In the course of your time with Mains’l and in your personal life, you will be performing behavior interventions and people will be performing them on you. The procedures below provide definitions and examples of what we can’t do, what we can do and what we should do when it comes to intervening in someone else’s behavior. Let’s start with the bad and end with the good.

The things we cannot do (also known as prohibited procedures)

The following are not allowed as a replacement for proper supervision or staffing, to reduce or stop a behavior, as punishment, or for staff convenience:

Chemical restraints Mechanical restraints Manual restraints Time out Seclusion Any other aversive or deprivation procedure

In summary, we do not do these things.  Not only do they make people unhappy, they generally do not work well to help people appropriately get their wants and needs met. Prohibited procedures may stop a behavior, but they do not teach a person what to do differently the next time. Prohibited procedures may also make a behavior worse. In addition, prohibited procedures can result in mental or physical injuries.

We have better options for you, so please keep reading. We will cover the things you can’t do first and end with the good stuff, positive supports.

Here are the simplified and technical definitions of prohibited procedures along with some and examples.

1. Chemical restraint:
   

   A chemical restraint is giving someone a drug or medication that has not been prescribed by their doctor to treat the behavior you are trying to avoid.  

   An example of chemical restraint is giving a person Xanax when they start yelling so they don’t become physically aggressive but Xanax is prescribed for the person to take when they have panic attacks. If Xanax is given for physical aggression and not a panic attack, this would be a chemical restraint.

   Technical definition: The administration of a drug or medication to control the person’s behavior or restrict the person’s freedom of movement and is not a standard treatment or dosage for the person’s medical or psychological condition.

2. Mechanical restraint:

   A mechanical restraint is using an object to limit or stop a person from freely moving a part of their body or have access to a part of their body

   An example of a mechanical restraint is taping gloves onto a person’s hands so they cannot scratch themselves, but they would not choose to wear the gloves on their own.

   Mechanical restraint does not include the following:  (1) devices worn by the person that trigger electronic alarms to warn staff that a person is leaving a room or area, which do not, in and of themselves, restrict freedom of movement; or (2) the use of adaptive aids or equipment or orthotic devices ordered by a health care professional used to treat or manage a medical condition.

   Technical definition: The use of devices, materials or equipment attached or adjacent to the person’s body, or the use of practices that are intended to restrict freedom of movement or normal access to one’s body, to prevent injury with a person who engages in self-injurious behaviors, such as head-banging, gouging, or other actions resulting in tissue damage that have or could cause medical problems resulting from the self-injury. Mechanical restraint also includes the use of practices that are intended to restrict freedom of movement or normal access to one’s body or body parts, or limits a person’s voluntary movement or holds a person immobile as an intervention precipitated by a person’s behavior.  

3. Manual restraint:
   

   A manual restraint is using your body to limit another person’s ability to move their own body.

   An example of a manual restraint is pinning someone to the ground to stop them from going somewhere.

   Technical definition: Physical intervention intended to hold a person immobile or limit a person’s voluntary movement by using body contact as the only source of physical restraint.

4. Seclusion:
   

   Basically, seclusion is making a person go somewhere or leave somewhere against their wishes and then not allowing them to leave.

   An example of seclusion is forcing a person to be separated because they were pinching the staff by putting them in a locked room while attending a birthday party.

   Technical definition: Removing a person involuntarily to a room from which exit is prohibited by a staff person or a mechanism such as a lock, a device, or an object positioned to hold the door closed or otherwise prevent the person from leaving the room; or otherwise involuntarily separating a person from an area, activity, situation, or social contact with others and blocking or preventing the person’s return.

5. Time out:

   A time out is making someone go to an area and it is experienced as a negative consequence. It differs from seclusion in that the person is not stopped from leaving the area they were sent to, but it is still not allowable for a staff to tell a person receiving services that a consequence of their behavior/actions is that they have to go to a designated area.

   Time out does not mean voluntary removal or self-removal for the purpose of calming, prevention of escalation, or de-escalation of behavior; nor does it mean taking a brief break or rest from an activity for the purpose of providing the person an opportunity to regain self-control.

   An example of a time out is sending a person to their bedroom after an argument, when they do not want to go. Another example is requiring someone to sit on a chair for a specified amount of time, but not physically forcing them to stay in the chair.

   Asking someone to ‘take a break’ to ‘cool down’, but not requiring them to do so, is not considered a time out. 

   Technical definition: The involuntary removal of a person for a period of time to a designated area from which the person is not prevented from leaving.  

6. Any other aversive or deprivation procedure: 

• Aversive procedure: An aversive procedure is doing or saying something during or right after a behavior that will cause a strong feeling of stress, anxiety, dislike or disgust in order to get the person to stop or reduce the behavior.
  

  An example of an aversive procedure is to wash someone’s mouth out with soap if they swear in the hope that they will not swear again.

  Technical definition: The application of an aversive stimulus based upon the occurrence of a behavior for the purposes of reducing or eliminating the behavior. 

• Aversive stimulus: Typically, an aversive stimulus is an unpleasant thing that punishes or limits a person. The thing that is used to try to stop the behavior is the aversive stimulus. The thing or situation itself does not have to be aversive on its own. It can be how it is used that it becomes aversive to the person.
  

  Examples of aversive stimulus are heat, cold, noise, a food or an event that is unwanted or unpleasant that is presented to stop someone or suppress a behavior.  

  Technical definition: An object, event, or situation that is presented immediately following a behavior in an attempt to suppress the behavior. 

• Deprivation procedure: A deprivation procedure involves taking away or not allowing someone to have something or do something they like, want, or need in order to get the person to stop or reduce the behavior.

• An example of a deprivation procedure is to take away someone’s dinner because they hit someone or not allow the person to go to the dance because they hit themselves.

• Technical definition: The removal of a positive reinforcer following a response resulting in, or intended to result in, a decrease in the frequency, duration, or intensity of that response.  Often times the positive reinforcer available is goods, services, or activities to which the person is normally entitled. The removal is often in the form of a delay or postponement of the positive reinforcer.

The things we can only do in certain circumstance ( also known as restricted procedures)

A restricted procedure is something that should not normally be done, but may be allowed in very specific circumstances if it is done properly and for acceptable reasons. Some restricted procedures include:

1. Procedures identified in a positive support transition plan A positive support transition plan is developed by the person’s expanded support team to implement positive support strategies to:

• Eliminate the use of prohibited procedures

• Avoid the emergency use of manual restraint and

• Prevent the person from physically harming self or others 

• Phase out any existing plans for the emergency or programmatic use of restrictive interventions that are prohibited.

Employees working with a person who has a positive support transition plan receive training before working unsupervised. In Minnesota, Mains’l develops a positive support transition plan on the forms and in the manner prescribed by the commissioner of DHS for a person who requires intervention in order to maintain safety when it is known that the person’s behavior poses an immediate risk of physical harm to self or others.  The positive support transition plan forms and instructions will supersede the requirements in Minnesota Rules, parts 9525.2750; 9525.2760; and 9525.2780. 

2. Emergency Use of a Manual Restraint:

• Emergency physical intervention intended to hold a person immobile or limit a person’s voluntary movement by using body contact as the only source of physical restraint.

• This means using a part of your body, such as your arms, hands, legs, or your entire body to stop the movement of another person.

• An example of an emergency use of a manual restraint is to use a wrist side hug procedure to move a person away from someone they are trying to assault.

1. Be implemented with a person in a manner that is sexual abuse, neglect, physical abuse, or mental injury.

2. Be implemented in a manner that violates a person's rights.

3. Restrict a person's normal access to a nutritious diet, drinking water, adequate ventilation, necessary medical care, ordinary hygiene facilities, normal sleeping conditions, necessary clothing, or any protection required by state licensing standards or federal regulations governing the program;

4. Deny the person visitation or ordinary contact with legal counsel, a legal representative, or next of kin;

5. Be used for the convenience of staff, as punishment, as a substitute for adequate staffing, or as a consequence if the person refuses to participate in the treatment or services provided by the program;

6. Use prone restraint, which means the use of manual restraint that places a person in a face-down position. Prone restraint does not include brief physical holding of a person who, during an emergency use of manual restraint, rolls into a prone position, if the person is restored to a standing, sitting, or side-lying position as quickly as possible;

7. Apply back or chest pressure while a person is in a prone position;

8. Be implemented in a manner that should not be used (contraindicated) for any of the person's known medical or psychological limitations;

9. Be implemented by a staff that has not completed training on the proper techniques to do an emergency manual restraint.

1. Physical contact or instructional techniques must use the least restrictive alternative possible to meet the needs of the person and may be used:

• To calm or comfort a person by holding that person when they show no resistance to being held.

• To protect a person known to be at risk of injury due to frequent falls as a result of a medical condition;

• To facilitate the person's completion of a task or response when the person does not resist or the person's resistance is minimal in intensity and duration;

• To block or redirect a person's limbs or body without holding the person or limiting the person's movement to interrupt the person's behavior that may result in injury to self or others with less than 60 seconds of physical contact by staff; or

• To redirect a person's behavior when the behavior does not pose a serious threat to the person or others and the behavior is effectively redirected with less than 60 seconds of physical contact by staff.

2. Restraint may be used as an intervention procedure to:

• To position a person with a physical disability in a manner specified in the person’s service and support plan.

• Assist in the safe evacuation or redirection of a person in the event of an emergency and the person is at imminent risk of harm. 

• Allow a licensed health care professional to safely conduct a medical examination or to provide medical treatment ordered by a licensed health care professional that is necessary to promote healing or recovery from an acute, meaning short-term, medical condition. 

3. Use of adaptive aids or equipment, orthotic devices, or other medical equipment ordered by a licensed health professional to treat a diagnosed medical condition do not in and of themselves constitute the use of mechanical restraint. 

The things that you should do (positive supports)

Positive approaches should be used first and be the most commonly used approached to intervening in another person’s behavior. Positive support approaches include:            

 

 

Showing is often more effective then telling. Act the way you want them to act. < >Take the time to understand what the person is trying to communicate with an inappropriate behavior and then teach appropriate behavior so they can get what they want or need. Follow the guidance in the person’s Services and Support Plan, their Person Centered Plan and if they have one, their Behavior Plan. Shift a person’s focus by talking with them about a different activity or topic. Reinforce appropriate behavior. When someone does the right thing, point it out! Offer choices, based on the person’s preferences, including activities that are relaxing and enjoyable to the person. Give regular and specific positive feedback. Listen carefully to what the person is telling you and  validate their feelings; Create a calm environment by reducing sound, lights, and other factors that may bother a person. Speak calmly with reassuring words, consider volume, tone, and non-verbal communication. Simplify a task or routine or discontinue until the person is calm and agrees to participate. Respect the person’s need for privacy or physical space ​

The first step in determining work place exposure to blood borne pathogens is through the development of an Exposure Control Plan (see attached.)  The Exposure Control Plan is designed to eliminate or minimize employee exposure to blood borne pathogens.  The Exposure Control Plan must contain:

I.    Exposure Determination
II.    Schedule and Method of Implementation for:
    A.    Methods of Compliance
    B.    Hepatitis B Vaccine and Post Exposure Follow Up
    C.    Communication of Hazards to Employees
    D.    Record Keeping
III.    Procedure for Evaluation of Circumstances Surrounding Exposure Incidents

The Exposure Determination (see Exposure Control Plan - Section I) is a site specific document completed by the Manager with the assistance of the Senior manager.  Its purpose is to delineate all tasks and procedures which may present an occupational exposure.  Because the primary tasks of all employees of Mains’l Services, Inc. is to offer training, assistance, and supervision to the people we serve, tasks posing an occupational exposure are considered collateral duties and are not regarded as primary job assignments.  The completed Exposure Determination for each site is maintained in the policy manual at the site.   The entire Exposure Control Plan, including the Exposure Determination, is reviewed and updated at least annually and whenever necessary to reflect new or modified tasks and procedures which affect occupational exposure and to reflect new or revised employee positions with occupational exposure.

