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3000 Investigation

APS Provider Investigations April 2017

APS PI investigates allegations of abuse, neglect, or exploitation of individuals receiving services (children and adults) from certain providers.

See 1310 APS Provider Investigations Jurisdiction.

3100 Notifications

3110 Notifications Applicable to All Settings

APS Provider Investigations April 2017

APS PI must make a notification of an allegation within specific time frames to:

  •  the administrator or designee of a provider;

  •  other state agencies; and

  •  law enforcement in specific situations.

The investigator notifies providers about allegations and documents the notifications in the IMPACT system. This includes allegations that do not fall under APS PI jurisdiction.

See 3700 Referrals.

3120 Notifications to State Agencies and Law Enforcement

APS Provider Investigations November 2017

APS PI notifies law enforcement and other state agencies in certain circumstances according to the location of the incident and the age of the alleged victim.

3121 Notification to Law Enforcement

APS Provider Investigations November 2017

For all provider settings except SSLCs, State Hospitals, or the ICF-IID Component of the Rio Grande State Center, APS PI notifies law enforcement unless the law enforcement agency reported the alleged abuse, neglect, or exploitation to the department.

The investigator makes notification to law enforcement using the following chart:

Setting Type

Age of Victim

Notify LE?

Timeframe

Method

SSLC, SH, or ICF-IID component of Rio Grande State Center

Child

Yes

Within one hour

Phone

SSLC, SH, or ICF-IID component of Rio Grande State Center

Adult

Yes, if the allegation is believed to constitute a criminal offense.

Within one hour

Phone

All other provider types

Child

Yes

Within 24 hours

Method agreed upon by DFPS and law enforcement

All other provider types

Adult

Yes, if the allegation is believed to constitute a criminal offense.

Within 24 hours

Method agreed upon by DFPS and law enforcement

See 3160 Exception to the Confidentiality of the Reporter’s Identity.

Allegations Involving a Child

APS PI conducts an investigation jointly with law enforcement when it is alleged that:

  •   a child has been, or may be, the victim of conduct that constitutes a criminal offense and poses an immediate risk of physical or sexual abuse;

  •   the abuse could result in the death of, or serious harm to, the child; or

  •   the victim is referred to a children’s advocacy center for a forensic interview.

The investigator must document any instance in which a law enforcement agency is unable or unwilling to conduct a joint investigation.

When available, the investigator requests the case number and name of the assigned officer for inclusion in the final Abuse and Neglect Report.

Death of an Individual Receiving Services

The investigator notifies law enforcement if the individual receiving services dies during the course of an investigation and it is suspected that the death is related to abuse or neglect. If law enforcement conducts a criminal investigation, the investigator cooperates with law enforcement.

See 2800 Sensitive or High Profile Cases.

When APS PI Is Not Going to Investigate Abuse, Neglect, or Exploitation

APS PI must notify law enforcement so that law enforcement can investigate if the reported victim is an individual receiving services, but:

  •   the investigator refers the allegation back to the facility or provider for action without conducting an investigation; or

  •   the reported incident may constitute a crime.

See Appendix I: Actions that Constitute a Crime.

3122 Notification to HHSC Office of Inspector General (OIG)

3122.1 Death of an Individual Receiving Services

APS Provider Investigations November 2017

When APS PI learns of an individual’s death and suspects the death is related to abuse or neglect, the investigator:

  •   notifies the Office of the Inspector General (OIG) at (512) 491-4707 within one hour of learning of the death at intake, or within one hour of receiving this information during an open investigation;

  •   opens the Intake Action page in the IMPACT system;

  •   selects from under the Forms drop-down menu the Intake Report option that contains the Reporter Information; and

  •   emails the intake report and contact information for APS PI to the OIG secure mailbox as soon as possible, but no later than the close of business on the first business day. If additional allegations are uncovered, a follow-up email is not required.

See 2800 Sensitive or High Profile Cases.

3122.2 Suspicion of Medicaid Recipient Fraud

APS Provider Investigations April 2017

If, during the course of the investigation, the investigator suspects Medicaid fraud, he or she must:

  •  report it to OIG at (800) 436-6184 or at the HHSC Inspector General's website within 24 hours; and

  •  document the report in a Contact Detail narrative.

Examples of Medicaid fraud include:

  •  billing Medicaid for care not given, care given to patients who have died or are no longer eligible, or for hours that were not worked;

  •  billing patients for services already paid for by Medicaid;

  •  transporting patients by ambulance when it’s not medically necessary; and

  •  giving a patient a generic drug and billing for a brand name drug.

See:

1440 Attorney General of Texas

1450 Office of Inspector General

3122.3 Allegations Believed to Constitute a Crime in a State-Supported Living Center (SSLC), a State Hospital, and the Rio Grande State Center’s ICF/IID

APS Provider Investigations April 2017

APS notifies OIG when DFPS receives an intake and has cause to believe that a resident of a state-operated facility was abused, neglected, or exploited in a manner that constitutes a crime.

The investigator must:

  •  notify OIG at (512) 491-4707 within one hour of receiving the allegation at intake, or within one hour of receiving additional allegations;

  •  open the Intake Action page in the IMPACT system;

  •  select from under the Forms drop-down menu the Intake Report option that contains the Reporter Information; and

  •  email the report and contact information for APS PI to the OIG secure mailbox as soon as possible, but no later than the close of business on the first business day. If additional allegations are uncovered, a follow-up email is not required.

If the allegation involves an individual on the streamlined caller list, the investigator notifies OIG via the OIG secure mailbox. The following information is provided:

  •  The name of the individual receiving services

  •  The date the individual receiving services was added to the streamlined caller list

  •  Specific information about the criteria used to establish a pattern for making frivolous or patently false allegations

This information may help OIG make a more informed decision on whether to investigate the incident.

3122.4 When DFPS Is Not Going to Investigate

APS Provider Investigations April 2017

In cases referred back to the facility because the allegations did not meet the definition of abuse, neglect, or exploitation, the investigator does not need to notify OIG, even if the allegations may rise to the level of a crime.

3130 Notification of Allegations Involving Independent School Districts

APS Provider Investigations April 2017

The investigator proceeds as follows when allegations involve independent school districts:

If:

Then:

The investigator determines that an abuse, neglect, or exploitation allegation involves:

  •  an employee of a public primary or secondary school providing educational services at a facility, on campus grounds, under either a contract or memorandum of understanding; and

  •  an individual receiving services who is an alleged victim and who is a student at the school.

The investigator notifies (by phone or in person):

  •  the facility within one hour; and

  •  the superintendent of the school district within 24 hours of receipt of the report or the next business day.

Investigations of school employees are a special category, and notifications at the close of an investigation are handled differently than other types of investigations.

School employees with a finding of Confirmed are eligible for an administrative review. Investigators follow the procedures in Appendix IV: Instructions for Release of School Investigations.

3140 Notification of Allegations Involving Alleged Victims in CPS Conservatorship

APS Provider Investigations April 2017

Investigators must check intake call narratives in each case involving a child or a young adult (up to 22 years of age) to see if the child or young adult is in CPS conservatorship. An open CPS case is indicated on the intake call narrative.

If the child or young adult is listed in an open CPS conservatorship case, the investigator notifies the CPS primary worker listed in the IMPACT system in the Subcare stage. This notification must be made by phone or email within 24 hours of receipt of the intake or by the next business day. The investigator documents the notification in IMPACT. The investigator notifies the CPS worker of the findings by phone or email at the conclusion of the investigation.

The program providing the service to the child notifies the parent or conservator.

3150 Notification of Allegations Involving Individuals Receiving Services With Guardians

APS Provider Investigations April 2017

Notifying DADS Guardianship

A memorandum of understanding between DADS and DFPS requires that DFPS notify the DADS guardianship caseworker if a DADS ward is the alleged victim in an abuse, neglect, or exploitation investigation. If the APS PI investigator is aware that a DADS guardianship caseworker is the guardian for an alleged victim, the investigator must notify the DADS guardianship caseworker by phone or email within 24 hours or the next business day upon learning of the DADS guardianship. The DFPS investigator documents the contact in IMPACT.

Notifying the Court That Has Jurisdiction

For probate courts to adequately supervise wards of the state, the court must be notified when a ward is alleged to be a victim of abuse, neglect, or exploitation and is receiving services from a provider.

DFPS Rules, 40 TAC Chapter 711

Probate courts are statutory probate courts, county courts, and county courts-at-law that have probate jurisdiction.

Notification to the probate court is not required when the information that is being alleged does not rise to the level of an allegation of abuse, neglect, or exploitation.

Locating a Guardian and Probate Court

At the beginning of an investigation, the investigator asks the individual receiving services (the ward of the state) and the provider whether the individual receiving services has a guardian.

The probate court is the court that the guardian reports to each year about the status of the individual receiving services. Providers keep records on guardians. Those records may also contain information on the probate courts, if copies of the letters of guardianship or other court documents are present.

If contact information on the probate court is not available through the provider, then the investigator contacts the guardian to obtain the information.

Sending Notice to the Court

Once the investigator identifies the correct probate court and APS has made a finding, the investigator notifies the court using Form 2326 Notification to Guardianship Court Provider Investigation Program.

Investigators maintain copies of Form 2326 on the left-hand side of the case file.

For the addresses of probate courts in Texas, see Texas Courts Online.

3160 Exception to the Confidentiality of the Reporter’s Identity

APS Provider Investigations April 2017

The investigator does not reveal the identity of the reporter to the administrator or designee of the provider or to other state agencies unless the allegation involves sexual exploitation of an individual receiving services by a mental health services provider, as defined in Chapter 81 of the Texas Civil Practices and Remedies Code.

3170 Notification Requirements for Facility, HCS, TxHmL, Local Authorities, and Community Center Investigations

APS Provider Investigations April 2017

The investigator makes the appropriate notifications when the alleged perpetrator is an employee of a facility, HCS or TxHmL waiver program provider, LIDDA, LMHA, or community center. See 3171 Notification When an Alleged Perpetrator is a Direct Provider of a Facility, HCS or TxHmL Waiver Program Provider, LIDDA, LMHA, or Community Center.

If the administrator or chief executive officer (CEO) is the alleged perpetrator, the investigator notifies the entities outlined in 3172 Notifications When the Administrator or CEO Is the Alleged Perpetrator.

As part of the notification process, the investigator informs the administrator or CEO whether the local law enforcement agency and Office of Inspector General (OIG) will be contacted.

The investigator notifies the administrator or CEO if a formerly unknown perpetrator is identified. The investigator documents this additional notification in IMPACT. For time frames for notifications involving formerly unknown perpetrators, see 3171 Notification When an Alleged Perpetrator is a Direct Provider of a Facility, HCS or TxHmL Waiver Program Provider, LIDDA, LMHA, or Community Center.

Notification is not required for an intake forwarded from Statewide Intake (SWI) as an I&R (information and referral) or for an intake that is considered a duplicate intake.

For allegations received in SSLCs or the Rio Grande State Center’s ICF/IID, the investigator obtains information outlined in 3180 Commencement Requirements in SSLCs and the Rio Grande State Center’s ICF/IID.

The investigator notifies DADS Consumer Rights and Services (CRS) if:

  •   the administrator or CEO of an HCS or TxHmL waiver program provider does not respond to the one-hour notification; or

  •   the investigator is unsuccessful in making contact to assure the safety of the individual receiving services.

The investigator notifies CRS by leaving a message at (512) 438-4186. If the notification is made during business hours, DADS makes every possible effort to find a contact with the provider, or at minimum alerts DADS Waiver Survey and Certification of issues.

3171 Notification When an Alleged Perpetrator is a Direct Provider of a Facility, HCS or TxHmL Waiver Program Provider, LIDDA, LMHA, or Community Center

APS Provider Investigations April 2017

The investigator notifies …

by …

within …

Does the investigator reveal the identity of the reporter?

the administrator, CEO, or designee of the facility, HCS or TxHmL waiver program provider, LIDDA, LMHA, or community center…

phone …

one hour of receiving the allegation. If the notification involves a formerly unknown person, the notification is made within one hour of identifying the name of the alleged perpetrator.

This occurs only if:

  •  the alleged perpetrator is a mental health services provider; and

  •  the allegation is sexual exploitation.

the administrator, CEO, or designee of the facility, HCS or TxHmL waiver program provider, LIDDA, LMHA, or community center…

faxing or emailing the de-identified intake …

24 hours or next business day.

This occurs only if:

  •  the alleged perpetrator is a mental health services provider; and

  •  the allegation is sexual exploitation.

law enforcement when an allegation of abuse, neglect, or exploitation involves a child …

phone, email, or fax …

  •  one hour of receiving the allegation at intake; and

  •  one hour (or as soon as possible) of receiving notice of additional allegations that meet the criteria for reporting to law enforcement.

Yes

law enforcement of any allegations of abuse, neglect, or exploitation that involve an individual receiving services that are believed to constitute a criminal offense under any law …

phone, email, or fax …

  •  one hour of receipt of the allegation at intake; and

  •  one hour (or as soon as possible) of receiving notice of additional allegations that meet the criteria for reporting to law enforcement.

Yes

the HHSC Office of Inspector General (OIG) of any abuse, neglect, or exploitation allegations involving an individual receiving services (child or adult) at a state-supported living center (SSLC), the Rio Grande State Center’s ICF/IID, and state hospitals that are believed to constitute a crime…

phone or email

  •  one hour of receipt of the allegation at intake; and

  •  one hour (or as soon as possible) of receiving notice of new or additional allegations that meet the criteria for reporting to OIG.

The investigator includes a follow-up email for each initial intake. See 3221.1 Reviewing Prior Case History.

Yes

DADS Consumer Rights and Services about allegations involving a provider of HCS or TxHmL programs …

email HCS and TxHmL…

24 hours of receipt of the allegation or by the next business day.

This occurs only if:

  •  the alleged perpetrator is a mental health services provider; and

  •  the allegation is sexual exploitation.

3172 Notifications When the Administrator or CEO Is the Alleged Perpetrator

APS Provider Investigations April 2017

The investigator notifies …

by …

within …

Does the investigator reveal the identity of the reporter?

the DSHS Office of Consumer Services and Rights Protection when allegations involve state hospitals or the Rio Grande State Center’s mental health services facility …

phone at (800) 252-8154 …

one hour of receipt of the allegation by DFPS.

This occurs only if:

  •  the alleged perpetrator is a mental health services provider; and

  •  the allegation is sexual exploitation.

DADS Consumer Rights and Services when allegations involve state-supported living centers (SSLCs) or the Rio Grande State Center’s ICF/IID …

phone at (800) 458-9858 …

one hour of receipt of the allegation by DFPS.

This occurs only if:

  •  the alleged perpetrator is a mental health services provider; and

  •  the allegation is sexual exploitation.

the alternate CEO or administrator’s designee when allegations involve Home and Community-Based Services (HCS) or Texas Home Living (TxHmL) programs …

phone …

one hour of receipt of the allegation by DFPS.

This occurs only if:

  •  the alleged perpetrator is a mental health services provider; and

  •  the allegation is sexual exploitation.

the licensed ICF/IID administrator’s designee when allegations involve licensed ICF/IIDs …

phone …

one hour of receipt of the allegation by DFPS.

This occurs only if:

  •  the alleged perpetrator is a mental health services provider; and

  •  the allegation is sexual exploitation.

DADS Consumer Rights and Services when allegations involve HCS or TxHmL, if both the administrator and the designee are alleged perpetrators …

phone at (800) 458-9858 …

one hour of receipt of the allegation by DFPS.

This occurs only if:

  •  the alleged perpetrator is a mental health services provider; and

  •  the allegation is sexual exploitation.

the following entities when allegations involve local authorities for mental health and intellectual disabilities:

  •  DADS Consumer Rights and Services,

  •  the DSHS Office of Consumer Services and Rights Protection, and

  •  either the chair of the community center board of trustees or the LIDDA or LMHA board of directors, as appropriate …

phone …

24 hours of receipt of the allegation or the next business day.

This occurs only if:

  •  the alleged perpetrator is a mental health services provider; and

  •  the allegation is sexual exploitation.

IMPACT Documentation

The investigator enters a contact documenting the date that DFPS made or attempted to make notifications.

For investigations involving law enforcement, when the information is available, the investigator documents in the Contact Detail narrative:

  •  the name of the assigned officer; and

  •  the law enforcement case number.

For investigations involving OIG, the investigator documents:

  •  the initial notification to OIG; and

  •  the follow-up email containing the intake report.

The follow-up email is documented in IMPACT as a contact, with the Purpose being Notification and the method being Other.

3173 Notification to Provider for Allegations Involving a Contractor

APS Provider Investigations April 2017

The investigator notifies the provider within one hour when an investigation involves an alleged perpetrator affiliated with a contractor of a facility, HCS or TxHmL waiver program provider, LIDDA, LMHA, or community center (for example, a dayhab as a contractor of an HCS). The provider is responsible for the safety of the individual receiving services. The provider notifies the contractor of the allegations so that the contractor can take appropriate action.

See 4614 Provider Investigation Conclusion.

3180 Commencement Activities Required in SSLCs and the Rio Grande State Center’s ICF/IID

APS Provider Investigations April 2017

APS PI documents commencement activities for investigations conducted in state supported living centers (SSLCs) and the Rio Grande State Center’s ICF/IID.

The investigator or investigator’s designee uses information provided at intake to begin planning the investigation and assisting the facility staff in protecting both the alleged victim and any evidence.

3181 Actions Required Within One Hour After SWI Receives an Intake

APS Provider Investigations April 2017

Within one hour of SWI’s receipt of an intake involving an alleged victim at either an SSLC or the Rio Grande State Center’s ICF/IID, the investigator or designee contacts a person at the facility who has current and reliable information about the alleged incident, such as an administrator on duty or an incident manager.

