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4000 Documentation and Case Closure

4100 General Documentation Requirements

APS Provider Investigations April 2017

IMPACT Documentation

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

  •  All notifications to facility and provider administrators and designees who receive initial and additional allegations.

  •  All contacts relevant to the investigation (face-to-face and telephone).

  •  Contacts with law enforcement at any point during the investigation.

Documenting within 24 hours means documenting on the day the notification was made or by midnight on the next business day. For example, if a notification was made at 4:00 p.m. on Thursday, the investigator documents the notification by 11:59 p.m. on Friday.

Electronic Documentation

The investigator is expected to maximize the use of mobile technology to provide greater efficiency in investigations. When an investigator uses any DFPS electronic device, he or she must take appropriate security measures.

Mobile Protective Services (MPS)

The investigator synchronizes cases when using MPS. An investigator uses a secure wireless connection to connect to the network and document directly into IMPACT. However, using the wireless connection could result in the loss of the connection, which results in the loss of documentation.

4110 Case Closure

APS Provider Investigations April 2017

After completing an investigation, the APS investigator:

  •  weighs the evidence collected and evaluates its credibility;

  •  reaches a finding based on the preponderance of the evidence;

  •  prepares the Provider Abuse and Neglect Report; and

  •  closes the investigation.

See also:

4200 Final Analysis of Evidence

4212 Evaluating Documentary Evidence

4213 Evaluating Physical and Demonstrative Evidence

4240 IMPACT and the Provider Abuse and Neglect Report

4300 Using the Analysis Headings in IMPACT

4400 Reaching a Disposition

4500 Determining the DADS and DSHS Classification

4600 Requirements for Case Closure

4120 Time Frames for Investigation Completion and Supervisory Approval

APS Provider Investigations November 2017

Time frames, priority assignments, and due dates differ depending on the specific facility or provider type. The investigator verifies the provider type at the time of intake to ensure the correct priority and that the time frame for completing the investigation is accurate.

Setting Type

Intake Priority

Completion and approval in…

SSLC or ICF-IID component of the Rio Grande State Center

I or II

10 calendar days

State Hospital

I or II

14 calendar days

State Hospital

III

21 calendar days

All other provider types

I, II or III

30 calendar days

In a non-SSLC setting, if the 14th, 21st or 30th day falls on a weekend or holiday, the Provider Abuse and Neglect Report is completed and approved by the next business day. Skeleton crew holidays are considered regular holidays.

See 2100 Priorities.

4121 Time Frames for Completing an Investigation in Non SSLC Settings

APS Provider Investigations April 2017

The investigator completes and the supervisor approves Priority I and II investigations within 14 calendar days of receipt of the report by DFPS. If the 14th day falls on a weekend or holiday, the Provider Abuse and Neglect Report is completed and approved by the next business day. Skeleton crew holidays are considered regular holidays.

The investigator completes and the supervisor approves Priority III investigations within 21 calendar days of receipt of the report by DFPS. If the 21st day falls on a weekend or holiday, the Provider Abuse and Neglect Report is completed and approved by the next business day.

See 2100 Priorities.

4122 Time Frames for Completing an Investigation in SSLCs and the Rio Grande State Center’s ICF/IID

APS Provider Investigations April 2017

In state supported living centers (SSLC) and the Rio Grande State Center’s ICF/IID, the investigator completes and the supervisor approves all investigations within 10 calendar days of receipt of the report by DFPS.

4123 Time Frames for Delivering the Investigation Report

APS Provider Investigations April 2017

The investigator provides the supervisor-approved Provider Abuse and Neglect Report to the provider according to the following time frames:

  •  In state supported living centers (SSLC) and the Rio Grande State Center’s ICF/IID, the investigator delivers the Provider Abuse and Neglect Report to the facility the next business day.

  •  In all other settings the investigator:

  •  sends or delivers the Provider Abuse and Neglect Report to the provider by close of business the next business day after approval; and

  •  sends or delivers the full case record, including the report, a de-identified copy of the intake, and the exhibits, to the provider by close of business the next business day.

  •  In facilities and local authorities (community centers) for mental health or intellectual disabilities, the investigator also includes the DADS Form AN-1-A (Client Abuse and Neglect Reporting) with the full case record sent to the facility by close of business the next business day after approval.

See 4630 Closing a Case Without Completing a Client Abuse and Neglect Reporting (DADS AN-1-A) Form.

4124 Extension Request

APS Provider Investigations April 2017

The APS program administrator or the program administrator’s designee may authorize an extension of time to complete an investigation.

The investigator requests an extension when circumstances warrant it by completing and submitting the Extension Request Form located under Contacts/Summaries in the IMPACT case management system. The APS program administrator or designee completes the approval process in IMPACT before the investigator submits the Extension Request Form to the provider.

Investigators ensure that an investigation is completed within the required time frames, or an approved extension form is submitted to the provider by the required deadline.

See:

4121 Time Frames for Completing an Investigation in Non SSLC Settings

4122 Time Frames for Completing an Investigation in SSLCs and the Rio Grande State Center’s ICF/IID

4126 Extraordinary Circumstances

Extended Time Frames

For investigations in state supported living centers and the Rio Grande State Center’s ICF/IID, the extension may be in one-to-10 day increments depending on the situation, but should not exceed 10 days. For all other provider investigations, the extension may be in one-to-14 day increments depending on the situation, but should not exceed 14 days.

If the extended time frame is not met, subsequent extensions may be authorized according to the needs of the case.

Required Notifications

All extensions require the investigator to notify the administrator or designee of a provider. If more than one provider is involved in the investigation, the investigator must notify each provider of the extension.

4125 Reasons for an Extension Request

APS Provider Investigations April 2017

The investigator’s request for additional time to complete an investigation must be for good cause.

The following reasons constitute good cause:

  •  Witnesses have not been available for interviews.

  •  Witnesses have not been cooperative with the investigator.

  •  Witnesses need to be re-interviewed.

  •  New witnesses were identified.

  •  An outside entity requires additional time to process evidence (for example, waiting for the results of Sexual Assault Nurse Examination kit, autopsy results, or forensic examination of a cell phone).

  •  Law enforcement requests that an investigation be temporarily discontinued.

  •  The HHSC Office of Inspector General requests that an investigation be temporarily discontinued.

  •  Extraordinary circumstances.

Annual leave and holidays do not constitute good cause and are not acceptable reasons to request an extension.

4126 Extraordinary Circumstances

APS Provider Investigations April 2017

An extraordinary circumstance is an unexpected event or external factor that delays the completion of an investigation; it is something that could not have been prevented even if reasonable measures had been taken.

Extraordinary circumstances include:

  •  inclement weather or natural disasters;

  •  a death in the primary investigator’s family;

  •  excessive workload due to APS employee vacancies or an uncommon rise in intakes; or

  •  IMPACT errors that prevent the investigation from being closed.

Only the APS program administrator or the program administrator’s designee can approve extensions based on extraordinary circumstances.

See HHSC Circular C-007 Inclement Weather Policy.

4127 Completing the Extension Request Form

APS Provider Investigations April 2017

The investigator completes all fields of the Extension Request Form located under Contacts/Summaries in the IMPACT case management system. The investigator selects the appropriate reason and, for all reasons other than extraordinary circumstances, includes a detailed justification of the need for the extension in the Other box.

The investigator takes the following steps to complete the Extension Request Form:

1.   Select the Extension Request contact/summary type on the Contact Detail page.

2.   Fill out the form, select the reason for extension, and provide a detailed justification in the Other box.

3.   Save and submit the contact to the APS program administrator or the program administrator’s designee.

4.   Obtain approval in IMPACT from the APS program administrator or designee.

5.   Print, sign, and date the approved Extension Request Form.

6.   Fax, email, or hand carry a copy of the signed form to the provider administrator or designee and, if appropriate, to the contractor CEO.

7.   Include a copy of the Extension Request Form and fax confirmation, read receipt, or delivery confirmation in the case record submitted to the provider or administrator, their designee, or the contractor CEO at the completion of the investigation.

If the APS program administrator or designee rejects the extension request in IMPACT, the investigator does not send a copy of the rejected form to the provider, administrator, designee, or contractor CEO.

If the reason for an extension is extraordinary circumstances, the APS program administrator or designee documents the justification for the extension in the Comments section of the extension approval page in IMPACT. The justification is not documented on the extension form. The APS program administrator or designee monitors the extended investigation to ensure it is closed in a timely manner.

4130 Review and Monitoring of Extension Requests

APS Provider Investigations April 2017

A report indicating the status of all investigations approaching and exceeding completion time frames is available to APS program administrators and supervisors on a daily basis for monitoring. State office reviews these reports for unusual or problematic trends.

The APS program administrator monitors the use of extension requests submitted because of extraordinary circumstances.

4200 Final Analysis of Evidence

APS Provider Investigations April 2017

When the investigator has collected all the relevant evidence, he or she organizes and analyzes it to see whether the evidence can establish what happened and whether abuse, neglect, or exploitation occurred. In analyzing the evidence, the investigator makes sound, defensible judgments about:

  •  what the key evidentiary differences are between competing versions of the incident;

  •  which evidence is most credible and why; and

  •  what finding a preponderance of the evidence supports.

The investigator’s documentation of the analysis must show that he or she:

  •  correctly identified and focused on key points of difference in the evidence;

  •  considered all evidence relevant to the key points of difference, as well as institutional and circumstantial factors, including:

  •  rules, policies, procedures, and treatment plans,

  •  physical conditions,

  •  precipitating events,

  •  the evident intentions of the persons involved, and

  •  staff training curricula and records;

  •  accurately assessed the credibility of the conflicting evidence;

  •  made adequate efforts to establish a probable version of events with the credible evidence;

  •  where a probable versions of events could be established, showed that it fit or did not fit the relevant definition of abuse, neglect, or exploitation;

  •  where a probable version of events could not be established because of a lack of evidence, showed why the finding must be inconclusive; and

  •  wrote the analysis with proper attention to grammar, syntax, organization, conciseness, tone, and ease of reading.