The Exposure Control Plan also contains a Schedule and Methods of Implementation for A) the OSHA recommended methods of compliance including the concept of universal precautions, engineering and work practice controls, personal protective equipment and general housekeeping standards, B) Hepatitis B Vaccine and Post Exposure Follow Up, C) Communication of Hazards to Employees, and D) Record Keeping.  

Using the Universal Precautions approach, Engineering and Work Practice Controls, Personal Protective Equipment and general housekeeping standards are in place in all sites as deemed necessary.  (see Exposure Control Plan - Section IIA.)   Information about the aforementioned topics is contained in the “Control of Infection and Communicable Disease” Training module and provided during the first 60 days of employment to new employees and immediately to current employees.  

The Infection Control Plan is found within the Mains’l Policy Manual as an attachment to the Exposure 
                        
Control Plan and incorporates related procedures addressing the universal precautions of hand washing, use of gloves, general cleaning procedures, and laundry procedure. 

The Schedule and Methods of Implementation also pertain to the administration of the Hepatitis B vaccine and Post Exposure Evaluation and Follow Up.  Pursuant to the OSHA modification of Hepatitis B vaccination requirements, employees who have occupational exposure as a “collateral duty” need not be offered the vaccine until an exposure incident has occurred.  (An exposure incident is defined as a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral (skin piercing) contact with blood or other potentially infectious materials that results from the performance of an employee’s duties).  Any unvaccinated person who has rendered assistance in any situation involving the presence of blood or other potentially infectious material, regardless of whether an actual exposure incident as defined by the OSHA standard has occurred, will be offered the vaccine.  The procedure following an exposure incident is delineated in the Exposure Control Plan - Section IIB.  New employees are instructed in the procedures during initial orientation and current employees are informed of the procedures during the training conducted by the Managers. 

The Schedule and Methods of Implementation also pertain to the communication of hazards to employees.  Warning labels and signs are not deemed necessary in the residential programs in which the employees of Mains’l work.  Occupational exposures only occur as collateral duties of employees and training is provided in infection control, universal precautions, personal protective equipment including the use of gloves, general work practice controls such as hand washing, and general housekeeping standards.

As mentioned throughout this procedure, comprehensive training is provided to all employees of Mains’l Services, Inc.  The training module includes all the elements recommended in the OSHA standard (see Exposure Control Plan - Section IIC.)   New employees receive training within the first sixty days of employment and the training will be reviewed annually for all employees, within one year of previous training.

Finally, the Schedule and Method of Implementation applies to record keeping (see Exposure Control Plan - Section IID.)  If an occupational exposure occurs, Mains’l Services will establish and maintain an accurate medical record for each employee with an occupational exposure.  The medical records will be confidential and will include all information as stipulated in the OSHA regulations.  Training records are maintained and contain all information as stipulated in the OSHA regulations.

The last component of the Exposure Control Plan is the procedure for evaluation of circumstances surrounding exposure incidents.  Following an exposure incident, the senior manager will review all documentation of the route(s) of exposure and the circumstances under which the exposure occurred and make recommendations to prevent future exposure incidents (See Exposure Control Plan - Section III).  The report will be reviewed by the Health Services Director who will make necessary changes or revisions to policy and procedure.
 

Private data includes all information on a person that Mains’l has gathered for the purpose of offering supports.

Notice of Privacy Rights

1. On the day services begin, and annually thereafter, the manager gives the Notice of Privacy Practices for Persons Receiving Service document to the person/legal representative and has the person/legal representative sign the Notice of Privacy Practices Acknowledgment of Receipt. 
2. The manager files this in the legal/consent section of the person’s Support Plan.

Sharing Information: Mains’l employees are allowed to share information with only the following persons or entities without a release:

• Person receiving services 
• The person’s legal representative 
• Mains'l employees and consultants on a need-to-know basis:
• Representatives of responsible federal, state, and local agencies; i.e. case managers, licensors, state or federal investigators.
• Representatives of responsible contracting agencies such as managed care organizations

A person receiving services or their legal representative has a right to access and review the individual record and may request copies of pages in their record.

Besides the person receiving services and their legal representative, the people identified above do not automatically have access to private data about a person receiving services or about other staff or agency employees.  Need-to-know basis means that the person must have a specific work reason requiring access to the information. Private data about a person is available only to those employees whose work assignments reasonably require access to the data; or who are authorized by law to have access to the data.

Any written or verbal exchanges about a person's private information by staff with other staff or any other persons will be done in such a way as to preserve confidentiality, protect data privacy, and respect the dignity of the person whose private data is being shared. As a general rule, if a person is unsure about sharing information regarding a person, they should contact their supervisor or reference this policy and procedure. 

Sharing Information with Other Parties
Information regarding a person receiving service from Mains'l may be released to outside persons/agencies only after the person or their legal representative authorizes the release by signing the Consent to Exchange Information. 

Obtaining Informed Consent and Authorization for Release of Information
Upon starting services and annually after that, the Mains’l manager or their designee will obtain informed consent and authorization to release information. There may be other times when a representative of Mains’l provides informed consent and requests authorization for release of information. The following procedures are to be followed at any time information is requested:

1. At the time informed consent is being obtained, the manager informs the person or the legal representative individual about the following:

• why the data is being collected;
• how Mains’l intends to use the information;
• whether the individual may refuse or is legally required to furnish the information;
• what known consequences may result from either providing or refusing to disclose the information, and with whom the collecting agency is authorized by law to share the data;
• what the person can do if they believe the information is incorrect or incomplete;
• how the person can see and get copies of the data collected about them; and any other rights that the individual may have regarding the specific type of information collected.

2. The manager maintains all informed consent documents in the person’s individual record.

    The following will be observed when completing the Consent to Exchange Information:

• The form is initially completed at the time services begin. It is updated annually thereafter (automatic one-year expiration). If additional information is to be released during the period of the authorization that is in addition to or other than that initially included, an additional or revised form will be completed.
• The type of information to be released, to whom, and for what purpose must be specified on the form in order for the authorization to be valid.
• If the person receiving service is under 18 but has been given the legal right of an adult (emancipated adult) they must sign the form.  If they are not, the legal guardian must sign the form.
• Informed consent must be obtained to validate the authorization to release information.  The senior manager or manager must review with the person or their legal representative what information is being requested and/or released, by whom, and the purpose for which it will be used.  It is advisable to have the person who is authorizing the release then repeat what has been explained to assure their understanding and ability to give informed consent.

Requesting Information from Other Licensed Caregivers or Primary Health Care Providers
Mains’l may need to request information about the person from other licensed providers. When this is needed, the manager will:

1. Complete a Release of Information form.  The manager will carefully list all the consults, reports or assessments needed, giving specific dates whenever possible.  Also, the manager will identify the purpose for the request.
2. Clearly identify the recipient of information.  If information is to be sent to the program's health care consultant or other staff at the program, include Attention: (name of person to receive the information), and the name and address of the program.

Release of Written Documents to Persons Receiving Service or Legal Representative

The following process is used when a person receiving supports or their legal representative wishes to obtain copies of written records:

•  A written request from the person or legal representative, which specifies the information requested, shall be given to the senior manager.
• The senior manager makes the requested material available within three (3) working days after the request.
• The senior manager is available to discuss the content and meaning of the data with the individual receiving service and/or the legal representative if this is requested.
• The person is informed that the agency is not required to release additional data within six (6) months of the first release of information.
• The person making the request signs a statement verifying the requested data was received and, if desired, discussed.
• If a person wishes to contest the accuracy of the information, they must notify the senior manager in writing.  The senior manager and director review the information and respond in writing to the person within thirty (30) days of the request for clarification.
• The person may submit additional written information to be placed in their data file at any time.

Release of photographs or video to other parties: Photographs or video of people supported by Mains'l are displayed or released to outside persons/agencies only if the person receiving service or their legal representative has authorized the release by signing an Authorization for Release of Photographs.

The following is observed when completing the release of photographs form:

1. The general nature of the photo/s to be used, to whom, and for what purpose is specified on the form in order for the authorization to be valid.  The authorization remains valid until the person requests in writing their desire to have the photo removed from future reproduction.
2. Informed consent is obtained to validate authorization.  The manager reviews with the person/legal representative what photograph/video is being requested/ released, by whom, and for what purpose it will be used.  
    

In addition to the behavior intervention policy and procedure, the following procedures are followed if and when it is necessary to perform the emergency use of a manual restraint.

Responding to Escalating Disruptive Behavior

When a person begins to engage in escalating disruptive behavior and it becomes apparent that they may likely engage in continuous aggression, self-injury, or high level disruptive behaviors that also threaten the safety and well-being of others if not redirected, implement the following steps:

1. Attempt de-escalation techniques. 
   • De-escalation techniques include restructuring the environment (noise, crowding, proximity), maintaining calm posture and body language, re-direction, positive verbal praise, active listening, and/or prompting (verbal and gestural).
2. If applicable, review the use of the person’s PRN use medication to address target mental health symptoms.
3. If the person’s behavior continues to be disruptive, ask that the person to remove themselves from the ongoing activity to a location where they cannot observe the ongoing activity  – this is a voluntary time out.
4.  Monitor the person’s behaviors while they choose to be in a voluntary time out.
5.  When the person stops the disruptive or threatening behavior, prompt them to return to normal activities.
6.  If appropriate or possible, remove all people whose safety is threatened, from the immediate area of the threatening person.
7.  If the person continues to refuse to remove him or herself from the situation and the challenging behaviors continue or escalate, implement personal safety techniques as trained.
   • Personal Safety Techniques:

• ​Wrist release:  Place one foot slightly forward and bend knees.  Use your free hand to grasp the back of their own hand and pull up following the direction of the thumb of the restrained hand until hold is released. Then position your hand on the inside of the individual’s opposite arm and pull to a one-arm wrap around
• Bite release:  Gently apply pressure, pushing the body part being bitten into individual’s mouth making a seal.  Simultaneously using thumb and forefinger to squeeze nose and block air passage until individual opens mouth to inhale and hold is released.​
• Clothing release: Use the outside hand to stabilize the hand grabbing clothing.  Then use the inside hand to hold clothing and gently pull out of individuals grasp.
• Hair pull: Use one hand to stabilize the wrist of hand pulling hair, then use your other hand to gently peel individual’s fingers from hair
• Object removal (not to be used with dangerous items i.e. butcher knives, guns): As individual begins to attack, bend at the elbows bringing hand towards toward face, palms facing outwards as to block.  Then reach to grab object and/or wrists and attempts to peel object out of individual’s hands.
• Blocking Punches and kicks: As individual advances to kick or punch, shuffle back while simultaneously bending arms and bringing both hands in front of face, palms facing outwards.