The investigator or designee then directs that person to do the following:

  •  Protect the alleged victim.

  •  Protect evidence for APS or law enforcement. This may include:

  •  protecting physical evidence, such as blood, clothes, or damage to the unit or room that was part of the incident;

  •  obtaining photographs of any physical evidence that may not be available at the time of an APS on-site visit; and

  •  taking appropriate steps to ensure that alleged perpetrators and other witnesses do not discuss the investigation.

  •  Reassign the alleged perpetrator to prevent contact with an individual receiving services.

  •  Notify any contractors about the intake.

See 3183 Documenting Commencement Activities in IMPACT.

3182 Actions Required Within 24 Hours After SWI Receives an Intake

APS Provider Investigations April 2017

Within 24 hours of SWI’s receipt of an intake involving an alleged victim at a SSLC or the Rio Grande State Center’s ICF/IID, the investigator or duty worker:

  •  contacts an individual from the facility who has current and reliable information;

  •  obtains the information explained in this item; and

  •  documents the information on the Contact Detail page in IMPACT.

Actions to Take Within 24 Hours of Intake

The investigator or designee uses the information obtained from the facility to determine whether:

  •  the alleged victim named in the intake is an individual receiving services;

  •  the alleged victim is showing signs of distress;

  •  the alleged victim has an injury and, if so, the severity;

  •  the alleged victim has been seen by medical staff;

  •  injuries have been treated;

  •  the alleged victim needs accommodations to communicate with the investigator;

  •  injuries are documented in an injury report;

  •  the incident has been documented in progress notes;

  •  the people involved can be identified,

  •  the intake meets the definition of abuse, neglect, or exploitation;

  •  all of the allegations from the intake are listed;

  •  the correct priority was assigned at intake; and

  •  partial or full referral is appropriate.

Allegations of Sexual Abuse

For allegations of sexual abuse, the investigator or duty worker also determines whether:

  •  the victim was examined for sexual assault and by whom; and

  •  the victim has showered.

Allegations of Exploitation

For allegations of exploitation, the investigator or duty worker also determines whether the alleged victim has access to his or her own money or resources.

Developing an Initial Plan

After making the determinations listed above, the investigator or duty worker develops an initial plan for the investigation.

See 3183 Documenting Commencement Activities in IMPACT.

3183 Documenting Commencement Activities in IMPACT

APS Provider Investigations April 2017

In IMPACT, on the Contact Detail page for notifications, the investigator or a designee documents whether the actions required by the following policies were completed within the required time frames:

3180 Commencement Requirements in SSLCs and the Rio Grande State Center’s ICF/IID

3181 Actions Required Within One Hour After SWI Receives an Intake

3182 Actions Required Within 24 Hours After SWI Receives an Intake

In the Contact Narrative field, the investigator or designee enters:

  •  the dates that the investigator met or attempted to meet requirements; and

  •  any case planning conducted.

Exception: If an initial face-to-face (FTF) interview with an alleged victim is attempted or completed within the required 24 hours, the investigator or designee documents it on the Contact Detail page for FTF contacts, not on the Contact Detail page for notifications.

See:

4100 General Documentation Requirements

3121 Notification to Law Enforcement

3122 Notification to HHSC Office of Inspector General (OIG)

3190 Notification Requirements for Community Provider Investigations

APS Provider Investigations April 2017

When a community provider’s employee is the alleged perpetrator, the investigator makes the appropriate notification as outlined in the tables below.

As part of the notification process, the investigator informs the appropriate individual whether the local law enforcement agency and Office of Inspector General (OIG) were contacted.

The investigator notifies the appropriate individual if a formerly unknown perpetrator is identified. The appropriate individual must be notified within one hour of identifying the name of the alleged perpetrator (see below). The investigator documents the additional notification in IMPACT.

Notification is not required for an intake forwarded from SWI as an I&R or for an intake that is considered a duplicate intake.

Service Provider

When the direct provider (alleged perpetrator) is an employee, agent, contractor, or subcontractor of a service provider, the investigator contacts the service provider:

within…

by…

24 hours of receipt of the allegation by DFPS …

phone.

24 hours or the next business day of receipt of the allegation by DFPS …

emailing the de-identified intake.

Limited Service Provider Company

When the direct provider (alleged perpetrator) is an employee, agent, contractor, or subcontractor of a limited service provider company, the investigator contacts the limited service provider company and service provider:

within…

by…

24 hours of receipt of the allegation by DFPS …

phone.

24 hours or the next business day of receipt of the allegation by DFPS …

emailing the de-identified intake.

Managed Care Organization

When the direct provider (alleged perpetrator) is an employee, agent, contractor, or subcontractor of a managed care organization (MCO), the investigator contacts the MCO:

within…

by…

24 hours of receipt of the allegation by DFPS …

emailing the de-identified intake.

Consumer Directed Services (CDS) Employer

When the direct provider (alleged perpetrator) is an employee, agent, contractor, or subcontractor of a CDS employer (individual receiving services or their legally authorized representative):

The investigator contacts …

within …

by …

the CDS employer …

24 hours of receipt of the allegation by DFPS …

phone and by providing the de-identified intake through the CDS employer’s preferred method of delivery.

the CDS employer …

24 hours or the next business day of receipt of the allegation by DFPS …

providing the de-identified intake through the CDS employer’s preferred method of delivery.

one of the following entities in addition to the CDS employer:

  •  Financial Management Service Agency for DADS programs

  •  MCO service coordinator for MCO clients

  •  DSHS case manager for DSHS clients …

24 hours or the next business day of receipt of the allegation by DFPS …

phone and by emailing the de-identified intake.

3191 Action Required When the Provider is Known at Intake

APS Provider Investigations April 2017

In some circumstances, the names of the alleged perpetrator and service provider are included in the intake narrative. If the investigator determines the service provider at the time of intake, he or she notifies the service provider of the alleged perpetrator and allegation no later than 24 hours after SWI receives the allegation.

3192 Action Required if Provider is Unknown at Intake

APS Provider Investigations April 2017

In some circumstances, the reporter may know the name of the alleged perpetrator but not the name of the service provider. If the name of the service provider is unknown, the investigator takes steps to determine the name and contact information of the service provider. These steps can be performed at the same time.

See:

3192.1 Initial TIERS Search

3192.2 Medicaid Managed Care Organization (MCO)

3192.3 Fee for Service (Not Managed Care)

3192.4 Case Initiation

3192.1 Initial TIERS Search

APS Provider Investigations April 2017

If the service provider is unknown at the time of intake, the investigator or the investigator’s designee conducts a TIERS search to determine the alleged perpetrator’s employer.

3192.2 Medicaid Managed Care Organization (MCO)

APS Provider Investigations April 2017

If a TIERS search shows the alleged victim is a member of a Medicaid MCO, the investigator emails the MCO using the MCO Template Form to determine and contact the service provider. The MCO has 24 hours to respond to the investigator’s initial email to the MCO.

3192.3 Fee for Service (Not Managed Care)

APS Provider Investigations April 2017

If a TIERS search shows the alleged victim is not a member of a Medicaid MCO, the investigator assumes that the alleged victim’s Medicaid is being delivered through fee-for-service. If a TIERS search did not provide the name of the service provider, the investigator emails DADS Consumer Rights and Services (CRS) at the CRS Complaints mailbox with DFPS INQUIRY CASE # entered in the subject line. In the contents of the email, the investigator or designee should provide as much of the following information about the individual receiving services as possible:

  •  Name

  •  Address

  •  Phone number

  •  Date of birth

  •  Social Security number

  •  Medicaid number

  •  Medicare number

The DADS CRS mailbox is monitored Monday through Friday, 8 a.m. to 5 p.m.

APS PI has authority to investigate abuse, neglect, and exploitation of a child receiving services from an HCSSA regardless of the funding source as well as an adult or child who lives in an HCS provider residence but who does not receive Medicaid waiver services. In these circumstances, TIERS, the MCO, and DADS may not have information related to the service provider. It may be necessary to contact other individuals with knowledge of the service provider.

3192.4 Case Initiation

APS Provider Investigations April 2017

A case initiation is when the investigator initiates an investigation by contacting an appropriate person who is able to provide objective, current, and reliable information about the identity of the alleged victim’s service provider. This may include the individual receiving services, reporter, or other collateral witnesses listed in the intake. It does not include the alleged perpetrator. The investigator completes a case initiation by telephone or face to face. The investigator documents this contact in IMPACT as “Case Planning.”

The purpose of a case initiation is to determine the identity of the alleged perpetrator’s employer (service provider). The goal is to contact the service provider responsible for ensuring the alleged victim’s safety and for protecting evidence.

Once the investigator determines the identity of the service provider, the investigator immediately notifies the appropriate individual listed in 3190 Notification Requirements for Community Provider Investigations.

The investigator documents all attempts to identify the service provider and all attempts to notify the service provider of the allegation in IMPACT.

3193 Action Required When the Provider is a CDS Employer

APS Provider Investigations April 2017

If the investigator determines that the alleged victim is using the Consumer Directed Services (CDS) option, the investigator contacts the:

  •  alleged victim, when the victim is responsible for directing his or her own services; or

  •  legally authorized representative (LAR), when the LAR is responsible for directing the alleged victim’s services.

The investigator contacts the alleged victim or LAR within 24 hours of SWI receiving the allegation, unless the allegation is received after hours. The investigator uses appropriate judgment when deciding whether to notify the individual after hours. The investigator considers the seriousness of the allegation and whether the alleged perpetrator has current access to the alleged victim.

Within 24 hours or by the next business day, the investigator also determines and contacts the alleged victim’s:

  •  Financial Management Service Agency;

  •  Managed care organization’s service coordinator; or

  •  DSHS case manager.

For notification requirements, see 3190 Notification Requirements for Community Provider Investigations.

3194 IMPACT Documentation

APS Provider Investigations April 2017

The investigator enters a contact documenting the date that DFPS made or attempted to make notifications.

For investigations involving law enforcement, when the information is available, the investigator documents in the Contact Detail narrative:

  •  the name of the assigned officer; and

  •  the law enforcement case number.

3200 Investigative Procedures

3210 Review the Intake

APS Provider Investigations April 2017

Intake Meets the Definition of Abuse, Neglect, or Exploitation

Before investigating an intake, the investigator or duty worker reviews the intake and determines whether:

  •  the information meets the definition of an allegation of abuse, neglect, or exploitation; and

  •  it is within APS PI’s jurisdiction.

See also:

2300 Examples of Abuse, Neglect, and Exploitation

2411 CAC Coordination Procedures

APS Facility 24-Hour Commencement Checklist (generated in IMPACT)

All Allegations Listed From Intake

The investigator or duty worker reviews the intake and verifies all allegations in the intake are listed as an allegation in IMPACT.

If allegations described in the intake narrative are missing in IMPACT, the investigator adds them to the Allegation Detail page.

See also:

2300 Examples of Abuse, Neglect, and Exploitation

APS Facility 24-Hour Commencement Checklist (generated in IMPACT)

Additional Allegations not Contained in the Intake

If an additional allegation related to the incident under investigation is reported or discovered during the investigation, within one hour the investigator:

  •  notifies the appropriate individual outlined in:

  •  3171 Notification When an Alleged Perpetrator is a Direct Provider of a Facility, HCS or TxHmL Waiver Program Provider, LIDDA, LMHA, or Community Center Employee Is an Alleged Perpetrator;

  •  3172 Notifications When the Administrator or CEO Is the Alleged Perpetrator; and

  •  3190 Notification Requirements for Community Provider Investigations; and

  •  notifies law enforcement or the HHSC Office of Inspector General, if appropriate.

If the investigator identifies a systemic issue requiring investigation, it is considered an additional allegation, and the appropriate individual should be notified as outlined in:

  •  3171 Notification When an Alleged Perpetrator is a Direct Provider of a Facility, HCS or TxHmL Waiver Program Provider, LIDDA, LMHA, or Community Center

  •  3172 Notifications When the Administrator or CEO Is the Alleged Perpetrator

  •  3190 Notification Requirements for Community Provider Investigations

The investigator documents the additional notification in the IMPACT system as a contact. (If notification cannot be made within one hour, the investigator documents the justification for the delay in the Contact Detail narrative in IMPACT.) The investigator must include the date and time each notification is made.

The investigator then:

  •  adds the allegation to the Allegation Detail page;

  •  investigates the additional allegation; and

  •  documents the findings in IMPACT.

For example, during an interview, the investigator learns of an additional allegation of physical abuse related to the incident under investigation. The interview lasts an hour and a half. The investigator concludes the interview, notifies the provider and law enforcement, and documents the notifications in IMPACT, including the reason for the 30-minute delay.

Additional Allegations of a Different Incident

If, during the investigation, a new allegation is reported or discovered that involves a different incident or a different alleged victim, the investigator reports the incident to SWI so that a new intake may be opened.

The investigator documents the information about the new case number in IMPACT, under the Administrative/Procedural Note section of the report. If the SWI report cannot be made within one hour, the investigator documents the justification for the delay in the Administrative/Procedural Note in IMPACT.

Intake Priority

The investigator or duty worker verifies that the priority assigned at intake is correct for the allegation and setting.

If the priority assigned at intake is changed, the investigator:

  •  completes the Priority/Closure page in IMPACT; and

  •  includes a justification for the priority change in the Comments section.

See also 2110 Changing Priorities.

3211 Determine Whether a Partial or Full Referral Is Appropriate

APS Provider Investigations April 2017

The investigator or duty worker reviews the intake to determine whether partial or full referral is appropriate according to 3700 Referrals.

See also APS Facility 24-Hour Commencement Checklist (generated in IMPACT).

3212 Determine Whether a Streamlined Investigation is Appropriate

APS Provider Investigations April 2017

The investigator or duty worker reviews the intake to determine whether a streamlined investigation is appropriate according to 3800 Streamlined Investigations in All Settings.

3213 Determine Whether an Abbreviated or Full Investigation is Appropriate

APS Provider Investigations April 2017

The investigator or duty worker reviews the intake to determine whether an abbreviated or a full investigation is required according to 3900 Abbreviated Investigations.

3214 Develop an Initial Plan for the Full Investigation

APS Provider Investigations November 2017

The investigator or duty worker develops an initial plan, based on the information gathered within the first 24 hours of the investigation.

The plan includes a list of sources that the investigator knows he or she will interview, based on the actions taken during the intake or notification stages.

The plan also includes:

  •   the important documentary evidence that will need to be collected and why that evidence is relevant; and

  •   the important demonstrative evidence that will be gathered if appropriate.

The investigator or duty worker develops the plan in IMPACT in the Contact Narrative for notifications to SSLCs, state hospitals, and the ICF component of the Rio Grande State Center.

3220 Planning the Full Investigation

APS Provider Investigations November 2017

At intake, the investigator develops a plan to guide the investigation. The investigator completes each of the steps listed below.

During the course of the investigation, the investigator analyzes the evidence to determine whether the original investigative questions have been answered and to formulate new questions as necessary.

The investigator continues to analyze the evidence to determine whether he or she has reached a determination based on a preponderance of the evidence. What constitutes preponderance varies with the allegation. Each definition of abuse, neglect, and exploitation is comprised of specific elements that must be established during an investigation.

The following is a suggested sequence of activities (the actual sequence may vary according to the circumstances) in conducting an investigation:

1.   Review the intake.

2.   Prepare specific questions to help determine:

  •   what happened;

  •   who may have witnessed it;

  •   who is the alleged perpetrator; and

  •   whether abuse, neglect, or exploitation occurred.

      For example: Who saw this incident? What does the individual’s treatment plan say about how much observation he or she needs? What time did the alleged perpetrator arrive at work?

      The more specific the question, the more information and direction the answer can provide to the investigation. The investigator can conduct a thorough and efficient investigation if he or she:

  •   identifies the questions that need to be answered by each witness;

  •   considers how questions are likely to be answered; and

  •   anticipates obstacles and ways to get around obstacles to obtain the necessary information and arrive at the truth.

3.   Interview the reporter.

4.   Conduct a walk-through and create a diagram of the scene of the incident.

5.   Interview the individual receiving services.

6.   Photograph injuries (or lack thereof), if applicable.

7.   Gather sufficient demonstrative evidence, including photographs of physical evidence or the incident scene to establish a preponderance of the evidence.

8.   Gather sufficient documentary evidence (such as progress notes, duty roster, assignment sheets, incident reports, and training records) to establish a preponderance of the evidence.

9.   Interview any other witnesses or persons who may provide collateral information, when necessary.

10. Interview the alleged perpetrator (for cases involving the Office of the Inspector General (OIG), the investigator follows 3223.1 Planning the Interview With the Alleged Perpetrator When OIG Is Involved).

11. Request additional interviews with witnesses, especially the alleged perpetrator, when necessary to resolve discrepancies.

12. Analyze all evidence a final time, considering the elements of the definitions to reach a finding.

13. Finish the investigative report.

For investigations in SSLCs and the Rio Grande State Center’s ICF/IID, see:

3221.1 Reviewing Prior Case History

3122 Notification to HHSC Office of Inspector General (OIG)

3221 Prior Case History

APS Provider Investigations April 2017

Investigators review prior investigations to understand the following:

  •  What occurred in the prior investigation?

  •  What did the analysis of evidence reveal?

  •  Does anything in the prior case provide additional information, insight, lines of inquiry, or collaterals for the current investigation?

3221.1 Reviewing Prior Case History

APS Provider Investigations April 2017

The investigator must review prior case history in SSLCs or the Rio Grande State Center’s ICF/IID for all principals.

Investigations conducted in all other settings do not require a review of prior case history for all principals; however, it should be used when the investigator suspects the history might reveal trends of behavior by principals that could impact the current investigation. Both APS PI and In-Home case history should be gathered and considered when conducting a prior case history search.

