Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-17 - Major Unusual Incidents and Unusual Incidents; Abuser Registry › Section 5123-17-02 - Addressing major unusual incidents and unusual incidents to ensure health, welfare, and continuous quality improvement

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
This rule establishes the requirements for addressing major
				unusual incidents and unusual incidents and implements a continuous quality
				improvement process to prevent or reduce the risk of harm to
				individuals.
(B) Scope
This rule applies to county boards, developmental centers, and
				providers of services to individuals with developmental disabilities.
(C) Definitions
For the purposes of this rule, the following definitions shall
				apply:
(1) "Administrative
			 investigation" means the gathering and analysis of information related to a
			 major unusual incident so that appropriate action can be taken to address any
			 harm or risk of harm and prevent recurrence. There are three administrative
			 investigation procedures (category A, category B, and category C) that
			 correspond to the three categories of major unusual incidents.
(2) "Agency provider" means a provider,
			 certified or licensed by the department that employs staff to deliver services
			 to individuals and who may subcontract the delivery of services. "Agency
			 provider" includes a county board while the county board is providing
			 specialized services.
(3) "At-risk
			 individual" means an individual whose health or welfare is adversely affected
			 or whose health or welfare may reasonably be considered to be in danger of
			 being adversely affected.
(4)
			 "Common law employee" has the same meaning as in rule
			 5123-9-32
			 of the Administrative Code.
(5)
			 "County board" means a county board of developmental disabilities as
			 established under Chapter 5126. of the Revised Code or a regional council of
			 governments as established under Chapter 167. of the Revised Code when it
			 includes at least one county board.
(6) "Department" means the Ohio department of
			 developmental disabilities.
(7)
			 "Developmental center" means an intermediate care facility for individuals with
			 intellectual disabilities under the managing responsibility of the
			 department.
(8) "Developmental
			 disabilities employee" means:
(a) An employee
			 of the department;
(b) A
			 superintendent, board member, or employee of a county board;
(c) An administrator, board member, or
			 employee of a residential facility licensed under section
			 5123.19 of the Revised
			 Code;
(d) An administrator, board
			 member, or employee of any other public or private provider of services to an
			 individual with a developmental disability; or
(e) An independent provider.
(9) "Incident report" means
			 documentation that contains details about a major unusual incident or an
			 unusual incident and shall include, but is not limited to:
(a) Individual's name;
(b) Individual's address;
(c) Date of incident;
(d) Location of incident;
(e) Description of incident;
(f) Type and location of injuries;
(g) Immediate actions taken to ensure health
			 and welfare of individual involved and any at-risk individuals;
(h) Name of primary person involved and his
			 or her relationship to the individual;
(i) Names of witnesses;
(j) Statements completed by persons who
			 witnessed or have personal knowledge of the incident;
(k) Notifications with name, title, and time
			 and date of notice;
(l) Further
			 medical follow-up; and
(m) Name and
			 signature of person completing the incident report.
(10) "Incident tracking system" means the
			 department's web-based system for reporting major unusual incidents.
(11) "Independent provider" means a
			 self-employed person or a common law employee who provides services for which
			 he or she must be certified in accordance with rules promulgated by the
			 department and does not employ, either directly or through contract, anyone
			 else to provide the services.
(12)
			 "Individual" means a person with a developmental disability.
(13) "Individual served" means an individual
			 who receives specialized services.
(14) "Intermediate care facility for
			 individuals with intellectual disabilities" has the same meaning as in section
			 5124.01 of the Revised
			 Code.
(15) "Investigative agent"
			 means an employee of a county board or a person under contract with a county
			 board who is certified by the department to conduct administrative
			 investigations of major unusual incidents.
(16) "Major unusual incident" means the
			 alleged, suspected, or actual occurrence of an incident described in paragraph
			 (C)(16)(a), (C)(16)(b), or (C)(16)(c) of this rule when there is reason to
			 believe the incident has occurred. There are three categories of major unusual
			 incidents that correspond to three administrative investigation procedures
			 delineated in appendix A, appendix B, and appendix C to this rule:
(a) Category A
(i) Accidental or suspicious death.
			 "Accidental or suspicious death" means the death of an individual resulting
			 from an accident or suspicious circumstances.
(ii) Exploitation. "Exploitation" means the
			 unlawful or improper act of using an individual or an individual's resources
			 for monetary or personal benefit, profit, or gain.
