| 6400.50(a) | Program Specialist #1, date of hire 12/30/24. During orientation training, Program Specialist #1 has 59 hours of documented training being completed on 12/30/24 and 30.5 hours on 12/31/24. Direct Service Worker #2 was hired on 8/4/25. During orientation training, Direct Service Worker #2 has 17.5 hours of documented training being completed on 8/4/25 and 56.5 hours on 8/6/25. | Records of orientation and training, including the training source, content, dates, length of training, copies of certificates received and staff persons attending, shall be kept. | 12-09-2025 Human Resource Director created a spreadsheet to track daily submissions of all staff's trainings. The spreadsheet will alert if the minimum amount of training hours exceeds 7.5 in a days' time.
12-09-2025 New Training Protocol established. Should the number of training hours exceed 7.5 hours in a days' time the trainings will not be accepted. |
12/09/2025
| Implemented |
| 6400.207(5)(III) | On 12/4/25 at 11:15AM, Individual #1's bed contained full bed rails that restricted the movement or function of the individual's body. The agency obtained a prescription for the bedrails on 10/4/24. Although the bedrails are prescribed by the medical practitioner, the most current assessment does not address if the individual can easily remove the device or if the device is removed by a staff person immediately upon the request or indication by the individual. Individual #1's individual plan that was last updated on 11/26/25 does not include periodic relief of the device to allow freedom of movement. On 12/4/25 at 11:20AM, Individual #2's bed contained full bed rails that restricted the movement or function of the individual's body. The agency obtained a prescription for the bedrails on 10/4/24. Although the bedrails are prescribed by the medical practitioner, the most current assessment does not address if the individual can easily remove the device or if the device is removed by a staff person immediately upon the request or indication by the individual. Individual #2's individual plan that was last updated on 12/3/25 does not include periodic relief of the device to allow freedom of movement. | A mechanical restraint, defined as a device that restricts the movement or function of an individual or portion of an individual's body. A mechanical restraint includes a geriatric chair, a bedrail that restricts the movement or function of the individual, handcuffs, anklets, wristlets, camisole, helmet with fasteners, muffs and mitts with fasteners, restraint vest, waist strap, head strap, restraint board, restraining sheet, chest restraint and other similar devices. A mechanical restraint does not include the use of a seat belt during movement or transportation. A mechanical restraint does not include a device prescribed by a health care practitioner for the following use or event: Protection from injury during a seizure or other medical condition, if the individual can easily remove the device or if the device is removed by a staff person immediately upon the request or indication by the individual, and if the individual plan includes periodic relief of the device to allow freedom of movement. | On 12-26-25 The Residential Supervisor contacted Individuals #1 and #2 Primary Care Physician and asked if there was any concern with the individuals using bed wedges instead of Bed Rails. Orders were obtained to have the Wedges replace the bed rails. On 01-05-2026 Residential Director Notified Program Specialist and Supports Coordinator to make the changes to the ISP and Assessment for the bed rails until the Wedges arrive. The Assessment and ISP will state when individuals are receiving periodic relief from the Bed rails from 6am-8pm Daily unless napping or ill. It will also include that They are checked on every 2 hours during the night, and it will include checking to see if they are indicating that they want relief from the bed rails. |
01/06/2026
| Implemented |