When reviewing prior case history, it is possible that the history from a provider other than the alleged perpetrator’s current employer may be relevant in a case. However, the current employer may not have the legal right to information from prior cases in other settings. This affects how the information can be used in the current case. The prior case history of principals should not be released across different settings or to different employers unless staffed with the APS director of field operations or the APS PI senior policy analyst to determine the most appropriate way to use the information.

A review of prior case history may:

  •  provide the investigator with the name of the current service provider;

  •  reveal trends of behavior by either the alleged victim or the alleged perpetrator that need to be brought to the provider’s attention so that appropriate action may be taken;

  •  provide the investigator with background information about both the individual receiving services and the alleged perpetrator;

  •  support a preponderance of the evidence; and

  •  assist with conducting a complete, thorough, and accurate investigation of the current allegation.

Prior case history may also show a series of documented concerns when the same or similar concerns have been raised in past cases. In such cases, the investigator may have identified a systemic issue requiring investigation. Cases with repeated employee training or administrative concerns include:

  •  multiple investigations having the same concern about a lack of training;

  •  a repeat of incidents with an insufficient number of staff on duty; or

  •  a trend indicating staff did not know policy or job expectations.

Case Example of a Possible System Issue

Case history shows that in the last month, four different individuals receiving services were left in the van. In each situation, the van checklist transfer sheet was not signed by the driver. See 4413 Basis for Designating a Perpetrator as a Systems Issue.

3221.2 Procedures for Reviewing Prior Case History

APS Provider Investigations April 2017

Using the Principal Case History report in IMPACT, except as noted in the following sections, the investigator identifies all prior investigations that concluded one year or less from the date of the current intake and involved either the alleged victim or alleged perpetrator. The investigator also reviews any older prior case history of the alleged victim or the alleged perpetrator if it appears that a prior case may be relevant to the current case.

Review of Prior Investigations Involving the Alleged Perpetrator

The investigator focuses on APS PI and In-Home investigations conducted in the past year, except in sexual abuse allegations against an alleged perpetrator. In sexual abuse cases, the investigator determines which investigations should be reviewed in more detail, including reviewing the analysis of the evidence. The investigator must review cases within the past year that:

  •  have dispositions of Confirmed;

  •  involve similar allegations regardless of the finding (Confirmed, Unconfirmed, Inconclusive, and Unfounded);

  •  involve the same alleged victim and alleged perpetrator; and

  •  the investigator deems relevant to the current investigation.

The investigator reviews all sexual abuse allegations made against an alleged perpetrator, regardless of date.

Review of Prior Investigations Involving the Alleged Victim

The investigator focuses on APS PI and In-Home investigations conducted in the past year. The investigator determines which investigations should be reviewed in more detail, including reviewing the analysis of evidence. The investigator must review cases within the past year that:

  •  involve similar allegations regardless of the finding;

  •  involve the alleged victim and the same alleged perpetrator; and

  •  the investigator deems relevant to the current investigation.

See also 4616 Documenting Use of Prior Case History in IMPACT.

3221.3 Considerations for the Use of Prior Case History

APS Provider Investigations April 2017

Use of Prior Case History During Interviews

After reviewing prior case history, investigators may identify trends or patterns of behavior that are relevant to the current investigation. It is appropriate for investigators to use relevant information from prior case history to direct the questioning of an alleged perpetrator, alleged victim, or collateral.

When interviewing either an alleged perpetrator or alleged victim, the investigator considers the following:

  •  A strong pattern of previous similar allegations leads the investigator to include interview questions for an alleged perpetrator about whether he or she has ever been accused of similar allegations before. The alleged perpetrator’s response to that question can be used to help test credibility of responses in the current investigation.

  •  Once the alleged perpetrator is aware that the investigator knows prior history, it becomes more difficult for the alleged perpetrator to claim the current allegation is an isolated incident.

  •  The investigator has an additional tool to use in questioning the alleged perpetrator because past history may eliminate some of the common excuses an alleged perpetrator uses to explain his or her conduct in the current case.

  •  The alleged perpetrator cannot claim he or she did not know the conduct was wrong or injurious if the alleged perpetrator has been accused of it before.

  •  It is harder for the alleged perpetrator to claim his or her actions in the current investigation were innocent or based on a misunderstanding of policy or lack of training because he or she has been accused before by others of similar actions.

  •  If the alleged victim is the same in prior cases, the investigator knows to explore the relationship between the alleged perpetrator and the alleged victim beyond the current allegation to gain insight into whose statement is more credible.

  •  If similar allegations have been made by the alleged victim before, the investigator now has additional lines of inquiry to explore whether the victim is being repeatedly victimized by one or more staff members or whether the victim’s allegations are false and may be because of an ongoing medical or mental health condition, or relationship with the alleged perpetrator.

Prior case history may lead to finding additional evidence in the current case, assisting in determining credibility, or allow the investigator to provide significant information to the alleged victim’s treatment team for consideration in revising his or her treatment plan. It may also allow the investigator to provide valuable information to the facility administration about removal of certain staff to other positions or the need for additional staff training on dealing appropriately with the alleged victim’s deteriorating behavior.

3221.4 Use of Prior Case History to Identify Additional Collaterals

APS Provider Investigations April 2017

The investigator may also use relevant prior case history to determine whether additional collaterals should be interviewed as a part of the current investigation. The investigator uses his or her judgment to determine which, if any, additional collaterals will be interviewed.

Factors to consider when determining if a collateral from a prior investigation should be interviewed include whether:

  •  the collateral witnessed a similar incident that may provide information for additional questioning of the alleged perpetrator or alleged victim; or

  •  the collateral’s knowledge of facility or provider policies or procedures is important to the current investigation.

3221.5 Using IMPACT to Conduct the Principal Case History Search

APS Provider Investigations April 2017

There are several ways to view principal case history information. To access the Principal Case History page, go to the workload page and select the case for review. Click on the third level Principal Case History tab to get to the Principal Case History page. This page will list all cases in which one of the principals in the current case was also a principal at the time of intake.

First, click on the Show List radio button next to one of the cases to open the Principal List at the bottom of the page. This list shows all principals in that particular case, including their role for each stage of the case and the disposition.

To generate a report for all the cases listed in the Case List on the Principal Case History page, select the PCH Tool – All Cases from the Reports dropdown box at the bottom of the screen. This launches a report that is generated under the Reports tab. To access the report, click on the Reports tab at the top of the screen and select the report to be generated. The report is in PDF format and breaks down the principal information by stage, including the roles of all involved principals in each stage and the overall disposition. The report may be several pages long, depending on the number of related cases.

Investigators may also generate a report that contains only information for certain cases listed on the Principal Case History page. Click the Link checkbox next to the desired cases, then click the Save button. Once the cases have been linked, select PCH Tool – Linked Cases from the Reports dropdown box at the bottom of the screen to generate a report that includes only the linked cases. This report may be retrieved in the same manner as the report for all cases.

3222 Investigation Contacts

3222.1 Initial Face-to-Face Requirements

APS Provider Investigations November 2017

The investigator makes a face-to-face contact with the alleged victim within the timeline established by the priority of the case. When there are two or more alleged victims in an investigation, the investigator makes contact with a minimum of one of them within the timeline established by the priority of the case. The investigator makes every effort to obtain a statement from the alleged victim and address the allegation during this contact.

Priority I: The investigator makes face-to-face contact with the alleged victim within 24 hours of receipt of the report by DFPS.

Priority II: The investigator makes face-to-face contact with the alleged victim within three calendar days of receipt of the report by DFPS.

Priority III: The investigator makes face-to-face contact with the alleged victim within seven calendar days of receipt of the report by DFPS.

See 3330 Interviewing Individuals.

3222.2 Exceptions to Initial Face-to-Face Requirements

APS Provider Investigations November 2017

The investigator makes a face-to-face contact with the alleged victim as outlined in 3222.1 Initial Face-to-Face Requirements, except when the intake alleges:

  •   exploitation as the only allegation type and the total alleged exploitation amount is less than $25.00; or

  •   neglect when there is no physical or emotional injury to the alleged victim and no risk of physical or emotional injury or death to the alleged victim.

The investigator conducts a telephone interview with the alleged victim in lieu of a face-to-face contact, if appropriate.

If during the course of an investigation the investigator determines a face-to-face contact with the alleged victim is necessary, the investigator makes the face-to-face contact within the timeline established by the priority of the case. 

See:

2100 Priorities

3800 Streamlined Investigations in All Settings

3900 Abbreviated Investigations

2411 CAC Coordination Procedures

3122.3 Allegations Believed to Constitute a Crime in a State-Supported Living Center (SSLC), a State Hospital, and the Rio Grande State Center’s ICF/IID

3342.3 Witnesses Who Have Direct Knowledge

3222.3 Follow-Up Face-to-Face Requirements

APS Provider Investigations April 2017

If the investigator is unable to make a face-to-face contact with the victim within the required time frame, a second attempt must be made as follows:

Priority I: The investigator makes a second attempt at face-to-face contact within 24 hours after the first attempt.

Priority II: The investigator makes a second attempt at face-to-face contact within three calendar days after the first attempt.

Priority III: The investigator makes a second attempt at face-to-face contact within five calendar days after the first attempt.

See 2411 CAC Coordination Procedures.

3222.4 Face-to-Face Requirements for Referrals or Streamlined or Abbreviated Investigations

APS Provider Investigations November 2017

A face-to-face contact with the alleged victim is not required for:

  •   intakes referred back to the provider as rights, clinical, administrative issues, or general complaints, or

  •   allegations that are eligible for a streamlined investigation or certain abbreviated investigations.

If the investigator determines a face-to-face interview is necessary, the investigator documents the interview in IMPACT.

See:

3330 Interviewing Individuals

3700 Referrals.

3800 Streamlined Investigations in All Settings

3900 Abbreviated Investigations

3222.1 Initial Face to Face Requirements

3222.5 Documented Efforts to Interview Principals

APS Provider Investigations April 2017

Alleged victims and alleged perpetrators are listed as principal sources in every investigation. The investigator makes every effort to locate and interview alleged victims and alleged perpetrators before closing the investigation.

Those efforts include:

  •  making phone calls;

  •  contacting the provider to gain additional information about the alleged victim or alleged perpetrator; and

  •  sending a letter to the last known address of the alleged victim or alleged perpetrator requesting an interview regarding the allegations.

When attempting to make contact, the investigator must consider personal safety in accordance with HR-1107 DFPS Safety Policy.

The investigator may use the TIERS system to help locate principals.

The investigator may also use the DFPS research system known as FINDRS to help locate principals. The results are returned within 24 hours, except on weekends.

To use FINDRS, the investigator:

  •  completes Form 2004 Request for Quick Find Online Records Search Assistance;

  •  submits the form to the FINDRS email box with “F-503-2004: Quick Find” entered in the subject line; and

  •  documents the search results and efforts as a contact in IMPACT in a Contact Narrative as a Case Planning Contact.

See also:

OP-6110 FBI Exigent Check

3331 Interviewing Persons Who Have Relocated In Texas

3320 Conducting Telephone Interviews

Appendix II: Jurisdictions

3223 Investigations Involving the Office of the Inspector General (OIG)

3223.1 Planning the Interview With the Alleged Perpetrator When OIG Is Involved

APS Provider Investigations April 2017

The HHSC Office of Inspector General (OIG) notifies DFPS about OIG’s intent to investigate the allegations within 24 hours of receiving the DFPS intake. If OIG indicates it will conduct an investigation, the APS investigator waits 72 hours after OIG was notified before interviewing the alleged perpetrator.

If OIG is unable to conduct an interview with the alleged perpetrator within 72 hours, the APS investigator may interview the alleged perpetrator. OIG makes every effort to prioritize interviews with alleged perpetrators, including attempting to schedule the interviews so that DFPS investigators can interview immediately after OIG.

3223.2 Interviewing an Alleged Perpetrator When OIG Is Involved

APS Provider Investigations April 2017

After OIG reads a Miranda warning to an alleged perpetrator, the alleged perpetrator:

  •  asserts his or her right to remain silent and gives no statement to OIG; or

  •  waives his or her right to remain silent and gives a statement to OIG.

The APS investigator must ask OIG which response OIG received from the alleged perpetrator.

Alleged Perpetrator Waives Miranda Rights

If the alleged perpetrator waives his or her right to remain silent and gives a statement to OIG, it is likely that he or she is willing to give an additional statement to the APS investigator.

If the alleged perpetrator refuses to give a statement to APS PI, the APS investigator proceeds as explained in the table below.

Alleged Perpetrator Asserts Miranda Rights

When an alleged perpetrator asserts his or her right to remain silent and refuses to give a statement to OIG, the APS investigator attempts to interview the alleged perpetrator, according to the procedures explained in the table below.

If the alleged perpetrator …

then the APS investigator …

refuses to give a statement to the APS investigator ...

  •  explains that the investigation will proceed without the alleged perpetrator’s statement and that the investigator will report the alleged perpetrator’s failure to cooperate to his supervisor;

  •  ends the interview (unless the alleged perpetrator relents); and

  •  reports the matter to the supervisor.

  •  agrees to speak with APS; and

  •  does not ask whether agreeing to talk to APS affects his or her Miranda rights ...

  •  conducts the interview; and

  •  volunteers no comment about Miranda rights.

  •  agrees to speak with APS; and

  •  inquires about whether the information he or she gives will be confidential and will not be shared with OIG or law enforcement …

explains that:

  •  the statement will be a part of the APS investigation report;

  •  APS will consider the statement when determining whether to make a finding of abuse, neglect, or exploitation; and

  •  by law, DFPS must share a copy of the completed investigation report with law enforcement and OIG.

3223.3 Conducting Joint Interviews of Individuals Receiving Services and Witnesses

APS Provider Investigations April 2017

An APS investigator may conduct, with OIG staff, joint interviews of individuals receiving services and witnesses, when OIG and DFPS deem appropriate.

Conducting joint interviews:

  •  improves evidence collection;

  •  increases the efficiency of the investigation process; and

  •  reduces the negative impact on facility residents that repeated interviews can cause, which is especially important.

If, after a joint interview, OIG does not immediately make a statement available to use as documentation for the interview, the investigator documents the interview on the DFPS statement form. The APS investigator does not wait for the OIG investigator to send his or her statement form.

Documentation Requirements

The investigator documents the following contacts in the IMPACT system within 24 hours or by the next business day:

  •  All notifications made to the administrators and designees of the provider about initial and additional allegations

  •  All contacts relevant to the investigation (those made face-to-face or by telephone)

  •  Contacts with law enforcement or OIG staff at any point during the investigation

For example, if notification was sent at 4:00 p.m. on a Thursday, the investigator would need to document the contact in IMPACT by 11:59 p.m. on Friday to comply with policy.

3224 Investigations Involving Children

3224.1 Child Privacy

APS Provider Investigations April 2017

The investigator must attempt to conduct an interview and visual inspection of the child in private without any third party present, unless the child needs an interpreter or the investigator determines that having another person present would be appropriate. However, if a parent denies consent for the child to be interviewed alone, the investigator must use his or her judgment to determine whether to proceed with the interview in the presence of a third party.

3224.2 Interviewing Children in any Setting

APS Provider Investigations April 2017

The investigator interviews a child when the child has direct or circumstantial knowledge about an allegation. A child may receive services in a facility or a community provider setting. A child may be interviewed as an alleged victim or as a collateral witness.

The investigator conducts a face-to-face interview with the alleged victim within the time frame established by the case priority. It may be appropriate to coordinate an interview with the children’s advocacy center depending on the allegation.

Before conducting an interview with a child, the investigator obtains consent from the responsible party.

See:

2411 CAC Coordination Procedures

3224.7 Interviewing Children Residing in a Facility or Group Home

3224.8 Interviewing Children in a Private Residence

3224.21 Documenting Interviews with Children

APS Provider Investigations April 2017

A minor cannot sign a legal document or consent to sign an APS electronic statement form. The investigator conducts a face-to-face interview with the child and documents the interview in the appropriate Contact Detail narrative.

If the child refuses to participate in the interview, the investigator documents the refusal in a Contact Detail narrative.

See:

3227.1 Permission to Enter a Private Residence

3342.5 Witnesses Who Refuse to Cooperate With the Interview

2411 CAC Coordination Procedures

2200 Statewide Intake Procedures

3224.8 Interviewing Children in a Private Residence

3224.3 Intakes that Allege Sexual Abuse (SXAB) or Serious Physical Injury as a Result of Physical Abuse (PHAB) or Neglect (NEGL)

APS Provider Investigations April 2017

If the allegation in the initial intake indicate sexual abuse or serious injury as a result of physical abuse or neglect, the investigator contacts and arranges an interview with the CAC according to the local memorandum of understanding and working protocol. The interview by the CAC should be coordinated to take place within investigation time frames.

If an interview at the CAC cannot be secured within mandated time frames, the investigator must make the initial face-to-face contact to confirm the child’s safety, without addressing the serious allegations with the child. The investigator follows local CAC procedures to coordinate the in-depth interview regarding the specific allegations.

3224.4 Intakes That Do Not Allege Sexual Abuse (SXAB) or Serious Physical Injury as a Result of Physical Abuse (PHAB) or Neglect (NEGL)

APS Provider Investigations April 2017

If the allegations in the intake do not indicate sexual abuse or serious physical injury as a result of physical abuse or neglect, the investigator conducts the face-to-face interview within mandatory time frames.

If the child makes an outcry of sexual abuse or serious injury as a result of physical abuse or neglect during the initial face-to-face interview, the investigator concludes the interview at a natural conclusion point without addressing the serious allegations. The investigator then either:

  •  coordinates an interview with the CAC if the sexual abuse or serious physical injury is related to the current allegation; or

  •  follows policy in 3210 Review the Intake if the outcry is not related to the current allegation.

