Guidance: Providers are not required to report Level I serious incidents via DBHDS’ web-based reporting application (CHRIS) to the Office of Licensing. Level I serious incidents, by definition, occur or originate during the provision of services or on the premises of the provider. “[D]uring the provision of a service” means that the incident occurs when the provider is actively providing a service to the individual. o For example, if an individual reports to his case manager that the individual fell off of his bicycle at the group home and sustained minor injuries, the case manager is not required to collect, maintain, and review this information as part of the quality improvement program, although this information may be pertinent to the case manager’s responsibilities under 12VAC35-105-1245. The DBHDS-licensed group home provider, however, is required to collect, maintain, and review this information as part of its quality improvement program (discussed further below).
Comment: If someone receiving in-home services goes to the ER independently would that be reportable? Using the guidance above, the in-home service provider would not be required to report as a Level 2 incident as there was no provision of service. Another example: If someone receiving in-home services is diagnosed with a decubitus ulcer while attending a doctor’s appointment with their parents, the in-home service provider would not be required to report as a Level 2 incident as there was no provision of service. It seems like the intent of the regulation is for DBHDS to know about the ER visit and the ulcer but for an in-home provider only events that occur when a staff is present would be reportable.
Guidance: Providers licensed to provide a “residential service” as defined by 12VAC35-105-20 provide 24-hour support to individuals. However, if an individual receiving residential services experiences a Level II serious incident while actively receiving services from another licensed provider, the residential service provider is not required to report the incident if the provider verifies that the other provider reported the incident
Comment: Not all residential services are provided 24 hours a day. Some individuals receive as little as 4 hours per week. The burden of reporting incidents that occur during the other 164 hours in the week should not fall on the provider.
Regulation: "Level II serious incident" includes a significant harm or threat to the health or safety of others caused by an individual.
Comment: Does this mean that if person in services #1 threatens harm to person in services #2 during the provision of service, that this is a reportable event? Is a provider reporting a threat to harm that does not result in any injury?
Guidance: Providers licensed to provide a “residential service” as defined by 12VAC35-105-20 provide 24-hour support to individuals. However, if an individual receiving residential services experiences a Level II serious incident while actively receiving services from another licensed provider, the residential service provider is not required to report the incident if the provider verifies that the other provider reported the incident. For example, if an individual who receives group home services sustains a serious injury at a day support program, the group home provider is not required to report the serious injury as long as the group home provider verifies that the day support provider reported the incident. However, if an individual receiving services from a residential service provider sustains a serious injury during an independent trip to the grocery store, the residential service provider must report the serious injury as a Level II serious incident.
Comment: If the above guidance is to be used, then ‘during the provision of service’ has no meaning to in-home providers. We are the default for reporting all incidents even when they occur outside of the provision of service.
Regulation: "Level II serious incidents" include:
Guidance: Please note that per Code of Virginia § 1-218 the term “includes” means “includes, but not limited to.” Therefore, Level II serious incidents are not limited to the incidents enumerated below.
Comment: The list is not exhaustive and allows for the discretion of interpretation of licensing specialists. This is not helpful for providers building policy and procedure to ensure thorough training of staff.
Guidance: DBHDS regulation 12VAC35-105-20 defines a “suicide attempt” as “a nonfatal, self-directed, potentially injurious behavior with an intent to die as a result of the behavior regardless of whether it results in injury.” If an individual admitted for services is admitted to the hospital as a result of self-directed behavior, and it is determined by a licensed professional that the individual intended to die as a result of the behavior, all providers are required to report this incident as a Level III serious incident regardless of whether the incident occurred within the provision of their services or on their property.
Comment: Is it accurate that if the provider asks the individual, “Did you intend to die?” and the answer is “No”, then the provider does not have to report this incident as a Level 3?
Regulation: Level II and Level III serious incidents shall be reported using the department's web based reporting application and by telephone or email to anyone designated by the individual to receive such notice and to the individual's authorized representative within 24 hours of discovery. Reported information shall include the information specified by the department as required in its web-based reporting application, but at least the following: the date, place, and circumstances of the serious incident. For serious injuries and deaths, the reported information shall also include the nature of the individual's injuries or circumstances of the death and any treatment received. For all other Level II and Level III serious incidents, the reported information shall also include the consequences that resulted from the serious incident. Deaths that occur in a hospital as a result of illness or injury occurring when the individual was in a licensed service shall be reported.
Comments: An example of consequences would be helpful to include.
General Comments:
Hope House Foundation also agrees with comment posted by Jennifer Fidura, VNPP
The expectations of the Guidance Document on Serious Incident Reporting appear to exceed the regulations.
“The definition of a "Level II" incident is "a serious incident that occurs or originates during the provision of a service or on the premises of the provider." The "guidance" expands that definition for a class of providers who provide residential service based on the assumption that 24 hour "support" includes exclusive services provision. The second sentence of that definition is, "Residential services provide a range of living arrangements from highly structured and intensively supervised to relatively independent requiring a modest amount of staff support and monitoring." The expectation that a residential provider is responsible to "verify" that another licensed provider has reported appropriately a Level II incident which occurred while they were providing service is both outside of their role and responsibility and requires an statement of fact that can not, by the provider, be verified.
I note that you do not include in your guidance any reference to the responsibility for reporting any incident which may have occurred while with family for the weekend, or while in the hospital. A trip to the store, part of the Support Plan, and therefore part of the service would seem to fall under the category of "during the provision of service." If the incident does not occur during the provision of services or on the provider's premises, there can not be any obligation/responsibility for reporting."
Hope House Foundation also supporting comments by Karen Tefelski – vaACCSES :
This is general comment indirectly related to this guidance document. There are two sides of CHRIS – a Licensing side and a Human Rights side. Sometimes a report is required on the OL side, sometimes on the OHR side, and sometimes the same report must be entered separately in both sides of CHRIS. OL has issued this guidance document and conducts almost-monthly on-line training sessions (that historically and routinely have technical difficulties prohibiting full provider participation). OHR has no guidance document and conducts periodic in-person regional trainings. Requests:
Hope House Foundation agrees with the comment made by Fairfax-Falls Church CSB: The expectation that a residential provider is responsible to "verify" that another licensed provider has reported appropriately a Level II incident which occurred while they were providing service is both outside of their role and responsibility and requires an statement of fact that cannot, by the provider, be verified.