8. If the person begins to engage in behavior that is continuous aggression, continuous self-injury, or high magnitude disruption that threatens the safety of themselves or others, emergency manual restraint may be implemented, as trained.  When implementing an emergency use of manual restraint start with the least restrictive procedure necessary to keep the individual and others safe.

• If a restraint is being implemented following a personal safety technique, following the implementation of the personal safety technique you may pull to a one-arm wrap around.

9. After implementing the manual restraint, attempt to release the person at the moment staff believe the person’s conduct no longer poses an imminent risk of physical harm to self or others and less restrictive strategies can be implemented to maintain safety.

Mains’l will not allow the use of a manual restraint procedure with a person when it has been determined by the person’s physician or mental health provider to be medically or psychologically contraindicated. Mains’l will complete an assessment of whether the allowed procedures are contraindicated for each person receiving services as part of the service planning required under section 245D.070, subdivision 2, for recipients of basic support services; or the assessment and initial service planning required under section 245D.071, subdivision 3, for recipients of intensive support services.

Manual Restraints Allowed in Emergencies

Below is a list of each of the manual restraints trained staff are allowed to use on an emergency basis when a person’s actions pose an imminent (it is about to happen) risk of physical harm to self or others and less restrictive strategies have not achieved safety. The list includes instructions for the safe and correct implementation of those procedures.

They are listed in order of least to most restrictive:

1. Wrist Side Hug Procedure:  Standing next to the individual, using your outside hand, grasp the individual’s wrist above or below the wrist bone, making sure to position their thumb on top of your wrist.  It is important to not grasp the wrist directly as this could cause pain and potentially injury to the person. With your inside hand, closest to individual, wrap your hand around the back of the individual and grasp their triceps on the opposite side of the individuals body, making sure to keep your fingers and thumb together and not grabbing at the individual to cause bruising or pain (This is only used to move an  individual out of harm’s way)
2. Wrap Around- Bear Hug Style:  standing next to individual, staff wrap both of their arms around individual using one hand to grasp their own wrist.

Conditions for Emergency Use of Manual Restraint

Emergency use of manual restraint must meet the following conditions:

• Immediate intervention must be needed to protect the person or others from imminent risk of physical harm;
• The type of manual restraint used must be the least restrictive intervention to eliminate the immediate risk of harm and effectively achieve safety.  The manual restraint must end when the threat of harm ends.
• A manual restraint is only allowed in an emergency when a person’s behavior poses an imminent risk of physical harm to them self or others and the less restrictive strategies have not achieved safety.
• Documentation must be provided to show that positive approaches have been tried and have been unsuccessful as a condition of implementing an emergency use of manual restraint.
• The program must monitor a person’s health
• Property damage, verbal aggression, or a person’s refusal to receive or participate in treatment or programming on their own, do not constitute an emergency.
• Within 24 hours of an emergency use of manual restraint, the legal representative and the case manager must receive verbal notification of the occurrence.
• The use of an emergency manual restraint has been approved in the person’s support plan.
• The employee performing the emergency use of a manual restraint has completed training and demonstrated competence in performing a manual restraint.

Restrictions When Implementing Emergency Use of Manual Restraint

Emergency use of manual restraint must not:

1.   be implemented with a child in a manner that constitutes sexual abuse, neglect, physical abuse, or mental injury;

2.   be implemented with an adult in a manner that constitutes sexual abuse, neglect, physical abuse or mental injury;

3.   be implemented in a manner that violates a person’s rights and protection;

4.   be implemented in a manner that is medically or psychologically contraindicated for a person;

5.   restrict a person’s normal access to a nutritious diet, drinking water, adequate ventilation, necessary medical care, ordinary hygiene facilities, normal sleeping conditions, or necessary clothing;

6.   restrict a person’s normal access to any protection required by state licensing standards and federal regulations governing this program;

7.   deny a person visitation or ordinary contact with legal counsel, a legal representative, or next of kin;

8.   be used as a substitute for adequate staffing, for the convenience of staff, as punishment, or as a consequence if the person refuses to participate in the treatment or services provided by this program;

9.   use prone restraint. “Prone restraint” means use of manual restraint that places a person in a face-down position. It does not include brief physical holding of a person who, during an emergency use of manual restraint, rolls into a prone position, and the person is restored to a standing, sitting, or side-lying position as quickly as possible; or

10. apply back or chest pressure while a person is in a prone position, supine (meaning a face-up) position, or side-lying position,

11. be implemented in a manner that is contraindicated for any of the person’s known medical or psychological limitations.

Monitoring Emergency Use of Manual Restraint

Mains’l must monitor a person’s health and safety during an emergency use of a manual restraint. When possible, a staff person who is not implementing the emergency use of a manual restraint must monitor the procedure. The purpose of the monitoring is to ensure the following:

1.   only manual restraints allowed in this policy are implemented;

2.   manual restraints that have been determined to be contraindicated for a person are not implemented with that person;

3.   allowed manual restraints are implemented only by staff trained in their use;

4.   the restraint is being implemented properly as required; and

5.   the mental, physical, and emotional condition of the person who is being manually restrained is being assessed and intervention is provided when necessary to maintain the person’s health and safety and prevent injury to the person, staff involved, or others involved.

Reporting Emergency Use of Manual Restraint

The staff who implemented any form of manual restraint procedure:

1. Notifies the assigned manager immediately.
2. Completes the Behavior Intervention Reporting Form (BIRF) and submits it to the manager prior to leaving the shift.
   
   • Each single incident of emergency use of manual restraint must be reported separately. A single incident is when the following conditions have been met:
     • after implementing the manual restraint, staff attempt to release the person at the moment staff believe the person’s conduct no longer poses an imminent risk of physical harm to self or others and less restrictive strategies can be implemented to maintain safety
     • upon the attempt to release the restraint, the person’s behavior immediately re-escalates; and
     • staff must immediately re-implement the manual restraint in order to maintain safety.
3. If a PRN medication is given for target behaviors (chemical restraint) rather than for target mental health symptoms, staff completes the BIRF.
4. If 911 was called, the staff responsible at the time of the incident:

• Completes an incident report;
• Calls the on-call administrative personnel to report the incident;
• Notifies the manager, who notifies the case manager and the legal representative of the incident within 24 hours

The manager/designated coordinator:

1. Within 24 hours of an emergency use of manual restraint, the manager contacts the legal representative and the case manager to provide verbal notification of the occurrence.

• When the emergency use of manual restraint involves more than one person receiving services, the incident report made to the legal representative and the case manager must not disclose personally identifiable information about any other person unless the program has the consent of the person.

b. Within (5) working days of the behavior intervention, reviews and finalizes the Behavior Intervention Internal Review form.

Expanded Support Team Review of Emergency Use of Manual Restraint

Within 5 business days after the completion of the internal review, the manage or senior manager must consult with the expanded support team to:

1.   Discuss the incident to:

a.   define the antecedent or event that gave rise to the behavior resulting in the manual restraint;  and

b.   identify the perceived function the behavior served.

2.   Determine whether the person’s service and support plan needs to be revised to:

a.   positively and effectively help the person maintain stability; and

b.   reduce or eliminate future occurrences of manual restraint.

3.   Make the revisions to the person’s service and support plan when it is determined necessary.

The written summary of the expanded support team’ discussion and decisions will be documented on the Expanded Support Team Review Form and saved in the person’s plan file.

Internal Review of Emergency Use of Manual Restraint

a. Within 5 business days after the date of the emergency use of a manual restraint, the senior manager must complete and document an internal review of the report prepared by the staff member who implemented the emergency procedure. The internal review must include an evaluation of whether:

1.   the person’s service and support strategies need to be revised;

2.   related policies and procedures were followed;

3.   the policies and procedures were adequate;

4.   there is need for additional staff training;

5.   the reported event is similar to past events with the persons, staff, or the services involved; and

6.   there is a need for corrective action by the program to protect the health and safety of persons.

b. Based on the results of the internal review, the senior manager must develop, document, and implement a corrective action plan designed to correct current lapses and prevent future lapses in performance by individuals or Mains’l.

c. The corrective action plan, if any, must be implemented within 30 days of the internal review being completed

d. The original is filed in the person’s plan file and a copy is submitted to the director.

External Review and Reporting of Emergency Use of Manual Restraint

Within 5 business days after the completion of the expanded support team review, the senior manager must submit the following to DHS using the online behavior intervention reporting form which automatically routes the report to the Office of the Ombudsman for Mental Health and Developmental Disabilities:

1.   report of the emergency use of a manual restraint;

2.   the internal review and corrective action plan; and

3.   the expanded support team review written summary.

Positive Support Transition Plan

If an individual uses a positive support transition plan, the plan will be written by a Board Certified Behavior Analyst.  The plan will be written and phased out within 11 months form the date of plan implementation. The BCBA will use the DHS created and approved plan.

 

Once services have started, the person receiving services continues the discovery process with people they have chosen to support them.  The process and procedure may vary, depending on the supports and needs of each person.

 

Mains’l employees are trained in offering person centered services. If at any time a Mains’l employee feels they do not have sufficient information regarding person centered practices, skills or tools, they are encouraged and expected to seek out a Person Centered coach. A list of coaches can be found on the Mains’l employee portal under Person Centered Thinking.    

 

A variety of tools and skills are used to assist in recording the information learned, in order to develop a Support Plan.  Tools/skills may include, but are not limited to: Matching Tools (to gain insight on what staff characteristics are preferred) and Discovery Tools (Important To, Importance For, Rituals and Routines, Relationship Map, Good Day/Bad Day, Communication Chart, Learning Log).  These tools inform the person centered description (see Person Centered Description packet and forms.)

 

1.    The person receiving services and Mains’l staff work together to develop a Personal Description of the person.  Employees will document what they learned using the materials in the Person Centered Description packet within the first 30 days of starting services.  Information discovered from this process creates the foundation of how supports will be offered.  A one-page personal profile/description is created, based on the information learned (a snapshot of the person), and includes what’s important to the person, what others like and admire about them, and how to best support them.

2.    The person receiving services and their support team, including Mains’l staff, work together to balance what is important to and for a person, and how to best support them. Information from existing support plans (i.e., Coordinated Service and Support Plan, Individual Service Plan, and Person Centered Plan, if available) is included in the Support Plan, which the manager will develop within the first 30-40 days of service. The Support Plan reflects what services and supports are offered, as well as how, when, and by whom the services will be provided.

3.    Mains’l employees collaborate with the person receiving services when documenting information.  This is to ensure the person has input into what is being recorded about them.  The person has the right to not participate in this process, but it is recommended and is encouraged.  This applies to all initial and ongoing recorded information gathered throughout the time the person receives supports from Mains’l.

4.    If a Person Centered Plan is not already in place, the manager works with the support team to identify who is responsible to create the plan, as appropriate.

 

Throughout the year, the manager, along with direct support staff and other key people, collaborate on how to best meet the persons’ identified needs, interests, preferences and goals. The person’s Support Plan is updated when needed, at minimum annually, based on the discoveries from conversations and changes in what is important to and important for the person. 