See:

2400 Children’s Advocacy Centers (CACs)

3210 Review the Intake

3224.2 Interviewing Children in any Setting

3224.5 Coordinating Interviews with Children’s Advocacy Centers

APS Provider Investigations April 2017

The investigator contacts and coordinates interviews with the local children’s advocacy center (CAC) according to the established agreement between the district APS and local CAC.

See 2400 Children’s Advocacy Centers (CACs).

3224.6 Interviewing Children at Public School

APS Provider Investigations April 2017

If the responsible party is at the school when the investigator visits to conduct the interview, the investigator obtains consent from the responsible party to interview the child.

If the responsible party is not at the school with the child, the investigator may interview the child if:

  •   the child attends a school under the jurisdiction of the Texas Education Agency; and

  •   the parent has not already refused consent.

3224.61 Notifying the Responsible Party of an Interview Conducted at School

If the child resides in a facility or group home, the provider is responsible for informing the responsible party of the APS PI interview.

If the child resides in a private residence, the investigator notifies the child’s responsible party by telephone of the interview within 24 hours of the interview.

The investigator:

  •  determines the responsible party’s contact information from appropriate sources, including the provider, IMPACT, school personnel, or CPS;

  •  contacts the responsible party by telephone and notifies him or her of the interview with the child; and

  •  documents the contact in IMPACT using a contact narrative.

See:

3224.7 Interviewing Children Residing in a Facility or Group Home

3224.8 Interviewing Children in a Private Residence

3224.7 Interviewing Children Residing in a Facility or Group Home

APS Provider Investigations April 2017

The investigator considers both the child’s residence and location of the interview when interviewing a child.

The investigator may interview, inspect, and photograph the child if:

  •   the child resides in a facility or group home;

  •   the interview is conducted on the provider’s property; and

  •   the responsible party has not already refused consent.

It is the provider’s responsibility to notify the child’s responsible party about the child’s involvement in an APS investigation. If the responsible party has notified the provider that the child cannot be interviewed, inspected, or photographed without his or her consent, it is the provider’s responsibility to notify the investigator. The investigator then coordinates with the responsible party. Even with the responsible party’s consent, the investigator must not proceed with the interview, inspection, or photography if the child objects.

3224.8 Interviewing Children in a Private Residence
3224.81 Consent to Interview a Child in a Private Residence

APS Provider Investigations April 2017

The Fourth Amendment of the U.S. Constitution requires that, in order to enter a residence or interview a child in a private residence, the investigator must have consent from the responsible party. Even with the responsible party’s consent, the investigator must not continue with the interview if the child objects.

3224.82 Consent to Visual Inspection or Photographs in a Private Residence

APS Provider Investigations April 2017

The investigator must have consent from the responsible party to conduct a visual inspection of the child or take photographs of the child. Even with the responsible party’s consent, the investigator must not continue with the inspection or photographs if the child objects.

3224.83 Refusal to Allow a Child to be Interviewed in a Private Residence

APS Provider Investigations April 2017

The investigator cannot interview the child if the responsible party refuses to grant consent for the interview in a private residence. Even if the responsible party has granted consent, the investigator cannot interview the child once the responsible party has revoked consent. If the investigator did not obtain prior consent to interview the child because the interview took place at a public school, the investigator cannot interview the child in his or her private residence without the responsible party’s consent.

3224.84 Refusal to Allow a Child to be Visually Inspected or Photographed in a Private Residence

APS Provider Investigations April 2017

The investigator cannot visually inspect or photograph the child if the responsible party refuses to grant consent for the inspection or photography in a private residence. Even if the responsible party has granted consent, the investigator cannot inspect or photograph the child once the responsible party has revoked consent. If the investigator did not obtain prior consent to inspect or photograph the child because the inspection and photography took place at a public school, the investigator cannot inspect or photograph the child in his or her private residence without the responsible party’s consent.

3224.85 Documentation of Consent or Refusal

APS Provider Investigations April 2017

The investigator documents the responsible party’s consent or refusal in a Contact Detail narrative.

3225 Investigative Procedure for SSLCs, the Rio Grande State Center’s ICF/IID, and Other ICF Facilities (Local Authorities and Community Centers)

3225.1 Commencement Checklist in an SSLC and ICF/IID

APS Provider Investigations April 2017

For investigations conducted in state supported living centers (SSLCs) or the Rio Grande State Center’s ICF/IID, the investigator or designee documents in the APS Facility 24-Hour Commencement Checklist (generated in the IMPACT system) and in the accompanying case narrative any casework conducted in the first 24 hours after an intake.

The checklist and accompanying case narrative explain the casework and planning necessary to initiate an investigation in a timely manner.

Filling out the checklist ensures that certain actions are completed as required within the first 24 hours after receiving an intake.

The investigator or designee documents successful contacts and attempted contacts.

See:

3180 Commencement Activities Required in SSLCs and the Rio Grande State Center’s ICF/IID

3182 Actions Required Within 24 Hours After SWI Receives an Intake

3225.11 Include the Commencement Checklist in the Case Documentation

APS Provider Investigations April 2017

The investigator includes a copy of the completed APS Facility 24-Hour Commencement Checklist in the case folder, as documentation, directly behind the investigative report that is sent to the facility, the HHSC Office of the Inspector General, law enforcement, and DADS state office. The checklist is generated in IMPACT.

3225.12 Initial Face-to-Face Requirements in SSLCs and the Rio Grande State Center’s ICF/IID

APS Provider Investigations April 2017

Investigators should make every effort to initiate a face-to-face contact with an individual receiving services in an SSLC or the Rio Grande State Center’s ICF/IID as soon as possible after receiving the intake. An investigator must see or attempt to see an individual receiving services within 24 hours or three calendar days in all SSLC investigations depending upon the priority.

3225.2 Clinician in SSLC or State Hospital Requests That APS Not Interview an Individual Receiving Services

APS Provider Investigations April 2017

There may be rare circumstances in which a psychologist, physician, or psychiatrist working in a state hospital, state supported living center, or the Rio Grande State Center’s ICF/IID requests that APS PI not interview an individual receiving services because of the individual’s mental state. This may occur because the clinician believes that the individual receiving services will suffer a significant negative outcome if APS PI interviews the individual about abuse, neglect, or exploitation.

In these instances, the investigator speaks to the administrator and the facility medical director to ensure that all parties at the facility agree with the clinician’s recommendations. The investigator obtains a written statement from the clinician making the request, outlining why it is not advisable for APS PI to interview the individual receiving services.

A statement must be obtained from the clinician for each intake that meets the definition of abuse, neglect, or exploitation. Investigators follow all other policies related to interviewing other witnesses in order to gather information about the allegations.

This is not a streamlined investigation as described in 3800 Streamlined Investigations in All Settings and does not apply in any other settings that are investigated by APS PI.

IMPACT Documentation

If the alleged victim is not interviewed based on the clinician’s recommendations, the investigator enters a face-to-face contact and documents that the alleged victim was not interviewed because the clinician determined it would be harmful to the victim.

3225.3 Facility Liaison in an SSLC, State Hospital, Rio Grande State Center’s ICF/IID, LIDDA, LMHA, or Community Center

APS Provider Investigations April 2017

The administrator of any of the following entities designates a staff person to serve as a liaison:

  •   State hospital

  •   State supported living center (SSLC)

  •   Rio Grande State Center’s ICF/IID

  •   Local authority

  •   Community center

The facility liaison may assist the investigator in collecting copies of external documentation and coordinating interviews with collaterals.

The investigator is responsible for assuring the integrity of the evidence. The investigator is also responsible for ensuring that all necessary documentation has been collected. If the investigator encounters difficulty obtaining cooperation, see 6200 Cooperation With Investigative Services.

3226 Five-Day Status Report in ICF/IID Investigations

APS Provider Investigations April 2017

When the investigator conducts an investigation in an SSLC, Rio Grande State Center’s ICF/IID, licensed ICF/IID, LIDDA, or LMHA (community center) that is considered an ICF/IID, the investigator:

  •  launches the Adult Protective Services ICF/IID Provider Investigative Report (Five-Day Status Report) in the IMPACT system; and

  •  ensures the report is received by the provider’s administrator no later than 5 p.m. on the fifth business day following the date of intake.

The investigator must include documentation in the case file supporting that the ICF/IID Provider Investigative Report (Five-Day Status Report) was delivered to the provider. Documentation may include:

  •  a copy of the fax receipt; and

  •  an Administrative Note listing the date and time of the delivery and the name of person who received the report.

Meeting the Deadline

The investigator completes interviews with the alleged victim, alleged perpetrator, and witnesses as soon as possible to meet the deadline for completing the status report. If the investigator experiences difficulty in having staff available for interviews or accessing records, he or she notifies the administrator or facility liaison for assistance.

Calculating the Deadline

When counting days, the day of the intake is day 0. The day following the intake is day 1.

For example, an intake is received by APS on Monday at 4 p.m. Day 1 is Tuesday and Day 5 is Saturday. Since Saturday and Sunday are not work days, the report to the administrator is due on Monday, the fifth work day, by 5 p.m.

3227 Investigative Procedures for Community Provider Investigations

3227.1 Establish the Link Between Victim and Direct Provider

APS Provider Investigations November 2017

The direct provider must be the person providing services to the victim during the alleged incident in order to be considered as an alleged perpetrator. 

For example, a HCSSA employee provides services to an individual from 8AM to 10AM every other day. One day during her shift, she slaps the individual. SWI receives a report alleging physical abuse by a direct provider. In this case, the HCSSA employee was providing services to the victim at the time of the alleged incident. Provider Investigations would investigate this as an allegation of physical abuse.

In another example, a HCSSA employee works for Company A – which makes her a direct provider. An individual is receiving provider services from Company B – which makes him an individual receiving services. One day, the Company A employee visits the individual receiving services from Company B, because the employee who worked for Company A used to work for the individual. During the visit, she and the former client get into an argument. The Company A employee slaps him. SWI receives a report alleging physical abuse by the HCSSA employee. In this case, the Company A employee was not actively providing services to her former client at the time of the alleged incident. Even though her former client is an individual receiving services, APS PI would not investigate the allegation of physical abuse. See 3121 Notification to Law Enforcement.

3227.2 Permission to Enter a Private Residence

APS Provider Investigations November 2017

The investigator must obtain permission either from the individual receiving services or a family member before entering a private residence. If the individual receiving services is a child, he or she cannot grant or revoke the investigator’s permission to enter. The investigator must not remain in the home if permission is revoked after it was initially granted regardless of who revokes permission. The investigator may attempt to use verbal persuasion to gain entry or remain in the home, but if this is unsuccessful, the investigator must leave.

If the investigator is unable to successfully enter the home, the investigator consults with the supervisor to determine whether it is appropriate to ask the provider for assistance.

Law enforcement may be present as a safety precaution for the investigator at the time that the alleged victim or another person refuses entry or asks the investigator to leave the home.

See:

1460 Allegations of Abuse, Neglect, and Exploitation on an Indian Reservation

See Appendix VI: Investigator Safety.

3227.3 Allegations of Abuse, Neglect, or Exploitation Committed Outside Regularly Scheduled Provider Hours

APS Provider Investigations November 2017

When an intake alleges a provider committed abuse, neglect, or exploitation outside regularly scheduled provider hours, the investigator conducts the investigation in the same manner as if the allegation occurred during regularly scheduled provider hours.

A direct provider is held to a higher standard of behavior and is subject to a provider investigation. The investigator notifies the provider of the allegation and sends a final investigative report to ensure adequate protections are in place for the individual receiving services.

Allegations with a confirmed finding that rise to the level of reportable conduct will be subject to the Employee Misconduct Registry process.

3227.4 Allegations of Exploitation

APS Provider Investigations November 2017

In a community provider setting, exploitation is defined as:

  •   the illegal or improper act or process of using or attempting to use an individual receiving services or the resources of an individual receiving services for monetary or personal benefit, profit, or gain; and

  •   theft as defined in Chapter 31 of the Texas Penal Code.

Resources include:

  •   cash;

  •   money from checking or savings accounts;

  •   medication prescribed to an individual receiving services;

  •   certificates of deposit or other interest-earning or investment accounts; and

  •   credit, debit, or other electronic benefits such as a food stamp card.

Property may also be considered a resource if it has monetary value from which the alleged perpetrator derives personal benefit, profit, or gain.

See:

2300 Examples of Abuse, Neglect, or Exploitation

4323 Elements of the Definition of Exploitation.

3228 Investigating Exploitation Allegations Involving Loans

APS Provider Investigations April 2017

Alleged Victim Makes a Loan to a Direct Provider Who Only has a Contractual Relationship with the Alleged Victim

When the alleged perpetrator is a person, employee, agent, contractor, or subcontractor with no other relationship to the individual than his or her employment, the investigator:

  •   considers an abbreviated investigation when the loan has been repaid in full before APS involvement; and

  •   conducts a full investigation when:

  •   the loan has not been repaid, or

  •   the loan has only partially been repaid.

The investigator asks investigative questions to help determine whether the loan was illegal or improper. Questions may include but are not limited to:

  •  Was there an expectation of repayment?

  •  Was there an agreed upon schedule for repayment?

  •  Who suggested the loan?

  •  Who else is aware of the loan?

  •  Who benefits from the loan?

  •  Was the individual receiving services coerced into making the loan?

  •   Are there provider rules, policies, or procedures in place instructing the alleged perpetrator not to borrow money from the alleged victim?

  •   Does the alleged victim have a supported decision maker to help him or her make appropriate financial decisions?

  •  Does the alleged victim have a diagnosis from a physician that indicates he or she is incapable of understanding the transaction?

  •  Does the alleged victim have other legal restrictions in place (such as a power of attorney or guardianship) that would prevent him or her from making such a transaction?

Alleged Victim Makes a Loan to a Direct Provider who is also a Family Member or has an Ongoing Relationship

When the alleged perpetrator is a family member or has an ongoing relationship with the individual, the investigator:

  •   considers an abbreviated investigation when:

  •   the loan has been repaid in full, or

  •   there is a history of similar financial transactions regardless of whether the loan has been repaid; and

  •   conducts a full investigation when:

  •   there is no history of similar financial transactions, and

  •   the loan has not been fully repaid.

See 9600 Identifying and Reporting Abuse, Neglect, and Exploitation.

3229 Exploitation Allegations and Medicaid Fraud

APS Provider Investigations April 2017

Failure of an HCSSA employee to show up for his or her assigned hours is not exploitation by the employee, but it may be Medicaid fraud if the APS investigator determines that:

  •  Medicaid is the payer source for the HCSSA services; and

  •  the direct provider misrepresented or the direct provider and the individual receiving services colluded to misrepresent the number of hours that the paid caretaker worked.

The APS investigator:

  •  reports the information to the HCSSA;

  •  reports the information to the HHSC Office of the Inspector General;

  •  follows policy related to a partial referral regarding the possible fraud in 3211 Determine Whether a Partial or Full Referral Is Appropriate; and

  •  investigates any allegation of neglect that may have occurred as a result of inadequate, delayed, or lack of services.

See:

1200 Definitions

1320 APS In-Home Jurisdiction

9600 Identifying and Reporting Abuse, Neglect, and Exploitation

3300 Collecting Testimonial Evidence

3310 Conducting Face-to-Face Interviews

APS Provider Investigations April 2017

Initial Face-to-Face Interviews

The investigator conducts unannounced or scheduled face-to-face interviews with the alleged victim and alleged perpetrator as soon as possible after receiving the intake. Although not always possible, unannounced interviews are preferable to minimize collusion among the people to be interviewed.

Individuals Who Can Be Present in Interviews

The investigator conducts one-on-one interviews, when possible. Under certain circumstances, the investigator may allow a person other than the interviewee to be present during the interview. However, the investigator must ensure that the other person is not involved in the investigation and will not influence the interviewee’s testimony.

The circumstances under which another person may be present during an interview include:

  •  when an individual receiving services requests the presence of another person;

  •  when an individual receiving services’ legal guardian asks to be present; or

  •  when the interviewee is in the custody of law enforcement.

The investigator must allow an individual to be present during the interview under the following circumstances:

  •  If an individual receiving services is on one-on-one supervision, a staff person who is not involved in the investigation must also be present during the interview. The investigator must not take on the responsibility of supervising the individual receiving services.

  •  The investigator requests the services of an interpreter. An interpreter is used when the interviewee does not speak English, has limited English proficiency, or has an impairment that affects his or her ability to communicate.

See:

1510 Who May Provide Interpreter Services

1520 Cost of Services

1530 Methods of Communicating

1540 Confidentiality

3224.2 Interviewing Children in any Setting

3320 Conducting Telephone Interviews

APS Provider Investigations April 2017

Interviewing Collaterals

The investigator may conduct telephone interviews with collateral witnesses in all provider settings, except state supported living centers and state hospitals, with supervisor approval.

Interviewing Persons Who Have Relocated Out of State

A face-to-face interview may not be practical if an individual receiving services, alleged perpetrator, or collateral witness has relocated out of state. The investigator obtains supervisory approval to conduct a telephone interview. Supervisory approval is required to determine whether the cost of interviewing a person who lives out of state is warranted, or if there is a more fiscally sound way to conduct the interview.

The investigator documents the supervisory approval as an investigator note under the contact narrative or under the administrative/procedural portion of the final investigative report.

Supervisory approval for not conducting a face-to-face interview is required only when the person has relocated out of state.

Documenting a Telephone Interview in IMPACT

The investigator:

  •  enters the telephone interview contact on the Contact Detail page in IMPACT;

  •  selects contact from the drop down window;

  •  selects assessment as the purpose of the interview;

  •  selects telephone call as the method of the interview;

  •  selects the name of the collateral interviewed from the principals/collaterals contacted list; and

  •  saves the contact.

After saving the contact, the investigator:

  •  selects the narrative button on the Contact Detail page;

  •  summarizes the interview in the contact narrative window; and

  •  saves the contact narrative.