4210 Evaluating Different Types of Evidence

APS Provider Investigations April 2017

In the final analysis of evidence, the investigator evaluates the relevance, significance, and credibility of the evidence collected. This is done by:

  •  viewing the evidence as a whole, to see what story or stories it supports; and

  •  when necessary, viewing each piece of evidence individually to assess its meaning and value.

Different factors determine the value and credibility of different types of evidence.

4211 Evaluating Testimonial Evidence

APS Provider Investigations April 2017

Assessing the credibility of testimonial evidence is often the primary function of evidence analysis in an investigation. When all the statements give essentially the same version of events except for minor, normal variation, then credibility assessment is unnecessary. The single version becomes the probable version of events by default.

When individual statements or groups of statements give differing versions of events, the investigator must determine which of them is more likely to be true by carefully:

  •  comparing the statements’ relationships to one another and to the other evidence; and

  •  evaluating each one’s internal strengths and weaknesses.

4211.1 Comparing Statements to Other Evidence

APS Provider Investigations April 2017

The investigator determines:

  •  which version of events is supported by the physical, demonstrative, or documentary evidence;

  •  how many of the statements support each version; and

  •  how strongly they support or contradict one another.

Credibility is not a simple matter of majority rule; in many cases false statements outnumber truthful ones. Generally, however, if there is no evidence of collusion, greater consensus means greater credibility.

4211.2 Assessing a Statement’s Internal Strengths and Weaknesses

APS Provider Investigations April 2017

In addition to having more or less support from other evidence, a statement’s credibility can also be assessed in terms of its coherence, completeness, straightforwardness, objectivity, and other internal characteristics.

  •  Does the version of events given in a statement or set of statements make sense on its own terms? Is it logical and in keeping with common experience? Do the actions portrayed have recognizable motivation? Or, do they seem strange, out of character, or arbitrary?

  •  Did the persons who provided direct evidence have good opportunity to witness what they claim to have witnessed? Could any statement have been affected by the person’s sensory or cognitive disabilities? Might conditions at the time of the incident have interfered with the person’s ability to perceive events accurately? What was the person’s physical proximity to the incident?

  •  Could a person’s knowledge, experience, role, or temperament have affected his or her perception of the incident, memory of the incident, or willingness to report it truthfully?

  •  Is there evidence of bias in any of the statements?

  •  Does the statement have an appropriate level of plausible detail? Are there unexplained gaps or evasive characterizations, rather than detailed explanations?

  •  Does any statement contradict itself or other statements the same person gave at another time?

4212 Evaluating Documentary Evidence

APS Provider Investigations April 2017

Documentary evidence can be inaccurate, just as testimonial evidence can be, for many of the same reasons. When evaluating documentary evidence, the investigator tries to answer the following questions:

  •  How does the document explain what took place?

  •  Who created the document? For what purpose was it created? When?

  •  What were the circumstances of the document’s creation?

  •  If the document is offered as an immediate account of an incident, like a medical chart note, was it written by someone with first-hand knowledge of the incident?

  •  How soon after the incident was it written?

  •  What role or relationship did the person writing the information have with others involved in the case?

  •  Did he or she have motive to represent the incident in a certain way?

  •  Where has the document been since it was created?

  •  Is there any indication that it has been altered or forged?

4213 Evaluating Physical and Demonstrative Evidence

APS Provider Investigations April 2017

Physical evidence, properly documented and represented in photographs and diagrams, is often crucial in determining the credibility of testimonial and documentary evidence. In weighing physical and demonstrative evidence, the investigator tries to answer the following questions:

  •  How does the physical evidence explain what happened?

  •  Who took the pictures or drew the diagrams? How accurately do they represent the physical evidence?

  •  What point in time do the individual pieces of demonstrative evidence represent? What differences might there be between conditions at that time and conditions at the time of the incident?

  •  Is there any reason to believe that the physical or demonstrative evidence was falsified?

See 4241 Evidence List in IMPACT.

4220 Importance of Documentation

APS Provider Investigations April 2017

Accurate and thorough documentation of an investigation is a crucial part of the investigative process. Provider Abuse and Neglect Reports are prepared for and read by persons outside DFPS. State facilities and providers are highly visible organizations, and problems of abuse and neglect are often the subject of media and legal inquiry. Therefore, it is essential that the investigator write in a manner clearly understood by people who will approach the case from various perspectives. Furthermore, employees and former employees who have experienced adverse personnel actions based on a DFPS investigation may challenge the investigation findings or seek legal recourse.

The investigator’s knowledge of an incident must be transferred to paper. Documentation must be thorough and complete. Information the investigator has in his or her head which does not end up in the final report is meaningless. The investigative report must provide the reader with all the information necessary to understand the findings.

Reports must be completed in a timely manner. The provider may be waiting for a report to take disciplinary action against an alleged perpetrator. Delayed reports may negatively impact the safety and well-being of persons served.

4221 Documentation Techniques

APS Provider Investigations April 2017

Case documentation must be concise, clear, factual, and objective.

Concise documentation is comprehensive but free of unnecessary words and information.

Clear documentation is understandable to anyone who reads it, regardless of the reader’s agency affiliation. The investigator should explain acronyms at first use and be sure the documentation answers who, what, when, where, why, and how.

Factual documentation is information recorded and reported accurately. Facts are known or can be verified and may be drawn from interviews, observations, or documents. The facts must be used to support the investigator’s interpretations.

Objective documentation does not include assumptions, speculation, or gossip. Persons reviewing Provider Abuse and Neglect Reports are looking for facts from an unbiased investigator. The investigative report must present the factual information available together with the reasoning used to reach the finding. These reports may be used in grievance hearings and criminal proceedings. Phrases such as “the evidence indicates ...” or “based on the evidence ...” should be used rather than phrases such as “it is the opinion of the investigator.”

4230 Identifying Sources and Use of Direct Quotes

APS Provider Investigations April 2017

The investigator should accurately record the source of information and the content in the case record. The investigator identifies witnesses by name, title, and their involvement in the case. An effective way to record witness information is to summarize the information gathered and use direct quotes, when appropriate.

Example Without Quotations:

Mr. Smith stated to this investigator that he wasn’t sure who hit him in the head with the mop. Mr. Smith thinks it may have been an employee who works in the cafeteria during the lunch shift.

Example Using Quotations:

Mr. Smith stated the following to this investigator: “I see this staff person every day at lunch time. He cleans the floors. He doesn’t like me. He called me a bad word a long time ago. I think he hit me with the mop. He was cleaning. I spilled my milk. He doesn’t like me. I was talking to Janet when my head got hurt. I didn’t see who hit me.”

Using Mr. Smith’s exact words clearly and factually conveys the thoughts and feelings of the witness. Direct quotes eliminate the possibility of faulty interpretation on the part of the investigator.

Occasionally, a witness may use obscene language when giving a statement. This language may be used to convey frustration or the person may be giving a direct quote. Statements should not be edited.

4240 IMPACT and the Provider Abuse and Neglect Report

APS Provider Investigations April 2017

To produce the Provider Abuse and Neglect Report, IMPACT pulls the information entered into the Contact/Summary pages during the Intake and Investigation stages and displays it under the appropriate headings in the report. The investigator launches the Provider Abuse and Neglect Report from the Provider Investigation Conclusion page under the Forms drop down box. Certain sections of the report are protected and cannot be changed, but the majority of the report can be edited. Changes to the content of the report should be made in the Contact/Summary page where the information was initially entered.

The Provider Abuse and Neglect Report contains the sections described in the following items:

4241 Evidence List in IMPACT

4142 Summary of Evidence in IMPACT

4143 Closing Summary in IMPACT

4440 Administrative and Procedural Notes

4450 Authentication

4241 Evidence List in IMPACT

APS Provider Investigations April 2017

Without a summary, this section lists all witness statements, photographs, documents, and video surveillance contained in the paper file. Information entered into the Evidence List contact type pre-fills in the Evidence List section of the Provider Abuse and Neglect Report. The Evidence List contact type provides a blank narrative in which the investigator can list each piece of evidence contained in the paper case file. The text below provides an example of how evidence should be listed in the Evidence List contact type and includes various document possibilities to gather from various facilities:

Exhibit A: De-identified Intake Report Number 123456789

Exhibit B: Statement from Sam Mayes, social worker and collateral

Exhibit C: Statement from Raymond Jones, individual receiving services and alleged victim

Exhibit D: Statement from Diana Brown, staff and alleged perpetrator

Exhibit E: Statement from Rosanna Felps, staff and collateral

Exhibit F: Statement from Alan Smith, RN

Exhibit G: Observation/Progress Notes

Exhibit H: Physicians’ Orders

Exhibit I: Nurse RN Note

Exhibit J: Daily Sign in Log

Exhibit K: Restraint/Seclusion Checklist

Exhibit L: Incident/Injury Report

Exhibit M: Person Directed Plan for Raymond Jones

Exhibit N: PNMP for Raymond Jones

Exhibit O: Behavioral Support Plan for Raymond Jones

Exhibit P: Employee Training Records for Diana Brown

Exhibit Q: Home Health Client Profile for Raymond Jones

Exhibit R: Employee Visit Plan for Raymond Jones

Exhibit S: Home Health Attendant Orientation/Supervisory Visit document for Raymond Jones

Exhibit T: Client Visit Log for Raymond Jones dated January 2016

Exhibit U: Dos and Don’ts for attendants

Exhibit V: Personnel Records for Diana Brown

Exhibit W: Psychological/Psychiatric Evaluation for Raymond Jones

The investigator should draw from all relevant community resources to gather the appropriate documentation that is applicable to the facility. Relevant resources include service coordinators, case managers, client rights officers, and administrators or program managers.