Ongoing Collaboration and Conversations

Mains’l values collaboration and partnerships when offering supports.  We have ongoing conversations with the person receiving services and their support team, to continually learn about the person and their changing preferences, needs, and personal goals and outcomes. The process of “Nothing about the person, without the person” is maintained to the greatest extent possible.

 

Personal outcomes and goals are reviewed with the person receiving services on an ongoing basis, and at least every six (6) months. The Support Plan is updated as needed to reflect any changes, and support team members are notified as progress and changes occur, when applicable. Learning logs may be used to assist in using innovative, creative ways to overcome barriers or enhance the supports offered.

 

Meetings are scheduled throughout the year, as requested and/or needed. Meetings are scheduled by the manager and/or the person and their support team, and are held at the person’s home, or another place determined by the person and their support team.

                                                                                                                       

1.    Mains’l encourages a face to face meeting with the person receiving services and their support team within the first 30-45 days of starting services to review how things are going and to ensure all documentation Mains’l has created is acceptable to the person and their support team.  While the person can choose to not have a face to face meeting, we strongly encourage this practice.

2.See Meeting Checklist (by service and meeting type) for a list of documents to be reviewed and/or completed prior to the meeting, at the meeting, and after the meeting. 

3.    The focus of all meetings is to continue to address what is important to and for the person.  The person receiving services and the team talk about what’s working and what’s not working, what has been tried, and share ideas for better support delivery.  The person receiving services is coached and encouraged to lead the meeting.  They are also asked to assist in creating the agenda, including areas they want addressed (or do not want addressed) at the meeting.   Person-centered skills and tools are used to assist the person in creating the agenda, as well as facilitating the meeting, as desired.

4.    Meetings may begin by an opening round.  A relevant positive question may be asked for all members to respond, i.e., “What is one highlight from the last year (week, month, etc.) you can share with the group?” or “What is one thing you like or admire about the person?”

5.    If a person centered plan has been developed, the team reviews and updates as desired.  If a plan has not been created, the manager works with the support team to identify who is responsible to create the plan, as appropriate.

6.    The person receiving services, if so desired, follows the agenda and then reviews the most recent Support Plan, telling the group if changes are needed.  The manager helps facilitate as needed.

7.    The manager requests the person or appropriate team member to sign all documents, as required, listed on the Meeting Checklist.

8.    A satisfaction survey is completed at each person’s Annual Meeting. A paper survey with a return envelope is offered, to consistently receive feedback on how we might improve our services.

9.    The team identifies next meeting date/s and how often they want to receive written updates and reports, as appropriate.

 

Inspections and Code Compliance:

• All new sites are inspected by a fire authority within 12 months of opening and licensure.
• All sites are annually inspected by municipal building inspectors against building and fire codes.
• Some sites are also inspected by fire inspectors (larger metro areas)
• County foster care licensors inspect initially and annually all licensed sites against MSA 245D requirements (Issued then a Community Residential Setting CRS license.)
• We also complete a Home Safety Checklist before the CRS license is issued.
• Re-inspections can be ordered at any time by state or local authorities.

 

Physical Plant Requirements:

 

Common Areas:

• Living area with adequate furnishings for living and social activities
• Dining area to accommodate meals for all residents

 

Bedrooms:

• At least 80 square feet of floor space
• 120 square feet if double occupancy
• Minimally 7 ½ foot ceilings
• Separated from halls, corridors and other rooms by floor to ceiling walls (no openings)
• Do not serve as a corridor to another room
• Have lockable doors with key issued to the person (copy to Manager for emergencies) complying with MSA 245D.04.

 

Bedroom Furnishings:

• Separate bed of proper size and height for convenience and comfort
• Clean mattress in good repair (normally inner spring, person may choose other – documented in their file.)
• Clean bedding appropriate for the season
• Individual cabinet or dresser*
• Shelving*
• Closet*
• Storage for personal belongings*
• Mirror for grooming*
• Person may choose not to use or have these (documented in their file)
• May bring personal possessions into their room, providing neat, orderly and not a fire hazard

 

For Service:

• All new managers and support coordinators will receive site specific maintenance training within the first 90 days of hire.
• In turn the manager should review an abbreviated version of the Maintenance Policy and Procedure with their staff during the September Team Meeting.  The outline for this training is in the September Monthly Team Meeting folder on the M-drive.
• Maintenance takes routine calls (612-636-8080) from 6:30 a.m. to 6:30 p.m. Monday - Friday.
• After hours calls can be made to the maintenance tech (if a real emergency), vice president of administration (651-249-6097) or the on call administrator (612-598-5700).

 

Service Contracts:

• All homes use Xcel “Home Smart,” CenterPoint “Service Plus,” or other utility service contractors.
• Covers the furnace, air conditioning, water heater, dishwasher, and refrigerator.
• The furnace, air conditioning, and water heater must be covered.  The other appliances are optional (decided by the manager and senior manager).
• CenterPoint Tel. No. 877-477-1664.  They ask for a P-I-N (provided at the training).
• Xcel Tel. No. 866-837-9762 (No P-I-N).
• Some outstate sites use other companies

 

Emergencies – Gas Smells, Fires:

 

If you smell gas or spot/suspect a fire:

1. Don’t try the fire extinguisher unless tiny fire.  Smoke can overtake you quickly.
2. Evacuate everyone – get more than 75 feet away from the house
3. Don’t use cell phones or other electronic devices
4. Watch out for static electricity
5. Don’t use the automatic garage door opener
6. (All these devices can spark an explosion if the gas is concentrated enough)
7. Once outside and clear of the house, call 9-1-1 immediately – they call fire rescue, gas company, etc.
8. Call the on call administrator and follow the Responding to and Reporting of Incidents and Emergencies Procedure

 

Emergencies – Extreme Temps:

1. If your AC or furnace is out, call Xcel or CenterPoint immediately 24/7.
2. Call the maintenance tech during business hours to report the outage.
3. Have a contingency plan (nearby hotel), if extreme temps in the house
4. (Over 85F or below 60F)
5. Use of fans or oil filled space heaters can sometimes help.

 

Emergencies – Water Leaks:

1. Leaks – turn of valve at the source (under sink for small leak) or for the entire house if major leak like a burst pipe (water shut off from the street) Do not delay!
2. The manager or support coordinator must show each new staff working at the site where these shut off valves are.
3. Call maintenance tech to describe the problem.  Can call vice president of administration of no response.
4. Will attempt to get a plumber out there ASAP.

 

Emergencies – Extreme Water Temps:

 

If the water heater is malfunctioning (too hot – in excess of 120F)

1. Stop all bathing, showering and unattended washing immediately, no exceptions.
2. Call maintenance tech immediately
3. Call Xcel or CenterPoint immediately
4. Once repaired, run the hot water for about 20 minutes to evacuate the overheated water to reduce the temp with fresh cold water.
5. Measure the water temp before returning to use (must be below 120F).
6. Best to measure closest to the water heater (laundry sink).

 

If the repair to the water heater will be delayed for more than 24 hours call the maintenance tech or vice president of administration to report the delay.  Also call the manager and/or senior manager to develop a contingency plan (hotel) until the repair is made.

 

Power Outages:

• If the power goes out and the rest of the neighborhood appears to be out too, call your electrical provider.  Companies and numbers to follow:
• Don’t assume you don’t have to call because someone else in the neighborhood has—call.  If it appears that the power will be out awhile, call the senior manager during regular business hours or the emergency on call administrator after hours to report the outage.  When the power is restored, repeat those calls.  Again, there might be the need for a contingency plan.

 

Power Outages Numbers to Call:

• Anoka Municipal Utility:                      763-576-2750
• Chaska Electric:                                 952-448-4335
• Connexus Energy:                              763-323-2660
• Elk River Public Utiity:                                    888-606-4660
• Rochester Public Utility:                     507-280-9191
• Xcel Energy:                                       800-895-1999

 

Maintenance Requests – Phone App – this is being tested and will be finalized soon.

 

Non-Emergency – Service:

Whenever any service technician comes to the home to make a repair, always ask the tech for a copy of the work ticket and get that ticket to the maintenance tech.

 

Non-Emergency – Service Technicians:

• If Home Smart of Service Plus comes to your site twice within any six month period to fix the same appliance, call the maintenance tech—may be a sign of a problem not getting resolved.
• Maintenance tech can help and talk with the service tech.

 

Non-Emergency – Water Softener:

1. Check the water softener canister periodically.
2. Verify the salt and water level are up close to the top.
3. Otherwise can clog plumbing.

 

Licensing Preparation – Licensed Sites:

1. When anyone at the site first learns about a scheduled date for a foster care licensing inspection call the maintenance tech immediately.
2. The maintenance tech can assist with the preparation.  The tech needs ample notice.

 

Fall/Winter Check Lists:

1. These are emailed out each fall to the manager to complete as winter preparation projects described on the form are completed.
2. E-mail or fax the completed form to the vice president of administration

 

Support Coordinator’s Role in Maintenance:

1. Remain alert to problems
2. Report needs to the manager and maintenance
3. Monitor work requests (is the work getting done?)
4. Review inspection (Maintenance Committee) for direction
5. Support your manager
6. Train staff
7. Lead by example
8. Keep persons receiving services first (it’s their home)

Manager’s Role in Maintenance:

1. Back up the support coordinator
2. Supervise staff
3. Enforce policies
4. Purchase needed supplies (can delegate with Wells Fargo cards)
5. Train staff in maintenance
6. Perform tasks assigned by inspections
7. Assess progress on maintenance requests

 

Maintenance Committee:

1. Internal committee of your peers
2. Inspects in site roughly every six months
3. Called the Semi-Annual Maintenance Inspection
4. Rates the condition of all physical plants and housekeeping including offices and hubs
5. Rating: 1 – Poor, 2 – Meets Standards, 3 – Excellent
6. Rating of 1 – committee returns to the site within a month to bring up to standards
7. Deficiencies are added to the site budget

 

Landlords of Rental Properties:

• Before any planned communication with any landlord first confer with the maintenance technician.
• Generally the maintenance technician communicates with landlords unless otherwise specified.

Inspections and Code Compliance:

• All new sites are inspected by a fire authority within 12 months of opening and licensure.
• All sites are annually inspected by municipal building inspectors against building and fire codes.
• Some sites are also inspected by fire inspectors (larger metro areas)
• County foster care licensors inspect initially and annually all licensed sites against MSA 245D requirements (Issued then a Community Residential Setting CRS license.)
• We also complete a Home Safety Checklist before the CRS license is issued.
• Re-inspections can be ordered at any time by state or local authorities.

 

Physical Plant Requirements:

 

Common Areas:

• Living area with adequate furnishings for living and social activities
• Dining area to accommodate meals for all residents

 

Bedrooms:

• At least 80 square feet of floor space
• 120 square feet if double occupancy
• Minimally 7 ½ foot ceilings
• Separated from halls, corridors and other rooms by floor to ceiling walls (no openings)
• Do not serve as a corridor to another room
• Have lockable doors with key issued to the person (copy to Manager for emergencies) complying with MSA 245D.04.