The investigator documents the telephone interview in a blank contact narrative. The investigator documents each contact separately and includes the date, time, location, method, and purpose. The investigator selects only the name of the person contacted. The investigator enters a narrative summarizing the information obtained.

If the investigator determines the telephone interview is not sufficient to answer all investigatory questions, he or she may schedule a face-to-face interview with the collateral witness.

See 3310 Conducting Face-to-Face Interviews.

3330 Interviewing Individuals

3331 Interviewing Persons Who Have Relocated In Texas

APS Provider Investigations April 2017

When an individual receiving services, alleged perpetrator, or collateral witness has relocated to another district in Texas and is not available for a face-to-face interview, the primary investigator may request assistance from a secondary investigator in that district. Collateral witnesses may also be interviewed by telephone with supervisory approval. See 3320 Conducting Telephone Interviews.

The secondary investigator provides assistance by:

  •  conducting interviews;

  •  taking statements;

  •  taking photographs;

  •  researching records; or

  •  providing other assistance as needed.

To request the assistance of a secondary investigator, the primary investigator or the investigator’s supervisor contacts the supervisor or the supervisor’s designee in the appropriate APS office. During the initial contact, both parties establish a timeline for completion of the assistance needed.

Once the secondary investigator has been identified, the primary investigator assigns the case to the secondary investigator.

The secondary investigator:

  •  documents case contacts in the IMPACT system; and

  •  provides the primary investigator with written statements and photographs, as appropriate.

3332 Interviewing Reporters

APS Provider Investigations April 2017

The investigator must interview the reporter in each investigation.

During the interview, the investigator:

  •  obtains a home address for the reporter whenever possible; and

  •  explains that a letter (Form 2313 Notification to Reporter) will be sent from DFPS to the reporter at the conclusion of the investigation.

After the interview, the investigator enters the reporter’s home address on the Person Detail page in IMPACT.

See:

2311 The Reporter

3342.3 Witnesses Who Have Direct Knowledge

3342.6 Witnesses Who May Give Circumstantial Evidence

3333 Interviewing Video Surveillance Monitors

APS Provider Investigations April 2017

If an employee reports an incident in his or her role as a video surveillance monitor, the investigator interviews the employee to determine whether he or she has any additional information.

The investigator uses discretion in determining whether a written statement is also required.

A written statement is not required, if:

  •  the video is clearly viewable and depicts the incident;

  •  the identities of the parties shown are known;

  •  the video can be summarized by the investigator; and

  •  the employee has no other information beyond what was seen on the video.

See:

3352 Employees Requesting Anonymity

3540 Video Surveillance

3334 Interviewing Wards of the State

APS Provider Investigations April 2017

A ward of the state is a person who has a court-appointed guardian. The investigator interviews a ward when the ward has direct or circumstantial knowledge about an allegation.

If the investigator is denied access to a ward, the investigator consults with his or her supervisor, APS district director (or a designee), and the APS regional attorney.

It is the provider’s responsibility to notify the ward’s guardian about the ward’s involvement in an APS investigation. If a guardian has notified the provider that the ward cannot be interviewed without the guardian’s consent, it is the provider’s responsibility to notify the investigator; the investigator then contacts the guardian to arrange for the interview.

APS may permit a guardian to be present during an interview of the guardian’s ward. Circumstances to consider include whether the guardian:

  •   is an alleged perpetrator or a collateral witness; or

  •   may have motive to influence the ward’s testimony.

The investigator requests that the guardian refrain from responding to interview questions, unless the guardian is directly responsible for interpreting or assisting the investigator with communication.

3335 Planning the Interview

APS Provider Investigations April 2017

Before an interview begins, the investigator must have the goals for it clearly in mind.

The investigator’s general goals are to:

  •  create an atmosphere of trust and cooperation;

  •  determine the interviewee’s opportunity to have gained knowledge of the incident;

  •  ask each of the investigative questions that the investigator believes the interviewee can answer;

  •  maintain control of the interview, keeping it focused on the incident and resisting any effort by the interviewee to:

  •  distract the investigator,

  •  change the subject, or

  •  characterize events or conditions, such as by stating, “We used proper PMAB (Prevention and Management of Aggressive Behavior)”orHe looked okay,” rather than describing the events or conditions in concrete, behavioral terms; and

  •  lead the interviewee through the incident in a systematic way, so that the interviewee’s written statement contains as full and as detailed an account as possible.

The investigator may prepare questions in advance, as an aid to accomplishing the interview goals. Time must also be spent anticipating possible obstacles to getting information from a particular interviewee.

Possible obstacles could include:

  •  the interviewee’s limited English proficiency;

  •  the interviewee’s emotional or psychological state;

  •  the interviewee’s possible motives to misrepresent what happened;

  •  cultural differences;

  •  the investigator’s own assumptions or lack of background knowledge; or

  •  distractions in the interview environment.

To the extent possible, the investigator develops strategies to overcome the anticipated obstacles, such as:

  •  changing the location of the interview;

  •  learning more about:

  •  the interviewee’s culture,

  •  the interviewee’s history, behavior, condition, or communication style, and

  •  the technical aspects of the case (daily routines, side effects of medication, symptoms of particular disorders, a particular individual receiving services’ behavior plan, and so on); and

  •  considering what form a particular interviewee’s resistance might take and what interview approach would be most likely to neutralize it.

3335.1 Structure of the Interview

APS Provider Investigations April 2017

A typical interview has five phases:

1.   The opening

  •   Purpose: to introduce oneself, build rapport, and explain the investigative process.

2.   The free narrative

  •   Purpose: to get a free-flowing, but detailed account of the incident.

3.   The assisted narrative

  •   Purpose: to go through the incident again step by step, in an effort to produce as much detail as the interviewee can recall through prompts, probing questions, and requests for clarification.

4.   The statement

  •   Purpose: to record on paper or electronically the full account of the incident produced in the assisted narrative.

5.   The closing

  •   Purpose: to answer the interviewee’s questions and address concerns, thank the interviewee for his or her time, and apprise him or her of the need for confidentiality.

3335.2 Answering the Investigative Questions

APS Provider Investigations November 2017

During the assisted narrative and while taking the statement, the investigator seeks answers to the specific investigative questions he or she has formulated to guide the investigation:

Category

Questions to Ask

Who

Who were the persons involved, including all witnesses (both staff and individuals receiving services) or any other persons who may have knowledge of the incident?

What

  •   Specifically, what occurred?

  •   What caused the incident?

  •   What are the circumstances surrounding the incident?

  •   What intentions did people involved in the incident have?

  •   What was the severity and type of injury sustained?

  •   What was the sequence of events?

  •   What objects, instruments, or procedures were used?

  •   What training, policy, procedure, or rule governed the behavior?

  •   What was the responsibility of the staff members involved?

  •   What was the understanding of the staff member regarding his or her responsibility?

  •   What action should the employee have taken in the circumstances surrounding the incident?

  •   What action did the expert recommend the employee take in the circumstances surrounding the incident?

  •   Was there a staff shortage or special circumstances surrounding the incident?

When

  •   When did the incident occur?

  •   If it has been recurring, when and how often has it been observed?

  •   When was it discovered?

  •   When was it reported?

  •   When was the alleged victim treated for any injuries?

Where

  •   Where did the incident occur?

  •   Where was the victim found?

  •   Where was the evidence (if any) found?

  •   Where were the witnesses when the incident occurred?

  •   Where was the alleged perpetrator when the incident occurred?

Why

Why did the people involved do what they did that resulted in abuse, neglect, or exploitation?

How

  •   How was the incident discovered?

  •   How did the reporter know that the incident occurred?

  •   How was the victim injured?

  •   How did the alleged perpetrator react?

  •   How did the witnesses react?

IMPACT Documentation

The investigator documents contacts with the victim, alleged perpetrator, and collateral witnesses. The investigator documents each contact separately and includes the date, time, location, method, and purpose. The investigator selects only the name of the person contacted. The investigator makes an electronic record of the interview. All interviews are typed into Mobile Protective Services (MPS) and uploaded into IMPACT. Contact narratives should not be documented directly on the Provider Abuse and Neglect Investigative Report.

See 3342 Obtaining Statements.

3335.3 Witness’s Opportunity to See or Hear the Incident

APS Provider Investigations April 2017

During the phases of the interview that involve the assisted narrative and taking statements, the investigator determines how the witness came by the knowledge he or she claims to have. The witness’s statement should make clear what opportunity he or she had to see or hear the incident. When determining the witness’s opportunity for knowledge, the investigator considers whether the witness:

  •  was present at the scene; and

  •  was close enough to see the incident occur.

Presence at the Scene

Was the witness present at the scene of the incident?

Proximity to and Ability to Perceive the Incident

  •  What was the location of the witness in relation to the victim, alleged perpetrator, and any other witnesses present during the incident?

  •  What direction was he or she facing?

  •  Did furniture, structures, or people moving in or out of the area interfere with his or her ability to see what happened?

  •  Diagrams created during the interview may assist the investigator in determining if the witness was in a position to know what he or she has stated.

3340 Analysis of Evidence During Investigation

APS Provider Investigations November 2017

Analysis is not an activity that begins after all evidence has been collected; it is part of the investigation process. During the investigation, the investigator interviews witnesses, examines documents, and views incident scenes. He or she analyzes the evidence and considers the applicable definition elements to determine whether the evidence:

  •   corroborates or contradicts evidence already collected;

  •   answers the investigative questions posed by the allegation;

  •   is sufficient to reach a preponderance; or

  •   indicates a need for further investigation.

Organizing evidence is an indispensable step in analyzing it. The investigator uses a variety of methods, including charts and diagrams, to sort, represent, and display the evidence. These methods help the investigator:

  •   review the evidence systematically; and

  •   plan the rest of the investigation.

See 4320 Elements of the Definitions of Abuse, Neglect, and Exploitation.

3341 Assessing Credibility During Interviews

APS Provider Investigations April 2017

Many factors can cause a person to be inaccurate or untruthful in an interview. A conscious effort to lie is only one such factor. Ordinary forgetfulness, lack of opportunity to see or hear events clearly, mental or physical disability, and conscious or unconscious bias can also limit a witness’s ability or willingness to accurately:

  •  perceive;

  •  remember; and

  •  report an incident.

As an investigator conducts interviews, he or she asks questions aimed at identifying possible causes of inaccuracy. The investigator is also alert to verbal and nonverbal signs of deception, emotion, and impairment.

3341.1 Influences on Testimony Affecting Credibility

APS Provider Investigations April 2017

Persons giving testimony about possible abuse, neglect, or exploitation may have strong feelings about other people in the case or about how the outcome of the investigation could affect them.

When analyzing the evidence (as well as during the interview process), the investigator evaluates possible influences on witness testimony. The investigator considers relationships, vested interests, collusion, and memory.

Witness’s Relationships

  •  Is there a family, friendship, or business connection between any of the witnesses?

  •  Does the witness feel solidarity with the victim or alleged perpetrator?

  •  Is the alleged perpetrator the witness’s supervisor or supervisee?

  •  Does the witness have attitudes toward others in the case based on their race, ethnicity, religion, gender, age, disability, sexual preference, or other attributes?

  •  Is there a history or indication of personal conflict between any witnesses?

Witness’s Self-Interest

Is any witness:

  •  fearing retaliation or disciplinary action for failure to notice, prevent, or report the incident, or job loss because of a confirmed finding;

  •  attempting to conceal other behavior that could get him or her in trouble;

  •  hesitating to admit he or she lacks knowledge; or

  •  concealing evidence of abuse to ensure that coworkers will continue to help him or her the next time a restraint or takedown is necessary?

Possible Collusion

If witnesses have discussed the case together, they may have influenced each other’s testimony, if only unintentionally.

Witnesses are influenced by what other people say and may believe they actually saw or heard something they heard about second-hand. Witnesses who are employees may also agree to lie to protect a coworker. Collusion may be evident as an artificial sameness in the way different persons describe an event.

Fading Memory

The ability of a witness to recall events with accuracy diminishes over time, especially during the first day or two after the incident. Some discrepancies among witnesses to a complex incident are normal and to be expected.

A witness may claim to be unable to remember an incident to avoid answering questions about it.

3341.2 Deception

APS Provider Investigations April 2017

Many people believe they can tell when a person is lying by applying one or more rules of thumb. They may believe, for example, that deceptive persons fail to maintain eye contact, stammer, show nervous agitation, or display some other tell-tale behavior. However, without specialized training and practice, the average person is unable to reliably distinguish liars from truth-tellers.

Behaviors related to the rules of thumb are highly variable by circumstance, by culture, and by individual temperament. Only by identifying baseline behavior for a given person, and comparing it to behavior when crucial questions are asked, can an investigator reliably detect deception.

Even when the investigator has skill at detecting deception and is strongly confident that a given person has lied, he or she verifies impressions by seeking evidence to prove or disprove the claims made.

3341.3 Confronting Discrepancies

APS Provider Investigations April 2017

A statement that is inaccurate, no matter what the cause, contains discrepancies. The discrepancies may be between:

  •  statements given by different people;

  •  different parts of the same statement;

  •  statements given by the same person at different times;

  •  the statement and physical, demonstrative, or documentary evidence;

  •  the person’s words and his or her manner of testifying, such as body language, tone of voice, and facial expressions; or

  •  the person’s description of someone’s actions and common sense, as when the action has no recognizable motivation or is different from what the person normally does under similar circumstances.

An investigator may confront witnesses about such discrepancies in an effort to:

  •  reconcile the differing pieces of evidence to clarify previous testimony; or

  •  make a deceptive person realize that his or her lie has failed and that the person now has an opportunity to correct the original statement.

Confrontation is not a use of physical, psychological, or emotional force. Investigators maintain a respectful, calm demeanor. An investigator does not:

  •  make threats or promise rewards, even by implication; or

  •  intrude on a witness’s personal space.

An investigator simply:

  •  points out the discrepancy;

  •  asks for an explanation; and

  •  offers a chance to set the record straight.

The investigator takes a new statement each time a person is interviewed. All statements must be included in the report. If they differ, the analysis must say which statement is more credible and why.

3342 Obtaining Statements

APS Provider Investigations November 2017

A statement may be obtained even if a person states that he or she has no knowledge of the incident. If evidence suggests that the person interviewed should have observed something or had knowledge of the incident, a statement is taken documenting that the person interviewed knew nothing about the incident. The investigator uses his or her judgment to decide whether to forgo interviews with potential witnesses once the evidence gathered establishes a preponderance.

3342.1 Procedures for Obtaining Electronic Statements

APS Provider Investigations November 2017

After conducting an interview the investigator enters the statement either in IMPACT or Mobile Protective Services (MPS). The investigator requests a policy exception from his or her supervisor if MPS or IMPACT is not available.

The statement:

  •   contains the language of the witness; and

  •   is signed by the investigator, the person interviewed, and third party (if appropriate). Though a statement is best documented in the words of the person interviewed, a question and answer format may be best when interviewing an individual receiving services.

IMPACT Documentation

The investigator documents contacts with the victim, alleged perpetrator, and collateral witnesses, as necessary. The investigator documents each contact separately and includes the date, time, location, method, and purpose of the contact. The investigator selects only the name of the person contacted. The investigator makes an electronic record of the interview.

All interviews are entered into a Provider Statement Form located either in IMPACT or Mobile Protective Services (MPS) and uploaded into IMPACT. Contact narratives should not be documented directly on the Provider Abuse and Neglect Investigative Report.

3342.11 Policy Exceptions

APS Provider Investigations April 2017

Under certain circumstances, a supervisor may grant approval for a statement to be documented using either the electronic Word version of the Provider Statement Form or a paper statement (Form 2314 Provider Investigations Statement and Form 2315 Provider Investigations Statement Continuation).

Policy exceptions for using either the approved version of the statement form or a paper statement include:

  •  the individual receiving services or collateral witnesses who are not staff and who have the right to refuse an electronic statement. For example, documented or discovered concerns or fears of technology (applies only to individual receiving services and non-staff collaterals);

  •  intake received and unable to sync or check out cases in MPS;

  •  courtesy interviews;

  •  documented or discovered aggression, violence, increased level of supervision, or danger to self or others by the person being interviewed;

  •  incarceration (follow rules of the jail or prison); or

  •  the investigator suffers an injury that prohibits use of Tablet PC, laptop, or keyboard.

The original statement form is entered into External Documentation and is attached as an exhibit in the case. The investigator documents the reason for the exception in an Investigator’s Note or documents the exception in the Contact Detail narrative.

Form 2314 Provider Investigations Statement (page 1)

Form 2315 Provider Investigations Statement Continuation (page 2)

Instructions for using electronic statement forms in MPS are located in Appendix III: Using the Tablet PC for Obtaining and Storing Statements and Diagrams.

Paper statement forms must be filled out according to the instructions (see Form 2314-15i).

3342.12 Interviews Conducted in Language Other Than English

APS Provider Investigations April 2017

When interviews are conducted and documented in a language other than English, the English translation is typed in a Contact Detail Narrative that is created with a Contact Date/Time that coincides with the Date/Time of the interview. For example, if the interview occurs on 1/1/12 at 2:00 p.m., the investigator adds a contact for 1/1/12 at 2:01 p.m. The narrative containing the translation is pulled into the Provider Abuse and Neglect Report, appearing in chronological order beneath the original statement.

3342.13 Obtaining Statements Using Mobile Protective Services (MPS)

APS Provider Investigations April 2017

The investigator uses MPS to check cases out of IMPACT. Electronic statement forms are created by clicking on the Contact Type drop-down box on the Contact Detail page and selecting APS Provider Investigations Statement.

The investigator conducts the interview and types the interviewed person’s statement in the narrative portion of the electronic statement form. Before signing the statement form, the investigator performs a spell check and verifies content is correct. After the review is complete, the investigator types in the address, phone, shift, location, Medicaid or Social Security number, and other applicable information.