4242 Summary of Evidence in IMPACT

APS Provider Investigations April 2017

This section of the report is a review of the information gathered during the investigation. It pre-fills with all electronic statements gathered via MPS and other contacts entered into the Contact/Summary page. Other evidence recorded in the Contact/Summary page (environmental, documentary, or physical), including documents and photographs, is also discussed in the summary of evidence.

4243 Closing Summary in IMPACT

APS Provider Investigations April 2017

This section of the Provider Abuse and Neglect Report includes the:

  •  analysis of evidence (see 3340 Analysis of Evidence During Investigation);

  •  concerns and recommendations (see 4420 Concerns and Recommendations);

  •  prior case history (see 3221 Prior Case History);

  •  administrative and procedural notes (see 4440 Administrative and Procedural Notes); and

  •  authentication (see 4450 Authentication)

4244 Analysis of Evidence in IMPACT

APS Provider Investigations April 2017

In this section of the Abuse and Neglect Report, the investigator reviews and discusses the credibility of the evidence collected to determine whether there is a preponderance of evidence to support or refute the allegation. The investigator must structure the Analysis of Evidence using the required headings as outlined in 4300 Using the Analysis Headings in IMPACT.

To enter the Analysis of Evidence, the investigator selects Provider Closing in the Contact/Summary page from the Type field and clicks the Narrative push button. The Analysis of Evidence template will appear. The information entered will pre-fill the Abuse and Neglect Report under the heading of Closing Summary.

4300 Using the Analysis Headings in IMPACT

APS Provider Investigations April 2017

The investigator uses the Analysis of Evidence page to document his or her closing summary in the IMPACT case management system. The closing summary is a drop-down option in the Contact Detail page under the Contact/Summaries window. The closing summary contains headings that are required by IMPACT. The investigator documents not applicable in fields related to headings that are not relevant to the investigation.

The headings are meant to guide the investigator in explaining to the reader:

  •  the key differences in the evidence;

  •  which evidence relating to those differences is more credible and why;

  •  what story the credible evidence tells; and

  •  whether that story fits the definitions of abuse, neglect, and exploitation.

The function of the first three headings is to set the stage for the major work of the analysis — the assessment of credibility.

4310 Required Documentation for Headings

APS Provider Investigations April 2017

The investigator must structure the Analysis of Evidence using the required headings below:

Restatement of the Allegation

The investigator:

  •  restates the allegation made at intake; and

  •  adds additional allegations that were identified in the course of the investigation.

Points of Agreement

The investigator states the main points of agreement relevant to the allegation.

Points of Disagreement

The investigator states the main points of contention relevant to the allegation.

Credibility

To begin the Credibility section of the report, the investigator writes a header that lists the allegation, and whether it is considered credible or not, without additional details.

Below the header, the investigator writes a detailed description of how the relevant pieces of evidence support or refute the allegation, with the following considerations:

  •  Discuss how the key testimonial, documentary, demonstrative, or physical evidence supports or refutes the allegation, and why.

  •  Attempt to reconcile differences in evidence.

  •  Focus on the allegation and the finding(s).

  •  In the case of conflicting evidence, explain why some evidence is considered less credible.

  •  Discuss any motives that might cause the witness to be untruthful.

  •  Focus on elements of the definition that will assist in reaching a disposition.

  •  Use bullet formatting to:

  •  keep the credibility section short,

  •  reduce unnecessary words, and

  •  focus on the relevant evidence.

See 4210 Evaluating Different Types of Evidence.

Probable Version of Events

The investigator describes the probable version of events as follows:

  •  Use a timeline of events to describe the most likely scenario based on the credible evidence gathered.

  •  When there is insufficient evidence to answer all (or any) of the investigative questions, the investigator makes clear to the reader what gaps these unanswered questions leave in the probable version of events.

There is always a probable version of events regardless of the finding.

Policy, Program, or Training Issues Relevant to the Findings

The investigator:

  •  discusses any policy or training material considered in reaching the finding. Relevant policies and procedures include supervision requirements, individual behavior or treatment plans, restraint policies, physician’s orders, safety policies, and so on;

  •  documents specific information and titles of the documents, when possible;

  •  documents how the material referenced here is relevant to the allegation; and

  •  documents attempts to locate evidence of this nature when no policies exist.

If no specific policy relates to the finding, the investigator states that this section is not applicable.

Conclusion

In the conclusion, the investigator:

  •  explains why the allegations meet or do not meet the definitions of abuse, neglect, or exploitation; and

  •  gives justifications for all judgments made throughout the Analysis of Evidence.

The conclusion should:

  •  establish APS jurisdiction for the investigation using the Texas Administrative Code. It is best practice to include the legal definition of abuse, neglect, or exploitation that coincides with the allegation type;

  •  establish the link between the evidence collected in the investigation and the elements of the definitions of abuse, neglect, or exploitation; and

  •  establish the investigation finding when completing the conclusion.

If abuse or neglect is confirmed and the individual receiving services was not injured, the investigator explains specifically how the provider’s staff put the individual at risk of physical or emotional injury or death.

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

APS Provider Investigations April 2017

Each definition is composed of specific elements that must be established during an investigation. The investigator must obtain supporting evidence to demonstrate that all elements of a definition have been satisfied before an allegation is confirmed. In the charts below, the elements of each definition are separated and include questions and comments to assist the investigator in establishing whether the evidence supports the elements.

See:

4321 Element of the Definitions of Physical Abuse

4322 Elements of the Definition of Sexual Abuse

4323 Elements of the Definition of Exploitation

4324 Elements of the Definition of Verbal or Emotional Abuse

4325 Elements of the Definition of Neglect

4321 Elements of the Definitions of Physical Abuse

APS Provider Investigations April 2017

The following items discuss three methods of confirming physical abuse.

4321.1 To Confirm Physical Abuse (Option 1)

4321.2 To Confirm Physical Abuse (Option 2)

4321.3 To Confirm Physical Abuse (Option 3)

4321.1 To Confirm Physical Abuse (Option 1)

APS Provider Investigations April 2017

Elements 1 – 6

To Confirm Physical Abuse (Option 1)

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

     See TAC §711.3 for definitions of perpetrator, agent, and contractor.

     See TAC §711.3 for definitions of facility, local authority, community center, HCS, TxHmL, and provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

     What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

An act

     What did the AP do?

OR

A failure to act

     What did the AP fail to do?

May include Incitement to act (This can satisfy an act or failure to act.)

     What did the AP do, or fail to do, to spur or instigate an act?

Element 4

That …

Was performed knowingly

     What evidence shows that the AP knew or should have known of what he or she was doing, or failing to do, and of the likely consequences?

OR

Was performed recklessly

     What evidence shows the AP acted or failed to act while consciously disregarding the likely consequences?

OR

Was performed intentionally

     What evidence shows the AP’s purpose in doing what he or she did or didn’t do?

Element 5

And …

Caused physical injury or death

     What evidence shows there was an injury?

     What does a medical professional think is the likely cause?

OR

May have caused physical injury or death

     If there isn’t an injury, what reasoning and evidence leads to the conclusion that a potential for injury or death existed, as a result of the act or failure to act?

Element 6

But was not …

The proper use of restraints and seclusion, including Prevention and Management of Aggressive Behavior (PMAB), and the approved application of behavior modification techniques

     What actions would the relevant provider rules and procedures have prescribed for the kind of situation faced by the employees?

     What evidence shows that the employees’ actions did or did not conform to those rules and procedures?

OR

An action taken in accordance with the rules of the Texas Department of Aging and Disability Services and the Texas Department of State Health Services

     What evidence shows that the employees’ actions did or did not conform to those rules and procedures?

OR

An action that an employee, contractor, or agent may reasonably believe to be immediately necessary to avoid imminent harm to self, an individual receiving services, or other individuals, provided the actions are limited only to those actions reasonably believed to be necessary under the existing circumstances.

     What evidence indicates that an accused staff member took action aimed at protecting himself or herself or another person?

     What would a person of ordinary prudence have done under the same circumstances?

4321.2 To Confirm Physical Abuse (Option 2)

APS Provider Investigations April 2017

Elements 1–6

To Confirm Physical Abuse (Option 2)

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

     See TAC §711.3 for definitions of perpetrator, agent, and contractor.

     See TAC §711.3 for definitions of facility, local authority, community center, HCS, TxHmL, and provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

     What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

Inappropriate force

     What evidence shows the use of force was not proper for the circumstances or to accomplish the goal?

OR

Excessive force

     What evidence shows the degree of physical force used was more than was needed for the circumstances or to accomplish the goal?

OR

Corporal punishment

     What evidence shows the use of force was aimed at punishing or disciplining the individual receiving services?

Element 4

That …

N/A

     No resulting injury required

Element 5

And …

N/A

Element 6

But was not …

The proper use of restraints and seclusion, including Prevention and Management of Aggressive Behavior (PMAB), and the approved application of behavior modification techniques

     What actions would the relevant provider rules and procedures have prescribed for the kind of situation faced by the employees?

     What evidence shows that the employees’ actions did or did not conform to those rules and procedures?

OR

An action taken in accordance with the rules of the Texas Department of Aging and Disability Services and the Texas Department of State Health Services

     What evidence shows that the employees’ actions did or did not conform to those rules and procedures?

OR

An action that an employee, contractor, or agent may reasonably believe to be immediately necessary to avoid imminent harm to self, an individual receiving services, or other individuals, provided the actions are limited only to those actions reasonably believed to be necessary under the existing circumstances.

     What evidence indicates that an accused staff member took action aimed at protecting himself or herself or another person?

     What would a person of ordinary prudence have done under the same circumstances?

4321.3 To Confirm Physical Abuse (Option 3)

APS Provider Investigations November 2017

Elements 1–6

To Confirm Physical Abuse (Option 3)

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

  •   See TAC §711.3 for definitions of perpetrator, agent, and contractor.