(iii) Failure to report. "Failure to report"
			 means that a person, who is required to report pursuant to section
			 5123.61 of the Revised Code, has
			 reason to believe that an individual has suffered or faces a substantial risk
			 of suffering any wound, injury, disability, or condition of such a nature as to
			 reasonably indicate abuse, neglect, misappropriation, or exploitation that
			 results in a risk to health and welfare of that individual, and such person
			 does not immediately report such information to a law enforcement agency, a
			 county board, or, in the case of an individual living in a developmental
			 center, either to law enforcement or the department. Pursuant to division
			 (C)(1) of section 5123.61 of the Revised Code,
			 such report shall be made to the department and the county board when the
			 incident involves an act or omission of an employee of a county
			 board.
(iv) Misappropriation.
			 "Misappropriation" means depriving, defrauding, or otherwise obtaining the real
			 or personal property of an individual by any means prohibited by the Revised
			 Code, including Chapters 2911. and 2913. of the Revised Code.
(v) Neglect. "Neglect" means when there is a
			 duty to do so, failing to provide an individual with medical care, personal
			 care, or other support that consequently results in serious injury or places an
			 individual or another person at risk of serious injury. Serious injury means an
			 injury that results in treatment by a physician, physician assistant, or nurse
			 practitioner.
(vi) Physical abuse.
			 "Physical abuse" means the use of physical force that can reasonably be
			 expected to result in physical harm to an individual. Such physical force may
			 include, but is not limited to, hitting, slapping, pushing, or throwing objects
			 at an individual.
(vii) Prohibited
			 sexual relations. "Prohibited sexual relations" means a developmental
			 disabilities employee engaging in consensual sexual conduct or having
			 consensual sexual contact with an individual who is not the employee's spouse,
			 and for whom the developmental disabilities employee was employed or under
			 contract to provide care or supervise the provision of care at the time of the
			 incident.
(viii) Rights code
			 violation. "Rights code violation" means any violation of the rights enumerated
			 in section 5123.62 of the Revised Code that
			 creates a likely risk of harm to the health or welfare of an
			 individual.
(ix) Sexual abuse.
			 "Sexual abuse" means unlawful sexual conduct or sexual contact as those terms
			 are defined in section
			 2907.01 of the Revised Code and
			 the commission of any act prohibited by Chapter 2907. of the Revised Code
			 (e.g., public indecency, importuning, and voyeurism) when the sexual conduct,
			 sexual contact, or act involves an individual.
(x) Verbal abuse. "Verbal abuse" means the
			 use of words, gestures, or other communicative means to purposefully threaten,
			 coerce, intimidate, harass, or humiliate an individual.
(b) Category B
(i) Attempted suicide. "Attempted suicide"
			 means a physical attempt by an individual that results in emergency room
			 treatment, in-patient observation, or hospital admission.
(ii) Death other than accidental or
			 suspicious death. "Death other than accidental or suspicious death" means the
			 death of an individual by natural cause without suspicious
			 circumstances.
(iii) Medical
			 emergency. "Medical emergency" means an incident where emergency medical
			 intervention is required to save an individual's life (e.g., choking relief
			 techniques such as back blows or cardiopulmonary resuscitation, use of an
			 automated external defibrillator, or use of an epinephrine auto
			 injector).
(iv) Missing individual.
			 "Missing individual" means an incident that is not considered neglect and an
			 individual's whereabouts, after immediate measures taken, are unknown and the
			 individual is believed to be at or pose an imminent risk of harm to self or
			 others. An incident when an individual's whereabouts are unknown for longer
			 than the period of time specified in the individual service plan that does not
			 result in imminent risk of harm to self or others shall be investigated as an
			 unusual incident.
(v) Peer-to-peer
			 act. "Peer-to-peer act" means any of the following incidents involving two
			 individuals:
(a) Exploitation which means the
			 unlawful or improper act of using another individual or another individual's
			 resources for monetary or personal benefit, profit, or gain.
(b) Theft which means intentionally depriving
			 another individual of real or personal property valued at twenty dollars or
			 more or property of significant personal value to the individual.
(c) Physical act which means a physical
			 altercation that:
(i) Results in examination
			 or treatment by a physician, physician assistant, or nurse practitioner;
			 or
(ii) Involves strangulation, a
			 bloody nose, a bloody lip, a black eye, a concussion, or biting which causes
			 breaking of the skin; or
(iii)
			 Results in an individual being arrested, incarcerated, or the subject of
			 criminal charges.