3342.14 Obtaining Signatures on Electronic Statement Forms in MPS

APS Provider Investigations April 2017

To sign the electronic statement form, the investigator clicks the pen icon located in the signature block and directs the interviewee to the signature box. The interviewee writes his or her signature on the tablet using the stylus. The procedure is followed by the third party if one is present.

After the form is completed, reviewed, and signed by, or in the presence of, the interviewee, the investigator signs the form. After signing the form, the investigator selects Save and Close. The statement is saved in the presence of the witness in a format that cannot be altered.

The form locks automatically when the investigator signs and selects Save and Close. A new statement form must be completed when additional information obtained after the completion of the statement form or interview alters the meaning of the statement in any way.

3342.15 Ensuring Integrity and Security of Electronic Signatures

APS Provider Investigations April 2017

A witness’s signature must not be altered or copied and pasted onto any other documents. It is the responsibility of the investigator to ensure the integrity and security of the statement, including the signatures.

3342.16 How to Synchronize an Electronic Device in a Mobile Environment

APS Provider Investigations April 2017

The investigator syncs his or her electronic device to ensure case information is uploaded and current in IMPACT. Syncing may be performed via high speed secure internet connections in the office, at home, or in a facility or provider agency. A secure wireless connection may also be used, if connectivity is strong.

3342.2 Witnesses Who Have Direct Knowledge

APS Provider Investigations November 2017

A person may have information relevant to the investigation without having been a direct witness to the abuse or neglect. For example, Prevention and Management of Aggressive Behavior (PMAB) instructors, other trainers, dieticians, psychologists, or psychiatrists may know about clinical issues or policies that are relevant to the allegations. Another example would be a person who had opportunity to observe an incident in a public location.

The investigator may take a statement from witnesses who have or should have:

  •   firsthand or direct knowledge of the incident; or

  •   direct knowledge or information pertaining to:

  •   the individual’s treatment; or

  •   policies relevant to the allegations being investigated.

The investigator:

  •   ensures that all relevant information obtained during an interview is included in the statement; and

  •   documents in the investigator’s notes any information that the witness shares in the interview but refuses to put in writing.

If the interview establishes that witness has no knowledge of the incident, the investigator is not required to obtain a statement. Instead, the investigator documents a summary of the interview in a Contact Narrative.

See 3320 Conducting Telephone Interviews.

3342.3 Witnesses and Principals Who Request to Record Interviews

APS Provider Investigations April 2017

If a collateral witness or principal requests to record the interview with the investigator, the investigator informs the witness or principal that the interview will not continue if the interviewee insists on recording it. If the interviewee is a provider employee, the investigator may remind the interviewee of his or her responsibility to cooperate with the investigation. If the interviewee continues to insist on recording the interview, the investigator terminates the interview and documents the interaction in IMPACT. If the interviewee terminates the interview, the investigator documents the refusal in IMPACT.

3342.4 Witnesses Who Refuse to Cooperate With the Interview

APS Provider Investigations April 2017

If a witness with direct knowledge refuses to be interviewed or to give a statement, the investigator documents the witness’s refusal in IMPACT. A supervisory consult is not required when a witness refuses to be interviewed or give a statement.

If a provider employee refuses to participate in an interview, the investigator contacts the facility liaison or provider agency for assistance. The investigator documents refusal of an employee as a concern to the provider.

See:

3225.3 Facility Liaison in an SSLC, State Hospital, Rio Grande State Center’s ICF/IID, LIDDA, LMHA, or Community Center

4420 Concerns and Recommendations

6000 Cooperation with Investigative Services

3342.5 Witnesses Who May Give Circumstantial Evidence

APS Provider Investigations November 2017

The investigator may interview people who are not eyewitnesses to the incident but who have knowledge of the incident’s circumstances. They may provide valuable information, such as the appearance of the victim before or after the incident or the location of individuals receiving services and staff. The investigator:

  •   may conduct a telephone or in-person interview with the witness to determine whether he or she has information relevant to the investigation;

  •   obtains a statement if the collateral witness provides information relevant to the investigation;

  •   is not required to obtain a statement but summarizes the content of the interview in the investigative report if the collateral witness does not have information relevant to the investigation; and

  •   if a statement is taken, includes in the summary the information that the witness shares in the interview but refuses to put in writing.

If the interview establishes that witness has no knowledge of the incident, the investigator is not required to obtain a statement. Instead, the investigator documents a summary of the interview in a Contact Narrative.

If a witness requests a copy of his or her statement, a copy may be provided once the investigation has been completed through the DFPS Records Management Group.

Supervisory approval is not required if an investigator interviews a witness via telephone and determines that an in-person interview is not required.

See:

3320 Conducting Telephone Interviews.

3342.3 Witnesses Who Have Direct Knowledge.

3341 Assessing Credibility During Interviews

3335.3 Witness’s Opportunity to See or Hear the Incident

7500 Request for Records

3342.6 Witness Statement of Confession

APS Provider Investigations April 2017

If the alleged perpetrator or a witness confesses to the allegation, a simple “I did it” is not enough. The witness or alleged perpetrator must:

  •  state how, when, where, why, to whom, with what; and

  •  explain whether he or she knew the possible consequences of the action.

The investigator then establishes a preponderance of the evidence using the elements of the definition of the allegation.

Witness Statement Documentation in IMPACT

The investigator documents the collection of a witness statement on the Evidence List in the IMPACT system. The investigator creates a list of external documentation through the Contact Detail page, by selecting Evidence List as the contact Type. In the blank narrative, the investigator lists evidence collected.

Each piece of external documentation is designated as an exhibit (Exhibit A, Exhibit B, and so on). These exhibit labels should correlate with those placed in the lower right hand corner of the APS Provider Investigations Statement forms:

Form 2314 Provider Investigations Statement (page 1)

Form 2315 Provider Investigations Statement Continuation (page 2)

Example:

Exhibit A: Statement from Mary Smith

See:

3540 Video Surveillance

4241 Evidence List in IMPACT

3342.7 Investigator’s Notes

APS Provider Investigations April 2017

All relevant information given by the witness is recorded in the statement. For example, if the witness indicates that he or she was present at the incident but did not have a clear view of what occurred, this information should be documented in the statement and not in the investigator’s note or other generic contact narrative. Examples of other comments that belong in the statement include:

  •  information that directly relates to the allegations;

  •  specific statements the witness makes that are relevant to the allegations;

  •  details about the witness that were addressed with the witness during the interview, such as:

  •  prior history related to the incident, and

  •  prior interactions with the victim that are relevant to the current allegations; and

  •  an employee’s testimony about restraint training, special meal preparation, or other policies and procedures that pertain directly to the allegations.

Investigator’s notes are used as additional information to describe what occurred during the interview. Investigator’s notes document details that enhance the reader’s understanding of what took place during the interview process. Examples of comments that should be listed in the investigator’s notes include:

  •  description of a witness’s demeanor or attitude, such as:

  •  the witness broke down crying and needed 10 minutes to calm down before the interview could be continued, and

  •  when questioned about prior case history, the witness became agitated and left the room without finishing the interview; and

  •  the witness’s refusal to write down specific statements the witness makes that are relevant to the allegation.

3342.8 Use of Polygraph

APS Provider Investigations April 2017

APS does not use polygraph results. Polygraph examinations must not be arranged by the investigator.

The investigator does not use the results of a polygraph arranged by another entity as evidence. For example, a provider might choose to have an employee or individual receiving services take a polygraph exam. Polygraph results are not considered when determining findings based on the preponderance of the evidence gathered during the investigation.

3350 Request for Anonymity

APS Provider Investigations April 2017

The investigator does not promise an interviewee that his or her identity will be kept confidential. Unlike the reporter of an allegation whose confidentiality is protected by law, witnesses are not afforded such protection. The finding of an investigation cannot be based on anonymous information.

3351 Individual Receiving Services Requesting Anonymity

APS Provider Investigations April 2017

An individual receiving services who is interviewed by APS PI and who fears physical retaliation by a provider employee may request that his or her identity be kept confidential. All information that may help answer the who, what, when, where, why, and how questions of an alleged incident is relevant. However, information from a person who is not willing to publicly stand by his or her account of the events under scrutiny may be considered less credible than identified sources.

If an individual receiving services requests that his or her identity remain confidential, the investigator explains that identity cannot be protected. If the individual receiving services then chooses not to give a statement, the investigator accepts that decision. However, the investigator may ask the individual receiving services to share the names of other people who may have witnessed the alleged incident. The investigator may act on such information without divulging the source.

Information that individuals receiving services were unwilling to share because of fear of retaliation by staff is appropriate for inclusion in the Concerns and Recommendations section of the Final Abuse/Neglect Report.

3352 Employees Requesting Anonymity

APS Provider Investigations April 2017

As a condition of employment, an employee must cooperate with the abuse and neglect investigation process. An employee is required to inform the investigator of all information pertaining to the case. An employee cannot provide an anonymous statement.

The identity of an employee is not confidential, with the exception of the role of the reporter. To ensure the confidentiality of an employee who is the reporter, the APS investigator obtains a home address for the employee whenever possible.

Upon completion of the investigative report, the letter to the reporter (Form 2313 Notification to Reporter) is mailed to the employee at his or her home address, if available. This protects the individual’s identity as the reporter.

If an employee refuses to be interviewed and provide a written statement, the investigator reminds the employee of the requirement to cooperate with the investigative process. If the employee continues to refuse, the investigator:

  •  terminates the interview;

  •  contacts the administrator for assistance; and

  •  documents the refusal in IMPACT.

3353 External Witness Requesting Anonymity

APS Provider Investigations April 2017

If an external collateral witness, such as a family member or neighbor, requests that his or her identity remain confidential, the investigator explains that identity cannot be protected. If the collateral then chooses not to give a statement, the investigator accepts that decision. However, the investigator may ask the collateral to share the names of other people who may have witnessed the alleged incident. The investigator may act on such information without divulging the source.

3400 Collecting Documentary Evidence

APS Provider Investigations November 2017

Regardless of the provider type, the investigator obtains documentary evidence that is needed to support the findings in the investigation. If the investigator learns that relevant documentary evidence is not available, this needs to be documented in the documentary contact. The investigator uses his or her judgment to decide whether to forgo collection of documents once the evidence gathered establishes a preponderance.

3410 Documentation of Medical or Physical Exam

APS Provider Investigations April 2017

Each provider has its own policies and procedures related to reporting and documenting incidents, accidents, and injuries involving individuals receiving services. When an allegation of abuse or neglect involves a physical injury, DADS- and DSHS-operated facilities require that medical care be provided to the victim within one hour. Any treatment or examination conducted by medical personnel may constitute evidence of possible abuse or neglect.

In a facility setting, the investigator should request a copy of the Client Injury/Incident Report form. The physician’s documentation during or following the exam should address:

  •  the injury’s cause, age, and treatment, to the extent that the information can be determined;

  •  the type and seriousness of the injury; and

  •  the timing of the medical exam with regard to the date the injury was received.

Each LIDDA and LMHA (community center) for persons with mental health or intellectual disabilities is responsible for assuring that prompt and appropriate medical attention is provided to a victim of abuse or neglect involving a physical injury. Such medical care typically occurs at a local clinic or hospital.

An individual receiving services in the community may be treated by a private physician or in a minor emergency clinic or hospital if he or she sustains an injury.

In any provider setting, the investigator should request a copy of the medical or physical exam when the allegation involves a physical injury. A copy of this exam should be made available to the investigator. If the investigator determines an interview with the medical professional is required to supplement the information provided in the medical or physical exam, the investigator:

  •  interviews the medical personnel who completed the exam as a collateral witness; and

  •  asks the medical personnel to provide a written statement.

The investigator may need a release of information signed by the individual receiving services to obtain such records from a private physician.

See 6200 Cooperation with Investigative Services.

IMPACT Documentation

The investigator documents the collection of a Client Injury/Incident Report, medical exam, or physician’s report on Evidence List page in IMPACT. The documentation includes the type of report and designation as an exhibit.

The investigator documents the seriousness of injury in the Allegation Detail page. If the allegation involves an injury that is non-serious, serious, or fatal, the investigator selects the Injury push button to access the Injury List/Detail page and enters the side, area, type and cause of injury.

The investigator documents the evidence according to 4240 IMPACT and the Provider Abuse and Neglect Report.

See 4241 Evidence List in IMPACT.

3420 Individuals’ Records

APS Provider Investigations April 2017

Each provider maintains records for individuals receiving services. The provider type will dictate the specific records maintained by the provider. It may be necessary to collect records for the individual receiving services as well as other individuals in the same residence, facility, or program.

The service record or chart of an individual receiving services often provides:

  •  information regarding the circumstances leading up to and surrounding the incident under scrutiny;

  •  the witnesses present; and

  •  other information regarding the incident.

The investigator reviews the record and copies relevant sections as evidence, if applicable to the investigation. However, the investigator is sensitive to the information contained in an individual receiving services’ record and exercises caution to avoid allowing such information to bias or prejudice his or her assessment of the credibility of the individual receiving services.

When possible, this information is obtained and reviewed by the investigator, rather than a facility liaison or provider designee.

Different providers may call the same type of record by different names. The investigator should ask for and review records relevant to the allegation, regardless of what labels the provider gives the record. Sections of the record to review include, but are not limited to:

Person Directed Plan

The Person Directed Plan is a document used to identify the individual’s existing supports and services necessary to achieve the individual’s desired outcomes, identify natural supports available to the individual, and negotiate services.

Behavioral Support Plan

A behavioral support plan is a team’s action plan outlining the specific steps to be used to promote the individual receiving services’ success and participation in daily activities and routines. The plan should include:

  •  the specific behaviors to address;

  •  the goal for change and the steps required to achieve it;

  •  procedures for recognizing and monitoring changed behavior; and

  •  the appropriate behavioral strategies that will be most effective.

Home Health Client Profiles

Home health client profiles are records used in the community provider HCSSA setting to describe:

  •  the service plan;

  •  living arrangements;

  •  special instructions for care; and

  •  current health conditions of the individual receiving services.

Employee Visit Plans

Employee visit plans are created and maintained by a community provider such as an HCSSA to ensure scheduling and types of services to be rendered are documented.

Home Health Attendant Orientation/Supervisory Visit document

The Home Health Attendant Orientation/Supervisory Visit documents tasks to be performed by provider such as bathing, dressing, exercising, and grooming.

Client Visit Logs

Client visit logs are used to document hours the community provider such as an HCSSA employee worked with the individual receiving services.

Dos and Don’ts for Attendants

Dos and Don’ts for attendants describe what the community provider in an HCSSA can and cannot do for their individuals receiving services.

Observation Notes

Observation notes are used in a variety of settings and contain daily entries by direct contact staff regarding significant events, including incidents, injuries, behavior problems, social activities, and so on.

Physician’s Orders

Physician’s order forms contain a physician’s orders for medications and treatments, including orders for restraint or seclusion.

Progress Notes

Progress notes are completed by all levels of direct care staff in mental health facilities to document assessments, treatments, behavior problems, social activities, and so on.

Restraint/Seclusion Checklist

This checklist provides information about:

  •  the behavior that required restraint or seclusion;

  •  what interventions were tried before the restraint or seclusion; and

  •  the type of restraint used.

It also:

  •  notes the time of the restraint or seclusion and how long it continued; and

  •  contains the initials of the persons observing or participating in the procedure.

Psychological/Psychiatric Evaluations

The records of an individual receiving services usually contain psychological and psychiatric evaluations. While clinical information may occasionally shed light on a particular allegation, its use may appear more prejudicial than relevant.

The investigator should not routinely:

  •  review these evaluations or diagnostic information before interviewing the individual receiving services; or

  •  copy these documents and include them as exhibits to the investigative report.

Service coordinators or case managers may be a resource for obtaining an individual’s records.

3430 Provider Records

APS Provider Investigations April 2017

Providers are required to keep employee records, including time sheets, training documentation, and policy or procedural documents. Different providers may have different names for the same type of document. The investigator requests, collects, and reviews relevant provider records applicable to the allegation.

3431 Duty Roster or Time Sheets

APS Provider Investigations April 2017

The duty roster or sign-in sheet documents the personnel on duty on a given day at a given time. This helps establish whether an alleged perpetrator was on duty at the time of an incident and provides the names of other staff who were on duty and who may be collateral witnesses.

Some providers also call these documents assignment logs or time sheets.

3432 Provider Policy, Procedure, or Training Issues

APS Provider Investigations April 2017

The investigator often has to determine whether provider employees followed the policies of:

  •  the departmental governing entity (DADS, DSHS, or HHSC);

  •  the specific internal program or service delivery option (such as HCS, TxHmL, MDCP, Star+Plus, or CDS); or

  •  the provider.

The investigator should collect documents related to policy, procedures, or training records that establish the elements of the definitions of abuse, neglect, or exploitation. The investigator evaluates whether policy was followed to help decide whether abuse, neglect, or exploitation occurred. The policy may be essential to the finding in the case.

If the investigator determines an interview with a provider employee, administrator, trainer, or policy expert is required to supplement the information provided in the policy, procedure, or training records, the investigator:

  •  interviews the employee or appropriate expert as a collateral witness; and

  •  asks the employee or expert to provide a written statement.

The investigator includes in the paper case record a copy of any policy used in the determination and ensures that the policy:

  •  was in effect at the time of the incident; and

  •  is complete.

See 4310 Required Documentation for Headings.

3433 Personnel Records

APS Provider Investigations April 2017

It may be necessary for the investigator to review the alleged perpetrator’s personnel records to determine whether they can be used as evidence. The records reviewed may include those maintained by the alleged perpetrator’s current employer or previous employers, including private agencies or companies.