  •   See TAC §711.3 for definitions of facility, local authority, community center, HCS, TxHmL, and provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

      What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

Use of chemical restraints

OR

Use of bodily restraints

OR

Seclusion

      What evidence shows the AP restrained or secluded the individual receiving services?

Element 4

That …

Was not in compliance with federal and state laws and regulations

      Did staff follow all relevant provider laws, rules, and regulations when initiating, executing, monitoring, and releasing the individual receiving services from restraint?

Element 5

And …

N/A

      No resulting injury required

Element 6

But was not …

The proper use of restraints and seclusion, including Prevention and Management of Aggressive Behavior (PMAB), and the approved application of behavior modification techniques

      What actions would the relevant provider rules and procedures have prescribed for the kind of situation faced by the employees?

      What evidence shows that the employees’ actions did or did not conform to those rules and procedures?

OR

An action taken in accordance with the rules of the Texas Department of Aging and Disability Services and the Texas Department of State Health Services

      What evidence shows that the employees’ actions did or did not conform to those rules and procedures?

OR

An action that an employee, contractor, or agent may reasonably believe to be immediately necessary to avoid imminent harm to self, an individual receiving services, or other individuals, provided the actions are limited only to those actions reasonably believed to be necessary under the existing circumstances.

      What evidence indicates that an accused staff member took action aimed at protecting himself or herself or another person?

      What would a person of ordinary prudence have done under the same circumstances?

4322 Elements of the Definition of Sexual Abuse

APS Provider Investigations November 2017

The following items discuss nine methods of confirming sexual abuse.

4322.1 To Confirm Sexual Abuse (Option 1)

4322.2 To Confirm Sexual Abuse (Option 2)

4322.3 To Confirm Sexual Abuse (Option 3)

4322.4 To Confirm Sexual Abuse (Option 4)

4322.5 To Confirm Sexual Abuse: Sexual Exploitation (Option 5)

4322.6 To Confirm Sexual Abuse (Option 6)

4322.7 To Confirm Sexual Abuse (Option 7)

4322.1 To Confirm Sexual Abuse (Option 1)

APS Provider Investigations November 2017

Elements 1 – 6

To Confirm Sexual Abuse (Option 1)

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

      See TAC §711.3 for definitions of perpetrator, agent, and contractor.

      See TAC §711.3 for definitions of facility, local authority, community center, HCS, TxHmL, and provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

      What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

Any sexual activity including…

Kissing

OR

Hugging

OR

Stroking

OR

Fondling

      What evidence shows this sexual activity occurred?

Element 4

That …

Had sexual intent

  •   What evidence is there of the AP’s purpose in their activity?

  •   What were the circumstances?

  •   What planning or preparation had occurred beforehand?

  •   What would a person of ordinary understanding consider to be the intention of the AP in taking the action he or she took?

Element 5

And …

N/A

Element 6

But was not …

Consensual sexual activity between an employee, agent, or contractor, and an adult alleged victim if the consensual sexual relationship began prior to the employee, agent, or contractor becoming an employee, agent, or contractor.

4322.2 To Confirm Sexual Abuse (Option 2)

APS Provider Investigations November 2017

Elements 1 – 6

To Confirm Sexual Abuse (Option 2)

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

  •   See TAC §711.3 for definitions of perpetrator, agent, and contractor.

  •   See TAC §711.3 for definitions of facility, local authority, community center, HCS, TxHmL, and provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

      What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

An AP engaging in sexual conduct as defined as deviate sexual intercourse, sexual contact, and sexual intercourse.

See Texas Penal Code §43.01

OR

Any obscene activity with an individual receiving services

      Does the activity satisfy all three parts of the definition of obscene as defined in the Texas Penal Code? (See Texas Penal Code §43.21)

Element 4

That …

N/A

Element 5

And …

N/A

Element 6

But was not …

Consensual sexual activity between an employee, agent, or contractor, and an adult alleged victim if the consensual sexual relationship began prior to the employee, agent, or contractor becoming an employee, agent, or contractor.

4322.3 To Confirm Sexual Abuse (Option 3)

APS Provider Investigations November 2017

Elements 1 – 6

To Confirm Sexual Abuse (Option 3)

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

  •   See TAC §711.3 for definitions of perpetrator, agent, and contractor.

  •   See TAC §711.3 for definitions of facility, local authority, community center, HCS, TxHmL, and provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

      What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

An AP requesting, soliciting, or compelling an individual receiving services to engage in sexual conduct as defined as deviate sexual intercourse, sexual contact, and sexual intercourse.

      See Texas Penal Code §43.01

OR

An AP requesting, soliciting, or compelling an individual receiving services to engage in any obscene activity

      Does the activity satisfy all three parts of the definition of obscene as defined in the Texas Penal Code? (See Texas Penal Code §43.21)

Element 4

That …

N/A

Element 5

And …

N/A

Element 6

But was not …

Consensual sexual activity between an employee, agent, or contractor, and an alleged victim if the consensual sexual relationship began prior to the employee, agent, or contractor becoming an employee, agent, or contractor.

4322.4 To Confirm Sexual Abuse (Option 4)

APS Provider Investigations November 2017

Elements 1 – 6

To Confirm Sexual Abuse (Option 4)

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

  •   See TAC §711.3 for definitions of perpetrator, agent, and contractor.

  •   See TAC §711.3 for definitions of facility, local authority, community center, HCS, TxHmL, and provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

      What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

An AP in the presence of an individual receiving services engaging in or displaying any obscene activity

  •   What evidence shows the individual receiving services was in the proximity or vicinity of the alleged perpetrator?

  •   Does the evidence obtained satisfy all three parts of the definition of obscene as defined in the Texas Penal Code? (See Texas Penal Code §43.21)

OR

An AP in the presence of an individual receiving services requesting, soliciting, or compelling an individual receiving services to engage in obscene activity

  •   What evidence shows the individual receiving services was in the proximity or vicinity of the alleged perpetrator?

  •   Does the evidence obtained satisfy all three parts of the definition of obscene as defined in the Texas Penal Code? (See Texas Penal Code §43.21)

Element 4

That …

N/A

Element 5

And …

N/A

Element 6

But was not …

Consensual sexual activity between an employee, agent, or contractor, and an adult alleged victim if the consensual sexual relationship began prior to the employee, agent, or contractor becoming an employee, agent, or contractor.

4322.5 To Confirm Sexual Abuse: Sexual Exploitation (Option 5)

APS Provider Investigations November 2017

Elements 1 – 6

To Confirm Sexual Abuse: Sexual Exploitation (Option 5)

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

  •   See TAC §711.3 for definitions of perpetrator, agent, and contractor.

  •   See TAC §711.3 for definitions of facility, local authority, community center, HCS, TxHmL, and provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

      What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

A pattern, practice, or scheme of conduct against an individual receiving services (may include sexual contact)

  •   What did the AP do?

  •   What evidence shows that a series of the AP’s actions had the same purpose or intent with regard to the individual receiving services?

  •   What planning had occurred beforehand?

Element 4

That …

Can reasonably be construed as being for the purposes of…

Sexual arousal of any person

OR

Gratification of any person

OR

Sexual abuse of any person

      What would a reasonable person consider to be the intention of the AP in taking the action he or she took?

Element 5

And …

N/A

Element 6

But was not …

Consensual sexual activity between an employee, agent, or contractor, and an adult alleged victim if the consensual sexual relationship began prior to the employee, agent, or contractor becoming an employee, agent, or contractor

OR

Obtaining information about a patient’s sexual history within standard accepted clinical practice

      What evidence indicates the alleged incident took place during or in relation to:

  • a clinical interview; or

  • for the purpose of obtaining and documenting a person’s history?

4322.6 To Confirm Sexual Abuse (Option 6)

APS Provider Investigations November 2017

Elements 1 – 6

To Confirm Sexual Abuse (Option 6)

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

  •   See TAC §711.3 for definitions of perpetrator, agent, and contractor.

  •   See TAC §711.3 for definitions of facility, local authority, community center, HCS, TxHmL, and provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

      What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

Sexual Assault

  •   What evidence shows that the AP committed sexual assault?

  •   See Texas Penal Code §22.011.

OR

Aggravated Sexual Assault

  •   What evidence shows that the AP committed aggravated sexual assault?

  •   See Texas Penal Code §22.021.

Element 4

That …

N/A

Element 5

And …

N/A

Element 6

But was not …

Consensual sexual activity between an employee, agent, or contractor, and an adult alleged victim if the consensual sexual relationship began prior to the employee, agent, or contractor becoming an employee, agent, or contractor.

4322.7 To Confirm Sexual Abuse (Option 7)

APS Provider Investigations November 2017

Elements 1 – 6

To Confirm Sexual Abuse (Option 7)

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

  •   See TAC §711.3 for definitions of perpetrator, agent, and contractor.

  •   See TAC §711.3 for definitions of facility, local authority, community center, HCS, TxHmL, and provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

      What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

An AP causing, permitting, encouraging, engaging in, or allowing the …

Photographing of an individual receiving services

OR

Filming of an individual receiving services

OR

Videotaping of an individual receiving services

OR

Depicting of an individual receiving services

Element 4

That …

Shows the AP knew or should have known the resulting photograph, film, videotape, or depiction of the individual receiving services is either:

  •   obscene; or

  •   pornographic.

(See Texas Penal Code §43.21)

Element 5

And …

N/A

Element 6

But was not …

Consensual sexual activity between an employee, agent, or contractor, and an adult alleged victim if the consensual sexual relationship began prior to the employee, agent, or contractor becoming an employee, agent, or contractor.

4323 Elements of the Definition of Exploitation

APS Provider Investigations November 2017

The following items discuss three methods of confirming whether a person has been exploited.