 

Bedroom Furnishings:

• Separate bed of proper size and height for convenience and comfort
• Clean mattress in good repair (normally inner spring, person may choose other – documented in their file.)
• Clean bedding appropriate for the season
• Individual cabinet or dresser*
• Shelving*
• Closet*
• Storage for personal belongings*
• Mirror for grooming*
• Person may choose not to use or have these (documented in their file)
• May bring personal possessions into their room, providing neat, orderly and not a fire hazard

 

For Service:

• All new managers and support coordinators will receive site specific maintenance training within the first 90 days of hire.
• In turn the manager should review an abbreviated version of the Maintenance Policy and Procedure with their staff during the September Team Meeting.  The outline for this training is in the September Monthly Team Meeting folder on the M-drive.
• Maintenance takes routine calls (612-636-8080) from 6:30 a.m. to 6:30 p.m. Monday - Friday.
• After hours calls can be made to the maintenance tech (if a real emergency), vice president of administration (651-249-6097) or the on call administrator (612-598-5700).

 

Service Contracts:

• All homes use Xcel “Home Smart,” CenterPoint “Service Plus,” or other utility service contractors.
• Covers the furnace, air conditioning, water heater, dishwasher, and refrigerator.
• The furnace, air conditioning, and water heater must be covered.  The other appliances are optional (decided by the manager and senior manager).
• CenterPoint Tel. No. 877-477-1664.  They ask for a P-I-N (provided at the training).
• Xcel Tel. No. 866-837-9762 (No P-I-N).
• Some outstate sites use other companies

 

Emergencies – Gas Smells, Fires:

 

If you smell gas or spot/suspect a fire:

1. Don’t try the fire extinguisher unless tiny fire.  Smoke can overtake you quickly.
2. Evacuate everyone – get more than 75 feet away from the house
3. Don’t use cell phones or other electronic devices
4. Watch out for static electricity
5. Don’t use the automatic garage door opener
6. (All these devices can spark an explosion if the gas is concentrated enough)
7. Once outside and clear of the house, call 9-1-1 immediately – they call fire rescue, gas company, etc.
8. Call the on call administrator and follow the Responding to and Reporting of Incidents and Emergencies Procedure

 

Emergencies – Extreme Temps:

1. If your AC or furnace is out, call Xcel or CenterPoint immediately 24/7.
2. Call the maintenance tech during business hours to report the outage.
3. Have a contingency plan (nearby hotel), if extreme temps in the house
4. (Over 85F or below 60F)
5. Use of fans or oil filled space heaters can sometimes help.

 

Emergencies – Water Leaks:

1. Leaks – turn of valve at the source (under sink for small leak) or for the entire house if major leak like a burst pipe (water shut off from the street) Do not delay!
2. The manager or support coordinator must show each new staff working at the site where these shut off valves are.
3. Call maintenance tech to describe the problem.  Can call vice president of administration of no response.
4. Will attempt to get a plumber out there ASAP.

 

Emergencies – Extreme Water Temps:

 

If the water heater is malfunctioning (too hot – in excess of 120F)

1. Stop all bathing, showering and unattended washing immediately, no exceptions.
2. Call maintenance tech immediately
3. Call Xcel or CenterPoint immediately
4. Once repaired, run the hot water for about 20 minutes to evacuate the overheated water to reduce the temp with fresh cold water.
5. Measure the water temp before returning to use (must be below 120F).
6. Best to measure closest to the water heater (laundry sink).

 

If the repair to the water heater will be delayed for more than 24 hours call the maintenance tech or vice president of administration to report the delay.  Also call the manager and/or senior manager to develop a contingency plan (hotel) until the repair is made.

 

Power Outages:

• If the power goes out and the rest of the neighborhood appears to be out too, call your electrical provider.  Companies and numbers to follow:
• Don’t assume you don’t have to call because someone else in the neighborhood has—call.  If it appears that the power will be out awhile, call the senior manager during regular business hours or the emergency on call administrator after hours to report the outage.  When the power is restored, repeat those calls.  Again, there might be the need for a contingency plan.

 

Power Outages Numbers to Call:

• Anoka Municipal Utility:                      763-576-2750
• Chaska Electric:                                 952-448-4335
• Connexus Energy:                              763-323-2660
• Elk River Public Utiity:                                    888-606-4660
• Rochester Public Utility:                     507-280-9191
• Xcel Energy:                                       800-895-1999

 

Maintenance Requests – Phone App – this is being tested and will be finalized soon.

 

Non-Emergency – Service:

Whenever any service technician comes to the home to make a repair, always ask the tech for a copy of the work ticket and get that ticket to the maintenance tech.

                  

Non-Emergency – Service Technicians:

• If Home Smart of Service Plus comes to your site twice within any six month period to fix the same appliance, call the maintenance tech—may be a sign of a problem not getting resolved.
• Maintenance tech can help and talk with the service tech.

 

Non-Emergency – Water Softener:

1. Check the water softener canister periodically.
2. Verify the salt and water level are up close to the top.
3. Otherwise can clog plumbing.

 

Licensing Preparation – Licensed Sites:

1. When anyone at the site first learns about a scheduled date for a foster care licensing inspection call the maintenance tech immediately.
2. The maintenance tech can assist with the preparation.  The tech needs ample notice.

 

Fall/Winter Check Lists:

1. These are emailed out each fall to the manager to complete as winter preparation projects described on the form are completed.
2. E-mail or fax the completed form to the vice president of administration

 

Support Coordinator’s Role in Maintenance:

1. Remain alert to problems
2. Report needs to the manager and maintenance
3. Monitor work requests (is the work getting done?)
4. Review inspection (Maintenance Committee) for direction
5. Support your manager
6. Train staff
7. Lead by example
8. Keep persons receiving services first (it’s their home)

Manager’s Role in Maintenance:

1. Back up the support coordinator
2. Supervise staff
3. Enforce policies
4. Purchase needed supplies (can delegate with Wells Fargo cards)
5. Train staff in maintenance
6. Perform tasks assigned by inspections
7. Assess progress on maintenance requests

 

Maintenance Committee:

1. Internal committee of your peers
2. Inspects in site roughly every six months
3. Called the Semi-Annual Maintenance Inspection
4. Rates the condition of all physical plants and housekeeping including offices and hubs
5. Rating: 1 – Poor, 2 – Meets Standards, 3 – Excellent
6. Rating of 1 – committee returns to the site within a month to bring up to standards
7. Deficiencies are added to the site budget

 

Landlords of Rental Properties:                                                                               

• Before any planned communication with any landlord first confer with the maintenance technician.
• Generally the maintenance technician communicates with landlords unless otherwise specified.

 

 

 

 

Personal Funds and Property when Starting and Ending of Service

1. Mains’l initiates conversations with a person’s teams when they will be moving in or out, about expectations related to personal property, funds and moving expenses/responsibilities.
2. A Consent to Manage/Audit Finances Form is completed within five working days of service initiation and annually thereafter when Mains’l will be managing any aspect of the person’s funds.
3. The support plan indicates if assistance is needed related to finances and when applicable, the frequency of financial reports to be sent to the team.
4. The Financial Funds and Property When Starting Services Form is completed either on paper or electronically when a person is moving into a Mains’l owned or leased property.
5. The Financial Funds and Property When Ending Services Form is completed either on paper or electronically when a person is moving out of a Mains’l owned or leased property.
   
   1. This form serves as a receipt that lists all items and funds given, date given, to whom they were given and who gave them.
      
      1. The form is signed by both parties
      2. A copy is saved in the person’s file
      3. A copy is given to the person to whom the items were given
6. When a person is no longer living in a Mains’l owned or leased property for any reason, any funds and property owned by the person must be given to the person or the person’s legal representative, or given to the executor or administrator of the estate.
   
   1. Assessment and distribution of a person’s property is done by the manager or senior manager as soon as possible and no longer than 28 days of a person moving out.
   2. Assessment and distribution of Mains’l property is done by the current manager if still providing services in home. If services are no longer provided in the home, the corporate administrative coordinator completes assessment and distribution.

Any suspicions of fraud, abuse, and waste should be directly reported to our Public Funds Compliance Officer, the Vice President of Administration.

The Public Funds Compliance Officer conducts an internal investigation. In the event that our Public Funds Compliance Officer, the Vice President of Administration is suspected or alleged to be involved in fraud, the Corporate Director of Human Resources completes the investigation. The investigation will include at least the following:

1. Whether fraud, abuse, or waste occurred;
2. Whether written policies and procedures were adequate;
3. Whether written policies and procedures were followed;
4. Whether there is a need for additional staff training;
5. Whether there is a need for external reporting.

 

If it is determined after a thorough investigation that any employee has committed fraud, their employment will end immediately.

 

If it is determined that a vendor, person who uses services, or other business partner has committed fraud, Mains’l reserves the right to end the relationship.

 

While Mains’l prefers that reports of suspected fraud and abuse are made internally, you have the right to report suspicions of Medicaid abuse or fraud to a state agency.

In California:    Department of Health Care Services/Health Care Programs at 800-822-6222 or             http://www.dhcs.ca.gov/individuals/pages/stopmedi-calfraud.aspx

            Office of the Attorney General 800-722-0432 or http://www.ag.ca.gov/bmfea/medical.htm

                                         

In Minnesota: Department of Human Services Provider Fraud: 800-657-3750 Recipient Fraud: 800-627-9977

http://mn.gov/dhs/general-public/licensing/report-fraud/index.jsp

Referrals
Mains’l engages in conversations with the person requesting services and their support team to help identify what’s important to and important for the person.  We are committed to a collaborative approach when developing services for people, and a team of Mains’l employees work together to determine if service needs can be met.  Team members may consist of a customer service specialist, navigator, senior manager and/or manager.

When a person contacts Mains’l about our services:

1.    We gather basic information about the person, including service needs, funding type, personal information, preferred characteristics of support staff, and the type of housing or roommate preferences, as applicable.

2.    We will ask if a person centered description and/or Person Centered Plan have been created.  If so, we request the information.  If not, we offer resources to assist the person in this process.  The process may involve an outside person centered planner.  

3.    We meet with the person and their circle of support (those invited by the person they want involved) about what is important to and for them.  Most often we have a “meet and greet” at a place designated by the person and/or at a place with potential roommates.  “A Getting To Know You” form can be used to begin recording information about the person.

4.    If during these conversations/introductions it is determined that Mains’l is a good fit for the person and/or their circle of support, information sharing continues.  Mains’l asks for the following, as applicable/available:

a.    Important to the person: 
o    Person Centered Plan (Picture of a Life, MAP, Essential Lifestyle Plan, etc.)
o    Personal Description and/or Personal Profile
o    Support/program plan (i.e., Coordinated Service and Support Plan or Individual Program Plan)
b.     Important for the person 
o    Personal Safety Plan (Individual Abuse Prevention Plan, Support/Program Plan)
o    Individualized Education Program Plan – completed by school professional
o    Medical and health care related information and/or assessments (psychological and/or psychiatric evaluation, behavior assessment, physical therapy, dental, occupational therapy, audiology, etc.)
o    Positive Support Transition Plan

5.    If there are concerns regarding potential risk to the agency, the assigned manager meets with the Vice President of Administration to determine if the referral process can continue. Certain medical needs or behavioral or criminal histories may pose too great a risk for the person or Mains’l.  History of arson, assault, and sexual offenses, for example, require special consideration and may not match Mains’l’s ability to provide supports. When there appears to be a mismatch between Mains’l’s ability to provide supports and the supports that are likely needed, the referral must be reviewed and approved by the executive leadership team.  

