the Oklahoma State Board of Nursing, 405-962-1800, fax 405-962-1826.
(h) The APS specialist sends a summary notification of findings to the caretaker, legal guardian, and next of kin.This statement includes:
(1) whether the Oklahoma Department of Human Services (OKDHS) has determined the findings to be substantiated or unsubstantiated; and
(2) a summary of the recommendations of OKDHS concerning the vulnerable adult.
(i) Form 08AP002E and any pertinent section of the APS Computer System are electronically mailed to Office of Client Advocacy (OCA).A hard copy of this material is sent in the mail on substantiated referrals involving personal care assistants who are not certified nurse aides and community service workers to OCA and to the Quality Assurance Section of Developmental Disabilities Services Division (DDSD).