4323.1 To Confirm Exploitation in Any Setting (Option 1)

4323.2 To Confirm Exploitation in Community Providers (Excludes HCS and TxHmL) (Option 2)

4323.3 To Confirm Exploitation by Theft in Community Providers (Excluding HCS and TxHmL) (Option 3)

4323.1 To Confirm Exploitation in Any Setting (Option 1)

APS Provider Investigations November 2017

Elements 1 – 6

To Confirm Exploitation in Any Setting (Option 1)

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

      See TAC §711.3 for definitions of perpetrator, agent, and direct provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

      What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

An act or process of using an individual receiving services

      What evidence shows that the AP caused the individual receiving services to perform a service?

OR

An act or process of using the resources of an individual receiving services

      Resources of an individual receiving services include, but are not limited to:

  • money;

  • identifying information; and

  • property

Element 4

That …

Was illegal

      Does the act or process constitute fraud?

      Examples of fraud include:

  • forgery;

  • stealing or receiving a stolen check;

  • credit card or debit card abuse;

  • fraudulent transfer of a motor vehicle; and

  • issuance of a bad check.

See Texas Penal Code Chapter 32

OR

Was Improper

  •   Was the act or process deceptive, unfair, or unethical?

  •   Did the AP take advantage of the client’s disability or inferior position of power?

See 3228 Investigating Exploitation Allegations Involving Loans

Element 5 *&*

And …

Was for the AP’s monetary benefit, profit, or gain

OR

Was for the AP’s personal benefit, profit, or gain

     What evidence shows that the AP moved resources from the individual receiving services’ possession to the AP’s possession?

Element 6

But was not …

Theft of property

     See Texas Penal Code Chapter 31

4323.2 To Confirm Exploitation in Community Providers (Excluding HCS and TxHmL) (Option 2)

APS Provider Investigations November 2017

Elements 1 – 6

To Confirm Exploitation in Community Providers (Option 2)

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

      See TAC §711.3 for definitions of perpetrator, agent, and direct provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

      What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

An act or process of attempting to use an individual receiving services

      What evidence shows that the AP attempted to cause the individual receiving services to perform a service?

OR

An act or process of attempting to use the resources of an individual receiving services

      Resources of an individual receiving services include, but are not limited to:

  • money;

  • identifying information; and

  • property.

Element 4

That …

Was illegal

      Does the attempted act or process constitute fraud?

      Examples of fraud include:

  • forgery;

  • stealing or receiving stolen a check;

  • credit card or debit card abuse;

  • fraudulent transfer of a motor vehicle; and

  • issuance of a bad check.

      See Texas Penal Code Chapter 32

OR

Was Improper

  •   Was the act or process deceptive, unfair, or unethical?

  •   Did the AP take advantage of the individual receiving services’ disability or inferior position of power?

Element 5

And …

Was for the AP’s monetary benefit, profit, or gain

OR

Was for the AP’s personal benefit, profit, or gain

      What evidence shows that the AP attempted to move resources from the individual receiving services’ possession to the AP’s possession?

Element 6

But was not …

Theft of property

      See Texas Penal Code Chapter 31

4323.3 To Confirm Exploitation by Theft in Community Providers (Excluding HCS and TxHmL) (Option 3)

APS Provider Investigations November 2017

Elements 1 – 6

To Confirm Exploitation by Theft in Community Providers (Excluding HCS and TxHmL) (Option 3)

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

      See TAC §711.3 for definitions of perpetrator, agent, and direct provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

      What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

An act that meets the Texas Penal Code definition of Theft - An act or process of taking a person’s possession(s) or resources without the person’s consent or prior knowledge

      See Texas Penal Code §31.01 for definition of Theft.

  •   Resources include, but are not limited to:

  • cash;

  • money from checking or savings accounts;

  • medication prescribed to the 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.

  •   What evidence shows the property was appropriated unlawfully with the intent to deprive the individual receiving services of the property?

  •   What evidence shows the property was unlawfully appropriated without the individual receiving services’ effective consent?

Element 4

That …

N/A

Element 5

And …

N/A

Element 6

But was not …

A loan

 

4324 Elements of the Definition of Verbal or Emotional Abuse

APS Provider Investigations April 2017

Elements 1 – 6

To Confirm Verbal or Emotional Abuse

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

     See TAC §711.3 for definitions of perpetrator, agent, and contractor.

     See TAC §711.3 for definitions of facility, local authority, community center, HCS, TxHmL, and provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

     What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

An act or use of verbal or other communication, including gestures

     What did the AP say or do?

Element 4

That …

Was used to curse, vilify, or degrade

OR

Threatened an individual receiving services with physical or emotional harm

     What does the AP say was the purpose of the communication?

     What was the context?

Element 5

And …

Resulted in observable distress or harm to the individual receiving services

     What evidence shows the individual receiving services experienced harm or extreme anxiety, sorrow, or pain?

OR

Was of such a serious nature that a reasonable person would have considered it harmful or causing distress

     Regardless of how the individual receiving services perceived the communication, would a reasonable person consider it to be of a serious nature?

Element 6

But was not …

N/A

4325 Elements of the Definition of Neglect

APS Provider Investigations April 2017

Elements 1 – 6

To Confirm Neglect

Element 1

The investigator must establish the alleged perpetrator is …

A direct provider

     See TAC §711.3 for definitions of perpetrator, agent, and contractor.

     See TAC §711.3 for definitions of facility, local authority, community center, HCS, TxHmL, and provider.

Element 2

The investigator must establish the alleged victim is ...

An individual receiving services

     What evidence shows the alleged victim is an individual receiving services defined by TAC §711.3?

Element 3

The investigator must establish that there was …

A negligent act

     What did the AP do?

     What evidence shows that the AP had a duty to act in a different manner and disregarded his or her duty?

OR

A negligent omission

     What evidence shows that the AP had a duty that was disregarded?

     What evidence shows that the AP knew or should have known he or she had that duty?

     What degree of caution or care would a reasonable person have exercised?

     Example of a negligent omission: A failure to establish or carry out an appropriate individual program or treatment plan for an individual receiving services if such failure results in a specific incident or allegation.

     What evidence shows the appropriateness of the individual program plan?

Or

A failure to provide adequate nutrition, clothing, or health care

     What evidence shows the adequacy?

Or

A failure to provide a safe environment (for example, a failure to maintain adequate numbers of appropriately trained staff) if such failure results in a specific incident or allegation

     What evidence shows the safety of the environment?

Element 4

That …

Caused physical or emotional injury or death

     What evidence shows there was an injury or a death?

     What does the medical professional think is the likely cause?

OR

Could have caused or put an individual receiving services at risk of physical or emotional injury or death

     If there is not an injury, what evidence or reasoning leads to the conclusion that a potential for injury or death exists?

     What result, if any, does the medical professional believe the negligent act or omission could have caused?

Element 5

And …

N/A

Element 6

But was not …

N/A

4400 Reaching a Disposition

APS Provider Investigations April 2017

At the conclusion of the investigation, the investigator must reach a disposition. The investigator weighs the evidence and determines if the preponderance of the evidence (greater weight of the evidence) supports whether the allegation did or did not occur.

4410 Dispositions of Confirmed, Unconfirmed, and Inconclusive

APS Provider Investigations April 2017

When the investigator establishes a preponderance of evidence that seems most consistent with reason and probability under the facts, the investigator determines the disposition as Confirmed or Unconfirmed.

When the investigator is unable to establish a preponderance of the evidence because the evidence is evenly divided between supporting and refuting the allegation, the investigator determines the disposition as Inconclusive. This may occur when there is a lengthy delay in reporting, key witnesses cannot be located or are unable to communicate, or the credibility of all witnesses is questionable.

If the investigator determines that the allegation is spurious or patently without factual basis before all relevant evidence is collected, the investigator determines the disposition as Unfounded.

The investigator makes the appropriate disposition supported by the preponderance of the evidence.

  •  Confirmed: The preponderance of the credible evidence supports that abuse, neglect, or exploitation occurred.

  •  Unconfirmed: The preponderance of the credible evidence supports that abuse, neglect, or exploitation did not occur.

  •  Inconclusive: There is not a preponderance of credible evidence to support or refute that abuse, neglect, or exploitation occurred.

  •  Unfounded: The evidence gathered indicates that the allegation is spurious or patently without factual basis.

4411 The Difference Between Unfounded and Unconfirmed

APS Provider Investigations April 2017

Unfounded Disposition

When the investigator does not collect all available evidence, including interviewing all relevant witnesses, but collects credible evidence to establish that an allegation is spurious or patently without factual basis, the case is closed with a disposition of Unfounded. The investigator documents a case with a disposition of Unfounded the same way he or she would document any other case.

The investigator exercises caution when making a determination that an allegation reported by an individual receiving services is unfounded. An individual receiving services may not know the names of all of the staff who work at a facility, or may be confused about dates and times. Factual information regarding an actual incident of abuse or neglect may be buried within the delusions of an individual receiving services.

The following are examples of cases with a disposition of Unfounded:

  •  An individual reports that last night 20 staff members rose up from the ground and beat him with chains while he was sleeping in his bedroom. The investigator verifies with medical personnel that the individual did not have injuries consistent with the allegation and interviews the individual’s two roommates, who testify an incident did not occur in their bedroom last night. The investigator collects no additional evidence. The case is closed with a disposition of Unfounded.

  •  Individual A reports that two days ago a staff member incited him to punch Individual B in the arm. The investigator interviews Individual A, who verifies the staff member’s identity and clarifies that the staff member incited Individual A on the same day Individual A punched Individual B. The investigator interviews the floor supervisor who was on duty on the night of the alleged incident. The floor supervisor states that Individual A punched Individual B because they were arguing over a video game. The floor supervisor also testifies that the staff member was not on the facility grounds at the time of the incident because the staff member was on vacation. The investigator collects no additional evidence. The case is closed with a disposition of Unfounded.

Unconfirmed Disposition

When the investigator collects all possible evidence, including interviewing all relevant witnesses, and determines by a preponderance of the credible evidence that abuse, neglect, or exploitation did not occur, the case is closed with a disposition of Unconfirmed.