Investigators examine the records for patterns of behavior and performance that parallel the allegation in the case currently under investigation.

The investigator can use prior behavior and job performance:

  •   when interviewing an alleged perpetrator; or

  •   to raise a concern or make a recommendation to the provider, if the administrator or director of the provider is unaware of the history.

Personnel records that may need to be reviewed include:

  •  performance evaluations;

  •  commendations;

  •  training records;

  •  written reprimands; and

  •  correspondence regarding performance-related concerns.

The investigator includes as evidence only pertinent records that closely parallel the current investigation in terms of the allegations made, the type of victim involved, or the methods used to commit the act.

An investigator may consult with his or her supervisor, the complex case specialist, or the APS regional attorney about whether to include personnel records as evidence.

Before an APS district releases the personnel records of an alleged perpetrator, the investigator must consult with the director of field operations for APS or the senior policy analyst for APS Provider Investigations.

Texas Human Resources Code, §48.154, Access to Records or Documents

3434 Consumer Directed Services (CDS) Records

APS Provider Investigations April 2017

Unlike other provider types, the CDS employer can be the individual receiving services or the legally authorized representative of the individual receiving services. The CDS employer hires and manages his or her own employees. Additionally, the CDS employer creates and maintains all employer and employee records. The investigator should request any relevant documentary evidence from the CDS employer. If the documentary evidence is not available via the CDS employer, the investigator may request the required documentary evidence from the Financial Management Services Agency (FMSA).

See the Consumer Directed Services page of the Texas Health and Human Services website.

3435 Documenting Individual and Provider Records in IMPACT

APS Provider Investigations April 2017

The investigator documents the information obtained from the relevant records in the IMPACT system by:

  •  navigating to the Contact Detail page;

  •  selecting Documentary as the Contact/Summary Type; and

  •  summarizing the information in the Narrative section.

After summarizing the program, policy, or training issue in the analysis of evidence, the investigator:

  •  interprets the written policy;

  •  explains how the policy was interpreted and applied by staff;

  •  cites any evidence that indicates staff failed to adhere to the policy; and

  •  specifies how staff’s failure to follow the policy resulted in abuse or neglect of the individual receiving services.

The investigator documents the information as evidence as described in 4240 IMPACT and the Provider Abuse and Neglect Report.

See 4241 Evidence List in IMPACT.

3436 Obtaining Evidence from External Sources

APS Provider Investigations April 2017

At times, pre-written statements and other documentary evidence are given to the investigator by provider employees and other external sources including investigatory agencies other than DFPS. Other sources may include:

  •  an HCSSA agency that has investigated the allegation;

  •  the alleged victim;

  •  a guardian of the alleged victim; or

  •  any other witness who has written an account of the incident.

Statements are written in advance of interviews arranged by the investigator. The investigator:

  •  obtains either the original statement or a copy to include in the case;

  •  enters the statement into the case; and

  •  includes it as part of the Evidence List.

After reviewing the pre-written statement or other documentary evidence, if there are no remaining questions or discrepancies to address, the investigator obtains supervisory approval to schedule phone contact with the witness. During the phone interview, the investigator:

  •  affirms the pre-written statement was documented by the witness; or

  •  affirms the documentary evidence is accurate.

The investigator then types the contact in IMPACT.

The investigator schedules a face-to-face interview to address any remaining questions. During the face-to-face interview, the investigator:

  •  asks additional questions to supplement the information already gathered;

  •  clarifies discrepancies; and

  •  types a statement documenting the additional information provided.

The investigator may use the pre-written statement or other documentary evidence to confront discrepancies during an interview with the collateral or principal as well.

See 3342.1 Procedures for Obtaining Electronic Statements.

3437 Collection and Documentation of Evidence Obtained from Social Media

APS Provider Investigations April 2017

Social media means online communication tools that allow users to interact by posting and sharing information, conversations, photos, videos, and other content electronically. Examples of social media include:

  •  Blogs (Huffington Post)

  •  Micro-blogs (Twitter)

  •  Social networking sites (Facebook, LinkedIn)

  •  Video and photo-sharing sites (YouTube, Flickr, Instagram)

  •  Online forums (message boards)

The DFPS Social Media Policy (DFPS-8101) is located on the DFPS intranet and outlines:

  •  use of social media in investigations; and

  •  documenting communication and evidence for an investigation.

3440 Criminal History Records

APS Provider Investigations November 2017

Criminal history records are only released to certain entities. Because APS PI distributes the Final Abuse and Neglect Report to more entities than are entitled to the criminal history record, APS PI does not collect criminal history records during an investigation.

APS PI does not use criminal history records to determine findings based on the preponderance of the evidence during the investigation.

Texas Government Code §411.114

3500 Collecting Demonstrative Evidence

3510 Photographs

APS Provider Investigations April 2017

Photographs provide an accurate, objective representation of the existence or absence of injuries and of the scene of the incident. A photograph can impart what a written description cannot and can be helpful in evaluating the evidence.

3511 Photographing the Scene of an Incident

APS Provider Investigations April 2017

Photographs of a room, hallway, bathing area, yard, or other area where an incident took place help the reader of the investigative report to understand what happened.

Photographing such areas can be a challenge because of their size. It may be impossible for one photograph to depict an entire room without distortion. To resolve this problem, the investigator plans shots carefully, selecting a good vantage point. The investigator may need to take a series of three or four photographs in a clockwise sequence to cover the entire area. The purpose of the shots is to enable the viewer to reconstruct the scene.

The investigator takes photographs from eye level for proper perspective. Before taking close-up shots of objects or smaller areas within a scene, the investigator first takes an establishing shot, capturing as much of the entire area as possible within one frame.

The investigator does not gather physical evidence. If physical evidence is found, the investigator photographs it before it is removed from the scene.

3512 Photographing Injuries

APS Provider Investigations April 2017

The investigator takes photographs any time injuries are alleged to any person involved in the allegation. If injuries are not alleged but it is possible that an injury could have occurred from abuse or neglect, the investigator takes photographs to record the absence of injury.

The investigator records the existence or absence of injuries by taking photographs. The investigator begins by asking the person being photographed for permission to take photographs. Photographs are taken immediately, if possible. However, if the investigator cannot take photographs immediately, he or she takes the initial photographs within:

  •  24 hours, for Priority I cases;

  •  three calendar days, for Priority II cases; or

  •  seven calendar days, for Priority III cases.

Bruises or other marks on the body may not be visible immediately. If the investigator suspects abuse has occurred but no injuries are visible at the time of the interview, the investigator may follow up within 24 to 48 hours to determine if additional photographs are needed.

Procedure for taking photographs

The investigator takes:

  •   an identifying photograph of the front of the person being photographed to help establish the identity of the person.

  •   full-length photographs of the sides or back of the person (if necessary); and

  •   close-up photographs of particular injuries.

A reader must be able to determine the scale of the injury based on the photograph taken. A best practice is to use a measuring device (such as a six-inch ruler or dollar bill) in each close-up shot to establish the size of the injury.

When it is necessary for the client to undress to reveal injuries in private areas, the investigator takes the photographs with a witness present.

See:

3224.82 Consent to Visual Inspection and/or Photographs of Children in a Private Residence

3224.84 Refusal to Allow a Child to be Visually Inspected or Photographed in a Private Residence

3512.1 Documentation of Refusal by Client to Be Photographed

APS Provider Investigations April 2017

An investigator does not photograph a client if he or she declines to be photographed.

The investigator uses judgment to determine if a non-verbal client has given consent using affirmative gestures.

The investigator documents the client’s refusal to be photographed in a contact narrative.

See 3224.84 Refusal to Allow a Child to be Visually Inspected or Photographed in a Private Residence.

3512.2 Documentation of a Client Who Is Unresponsive

APS Provider Investigations April 2017

An unresponsive client (for example, sleeping or unconscious) cannot be presumed to have given consent or declined to be photographed. The client’s condition or responsiveness may change, so the investigator returns to the facility at a later time to photograph the client. If there is an observable injury, the investigator follows up as soon as possible but no later than the assigned priority time frame.

A photograph may be taken of an unresponsive client only when the parent or guardian has given permission.

The investigator documents the client’s condition, responsiveness, or both in a contact narrative.

3512.3 Sharing Photographs of Injuries with OIG Before Completion of Investigation

APS Provider Investigations April 2017

The investigator’s photographs of injuries may also be considered evidence in an HHSC Office of Inspector General (OIG) investigation. OIG may need the photographs before the APS investigation is completed.

Upon request, the investigator may share photos of physical evidence with OIG before the APS investigation is completed. If evidence is shared with OIG before the APS investigation is completed, the APS investigator documents in IMPACT what and when information was provided to the OIG investigator.

See:

3600 Collecting Physical Evidence

3223 Investigations Involving the Office of the Inspector General (OIG)

3513 Instructions for Digital Photographs

APS Provider Investigations April 2017

Alteration of Digital Photographs

It is essential to preserve the original digital image and protect it from alteration to ensure the photograph is admissible in court. Alteration of digital images by DFPS staff is strictly prohibited. To enlarge, crop, brighten, or otherwise alter digital photographs, the investigator uses a photographic service outside DFPS.

If alterations are made, the investigator retains the original photograph, and alterations are made on a copy. The investigator documents in the case what type of alteration was made and the number of the photograph.

Resolution of Photographs

Digital photographs should range between 640 x 480 to 1280 x 960 pixels.

IMPACT Documentation

The investigator documents information obtained from a photograph on the Contact/Summary page by selecting Documentary as the Type. A description of the photograph is entered in the Narrative section of the page.

The investigator documents that photographs were taken on the Evidence List Contact page in the IMPACT system. Each photograph (or set of photographs) is designated as an exhibit.

Example: “Exhibit M: Photograph of the Spruce Unit day room at Vernon State Hospital”

See 4241 Evidence List in IMPACT.

3513.1 Storing and Printing Digital Photographs

APS Provider Investigations April 2017

Storing Digital Photographs

The investigator uploads digital photographs to the External Documentation page in IMPACT and fills out the following required fields:

  •  Subject of Photo

  •  Picture Type

  •  Date

  •  Time

  •  Detailed Description

In the Subject of the Photo field, the investigator documents the subject of the photo and labels the photographs to match the documentation in the summary of evidence. For example, “Photograph A,” then “Photograph B,” and so on.

Storing Photographs Obtained From Other Sources

To store digital photographs obtained from sources outside of DFPS, the investigator uploads them to the External Documentation page in IMPACT.

To store paper photographs obtained from sources outside of DFPS, the investigator files them in the external paper file.

Printing Digital Photographs in IMPACT

The investigator prints the photograph from IMPACT and ensures that all fields are filled out correctly. The printed photograph is labeled as an exhibit and included with the hard copy of the case file.

Online Photograph Processing Service

To enlarge, crop, brighten, or otherwise alter digital photographs, the investigator uses a photographic service outside DFPS.

To print digital photographs, the investigator uses the DFPS online photo processing service. The service is used only as needed; for example, for case consultations, criminal investigations, and court proceedings.

3520 Diagrams

APS Provider Investigations April 2017

Diagrams can supplement photographs and may be used to recreate the scene at a specific point in time. Diagrams also provide an overview of the scene that photographs may not adequately represent. Visiting the scene and documenting the placement of furniture, entrances and exits, location and size of windows and doors, and any other objects in the area may help the investigator visualize the action described in a statement and evaluate the credibility of the evidence collected.

The investigator may use diagrams as an investigative tool during an interview to:

  •  identify the location of additional witnesses;

  •  establish proximity to the incident — for example 20 feet away, or around a corner;

  •  clarify position and opportunity for knowledge — such as seating arrangements in a cafeteria, van, or day room; or

  •  recreate scenes that are no longer available, such as a fair, field trip, seasonal activity, or outdoor event.

The investigator decides who is best suited to draw the diagram: the witness, client, or investigator. The investigator may also choose to scan building layouts into the tablet if they are available. The investigator may use those layouts to make notations instead of creating a diagram from scratch.

A reader of the provider investigation report must be able to view the diagram and understand what the diagram portrays, including the approximate size of the area and why it is important to the case. It is best practice to have the creator of the diagram label items and include a legend to identify those items the scene describes. IMPACT case number and client name are not required on a diagram.

If a photograph provides a better understanding of a scene, photos may be used in place of diagrams. Photos may show distance, line of sight, obstructions, and perspective. If the investigator chooses to use photos, the investigator must preserve the original digital image according to policy.

See 3513 Instructions for Digital Photographs.

3530 Timelines

APS Provider Investigations April 2017

Timelines display a list of events in chronological order. Timelines allows the investigator to create a graphical representation of an event by displaying items sequentially along a line. Timelines can be organized by time of day, date, or event. Timelines help the reader and the investigator visualize the progression of an incident. The investigator may use a variety of timeline types; the most common are vertical and horizontal timelines. The timeline should clearly demonstrate to the reader the sequence of events, dates, or significant moments the investigator is attempting to recreate.

3540 Video Surveillance

3541 State Supported Living Centers

APS Provider Investigations April 2017

State supported living centers (SSLC) and the Rio Grande State Center’s ICF/IID are mandated to have video surveillance equipment in all common locations of each unit. This is another source of evidence to inquire about for each investigation. Investigators contact the SSLC director to obtain permission to view video surveillance. As soon as the investigator is aware of the existence of video surveillance footage, the investigator should follow any steps necessary to request access to it. Given the requirement for 10-day completion of investigations, it is important to request access to video surveillance footage as soon as possible.

If video surveillance footage is used in the findings of an investigation, either to support a confirmation or other finding, it must be collected by requesting a copy via email from the director of the SSLC.

3542 State Hospitals and Mental Health Component of the Rio Grande State Center

APS Provider Investigations April 2017

Each state hospital and the mental health component of the Rio Grande State Center has individual procedures for viewing and obtaining copies of video surveillance footage. Investigators should know the procedures for viewing and obtaining copies of video surveillance footage from the state hospitals in their area.

3543 Other Types of Video Recordings

APS Provider Investigations April 2017

An investigator may use video from an entity that is not a state-operated facility, including video from cell phones, camcorders, or other electronic devices. If a copy of the video recording cannot be copied and saved to the case file, the investigator should have a secondary person witness what is seen on the video and sign a written statement form to that effect. The investigator should also document a description of what he or she viewed under the demonstrative evidence section of the report.

3544 Documenting Video Information in IMPACT

APS Provider Investigations April 2017

The investigator obtains a copy of the video surveillance evidence and summarizes it in the investigative report as demonstrative evidence. The investigator should describe the information in enough detail that the reader can understand who and what was recorded, the actions — or lack of actions — of any individuals, and how the video was used to determine a preponderance of evidence. The summary should include a description of what the individuals in the video were wearing and the time of the alleged incident, so another viewer may identify the individuals in the description.

During the course of an investigation, the investigator may show the video to a principal or collateral witness to clarify previous testimony or to help determine the credibility of the witness. The investigator documents in IMPACT whom he or she showed the video to and for what reason.

The investigator lists the video as evidence on the Exhibit List contact type.

3545 Storing Video Surveillance Information

APS Provider Investigations April 2017

The investigator stores a copy of the video surveillance on a CD in the external case file.

See 7200 Release of the Provider Abuse and Neglect Report.

3600 Collecting Physical Evidence

APS Provider Investigations April 2017

Physical evidence is any item or substance related to an allegation that can be seen or touched. Because APS does not collect and store physical evidence, investigators document it by taking photographs of it in place and describing it in the case report.

If the evidence has potential importance for a criminal case, the investigator notifies law enforcement of the evidence and offers to protect it until an officer arrives. Law enforcement collects the evidence from the scene. If law enforcement is present, the investigator may request to photograph evidence before its removal.

The investigator’s photographs of injuries or physical evidence and diagrams may also be considered evidence in an HHSC OIG investigation. OIG may need these photographs and diagrams before the APS investigation is completed.

For investigations involving OIG, the investigator may share photos of physical evidence before completing the investigation. If evidence is shared with OIG before the APS investigation is completed, the investigator documents in IMPACT what and when information was provided to the OIG investigator.

See:

3512 Photographing Injuries

3520 Diagrams

3610 Suspicious Injuries

APS Provider Investigations April 2017

The investigator reviews the intake report or I&R for suspicious injuries. If there is a suspicious injury or an injury of unknown origin, the investigator obtains an opinion from a medical professional (registered nurse, advance practice nurse, or physician) in the form of an injury report or written statement to determine whether the injury may be the result of abuse or neglect. The injury report or other medical report may be available from the provider, emergency room physician, or the individual receiving services’ own physician, if the individual receiving services lives in the community.

The following injuries may be indicative of physical abuse:

  •  Bruises that are:

  •  clustered as from repeated striking;

  •  patterned or multi-shaped;

  •  located on soft tissue areas such as the trunk, upper anterior and inner thigh, back, buttocks, upper arms, chest, face, and abdomen; or

  •  shaped similarly to objects, such as a looped cord, belt, buckle, wire coat hanger, or prints of a thumb, finger, or hand.

  •  Burns that are:

  •  symmetrical, with distinct margins, indicating forced immersion;

  •  patterned, like a stocking or glove pattern on lower legs, buttocks, or perineum (generally, the area below the anus and above the posterior part of the external genitalia); or

  •  patterned, in a way that suggests common objects such as a cigarette, cigarette lighter, iron, or curling iron injury.

  •  Spiral fractures

  •  Fractured ribs

  •  Internal bleeding

  •  Injuries to genitalia

3620 Sexual Assault Evidence

APS Provider Investigations April 2017

Evaluations for sexual assault and collection of medical evidence (such as a rape kit) are conducted at a local hospital emergency room by qualified medical personnel. Hospital staff typically forwards such evidence to the Texas Department of Public Safety for analysis. The turnaround time is six to eight weeks.