6.    If it is determined that the person and Mains’l are not a good fit and we are not going to provide services, the  manager will provide documentation of  the reason to the person, the person’s legal representative, and case manager, upon request. 

7.    When the person requesting services and Mains’l agree that we are a good match, the manager negotiates the service agreement with the case manager.  Upon receiving the service agreement, (or authorization that the agreement is in process), the manager begins developing services.

8.    The manager meets with additional Mains’l staff when the supports requested require resources that extend beyond our current support options. Members may include the following: services director, human resources representative, nurse, therapeutic specialist, finance representative, and/or a housing representative.  The development team works together to ensure the person’s support needs can be met, and within the expected timeframe(s).  The team meets on a regular basis to communicate updates on progress to the person and their support team, as needed.

9.    Mains’l support team members and the person requesting services continue the discovery process to learn as much as possible about each other.  Mains’l uses a variety of person centered practices to assist in documenting the information learned. These tools/skills may include, but are not limited to: Matching Tools (to gain insight on what staff characteristics are preferred) and Discovery Tools (Important To/For, Rituals and Routines, Relationship Map, Good Day/Bad Day, Communication Chart, Learning Log).  Many of these tools are contained in the Person Centered Description materials packet. 

The information gathered is used to assist with the development of the person’s support plan.

Enrollment
When the person requesting services and Mains’l agree that we are a good match, the process of starting services begins.  This procedure may vary, depending on the supports and needs of each person.

1.    When new staff are needed, Mains’l partners with the person and their support team to recruit employees who are the right fit for the person and Mains’l.   

2.    If during the referral process it has been determined that the person requesting services is looking for a new place to live, the support team members determine the roles and responsibilities of each member in locating housing.  Depending on the supports identified, different levels of supports will be needed.
a.    In some cases, Mains’l may have an established home that provides up to 24 hours of support. If a roommate is desired by existing tenants of the established home, and this level of support is requested by the person, the manager will make arrangements for the people to meet and get to know each other.
b.    If the person has a criminal background which may affect roommates, the manager notifies the roommates and/or their guardians and case managers (i.e., is on a sexual predator registry.)  Also, the manager notifies the person requesting supports if one of the potential roommates is on a sexual predator registry.
c.    If everyone agrees the living arrangement is a good match for all, a move in date is scheduled by the manager, the person, and their support team.
d.    When new housing must be arranged before supports start, a move-in date is set when the person’s home has been secured (lease signed, roommates identified if needed, etc.)  The roles and responsibilities are assigned by the person and their support team, depending on the level of support requested.
e.    Once staffing and housing is established, as needed, an enrollment meeting can be scheduled.

3.    An enrollment meeting is scheduled by the manager, and/or the person and their support team.  Meetings are held at a place agreed upon by the person and their circle of support. 

4.    At the meeting, conversations continue to address what is important to and for the person.  These conversations help the manager record information that will inform the person’s Support Plan.  
a.    If a Person Centered Plan has not been created by/for the person, the team addresses who will be responsible to develop the plan, as appropriate.
b.    All documents listed on the Enrollment Checklist will be reviewed and/or signed by the person and/or their guardian. 
c.    The manager offers a Mains’l Guidebook to Supports.  The handbook includes policies and procedures on how we offer services. 
d.    A date when services will actually begin will be determined by the person and the support team.

5.    The manager completes a Starting Services form to notify other Mains’l departments when services are starting. 

6.    The manager begins the process of developing the person centered Support Plan (see How We Offer Supports and Services Policy and Procedure).  This document is developed as soon as possible (best practice 15 days but no later than 30 days after the initial starting services meeting) and is sent to the person and their identified support team
 

A representative payee can be appointed by the Social Security Administration to receive the Social Security or SSI benefits for a person who can’t manage or direct the management of his or her benefits.  Mains’l does not charge a monthly fee from Social Security benefits and/or Supplemental Security Income (SSI) benefits, but charges may apply depending on the business relationship between Mains’l and the person requesting representative payee services.

1. When the individual requesting representative payee services also receives consumer/participant directed services, Mains’l charges and receives a monthly fee through the person’s Medicaid waiver.
2. When the individual requesting representative payee services also receives traditional waiver services and is requesting the service in order to ensure payment to Mains’l for other services, representative payee services are provided at no charge.

A representative payee’s main duties are to use the benefits to pay for the current and future needs of the beneficiary, and properly save any benefits not needed to meet current needs. A payee must also keep records of expenses.

 

Establishing Mains’l as a Representative Payee

 

The following steps are to be followed to establish Mains’l as Representative Payee:

1. The person requesting representative payee services informs their manager and provides the person or  representative with the contact information of the person designated at Mains’l to be representative payee.
2. The manager contacts the individual designated to be representative payee at Mains’l to inform him or her that a request to perform representative payee services has been made.
3. The representative payee, after being contacted by the person or their representative, plans a meeting.
4. A meeting is held to determine if the person would like to choose Mains’l as rep payee. If so, next steps are identified to determine when and how paperwork will be completed.
5. After paperwork is completed, Mains’l begins performing representative payee services.

 

 

 

 

 

Fulfilling Representative Payee Responsibilities

1. Required Duties: The person assigned at Mains’l as a representative payee works with the person receiving services and their support team to ensure his or her day to day needs are being met by performing the following duties:

1. Determine the beneficiary’s needs and use his or her payments to meet those needs;
2. Save any money left after meeting the beneficiary’s current needs in an interest bearing account or savings bonds for the beneficiary's future needs;
3. Report any changes or events which could affect the beneficiary’s eligibility for benefits or payment;
4. Keep records of all payments received and how the money was spent and saved;
5. Provide benefit information to social service agencies or medical facilities that serve the beneficiary;
6. Help the beneficiary get medical treatment when needed;
7. Report to the Social Security Administration  any changes that would affect our performance or our ability to continuing as payee;
8. Complete written reports accounting for the use of funds; and
9. Return to the Social Security Administration any payments to which the beneficiary is not entitled.
10. Mains’l completes the annual Representative Payee reports from Social Security for each person we provide rep payee services for, as requested by Social Security. 

1. Monthly Process

1. Mains’l collects the social security benefits each month and deposits the funds into each individual’s rep payee account in QuickBooks. 
2. By the 5^th of each month, the rep payee checks the account balance of each person they are payee for to ensure there are enough funds in the persons account to process payments for the month.
   
   • Payee pays bills for each person, as needed before the due dates.
   •  Payee issues a personal needs check by the 5^th of each month

 

If you suspect, witness, or become aware of suspected abuse of dependent adult or elderly, report immediately! You are one of those people – a “mandated reporter”

 

• Immediately call 911 if you observe or are aware of a physical or sexual assault in progress;
• Immediately (as soon as possible, but not more than 24 hours from initial knowledge) contact the Mains’l administrative on-call personnel. Mains’l does not release identifying information about the mandated reporter unless given permission by the mandated reporter, or as required by law. Only information about the suspected maltreatment or injury is reported.

 

Where to report suspected abuse:

 

To report to Mains’l, call the administrative on-call phone at 530-723-2913 or contact your Program Manager

 

 

 

 

 

 

 

To report outside of Mains’l: For Adults: Adult Protective Services 1-800-664-9774 For Long Term Care Facilities: Ombudsman 1-800-846-4042

 

 

 

 

 

 

 

 

 

Suspected abuse must be reported.

                                        You do not need to have proof that it has occurred.

                      

How people learn about responding to and reporting suspected abuse

 

1. All employees receive orientation training on their responsibilities as a mandated reporters, including video and in person training, review of this policy and procedure, statutes referenced in policy, the Personal Safety Plan within 72 hours of first working in a direct care service and then participate in ongoing training each year. Training is documented for each employee.

 

1. All people receiving services and their conservators (when applicable) receive orientation to this policy and procedure, the Personal Safety Plan within 24 hours of starting services with Mains’l. For a person whom would benefit more from a later orientation, the orientation may take place within 72 hours of starting services. This orientation is documented on the Orientation for Person Receiving Supports Form

 

1. This policy and procedure is made readily accessible to people by posting the critical information at each work location.

 

 

The who, what, where, why, and how for responding to and reporting suspected abuse

 

Who is considered a dependent adult? In general, any person who needs assistance to adequately care for him or herself, and is therefore at a greater risk of abuse, is considered a dependent adult. Based on California laws, any person receiving services from Mains’l is considered a dependent adult.

 

Who is considered a mandated reporter? A person who has assumed full or intermittent responsibility for care of a dependent adult, whether or not paid for that responsibility.  Mandated reporters can include family, friends, hired employees, contracted service providers, and volunteers.

           

What is abuse? For dependent adults, abuse is defined as physical abuse, serious bodily injury, neglect, or financial abuse, abandonment and isolation. Definitions of each type of abuse are provided below in the definitions section.

 

Who is required to report suspected abuse? While anyone can report, many people are required by law to report, including you.  A complete list of who is required to report can be found in the Statutes listed above. Some professionals who are mandated reporters are people who work in the following areas:

 

• Care of vulnerable adults or minor children; including relatives and other paid and unpaid caregivers
• Healing arts

• If you SEE SOMETHING… SAY SOMETHING!

  Social  services

• Hospitals, medical clinics, and nursing homes                     
• Psychological or psychiatric treatment
• Child care  and education
• Law enforcement and corrections
• Vocational rehabilitation
• Medical examiner or coroner

 

What is required to be reported? Suspected abuse must be reported within 24 hours of finding out.  Definitions of abuse are listed in this document.

 

Who do I report to? For the suspected abuse of a dependent adult, report to the California Adult Protective Services (APS). You may complete the documentation on line with the (SOC 341). For suspected abuse in a licensed service it also needs to be reported to the licensing entity Community Care Licensing (CCL) We also ask that you contact the Mains’l administrative on-call personnel.

 

What happens at Mains’l after a report is made? When Mains’l has a reason to believe that an internal or external report of alleged or suspected abuse has been made, we also report and respond.

1. When an internal suspected abuse report is received, Mains’l administrative on-call personnel is responsible for deciding if the report should be forwarded to the Adult Protective Services (APS). If the administrative on-call person is involved in the suspected maltreatment, contact your senior manager, so they can take responsibility for deciding if the report should be forwarded. 

 

 

1. An internal review is completed within 30 calendar days and corrective action is taken, if necessary, to protect the health and safety of dependent people.  The review includes an evaluation of whether:

1. related policies and procedures were followed;
2. the policies and procedures were adequate;
3. there is a need for additional staff training;
4. the reported event is similar to past events with the person or the services involved; and
5. there is a need for Mains’l to take corrective action to protect the health and safety of people.

 

Internal reviews are completed by Anne Silcher, Director or a designated Senior Manager.  Mains’l documents completion of the internal review and will provide a copy to the commissioner immediately upon request.

 

1. Based on the results of the internal review, Mains’l develops, documents, and implements a corrective action plan designed to correct current lapses and prevent future lapses in performance by the agency or a specific person/group of people, if any.

 

What happens if I do not report suspected abuse? There are many things that can happen if you do not report including:

• the continuation of abuse to the person
• you being removed from your responsibilities
• you may be found guilty of a misdemeanor and liable for damages caused by the failure
• you may not clear a background study required for many jobs

 

If you are asked to not report something, you can explain to the person that you are required by law to report. You also do not have to inform the person that you are making a report, go ahead and make the report if you suspect abuse has occurred.