The following are examples of cases with a disposition of Unconfirmed:

  •  A staff member reports that yesterday, while in the dining room, the alleged perpetrator hit an individual receiving services. The investigator collects all evidence, including interviewing all witnesses in the dining room during the alleged time frame, and establishes by a preponderance of the credible evidence that the alleged perpetrator did not hit the individual receiving services because the alleged perpetrator was not on facility grounds. The case is closed with a disposition of Unconfirmed.

  •  An individual receiving services reports that last night a staff member threw a brick at her leg while the she was dancing in the laundry room. The individual alleges that she sustained bruising because of the staff member’s actions. The investigator interviews her, and she has no injuries. The investigator collects all evidence, including interviewing all witnesses who were located in the hallway connected to the laundry room, and establishes by a preponderance of the credible evidence that the staff member did not throw a brick at the individual receiving services. The case is closed with a disposition of Unconfirmed.

4412 Unknown Perpetrators

APS Provider Investigations April 2017

When the preponderance of the evidence establishes that abuse, neglect, or exploitation occurred, but positive identification of the responsible person cannot be made, the investigator designates a perpetrator as Unknown in the IMPACT case management system. The investigator makes all reasonable efforts to identify and name the perpetrator; however, the evidence in some cases may not prove who, specifically, is responsible.

4413 Basis for Designating a Perpetrator as a Systems Issue

APS Provider Investigations April 2017

When the preponderance of the evidence establishes that abuse, neglect, or exploitation occurred, the investigator designates a perpetrator as a Systems Issue in the IMPACT case management system, if:

  •  the provider’s lack of established policy or procedure contributed to the abuse, neglect, or exploitation; or

  •  the provider’s established policy is inadequate and fails to ensure the safety of the individual receiving services.

The following are examples of cases with a disposition of Systems Issue:

  •  An individual receiving services is injured while being transferred from a toilet to a wheelchair. The alleged perpetrator executing the transfer was never trained to make such a transfer.

  •  Three staff members take 20 individuals receiving services on an outing. One individual is left behind. He does not have sufficient safety skills to be in the community without staff supervision. Each of the three staff members thought that he left with one of the other staff members. The facility has no policy to ensure that individuals receiving services leave an outing together, such as conducting a headcount or assigning each staff member to a group of individuals receiving services.

  •  A facility’s policy is for the staff to cook family style meals and eat with the individuals receiving services; however, the individuals are paying for the food for both themselves and the staff.

4420 Concerns and Recommendations

APS Provider Investigations November 2017

In the Concerns and Recommendations section of the Provider Abuse and Neglect Report, the investigator addresses the future protection of the individual receiving services. If an employee has not received necessary training or the investigation reveals that a provider policy or procedure is unclear, the investigator documents those issues here.

The investigator enters concerns and recommendations on the Analysis of Evidence template under the appropriate heading. The concerns and recommendations will pre-fill onto the Provider Abuse and Neglect Report.

The investigator identifies issues but avoids dictating required actions to the provider. The investigator may want to review this section with his or her supervisor if there is a question about whether a concern or recommendation is appropriate.

See below for examples of the correct and incorrect way to document issues:

Incorrect

Correct

The alleged perpetrator needs PMAB training immediately.

It is concerning that the alleged perpetrator has not received refresher training in the Prevention and Management of Aggressive Behavior (PMAB) in over two years.

The provider policy on close observation is ineffective and needs to be revised.

It is recommended that provider administrative staff review the policy on close observation to determine if it provides an appropriate level of protection to individuals receiving services.

The CDS employer should not participate in the CDS service delivery option and should have an agency provider.

It is recommended that the CDS employer reviews the CDS policy regarding employer responsibilities and employee training to ensure the continued health and safety of the individual receiving services.

The HCSSA agency doesn’t train employees regarding abuse, neglect, and exploitation.

It is a concern to this investigator that a copy of the requested document, Abuse, Neglect, and Exploitation Training for AP, was not provided during the investigation.

4430 Use of Prior Case History to Document Concerns and Recommendations

APS Provider Investigations April 2017

At the initiation of each investigation, the investigator conducts a search of relevant prior case history. The results of the prior case history search may be used to inform the current investigation. If the investigator determines there are concerns or issues regarding various relevant patterns, he or she clearly documents the information under Concerns and Recommendations in the Provider Abuse and Neglect Report. Patterns could involve behaviors, personnel, training, safety or risk, or the number of cases the alleged perpetrator or individual receiving services has been involved in. The investigator also considers cases in other DFPS programs, such as in APS In-Home, CPS, and CCL.

Multiple Inconclusive Findings With Similar Trends

The investigator may document prior case history under Concerns and Recommendations when an alleged perpetrator has been involved in multiple cases with inconclusive findings and similar trends. Cases with similar trends include:

  •  multiple allegations involving similar victimology of individuals receiving services, such as the same gender, age, or communication abilities;

  •  repeat incidents in similar locations, such as an individual receiving services’ bedroom; and

  •  similar allegations involving one person’s word against another, with no other witnesses.

Case Example

Case history shows that the alleged perpetrator has been involved in four investigations with inconclusive findings. All of the investigations involved allegations that he called the individual receiving services a name, without any witnesses to the incident.

Trends of the Same Type of Allegations Involving an Alleged Perpetrator and Multiple Individuals Receiving Services

Trends involving similar allegations with the same alleged perpetrator, but with different individuals receiving services, should be documented under Concerns and Recommendations.

Case Example

Case history shows that multiple individuals receiving services say the same one-to-one staff throws cold water on them while they are in the shower.

4440 Administrative and Procedural Notes

APS Provider Investigations April 2017

In the Administrative/Procedural Notes section, the investigator addresses procedural issues not addressed elsewhere in the Provider Abuse and Neglect Report. For example, if a new, unrelated allegation surfaced during the investigation, the investigator notes that it is being addressed in a separate investigation.

IMPACT

The investigator enters Administrative/Procedural Notes directly onto the Provider Abuse and Neglect Report after it is launched from the Provider Investigation Conclusion page.

4450 Authentication

APS Provider Investigations April 2017

The investigator authenticates the paper copy of the Provider Abuse and Neglect Report with his or her signature. The date for completion of the report is frozen to match the date that the investigation was approved by the supervisor. The report should be mailed, faxed, or hand delivered as soon as possible after completion.

4500 Determining the DADS and DSHS Classification

APS Provider Investigations April 2017

Facilities, local authorities, and community centers use the classification recommended by APS PI to determine the appropriate disciplinary action for an employee who is a designated perpetrator in an investigation with a disposition of Confirmed.

The investigator recommends a classification for each allegation using the DADS and DSHS classification system. The investigator relies on the facts of the case rather than what was alleged at the time of intake to determine the appropriate classification. In cases involving physical injury, the investigator relies on the severity of the injury as determined by qualified medical personnel (usually a physician), as well as the circumstances surrounding the incident.

Class I

The investigator recommends Class I for:

  •  any act or failure to act performed knowingly, recklessly, or intentionally, including incitement to act, which caused or may have caused serious physical injury to an individual receiving services; or

  •  any sexual abuse involving an employee, agent, or contractor and an individual receiving services, without regard to injury.

Class ll

The investigator recommends Class II for:

  •  any act or failure to act performed knowingly, recklessly, or intentionally, including incitement to act, which caused or may have caused non-serious physical injury to an individual receiving services;

  •  any act of force or corporal punishment, including striking or pushing an individual receiving services, regardless of whether the act results in non-serious injury to the individual; or

  •  exploitation.

Class lll

The investigator recommends Class III for:

  •  any use of verbal or other communication to curse, vilify, or degrade an individual receiving services, or to threaten an individual receiving services with physical or emotional harm; or

  •  any act that vilifies, degrades, or threatens an individual receiving services with physical or emotional harm.

Neglect

The investigator recommends Neglect for a negligent act or omission by any individual responsible for providing services in a provider rendering care or treatment that:

  •  caused or may have caused physical or emotional injury or death to an individual with mental health or intellectual disabilities; or

  •  placed an individual with mental health or intellectual disabilities at risk of physical or emotional injury or death.

Classification Documentation

To enter the classification, the investigator navigates to the Facility Allegation Detail page. The investigator enters a classification for each allegation except those that have a finding of Other, which is used for rapid closure.

In determining the appropriate classification, the investigator refers to 4610 IMPACT Documentation for Normal Closure. IMPACT does not have an edit function to correct wrong or inappropriate entries. For this reason, the investigator must exercise care to select the appropriate classification that corresponds to each allegation.

The investigator also documents the recommendations on the individual receiving services Abuse and Neglect Reporting Form (DADS AN-1-A), and sends the form to the facility and community center at the conclusion of the investigation. See 4630 Closing a Case Without Completing a Client Abuse and Neglect Reporting (DADS AN-1-A) Form for procedures related to sharing recommended classifications with providers.

4600 Requirements for Case Closure

APS Provider Investigations April 2017

There are two types of closure categories: Normal Closure and Rapid Closure. Investigations that have a disposition of Confirmed, Unconfirmed, Inconclusive, or Unfounded are appropriate for normal closure. The investigator selects Normal Closure from the Closure Reason dropdown list on the Facility Investigation Conclusion page.

Investigations that are referred to the facility or provider for handling are appropriate for rapid closure. The investigator selects from the Closure Reason list the appropriate closure reason that corresponds with the reason selected on the Adult Protective Services Referral Form. For example, if an allegation is referred as a client rights issue, the closure reason selected is Client Rights.

The investigator may choose other rapid closure reasons based on one of the following descriptions:

  •  Does not meet definition of APS Provider – What is alleged does not meet the definition for investigation and is not an issue that is referred to the facility.

  •  Duplicate referral already investigated – The allegations have already been investigated by APS Provider Investigations.

  •  Reclassification – The allegations were reclassified as an APS In-Home investigation or are under the jurisdiction of another agency.