(d)
			 Sexual act which means sexual conduct and/or contact for the purposes of sexual
			 gratification without the consent of the other individual.
(e) Verbal act which means the use of words,
			 gestures, or other communicative means to purposefully threaten, coerce, or
			 intimidate the other individual when there is the opportunity and ability to
			 carry out the threat.
(vi) Significant injury. "Significant injury"
			 means an injury to an individual of known or unknown cause that is not
			 considered abuse or neglect and that results in concussion, broken bone,
			 dislocation, second or third degree burns or that requires immobilization,
			 casting, or five or more sutures. Significant injuries shall be designated in
			 the incident tracking system as either known or unknown cause.
(c) Category C
(i) Law enforcement. "Law enforcement" means
			 any incident that results in the individual served being tased, arrested,
			 charged, or incarcerated.
(ii)
			 Unanticipated hospitalization. "Unanticipated hospitalization" means any
			 hospital admission or hospital stay over twenty-four hours that is not
			 pre-scheduled or planned. A hospital admission associated with a planned
			 treatment or pre-existing condition that is specified in the individual service
			 plan indicating the specific symptoms and criteria that require hospitalization
			 need not be reported.
(iii)
			 Unapproved behavioral support. "Unapproved behavioral support" means the use of
			 a prohibited measure as defined in rule 
											5123-2-06
			 of the Administrative Code or the use of a restrictive measure implemented
			 without approval of the human rights committee or without informed consent of
			 the individual or the individual's guardian in accordance with rule
			 5123-2-06 of the Administrative Code, when use of the
			 prohibited measure or restrictive measure results in risk to the individual's
			 health or welfare. When use of the prohibited measure or restrictive measure
			 does not result in risk to the individual's health or welfare, the incident
			 shall be investigated as an unusual incident.
(17) "Physical harm" means any injury,
			 illness, or other physiological impairment, regardless of its gravity or
			 duration.
(18) "Primary person
			 involved" means the person alleged to have committed or to have been
			 responsible for the accidental or suspicious death, exploitation, failure to
			 report, misappropriation, neglect, physical abuse, prohibited sexual relations,
			 rights code violation, sexual abuse, or verbal abuse.
(19) "Program implementation incident" means
			 an unusual incident involving the failure to carry out a person-centered plan
			 when such failure causes minimal risk or no risk. Examples include, but are not
			 limited to, failing to provide supervision for short periods of time,
			 automobile accidents without harm, and self-reported incidents with minimal
			 risk.
(20) "Provider" means an
			 agency provider or an independent provider.
(21) "Qualified intellectual disability
			 professional" has the same meaning as in
			 42 C.F.R.
			 483.430 as in effect on the effective date of
			 this rule.
(22) "Specialized
			 services" means any program or service designed and operated to serve primarily
			 individuals, including a program or service provided by an entity licensed or
			 certified by the department.
(23)
			 "Systems issue" means a substantiated major unusual incident attributed to
			 multiple variables.
(24) "Team"
			 means, as applicable:
(a) The group of
			 persons chosen by an individual with the core responsibility to support the
			 individual in directing development of his or her individual service plan. The
			 team includes the individual's guardian or adult whom the individual has
			 identified, as applicable, the service and support administrator, direct
			 support staff, providers, licensed or certified professionals, and any other
			 persons chosen by the individual to help the individual consider possibilities
			 and make decisions; or
(b) An
			 interdisciplinary team as that term is used in
			 42 C.F.R.
			 483.440 as in effect on the effective date of
			 this rule.
(25) "Unusual
			 incident" means an event or occurrence involving an individual that is not
			 consistent with routine operations, policies and procedures, or the
			 individual's care or individual service plan, but is not a major unusual
			 incident. Unusual incident includes, but is not limited to: dental injuries;
			 falls; an injury that is not a significant injury; medication errors without a
			 likely risk to health and welfare; overnight relocation of an individual due to
			 a fire, natural disaster, or mechanical failure; an incident involving two
			 individuals served that is not a peer-to-peer act major unusual incident;
			 rights code violations or unapproved behavioral supports without a likely risk
			 to health and welfare; emergency room or urgent care treatment center visits;
			 and program implementation incidents.
(26) "Working day" means Monday, Tuesday,
			 Wednesday, Thursday, or Friday except when that day is a holiday as defined in
			 section 1.14 of the Revised
			 Code.