 

Will I be protected from retaliation if I make a report?  Yes, Mains’l will not retaliate against anyone for making a report in good faith (an honest report) and takes action to protect people who report. There are also laws in place to protect people who make good faith reports.

 

A person who intentionally makes a false report may be found liable in a civil suit for any actual damages suffered by the reported facility, person or persons and any punitive damages up to $10,000.00 and attorney’s fees.

 

Suspected Abuse definitions for adults

 

Abuse: Abuse can be physical, emotional, verbal, or sexual. This includes but is not limited to:

1. Physical Abuse:

1. Physical assault
2. Sexual assault
3. Unreasonable physical restraint

1. See CA Statutes for complete definitions and additional information.

   Deprivation of food and water

2. Inappropriate use of physical or chemical restraint

1. Emotional Abuse:

a.   Verbal assaults, threats, and intimidation

b.   Subjection to fear, isolation or emotional stress

c.   Withholding emotional support

1. Confinement

 

Neglect: Occurs when an individual’s health and safety needs are not being met. This includes, but is not limited to:

1. Failure to supply an individual with care or services, including but not limited to food, clothing,

shelter, health care, or supervision, which is reasonable and necessary to obtain or maintain the person’s physical or mental health or safety, and is not the result of an accident or therapeutic conduct.

 

 2.  Absence or likelihood of absence of care or services, including but not limited to food, clothing, shelter, health care, or supervision necessary to maintain the physical and mental health of the individual which a reasonable person would deem essential to obtain or maintain the person’s health, safety, or comfort.

           

Financial exploitation/abuse: Occurs when a person misuses funds, assets, or property of a dependent adult. This includes but is not limited to:

1.   Failure to use the dependent adult’s financial resources to provide food, clothing, shelter, health care, therapeutic conduct or supervision for the individual, and the failure results in or is likely to result in detriment to the  individual;

 

1. Willfully using, withholding, or disposing of funds or property of a dependent adult without legal

authority;

 

1. Acquiring possession of, control of, or an interest in, funds or property of a vulnerable individual through the

use of undue influence, harassment, duress, deception, or fraud;

 

1. Forcing, compelling, coercing, or enticing a dependent adult against his or her will to perform services for the profit or advantage of another.

 

Remember… Respond immediately if you suspect, see, or hear about maltreatment!

• Immediately call 911 if you observe or are aware of a physical or sexual assault in progress;
• Immediately contact the Adult Protective Services
• We also ask that you immediately contact the Mains’l administrative on-call personnel at 530-723-2913

                                                                              

Thank you for helping to protect people from harm.

 

The AWAIR Program is intended to:

1. Establish an executive policy statement (we’re committed to safety)
2. Develop strategies to reduce workplace accidents and injuries
3. Provide for the safety inspection of worksites
4. Establish enforcement strategies to insure compliance
5. Provide for a training program (blood borne pathogens)
6. Provide for the assessment and control of hazards

 

Strategies to reduce workplace accidents and injuries:

Once each year; CRS sites will conduct an exercise to list together 3-4 workplace conditions or behaviors that can cause accidents and/or injuries.  In turn the supervisor will elicit solutions from the participants to address these conditions or behaviors.  The results will be sent to the vice president of administration for review and any follow up action necessary.

 

Inspections of Work Sites:

Home Safety Inspection Checklists will be used by CRS site staff to identify potential conditions that might also cause accidents or injuries.  These checklists are to be completed once every two months and sent to the vice president of administration for review and any follow up actions necessary.

 

Enforcement Strategies:

Employees who fail to follow safety rules or requirements will be subject to employee discipline as described in HR policies.

 

Training:

The primary training for safety in the workplace is blood borne pathogens.  Otherwise CRS sites will acquaint employees with local safekeeping practices.

 

Assessment and Control of Hazards:

Mains’l prohibits use and storage of hazardous materials.

 

Safety Coordinator:

The safety coordinator for Mains’l is the vice president of administration.

 

Food and Food Safety:

The manager of each home is responsible for the coordination of:

1. Food served to those persons receiving services meets the special dietary needs of each person as prescribed by their physician or dietician,
2. Three nutritionally balanced meals each day are served or made available to each person along with nutritious snacks available between meals.
3. Written menus are developed and adequate along with appropriate groceries and purchased and available’
4. Food is handled and properly stored to prevent contamination, spoilage, or a threat to the health of the person with all left overs labeled with identifying the contents and the date stored.

 

Goods Provided by the Agency:

The manager of each home is also responsible to ensure that:

1. Individual clean bed linens appropriate for the season and the person’s comfort, including towels, washcloths, and window coverings on windows for privacy are provided for each person receiving services,
2. Linens and in good repair and functional to meet the daily needs of persons living in the home and communicate any linen needs to the senior manager.
3. Household items for meal preparation and cleaning supplies to maintain the cleanliness of the home are available on site.

 

The senior manager for each home checks to verify that each person has clean and adequate supply of linens in good condition during their scheduled quarterly site visits and documents such on the Site Visit Checklist.

 

Personal Items:

The manager for each home is responsible to assure that:

1. Each person has an adequate supply of hygiene items appropriate to their specific needs and supplies are replenished as needed,
2. Each person’s personal hygiene supplies are not shared with other persons,
3. Personal health and hygiene items are stored separate from other personal items in a safe and sanitary manner.

 

Pets and Service Animals:

The manager of each home is responsible to assure that:

1. Pets and service animals within the home are immunized and kept in good health as required by state and local laws,
2. A record of immunizations and veterinary visits is kept on file at the site for each animal,
3. A person and the person’s legal representative are notified, before admission, of the presence of and kind of pets in the home.

 

Control of Pests and Vermin:

All staff will remain vigilant keeping an eye open for any signs of insects or vermin.  If sighted or suspected, staff will immediately report that information to their supervisor.  The supervisor will evaluate the report, gather any additional information needed, conduct a site visit and report their findings to the senior manager or maintenance.

 

The senior manager with consultation with the vice president of administration will immediately summon an exterminator to report to the site within 24 hours.  Exterminators have protocols on treating homes and sites on addressing furnishings, furniture and household structures and environments.  This includes the extermination of bed bugs for which there is a specific protocol.

Service Recipient Records

Documents that are created or received by Mains’l that pertain to a person receiving services are saved in the person’s secure electronic record or paper file.  

For paper files, after a County Foster licensing review, information is removed from the individual’s medical and plan file and scanned into the Mains’l document management system.  At this time, information that has been summarized into another format (e.g. data into a progress review) may be discarded. Managers organize the information to be scanned as follows:

1.    Separate the documents into the categories of:
a.    Program
b.    Medical
c.    Financial
2.    Incorporate all documents from work books into the primary file and remove pages that are          duplicates or are general in nature and not specific to the individual.
3.    Prepare all documents for scanning:
a.    Within the categories above, arrange them in the order they appear in the plan file or medical file, according to the table of contents 
b.    Organize all pages chronologically and orient all pages within the pile the same direction
c.    Remove all staples
d.    Straighten all folded, curled edges at the top of the page
4.    Scan documents into the appropriate category within the Fortis  system.
5.    Once scanning is complete, verify that all pages have been scanned and are readable      before destroying the original.

Program Records

1.    The program services, support services and human resources departments are responsible for scanning these documents:
a.    Incident Reports        
b.    Contracts            
c.    Licensing documents        
d.    Policies and Procedures
2.    Prepare all documents for scanning as follows:
a.    Organize all pages chronologically and orient all pages within the pile the same direction
b.    Remove all staples
c.    Straighten all folded, curled edges at the top of the page
3.    Scan documents into the appropriate category within the document management system
4.    Once scanning is complete, verify that all pages have been scanned and are readable before destroying the original.

    

                    (Rev. 1/8/19; SR
 

These rights are established for the benefit of persons receiving services. Mains’l will not require a person to surrender these rights as a condition of receiving services.  A guardian or legal representative or, when there is no guardian or legal representative, a designated person, may seek to enforce these rights.

Informing people about rights

1. On the day that services start, the manager provides a copy of the Service Recipient Bill of Rights to the person or the legal representative for them to keep. 
2. The manager provides an explanation of the rights to the person or their legal representative on that day or no later than five days after services have started. The person/legal representative signs an agency copy of the rights to document that the rights have been explained and that they received a copy.  
3. The manager files this form in the legal/consent section of the person’s data file. 
4. At each annual review meeting, the manager reviews the rights with the person and/or the legal representative, acquiring their signature(s) on the Service Recipient Bill of Rights form, which is then filed in the legal/consent section of the plan file. 
5. Reasonable accommodations are made by Mains’l to provide this information in other formats as needed to facilitate understanding of the rights by the person and their legal representative, if any. 

Implementing a rights restriction
Restriction of a person’s rights is allowed only if determined necessary to assure the health, safety, and well-being of the person.  Any restriction of these rights is documented in the person’s coordinated service and support plan. Mains’l support plan and must be approved by the person or their legal representative before the restriction is implemented. Approval may be withdrawn at any time, at which time the right must be immediately and fully restored. Restrictions are reviewed, minimally, semiannually and more frequently if requested by the person or their legal representative if any, and case manager.

1. The manager initiates discussion of the restriction in a meeting with the support team. 
2. If the person and the team agree to a specific plan to restrict a right, the manager completes a Rights Restriction Summary, signed and dated by the person or their legal representative and submits it to the senior manager and the Disability Rights of California Association (CA only)  
3. Following review, the senior manager submits to the persons support team who responds in writing to the proposed restriction to indicate approval and/or any recommendations.
4. The senior manager or manager documents the outcome of the conversations on the rights restriction form and returns the form to the manager. If approved, the manager may implement the restriction.
5. The completed Rights Restriction Summary is filed in the legal/consent section of the person’s plan file.
6. The support team reviews a restriction at least semi-annually from the date of initial approval, or more frequently if requested by the person, legal representative, or case manager.
7. Approval for a restriction may be withdrawn at any time; the right must then be immediately and fully restored. Withdrawal must be in writing from each member of the individual’s team. If the decision is made during a meeting, the decision will be reflected on the Meeting Minutes Summary, and all team members will provide their signature that they were present and agreed to the change/s.
    