4610 IMPACT Documentation for Normal Closure

4611 Person Detail Page

APS Provider Investigations April 2017

Before closing a case as a normal closure, the investigator completes the following documentation requirements on the Person Detail page:

  •  Perform a person search on all persons on the Person List page if a search has not already been performed, make changes to correct the names as appropriate, and add names of collaterals interviewed during the course of the investigation. See the IMPACT FYI Person Detail page for instructions on viewing, adding, or modifying a person.

  •  Select the applicable person characteristics for all principals on the Person List page.

  •  Enter the following person identifiers for all individuals receiving services:

  •  Date of birth.

  •  Medicaid number if the individual receiving services is Medicaid eligible.

  •  Social Security number, if provided.

  •  Enter the following person identifiers for all alleged perpetrators:

  •  Date of birth

  •  Social Security number, if provided

If the individual receiving services or alleged perpetrator declines to provide his or her Social Security number, the investigator:

  •   enters only the date of birth; and

  •   documents in the contact that summarizes the interview that the individual receiving services or the alleged perpetrator declined to provide his or her Social Security number.

Under no circumstances should the investigator fabricate a number or use only a partial or pseudo-numbers when the person has not provided the Social Security number. Documentation in the case is all that is required when the Social Security number is not provided. If the alleged perpetrator is involved in a confirmed case of abuse, neglect, or exploitation that does not rise to the level of Employee Misconduct Registry, the investigator cannot request the alleged perpetrator’s Social Security number from the employer.

4612 Contacts and Summaries

APS Provider Investigations April 2017

The investigator:

  •  enters all contacts individually, choosing Assessment from the Purpose list for at least one of the contacts in the Contact Detail page;

  •  enters information about external documentation (such as witness statements and documentary evidence) by selecting the Evidence List from the Contact/Summary Type dropdown box; and

  •  enters photographs in the External Documentation page per instructions in 3513 Instructions for Digital Photographs.

4613 Allegation Detail Page

APS Provider Investigations April 2017

The investigator adds allegations on the Allegation List page. Investigations can have multiple facilities or providers, as well as provider resource IDs (addresses), added to the investigation (see 4614 Provider Investigation Conclusion). The investigator ensures that the appropriate provider, facility, or resource ID is linked to the correct allegation based on the individual receiving services. For example, if Individual A is served by Provider A and Individual B is served by Provider B, then Provider A needs to be linked to the allegation for Individual A, and the allegation for Individual B needs to be linked to Provider B. The resource identification number and the resource name are listed in the Provider field to assist in choosing the correct facility or provider.

The investigator completes the following steps on each allegation on the Provider Allegation Detail page for cases with a normal closure. See:

4613.1 Facility Allegation Detail

4613.2 Investigator Findings

4613.3 Comments

4613.1 Facility Allegation Detail

APS Provider Investigations April 2017

The investigator documents the following:

  •  Date field — The investigator enters the date and time of the alleged incident, if known.

  •  Seriousness of Injuries list — The investigator selects the code consistent with the allegation.

  •  Provider — The investigator must designate a provider for each allegation. In cases involving multiple facilities or providers, the investigator selects the resource identification number for a specific provider along with the name of the provider.

See 3435 Documenting Individual and Provider Records in IMPACT for use of the selection of Fatal in the Seriousness of Injuries list.

4613.2 Investigator Findings

APS Provider Investigations April 2017

The investigator documents the following:

  •  Date field — The investigator enters the date that he or she reaches the disposition for the allegation.

  •  Class list — The investigator selects the classification recommended for the allegation. Refer to 4500 Determining the DADS and DSHS Classification.

  •  Disposition list — The investigator selects a disposition of Confirmed, Unconfirmed, Inconclusive, Other (for a specific allegation referred to the facility or for rapid closure), or Unfounded.

  •  Source of A/N/E — The investigator selects the status of the person who committed the abuse, neglect, or exploitation (such as Employee, Contractor, or Perp Unknown).

See 3410 Documentation of Medical or Physical Exam.

4613.3 Comments

APS Provider Investigations April 2017

The investigator documents the specific allegation details in the Comments box. Information on the Provider Allegation Detail page appears on the front page of the report.

4614 Provider Investigation Conclusion

4614.1 Facility or Provider Information: Resource (Facility or Provider) Searches

APS Provider Investigations April 2017

It is imperative that the investigator links the correct provider to the investigation.

Example

The alleged abuse, neglect, or exploitation occurs in a day habilitation setting, but the individual receives services from a Home and Community-based Services (HCS) provider. In this case, the investigator links the resource ID (from the IMPACT Resource Directory) for the HCS provider to the investigation by choosing that provider from the IMPACT Resource Directory. The day habilitation provider is not linked to the investigation and is not displayed on the Provider Investigation Conclusion page.

The primary HCS provider contracts for day habilitation services and, therefore, is the primary HCS provider linked to the investigation.

4614.2 Investigations Involving More Than One Facility or Provider

APS Provider Investigations April 2017

An investigation may involve multiple facilities, providers, or provider resource IDs (addresses). The investigator needs to search and select each facility or provider that serves an individual receiving services who is listed as an alleged victim in the investigation. The Provider Investigation Conclusion page is designed to list each facility, provider, or provider resource ID under the section marked Providers. The investigator must select Add in order to list multiple facilities or providers.

When adding another facility or provider to the Provider section of the Investigation Conclusion page, the investigator is directed to the resource search function and completes the steps outlined in 4614.3 Investigations Involving Multiple Addresses for the Same Provider and 4614.4 Completing a Search. To complete the Provider Abuse and Neglect Report, the investigator must ensure that each allegation on the Provider Allegation Detail page has the correct provider resource ID linked to each allegation.

4614.3 Investigations Involving Multiple Addresses for the Same Provider

APS Provider Investigations April 2017

In rare instances, one provider may be serving multiple individuals receiving services in multiple locations.

For example, XYZ Provider has three different group homes and serves two individuals receiving services who are alleged victims in the investigation. One individual lives at one group home address and the other individual lives at another group home address. The investigator should add XYZ Provider to the Facility Investigation Conclusion page twice so he or she can list each group home address associated with each alleged victim. The resource identification number for each XYZ group home that is associated with the investigation appears next to the resource name on the Provider Allegation Detail page.

All DADS and DSHS facility resources for state facilities and community centers are maintained in state office. All Provider resources for HCS and ICF/IIDs are updated in IMPACT weekly by an interface program from the DADS Client Assignment and Registration (CARE) system. All Provider resources for DADS HCSSAs are updated in IMPACT weekly by an interface program from the DADS Long Term Care Quality Reporting System (LTC QRS).

4614.4 Completing a Search

APS Provider Investigations April 2017

If the investigator notices that the wrong facility or provider is displayed in the Facility field on the Provider Investigation Conclusion page or that the Facility field is blank, the investigator must perform a facility search from the IMPACT Resource Directory. The investigator does not type a name in the Facility field on the Investigation Conclusion page.

To perform a facility or provider agency search, the investigator:

  •  accesses the Provider Investigation Conclusion page and selects the Resource push button. The Resource Search Criteria page appears;

  •  selects Provider from the Resource Type field;

  •  selects MHMR Code from the Identification Number drop-down list and enters the component code, if known;

  •  enters the first two-to-four letters of the name of the facility;

  •  clicks on the Search button;

  •  selects the appropriate facility address by clicking on the radio button (circle) to the left of the facility’s name, and then clicking the Continue button; and

  •  contacts state office if a match is not found by emailing the Resource Maintainer APS mailbox.

The (DADS or DSHS) component code populates on the Provider Investigation Conclusion page when the investigator selects the resource from the Resource Directory.

4615 Provider Investigation Conclusion: Location of Incident

APS Provider Investigations April 2017

The investigator chooses the location of the incident before closing an investigation. The items in the drop-down list change depending upon what type of setting (facility or community provider) is listed on the Provider Investigation Conclusion page.

4615.1 Community-Based Settings: HCS, Licensed ICFs/IID, Community Centers, and Community Provider Residential Settings

APS Provider Investigations April 2017

Investigators use the Location of Incident drop-down on the Provider Investigation Conclusion page to show that the location of the incident is:

  •  a foster care home;

  •  a group home;

  •  the provider’s own home or family home;

  •  a day habilitation or workshop;

  •  a supervised outing;

  •  transport;

  •  unknown; or

  •  other.

4615.2 Facility Settings: SSLCs, State Hospitals, and Rio Grande State Center

APS Provider Investigations April 2017

The Location of the Incident drop-down on the Provider Investigation Conclusion page provides the following options:

  •  On grounds

  •  Off grounds

  •  Other

  •  Unknown

If there is more than one provider type listed in the investigation, the drop-down list in IMPACT defaults to the one used for community-based providers.

4616 Documenting Use of Prior Case History in IMPACT

APS Provider Investigations April 2017

If an investigator conducts a prior case history search, the investigator must document how he or she used the prior case history in the current investigation. To document this, the investigator goes to the Provider Investigation Conclusion page and selects the most appropriate choice from the Prior History Reviewed drop-down list. Drop-down options include:

Drop-Down Option

Reason for Selection

Not Used In Current Case

The investigator chooses this option if there was prior case history for any of the principals, but the history was not used in the current investigation.

Used for Concerns and Recommendations

The investigator chooses this option if there was prior case history for any of the principals, and history showed a trend that was documented under Concerns and Recommendations.

Used Information for Current Case

The investigator chooses this option if there was prior case history for any of the principals, and the history was used to support interviews, credibility, evidence collection, or in other parts of the current investigation.

No Prior History

The investigator chooses this option if there was no prior case history for any of the principals.

If an investigator conducts a prior case history search in an investigation involving multiple providers, the investigator documents the name of each principal who requires a search under the Prior Case History Comments section of the report.

See also 3221 Prior Case History.