Although all reports of a sexual offense are reported to local law enforcement and medical evidence is collected by medical personnel, the investigator proceeds with an investigation unless the local law enforcement agency requests otherwise. The investigator requests that the law enforcement agency forward rape kit results as soon as they are available.

Local law enforcement or the alleged victim of sexual assault may request a medical forensic exam. Sexual Assault Nurse Examiner (SANE) is a qualification for forensic nurses who have received special training to conduct sexual assault evidentiary exams for victims of sexual assault.

See 2411 CAC Coordination Procedures.

3700 Referrals

APS Provider Investigations November 2017

In a full referral the investigator refers all of the investigation to the provider. In a partial referral the investigator refers only parts of an investigation to the provider and continues to investigate the remaining allegations of abuse, neglect, or exploitation.

A full or partial referral may be made if all or part of the information reported to DFPS for investigation fails to meet the definition of an allegation of abuse, neglect, or exploitation. When assessing an intake, the investigator or duty worker reviews it to determine whether to send a partial or full referral to the provider.

A referral includes reports of:

  •   general complaints, including:

  •   client rights issues;

  •   administrative issues;

  •   theft of property determined not to be exploitation in a facility, HCS waiver program provider, TxHmL waiver program provider, LIDDA, or LMHA (community center); and

  •   any situation in which the information reported to APS PI does not meet the Texas Administrative Code definition of abuse, neglect, or exploitation; or

  •   clinical practice issues involving a licensed professional (see 3930 Peer Review).

DFPS Rules, 40 TAC §711.7

In a community provider setting, exploitation includes theft as defined in Chapter 31 of the Texas Penal Code and is not considered a referral.

Investigators must determine if the information reported at intake or alleged during the course of an investigation falls into one of the categories above. It is often necessary to contact provider employees, the victim, or other collaterals to gather enough information to determine if the report or allegation should be referred to the provider.

The details of a given situation can be the difference between conducting a full investigation and referring parts or all of an investigation to the provider.

If a partial or full referral is identified, the investigator or duty worker documents:

  •   the determination regarding full or partial referral;

  •   any contacts made to determine whether some or all of the allegations need to be referred back to the provider as a client’s rights, administrative, clinical, or other issue; and

  •   the referral having been sent back to the provider as a general complaint.

Allegations may appear on the surface to be appropriate for referral back to the provider, but upon obtaining additional information, the investigator or duty worker may determine that an abbreviated or full investigation is warranted.

See also:

4612 Contacts and Summaries

3710 Examples of Issues or General Complaints Appropriate for Referral

3211 Determine Whether a Partial or Full Referral Is Appropriate

3721 Partial Referrals Made During the Investigation

1200 Definitions

3710 Examples of Issues or General Complaints Appropriate for Referral

3711 General Complaints

3711.1 Client Rights Complaints

APS Provider Investigations November 2017

Rights violations that should be referred to the provider include incidents in which a client:

  •   has been prevented from using the phone or having visitors;

  •   has been prevented from voting;

  •   was not permitted to smoke when he or she wanted to, or to keep his or her own cigarettes on his or her person;

  •   has not been allowed to keep or use his or her personal possessions;

  •   has not been allowed grounds privileges;

  •   has not been informed of changes regarding his or her treatment; or

  •   needs, but has not been provided with, the assistance of an interpreter.

Rights issues may not always be clear at the onset of the investigation. Examples of additional possible rights violations appropriate for referral include:

  •   door alarms installed for the safety and protection of one individual receiving services in a three-bed HCS home;

  •   nutritional advice on healthy choices that restrict an individual receiving services’ food choices beyond the facility-approved nutritional or dietary plan; or

  •   a locked refrigerator to limit access to food.

See:

HHSC Consumer Rights and Services

DSHS Consumer Rights for Mental Health Services

DSHS Rights Rules, 25 TAC Chapter 414

DADS Rights Rules, 40 TAC Chapter 4

3900 Abbreviated Investigations

3711.2 Administrative Complaints

APS Provider Investigations November 2017

Administrative issues are those incidents in which provider employees may not have followed procedures or policy, but their actions did not result in abuse, neglect, or exploitation. APS PI does not investigate administrative issues. Administrative complaints include:

  •   allegations involving the business operation of managed care or consumer directed services; and

  •   other clerical or administrative practices that do not involve or impact the individual receiving services.

The following are examples of administrative issues:

  •   An employee clocks in 15 minutes late even though he arrived on time for his shift. He completes all his tasks during his shift. The employee consistently clocks in and out incorrectly. The employee’s actions do not impact the individual receiving services.

  •   Two employees argue with one another while on shift. The employees’ actions do not impact the individual receiving services.

See 3900 Abbreviated Investigations.

3711.3 Does Not Meet the Definition of Abuse, Neglect, or Exploitation

APS Provider Investigations November 2017

Theft in SSLC, State Hospital, HCS, TxHmL, LIDDA, LMHA, and Community Center Settings

It is important for investigators to distinguish between exploitation and a general complaint involving theft of the property of an individual receiving services.

A transaction between an individual receiving services and a facility, HCS, TxHmL, LIDDA, LMHA or community center employee must exist for an exploitation allegation to exist.

Theft involves loss without knowledge, consent, or any type of reimbursement.

Injuries of Unknown Origin

At times a report contains an allegation of physical abuse, sexual abuse, or neglect, but the source of the injury was not observed by any person, or the source of the injury could not be explained by the individual receiving services. If a medical expert determines the injury is not a result of abuse or neglect, the investigator refers the allegation back to the provider as an injury of unknown origin.

Other Reports

If the investigator determines the information reported to DFPS does not meet the definition of abuse, neglect, or exploitation, he or she may refer the information back to the provider.

3712 Clinical Issues

APS Provider Investigations November 2017

Clinical practice issues are those allegations involving a licensed professional that relate to his or her clinical practice. Clinical practice relates to the demonstration of professional competence of a licensed professional as described by the licensing professional board.

Texas Administrative Code (TAC) §711.3(7)

The following scenarios are examples of clinical issues referred back to a provider:

  •   A nurse administers John Smith’s medications to John Doe.

  •   A licensed vocational nurse fails to provide consistent wound care for a known injury.

  •   A dentist does not prescribe pain medication after performing a root canal.

  •   An individual receiving services is agitated and pacing floors while screaming racial epithets at staff. At 2 a.m., a nurse administers Benadryl to quiet the individual receiving services. For the next two weeks the nurse administers the prn medication at 9 p.m. (lights out time) whether the individual is agitated or not.

  •   A nurse fails to provide training to direct care staff responsible for feeding an individual receiving services with a gastric feeding tube (g-tube), used to feed blended meals directly into the stomach.

See also 3930 Peer Review.

3720 Full Referral

APS Provider Investigations April 2017

When the investigator determines that the allegation information provided at intake or during the course of an investigation is a full referral, the investigator:

  •  collects and documents evidence as needed to show that the allegation is a client rights, clinical practice, or theft issue (in facilities);

  •  documents, using the APS Referral Form 2323 generated from the Referral contact type located on the Contact Detail page:

  •  all notifications, contacts, and evidence collected,

  •  why the allegation is being referred (that is, why APS PI does not have jurisdiction to investigate), and

  •  closure of the investigation in its entirety;

  •  obtains supervisory approval in IMPACT; and

  •  based on the chart below, emails APS Referral Form 2323 to the facility or provider within 24 hours or the next business day following the determination that the allegation is a full referral.

Type of Setting

The Investigator Emails the Referral to…

Facility

the facility.

Home and Community-based Services (HCS) or Texas Home Living (TxHmL)

the HCS or TxHmL waiver provider.

Local authorities for mental health and intellectual disabilities and community centers

the appropriate local authority or community center.

Licensed ICF/IID

the ICF/IID provider.

HCS and TxHmL, Licensed ICF/IID, and state supported living centers (SSLC)

DADS Waiver Survey and Certification

Community providers

the provider, if known at the time of intake.

IMPACT System Documentation

The investigator documents the reason for referral on APS Referral Form 2323 in IMPACT.

The rapid closure code should match the Nature of Referral indicated on APS Referral Form 2323.

The investigator searches facility, HCS, TxHmL, community center, or licensed ICF/IID and enters a correct MHMR (DADS or DSHS) component code in the IMPACT Facility Conclusion page.

The investigator selects Other as the disposition on the Allegation Detail page.

Notification to the Reporter

The investigator sends Form 2312 Notification That APS Will Not Investigate to the reporter explaining that DFPS is not conducting an investigation.

3721 Partial Referrals Made During the Investigation

APS Provider Investigations April 2017

When an allegation or general complaint emerges during the course of an investigation that is distinct from the allegation under investigation, the investigator:

  •  completes an APS Partial Referral Form 2323 from the Contact Detail page, to document:

  •  evidence as needed to show that the allegation is a client rights, clinical practice, or theft issue (in facilities),

  •  notifications, contacts, and evidence collected, pertaining to specific issues being referred back to the provider,

  •  why the allegation is being referred (that is, why APS PI does not have jurisdiction to investigate), and

  •  that other concerns in the intake that do meet APS PI jurisdiction will continue to be investigated; and

  •  forwards the APS Partial Referral Form to the facility or provider within three calendar days, unless the issue, concern, or recommendation affects the safety of a client. If the safety of the client is at risk, the investigator immediately notifies the appropriate staff and forwards the APS Partial Referral Form within 24 hours, or by the next business day as outlined below:

Type of Setting

The Investigator Emails the APS Partial Referral Form to …

Facility

the facility.

Home and Community-based Services (HCS) or Texas Home Living (TxHmL)

the HCS or TxHmL provider.

Local authorities for mental health and intellectual disabilities (community centers)

the appropriate community center.

Licensed ICF/IID

the ICF/IID provider.

HCS and TxHmL, Licensed ICF/IID, and state supported living centers (SSLC) settings

DADS Waiver Survey and Certification.

Community provider

the provider.

The investigator documents in an Administrative/Procedural Note in the investigative report the date and time the APS Partial Referral Form was sent.

3800 Streamlined Investigations in All Settings

APS Provider Investigations April 2017

A streamlined investigation is conducted when an individual receiving services:

  •   is on the streamlined caller list; and

  •   makes an allegation that follows the established pattern of frivolous or patently false allegations of abuse, neglect, or exploitation.

See 2390 Streamlined Caller List.

3810 Streamlined Investigation Procedures for All Settings

APS Provider Investigations April 2017

Upon identifying an individual receiving services who is eligible for a streamlined investigation, the investigator:

  •   obtains supervisory approval to use streamlined investigation procedures;

  •   notifies the following entities of the investigator’s plans to conduct a streamlined investigation for allegations that follow the established pattern:

  •   interdisciplinary or service planning team in a facility, the Rio Grande State Center’s ICF/IID, an HCS or TxHmL waiver provider, an LMHA, LIDDA, or community center provider; or

  •   the provider administrator or designee, and the case manager, service coordinator, or service planning team, as applicable, in a community provider setting; and

  •   if necessary, requests that the applicable support entities (i.e. Interdisciplinary Team, service coordinator) meet to discuss possible therapeutic measures.

The procedures for streamlined investigations differ depending on whether the individual receiving services alleges injury.

No Injury Alleged

If the alleged victim does not allege injury, the investigator:

  •   notifies the provider administrator or designee in accordance with 3100 Notifications;

  •   conducts telephone interviews with principals and collaterals, as needed to determine the condition of the alleged victim;

  •   reviews documentation;

  •   completes a review of prior case history in required settings;

  •   documents all information gathered that describes the situation and condition of the alleged victim;

  •   determines a probable version of events;

  •   documents in IMPACT the Conclusion, and, if applicable, Concerns and Recommendations; and

  •   either:

  •   closes the case as Unfounded if the evidence supports the determination that the allegation is frivolous or patently without a factual basis, or

  •   follows regular investigator protocols if the evidence supports that the allegation is not frivolous or patently without a factual basis.

See:

2390 Streamlined Caller List

3100 Notifications

3221 Prior Case History

Injury Alleged

If the alleged victim alleges injury, the investigator:

  •   notifies the provider administrator, or designee, in accordance with 3100 Notifications;

  •   conducts a telephone interview with the appropriate medical professional, such as the charge nurse or director of nursing, or assigned supervisory staff who has knowledge of the current situation and condition of the alleged victim; and

  •   conducts an investigation following regular investigation protocols if it is verified that the alleged victim:

  •   has an injury that may be related to the allegation, or

  •   is at significant risk of injury or harm.

See 3100 Notifications.

3900 Abbreviated Investigations

APS Provider Investigations November 2017

At times, an intake includes an allegation that meets the Texas Administrative Code definition of abuse, neglect, or exploitation, but the investigator disproves one or more of the elements of the definition with a minimal number of contacts. When this occurs, the investigator uses his or her judgement to forgo a full investigation and conduct an abbreviated investigation.

An abbreviated investigation may include the following allegation types:

  •   Physical abuse

  •   Emotional or verbal abuse

  •   Neglect

  •   Exploitation

If an investigation is eligible for abbreviation, the investigator:

  •   documents any contacts made;

  •   documents any evidence collected; and

  •   completes the abbreviated investigation process as outlined in 3910 Procedure.

3910 Procedure

APS Provider Investigations November 2017

The investigator takes preliminary steps to determine whether an abbreviated or full investigation is necessary. The following is a suggested sequence of activities (the actual sequence may vary according to the circumstances) in conducting an abbreviated investigation.

1.   Review the intake.

2.   Notify the provider and state agency, if applicable.

3.   Notify law enforcement or OIG, as required.

4.   Make other notifications as required by policy 3100 Notifications, if applicable.

5.   Prepare specific investigative questions to help determine what needs to be discovered or considered (see tables below).

6.   Complete the initial face-to-face interview with the alleged victim, if applicable, according to policy 3222.1 Initial Face-to-Face Requirements or 3222.2 Exceptions to Initial Face-to-Face Requirements.

7.   Conduct an interview with the reporter.

8.   Conduct telephone interviews with principals and collaterals, as needed.

9.   Review prior case history in required settings.

10. Consider, if appropriate to the allegations:

  •   consulting with the appropriate professional or expert, and

  •   collecting relevant documentation and other witness interviews.

11. Review relevant documentation.

12. Staff with the supervisor as appropriate.

13. Determine whether one or more elements of the definition of abuse, neglect, or exploitation can be disproved as a result of investigative actions.

Once the investigator has completed the abbreviated investigation, he or she may either:

  •   determine a preponderance of evidence by disproving the elements of the definition of abuse, neglect, or exploitation and finish the abbreviated investigation report as unconfirmed, or

  •   determine a full investigation is required based on evidence collected.

See:

3100 Notifications

3121 Notification to Law Enforcement

3122 Notification to HHSC Office of Inspector General (OIG)

3920 Documenting an Abbreviated Investigation

APS Provider Investigations November 2017

If the investigator determines the investigation is eligible for abbreviation, he or she:

  •   documents all interviews conducted in Contact Narratives;

  •   documents all information gathered that describes the situation and condition of the individual receiving services;

  •   completes the Conclusion, and, if applicable, Concerns and Recommendations;

  •   closes the case with a disposition of Unconfirmed; and

  •   selects Normal Closure as the closure reason on the Investigation Conclusion page.

See:

3100 Notifications

4400 Reaching a Disposition

3221 Prior Case History

3930 Peer Review

APS Provider Investigations April 2017

Some providers have a process to determine whether allegations involve clinical practice. The process involves review by the appropriate medical professionals. This is known as peer review.

Process for Determining Appropriateness for Referral to Peer Review

In DSHS facility (state hospital) investigations, the investigator determines whether the allegation involves clinical practice by consulting with an appropriate professional.

25 TAC §417.509

For all other providers, the investigator consults with an appropriate professional to determine if the allegation involves clinical practice. If so, the investigator refers the allegation to the provider for peer review.

If the provider is unable to determine whether the allegation involves the clinical practice of a medical or nursing professional, the investigator refers the allegation to the Forensic Assessment Center Network (FACN) for a decision.

If the provider is unable to determine whether the allegation involves the clinical practice of a licensed professional other than a medical or nursing professional:

  •  within 24 hours, the APS district director or designee and the administrator of the provider agree to consult a previously mutually agreed-upon licensed professional; and

  •  the provider is responsible for the costs of the consultant’s services.

If the provider does not have a peer review process, the investigator refers the allegation to the provider as well as the appropriate professional licensing board.

If the allegation is determined not to involve clinical practice, the investigator investigates the allegation.

If there are multiple allegations, the investigator refers any allegation involving clinical practice to the provider for peer review and investigates any allegation not involving clinical practice.

IMPACT Documentation

In a completed investigation with multiple allegations, the investigator documents the referral of a licensed professional to a professional board in the Administrative/Procedural Note section of the Analysis of Evidence.

See:

3712 Clinical Issues

7250 Release of Investigation Records Involving Confirmed Non-Clinical Abuse, Neglect, or Exploitation to Professional Boards (Excluding State Hospitals and State Supported Living Centers)

3931 Referral to the Professional Board

APS Provider Investigations April 2017

Process for Clinical Practice Referrals to a Professional Board in a State Hospital

If the investigator and appropriate professional determine the allegation involves the clinical practice of a physician, dentist, pharmacist, registered nurse, or licensed vocational nurse, the investigator refers the allegation to the facility for professional review.

25 TAC §417.509

If the allegation involves a licensed professional other than those listed above, the investigator refers the allegation back to the facility as well as to the appropriate professional board.

Process for Clinical Practice Referrals to a Professional Board

For all other providers, the investigator uses information gathered from the appropriate professional licensing board portal to make a referral to the applicable board.

3712 Clinical Issues

4440 Administrative and Procedural Notes

7250 Release of Investigation Records Involving Confirmed Non-Clinical Abuse, Neglect, or Exploitation to Professional Boards (Excluding State Hospitals and State Supported Living Centers)

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