<p><strong>Suspending Services</strong></p>

<p><strong>Reasons for temporary suspension of services:&nbsp;</strong></p>

<ol>
<li>A person may suspend services with Mains’l at any time. Some reasons a person might choose to suspend services are:</li>
</ol>

<ul class="rteindent1">
<li>Scheduling conflicts or lack of staffing.</li>
<li>Times when services are not needed or wanted for a short period of time, such as trying a different living situation (less than 3 months).</li>
<li>Temporary situations that change the person’s service needs such as a medical condition (less than 3 months).&nbsp;</li>
<li>Person receiving services does not qualify for the service or is not eligible under program rules for a short period of time (less than 3 months).</li>
</ul>

<p class="rteindent1">2. Mains’l may also choose to suspend services. Temporary service suspension by Mains’l is limited to the following situations:</p>

<ul>
<li>The person's conduct poses an imminent risk of physical harm to self or others and either:
<ul>
<li>positive support strategies have been implemented to resolve the issues leading to the temporary service suspension, but have not been effective and additional positive support strategies would not achieve and maintain safety; OR</li>
<li>less restrictive measures would not resolve the issues leading to the suspension.</li>
</ul>
</li>
<li>The person has medical issues that exceed our ability to meet the person's needs.</li>
<li>Mains’l has not been paid for services.&nbsp;
<ul>
<li>This includes non-payment of waiver obligations, spenddowns, private pay, GRH, Medicaid and any other funding sources.&nbsp;</li>
<li>Medicaid or other funding being inactive or person is no longer eligible for services.&nbsp;</li>
</ul>
</li>
</ul>

<p><strong>Actions taken before services are suspended:</strong> Mains’l requests that we be notified in writing if a person chooses to suspend their services. Before Mains’l gives notice of temporary service suspension, the manager documents actions taken to minimize or eliminate the need for suspension.&nbsp;</p>

<ol>
<li>Action taken by Mains’l must include, at a minimum:</li>
</ol>

<ul class="rteindent1">
<li>Consultation with the person's support team or expanded support team to identify and resolve issues leading to the notice being issued; and</li>
<li>A request to the case manager for intervention services identified, including positive support services, in-home or out-of-home crisis respite services, specialist services, or other professional consultation or intervention services to support the person.</li>
<li>Prior to suspension due to risk of physical harm, the manager requests the assistance of agency positive supports staff to identify and document strategies/interventions that may delay or avoid service suspension.</li>
<li>Prior to suspension due to medical issues, the manager requests the assistance of agency nurses and/or the person’s medical professional team to identify and document strategies/interventions that may delay or avoid service suspension.</li>
<li>Prior to suspension due to non-payment, the person is sent written notification from Mains’l detailing the money owed and payment expectations.&nbsp;</li>
</ul>

<p>If, based on the best interests of the person, the circumstances at the time of the notice were such that the manager was unable to consult with the person’s team or request interventions services; the manager must document the specific circumstances and the reason for being unable to do so.</p>

<p><strong>Actions taken when suspending services:&nbsp;</strong></p>

<ol>
<li>The manager notifies the person or the person’s legal representative and the case manager in writing of the intended temporary service suspension by completing a Notice of Temporary Suspension of Services. &nbsp;</li>
<li>If the temporary service suspension is from supported living services or community residential services:a.&nbsp;&nbsp; &nbsp;</li>
</ol>

<ul class="rteindent1">
<li>In Minnesota, the senior manager must notify the DHS Commissioner in writing. DHS notification will be provided by fax at 651-431-7406.&nbsp;</li>
<li>In California, the senior manager must notify the Case Management Supervisor in writingThe Notice of Temporary Service Suspension is given on the first day of the service suspension</li>
</ul>

<p class="rteindent1">3. The Notice of Temporary Service Suspension is from supported living services or community residential services:</p>

<p>&nbsp; &nbsp; &nbsp; 4. The written notice of service suspension must include the following elements:&nbsp;</p>

<ul>
<li>The reason for the action;</li>
<li>A summary of actions taken to minimize or eliminate the need for temporary service suspension; and&nbsp;
<ul>
<li>Why these measures failed to prevent the suspension.<br />
5. During the temporary suspension period the manager must:</li>
</ul>
</li>
<li>In Minnesota, the senior manager must notify the DHS Commissioner in writing. DHS notification will be provided by fax at 651-431-7406.&nbsp;</li>
<li>In California, the senior manager must notify the Case Management Supervisor in writing.&nbsp;</li>
</ul>

<p class="rteindent1"><br />
a.&nbsp;&nbsp; &nbsp;The reason for the action;<br />
b.&nbsp;&nbsp; &nbsp;A summary of actions taken to minimize or eliminate the need for temporary service suspension; and&nbsp;<br />
c.&nbsp;&nbsp; &nbsp;Why these measures failed to prevent the suspension.</p>

<p>5.&nbsp;&nbsp; &nbsp;<br />
a.&nbsp;&nbsp; &nbsp;Provide information requested by the person or case manager;<br />
b.&nbsp;&nbsp; &nbsp;Work with the support team or expanded support team to develop reasonable alternatives to protect the person and others and to support continuity of care; and<br />
c.&nbsp;&nbsp; &nbsp;Maintain information about the service suspension, including the written notice of temporary service suspension in the person’s record.</p>

<p>d.&nbsp;&nbsp; &nbsp;Returning to services after suspension: A person has the right to return to receiving services during or following a service suspension with the following conditions:</p>

<p>1.&nbsp;&nbsp; &nbsp;Based on a review by the person’s support team or expanded support team, the person no longer poses an imminent risk of physical harm to self or others, the person has a right to return to receiving services.&nbsp;</p>

<p>2.&nbsp;&nbsp; &nbsp;If the support team or expanded support team makes a determination that is different than the recommendation of a licensed professional treating the person for the reason services were suspended, the manager must document the specific reasons why a different decision was made.</p>

<p>Ending Services</p>

<p>a.&nbsp;&nbsp; &nbsp;Reasons for ending services:&nbsp;</p>

<p>1.&nbsp;&nbsp; &nbsp;A person may end services with Mains’l at any time. Some reasons a person might choose to end services are:<br />
o&nbsp;&nbsp; &nbsp;The services are no longer in the best interest of the person receiving services.<br />
o&nbsp;&nbsp; &nbsp;The person wishes to change to a different provider and/or is not interested in receiving supports by Mains’l.&nbsp;<br />
o&nbsp;&nbsp; &nbsp;Person receiving services no longer qualifies for the service or is no longer eligible under program rules.<br />
o&nbsp;&nbsp; &nbsp;The person is not satisfied with the services being provided or does not feel that Mains’l is a good fit for what they need.&nbsp;<br />
o&nbsp;&nbsp; &nbsp;The person moving to a location where services cannot be or do not need to be provided.<br />
o&nbsp;&nbsp; &nbsp;Person has successfully achieved their goals and no longer requires the support of Mains’l.&nbsp;</p>

<p>2.&nbsp;&nbsp; &nbsp;Mains’l may also choose to end services. Termination of service by Mains’l is limited to the following situations:<br />
o&nbsp;&nbsp; &nbsp;The termination is necessary for the person's welfare and the person's needs cannot be met by Mains’l.<br />
o&nbsp;&nbsp; &nbsp;The safety of the person or other people is endangered and positive support strategies were attempted and have not achieved and effectively maintained safety for the person or others.<br />
o&nbsp;&nbsp; &nbsp;The health of the person or others would otherwise be endangered.<br />
o&nbsp;&nbsp; &nbsp;Mains’l has not been paid for services.<br />
o&nbsp;&nbsp; &nbsp;Mains’l no longer offers the service.<br />
o&nbsp;&nbsp; &nbsp;The person has been terminated by the lead agency from waiver eligibility.<br />
o&nbsp;&nbsp; &nbsp;If the person indicates through their behavior that they no longer wish to receive services by Mains’l (i.e., several missed appointments, not home when support staff comes to visit) and has not returned our phone calls or e-mails.)</p>

<p>b.&nbsp;&nbsp; &nbsp;Actions taken before services are terminated: Mains’l requests to be notified in writing if a person chooses to end their services. Before Mains’l gives notice of service termination, the manager will document the actions taken to minimize or eliminate the need for termination.</p>

<p>&nbsp;&nbsp; &nbsp;Actions taken will include, at a minimum:<br />
o&nbsp;&nbsp; &nbsp;Consultation with the person’s support team to identify and resolve issues leading to the notice being issued; and<br />
o&nbsp;&nbsp; &nbsp;A request to the case manager for intervention services, including &nbsp;positive support services, in-home or out-of-home crisis respite services, specialist services, or other professional consultation or intervention services to support the person.<br />
a.&nbsp;&nbsp; &nbsp;A request for intervention services will not be made for service termination notices issued because the program has not been paid for services.<br />
o&nbsp;&nbsp; &nbsp;An individual agreement will be developed with the person, if it is believed that their commitment to receiving services from Mains’l is absent.&nbsp;</p>

<p>If, based on the best interests of the person, the circumstances at the time of the notice were such that the manager was unable to consult with the person’s team or request interventions services; the manager must document the specific circumstances and the reason for being unable to do so.</p>

<p><br />
c.&nbsp;&nbsp; &nbsp;Actions taken when terminating services:&nbsp;</p>

<p>1.&nbsp;&nbsp; &nbsp;A written notice of an intended service termination, including those situations which began with a temporary service suspension, must be completed on the Notice of Service Termination form and given to the person, their legal representative, and the case manager before the proposed effective date of service termination.&nbsp;<br />
a.&nbsp;&nbsp; &nbsp;For California services, and for intensive services in Minnesota, the notice must be provided at least 60 days before the proposed effective date of service termination.<br />
b.&nbsp;&nbsp; &nbsp;For all other services, the notice must be provided at least 30 days before the proposed effective date of service termination.<br />
c.&nbsp;&nbsp; &nbsp;&nbsp;&nbsp; &nbsp;If the service termination is from supported living services or community residential services:<br />
o&nbsp;&nbsp; &nbsp;In Minnesota, the senior manager must notify the DHS Commissioner in writing. DHS notification will be provided by fax at 651-431-7406.<br />
o&nbsp;&nbsp; &nbsp;In California, the senior manager must notify the Case Management Supervisor in writing within 60 days.&nbsp;</p>

<p>2.&nbsp;&nbsp; &nbsp;This notice may be given in conjunction with a notice of temporary service suspension.</p>

<p>3.&nbsp;&nbsp; &nbsp;The written notice of a proposed service termination must include all of the following elements:<br />
a.&nbsp;&nbsp; &nbsp;The reason for the action;<br />
b.&nbsp;&nbsp; &nbsp;A summary of actions taken to minimize or eliminate the need for service termination, and why these measures failed to prevent the termination. A summary of actions is not required when service termination is a result of Mains’l no longer providing the service (ceasing operation);<br />
c.&nbsp;&nbsp; &nbsp;&nbsp;&nbsp; &nbsp;The person's right to appeal the termination of services under Minnesota Statutes, section 256.045, subdivision 3, paragraph (a); and&nbsp;<br />
d.&nbsp;&nbsp; &nbsp;In Minnesota, the person's right to seek a temporary order staying the termination of services according to the procedures in section 256.045, subdivision 4a or 6, paragraph (c).</p>

<p>4.&nbsp;&nbsp; &nbsp;During the service termination notice period, the manager must:<br />
a.&nbsp;&nbsp; &nbsp;Work with the support team or expanded support team to develop reasonable alternatives to protect the person and others and to support continuity of care;<br />
b.&nbsp;&nbsp; &nbsp;Provide information requested by the person or case manager;<br />
c.&nbsp;&nbsp; &nbsp; &nbsp; Complete a Starting Service/Change Form and Employee Status Change or Termination forms as applicable and distribute within the agency as the forms direct.<br />
d.&nbsp;&nbsp; &nbsp;Assure that information about the service termination, including the written termination notice, is maintained in the person’s plan file.&nbsp;<br />
e.&nbsp;&nbsp; &nbsp;Organize the person’s personal information according to the Record Retention Procedure, and scan the records for electronic storage<br />
&nbsp;</p>