4620 IMPACT Documentation for Rapid Closure

APS Provider Investigations April 2017

The investigator documents all contacts made before closing a case with a rapid closure code and sends the Adult Protective Services Referral Form 2323, located in IMPACT, with the intake and related documents to the facility or provider.

The investigator also emails the referral form to DADS Waiver Survey and Certification if the rapid closure is for an investigation of one of the following providers:

  •   Home and Community-based Services (HCS)

  •   Texas Home Living (TxHmL)

  •   State-supported living center (SSLC)

  •   Licensed intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID)

When an intake does not meet APS PI jurisdiction and is reclassified to another DFPS program, the investigator documents in the contact narrative in IMPACT:

  •  the supervisory consult; and

  •  any casework completed.

If the investigator has already notified the provider at the time of intake, he or she will need to complete Referral Form 2323 and forward it to the provider.

If the provider has not been notified at the time of intake, the investigator makes a note of the reclassification in a contact narrative in IMPACT

See 4624.7 Closure Reason: Reclassification.

4621 Person Detail Page

APS Provider Investigations April 2017

The investigator enters the following information on the Person Detail page, even if he or she refers the allegations to the facility or provider:

  •  Person information on all individuals receiving services and correct spelling of first and last names

  •  The following person identifiers for all individuals receiving services:

  •  Date of birth

  •  Medicaid number if the individual receiving services is Medicaid eligible

  •  Social Security number (SSN), if possible (the individual receiving services may decline to provide his or her SSN)

Under no circumstances should the investigator use only partial numbers when the person has not provided the SSN.

4622 Contacts and Summaries

APS Provider Investigations April 2017

The investigator enters all contacts made in the Contact Detail page. Contacts include the one-hour notification to the facility or provider and the:

  •  initial face-to-face contact; or

  •  all other contacts made when a case meets the criteria for the Rapid Closure code and a face-to-face contact is not required.

4623 Allegation Detail Page

APS Provider Investigations April 2017

The investigator selects Other from the Disposition drop-down list so each investigation can have an overall disposition on cases closed with a Rapid Closure code.

4624 Provider Investigation Conclusion

APS Provider Investigations April 2017

In addition to entering the Documentation Completion date and the Closure Reason, the investigator must complete a resource search to ensure the correct resource is linked to the investigation. The investigator links a facility or provider agency with a component code to the investigation for the following rapid closure reasons:

  •  Administrative Referral

  •  Clinical Issue

  •  Client Rights

  •  Theft (by an employee, agent, or contractor of a facility, local authority, community center, HCS, TxHmL, or community provider).

  •  Duplicate Referral/Already Investigated

A component code is not required for the following rapid closure reasons, but must be entered if known:

  •  Does not meet the definition of APS Provider Investigations

  •  Reclassification

  •  Administrative Closure

4624.1 Closure Reason: Administrative Referral

APS Provider Investigations April 2017

Administrative issues are those incidents in which staff may not have followed provider procedures or policy, but their actions did not result in abuse, neglect, or exploitation. APS PI does not investigate administrative issues. The investigator may need to ask initial questions or gather additional documentation to determine whether the allegation involves abuse, neglect, or exploitation, or is an administrative issue. When the investigator determines that the information contained in the intake is an administrative issue, he or she closes the investigation using the closure code Administrative Referral.

See:

3700 Referrals

3710 Examples of Issues or General Complaints Appropriate for Referral

3711.1 Client Rights Complaints

3711.2 Administrative Complaints

3712 Clinical Issues

4624.2 Closure Reason: Clinical Issue Referral

APS Provider Investigations April 2017

Clinical practice issues are those allegations involving the professional responsibilities or duties of licensed professional. The investigator may need to ask initial questions or gather additional documentation to determine whether the allegation:

  •   involves abuse, neglect, or exploitation;

  •   is a clinical issue; or

  •   involves both of the above.

When the investigator determines that the information contained in the intake is a clinical issue, he or she closes the investigation using the closure code Clinical Issue.

See:

2383 Client Rights or Administrative Issues

3700 Referrals

3710 Examples of Issues or General Complaints Appropriate for Referral

3711.1 Client Rights Complaints

3711.2 Administrative Complaints

3712 Clinical Issues

4624.3 Closure Reason: Client Rights Referral

APS Provider Investigations April 2017

APS PI does not investigate client rights issues. The investigator may need to ask initial questions or gather additional documentation to determine whether the allegation involves abuse, neglect, or exploitation, or is a client rights issue. When the investigator determines that the information contained in the intake is a client rights issue, he or she closes the investigation using the closure code Client Rights.

See:

3700 Referrals

3710 Examples of Issues or General Complaints Appropriate for Referral

3711.1 Client Rights Complaints

3711.2 Administrative Complaints

3712 Clinical Issues

4624.4 Closure Reason: Theft

APS Provider Investigations April 2017

APS PI does not investigate theft in cases involving employees, agents, or contractors of facilities, local authorities, community centers, HCS, or TxHmL settings. It is important for investigators to distinguish a general complaint involving theft of an individual receiving services’ property from allegations of exploitation in these settings. The investigator may need to ask initial questions or gather additional documentation to determine whether the allegation involves exploitation or is theft. When the investigator determines that the information contained in the intake is theft, he or she closes the investigation using the closure code Theft.

See:

3700 Referrals

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

4624.5 Closure Reason: Duplicate Referral/Already Investigated

APS Provider Investigations April 2017

When the original case has been completed or closed and a second identical intake is received, the investigator closes the new intake using the closure code Duplicate Referral/Already Investigated.

To be identical, the second intake must have the same:

  •  allegations or incident;

  •  victims; and

  •  alleged perpetrators.

If a new intake is received while the original case is still in the investigation stage, the investigator merges the cases and does not close out the second intake as Duplicate Referral/Already Investigated.

4624.6 Closure Reason: Does Not Meet the Definition of APS Provider Investigations

APS Provider Investigations April 2017

If the intake report concerns alleged abuse, neglect, or exploitation of an individual receiving services from a provider that does not fall under the jurisdiction of APS PI, or the individual receiving services is in another state, the investigator forwards the intake information to the appropriate investigative authority that has jurisdiction. The investigator closes out the intake as Does Not Meet the Definition of APS Provider Investigations.

See 2900 Intakes from Other States.

4624.7 Closure Reason: Reclassification

APS Provider Investigations April 2017

If the investigation falls under the jurisdiction of another DFPS program, the APS PI supervisor or the supervisor’s designee contacts SWI support personnel at 1-800-252-3223 or 512-929-6920 and requests that SWI reclassify the intake for the correct program.

4624.8 Closure Reason: Administrative Closure

APS Provider Investigations April 2017

In rare situations, the investigator closes an intake as Administrative Closure because it does not fall under the options of Normal Closure, Administrative Referral, Clinical Issue Referral, Client Rights Referral, Theft (by an employee, agent, or contractor of a facility, local authority, community center, HCS, TxHmL), Duplicate Referral/ Already Investigated, Does Not Meet the Definition of APS Provider Investigations, or Reclassification.

For example, an investigator may use an administrative closure when an intake has an unknown victim and unknown perpetrator at an unknown provider, with an anonymous reporter.

Before closing the intake using the closure reason Administrative Closure, the investigator must staff the allegation with the supervisor and document:

  •  the supervisory consult;

  •  any casework completed; and

  •  the reason the investigator and supervisor decided to use the closure reason Administrative Closure.

4630 Closing a Case Without Completing a Client Abuse and Neglect Reporting (DADS AN-1-A) Form

APS Provider Investigations April 2017

Facilities and Local Authorities (Community Centers) for Mental Health or Intellectual Disabilities

At the conclusion of an investigation involving a facility or local authority, the investigator:

  •  completes a Client Abuse and Neglect Reporting (DADS AN-1-A) form;

  •  recommends on the form the classifications for each allegation (see 4500 Determining the DADS and DSHS Classification); and

  •  sends the form, along with the Provider Abuse and Neglect Report, to the administrator of the facility or to the provider.

When the investigator receives the DADS AN-1-A form back from the facility administrator, signed and reflecting the administrator’s final determination about the classifications for the allegations, the investigator closes the case.

See Texas Administrative Code §414.558 (DSHS Rules) for information about the administrator’s responsibility to report the data collected on the DADS AN-1-A form.

If the administrator …

then the investigator …

does not return DADS AN-1-A within two months after the form was submitted by the investigator …

determines whether the final determination has been delayed because of a pending review, appeal, or grievance hearing.

Such procedures can be time-consuming and may delay the return of the form for extended periods.

has not requested a review of the finding and there is no pending appeal or grievance hearing within the required two months …

contacts the administrator by phone and in writing to request that the administrator return the form.

indicates that he or she will not return the form within the required two months because he or she disagrees with the classifications that the investigator has recommended for each allegation …

  •  notifies his or her supervisor; and

  •  closes the case without the findings of the administrator, if there is no pending review, appeal, or grievance, and if contacts with the administrator have been unsuccessful.

HCS, TxHmL, and Community Providers

The investigator does not send the DADS AN-1-A form to the provider when allegations are made against:

  •   a provider of HCS or TxHmL services;

  •   the provider’s staff, contractors, or agents; or

  •   a community provider.

However, if the provider of the HCS or TxHmL services is a local authority, the investigator sends the provider the DADS AN-1-A when the case is closed.

The investigator waits 30 calendar days from the date the completed Provider Abuse and Neglect Report is provided to DADS and the HCS or TxHmL administrator before closing the case. This interval allows ample time for the administrator to file a request for an appeal.

If the administrator does not file a request for appeal, the investigator closes the case.

4640 Supervisory Approval Process in IMPACT

APS Provider Investigations November 2017

Regardless of whether the supervisor or designee approves or rejects the investigation, the deadline for completion remains based on the priority or setting of the investigation, unless an extension is granted for good cause. See:

2100 Priorities

4120 Time Frames for Investigation Completion and Supervisory Approval

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