Cabinet for Health and Family Services s11

Cabinet for Health and Family Services Department for Community Based Services Division of Protection and Permanency

Search Table of Contents

4B APS INVESTIGATION AND ASSESSMENT Introduction 4B.1 INITIAL INVESTIGATIONS 4B.2 GENERAL INTERVIEWING GUIDELINES 4B.3 SAFETY PLANNING 4B.4 STATE OPERATED FACILITIES 4B.5 FAILURE TO GAIN ENTRY 4B.6 INVESTIGATIONS IN ALTERNATE CARE FACILITIES 4B.7 INVESTIGATIONS OF RESIDENT TO RESIDENT ALLEGATIONS IN ALTERNATE CARE SETTINGS 4B.8 INVESTIGATIONS IN A LICENSED HEALTH CARE FACILITY 4B.9 INVESTIGATIONS IN STATE OPERATED FACILITIES 4B.10 INVESTIGATIONS IN ASSISTED LIVING FACILITIES, REGISTERED BOARDING HOMES, AND SUPPORTS FOR COMMUNITY LIVING 4B.11CONDUCTING INITIAL AND SEMI-ANNUAL ASSESSMENT OF FAMILY CARE HOMES AND PERSONAL CARE HOMES 4B.12ADULT FATALITY INVESTIGATION AND REVIEW 4B.13DETERMINING THE FINDINGS OF AN ADULT ABUSE/NEGLECT/EXPLOITATION INVESTIGATION 4B.14DETERMINING THE FINDINGS OF AN ALTERNATE CARE INVESTIGATION 4B.15COMPLETION AND DISTRIBUTION OF THE NOTIFICATION OF PROTECTIVE SERVICES INVESTIGATIVE FINDINGS REPORT FORM

Division of Protection and Permanency Page 1 of 29 SOP 4.3 SOP 4B R. 8/1/03 R. 11/15/05 APS INVESTIGATION AND ASSESSMENT

INTRODUCTION: The Department for Community Based Services notifies all pertinent community partners and attempts to coordinate investigations. DCBS also conducts investigations of reports alleging abuse, neglect or exploitation of: 1. An vulnerable abused and / or neglected adult as defined by KRS Chapter 209 Protection of Adults (KRS 209.020 (4) –Definitions for Chapter); or 2. A victim of spouse/partner abuse or neglect as defined by KRS Chapter 209A Spousal Abuse and Neglect (KRS 209A.020 (4)-Definitions for Chapter); or 3. A person in an ongoing, cohabitating and intimate relationship who is eighteen (18) years of age or older and the victim of alleged abuse by a partner as provided by Ireland v Davis, Ky. App., 957 S.W. 2nd 310 (1997); and Provides protective services upon acceptance, request or court order.

An investigation includes contact with the alleged victim and may include contact with the person who had access to the victim at or around the time of the incident alleged perpetrator and collaterals. In spouse/partner investigations the alleged victim must grant express permission to interview the alleged perpetrator.

The purposes of conducting an adult protective services investigation are: 1. To determine through personal contact whether alleged maltreatment of an adult has occurred; 2. To assess the need for protective services; 3. To provide protective services upon request, acceptance, or court order; and, 4. To initiate court action in the Circuit, District, or Family Court when: (a)The adult is in need of protective services; (b)The adult lacks the capacity to consent and refuses services; (c) The adult is in a state of abuse or neglect and an emergency exists; (d)No person is authorized by law or court order to give consent or such person refuses to give consent; and (e)The intervention is the least restrictive. 5. To distribute investigative findings that may help collaborating authorized agencies in the performance of their duties and the protection of the adult.

Referrals Reports are completed in the county where the adult victim resides. If a case needs to be opened, it remains in the county where the adult victim resides. An onsite request to another county or region for information regarding an investigation is made to assist in obtaining: (a)Interviews; (b)Police reports;

Division of Protection and Permanency Page 2 of 29 (c) Hospital or other medical records; and (d)Legal documentation (from courthouse, etc.).

The SSW completes the investigation and assessment of risk on the Adult CQA and submits to the FSOS for approval and signature within thirty (30) working days after initiation of the investigation. The FSOS may grant an extension for completing the investigation upon justification by the SSW with all extensions documented in TWIST.

SOP 4.3.1 SOP 4B.1 R. 8/1/03 R. 11/15/05 INITIAL INVESTIGATIONS

COA STANDARDS:  G8.2 Intake, Assessment, and Service Planning - Assessment Process  S11.1 Adult Protective Services - Access to Service

LEGAL AUTHORITY:  42 U.S.C. 1397 includes the provision of adult protective services in the State's plan.  KRS 209.020 Definitions for chapter  KRS 209.030 Rules and regulations - Reports - Cabinet actions  922 KAR 5:070 Adult Protective Services

PROCEDURE: If the referral reporting source claims and the FSOS determines that: 1. The adult's condition presents a substantial risk of death or immediate and serious physical harm, the SSW initiates the investigation within one (1) hour of the receipt of the report. 2. The adult is not in a state of emergency, the SSW initiates the investigation within twenty-four (24) hours forty-eight (48) hours of receiving the report.

To initiate an Adult Protective Services (APS) investigation the SSW is required to have face-to-face contact with the reported victim(s). The SSW documents the legitimate attempts that have been made to locate the alleged victim(s) only after attempts at face-to-face contact within the required time frames have failed.

Division of Protection and Permanency Page 3 of 29 SOP 4.3.2 SOP 4B.2 R. 8/1/03 R. 11/15/05

GENERAL INTERVIEWING GUIDELINES

COA STANDARDS:  G8.2 Intake, Assessment, and Service Planning - Assessment Process  S11.1 Adult Protective Services - Access to Service  S11.2 Adult Protective Services - Service Elements

PROCEDURE: 1. When conducting interviews during an adult protective services investigation the SSW: (a)Identifies self and states the purpose of the interview; (b)Conducts face-to-face interviews in private, if possible; (c) Explains the statutory responsibility to investigate; (d)Allows the alleged victim and the person who had access to the victim at or around the time of the incident alleged perpetrator to respond to allegations, as appropriate; (e)Encourages the alleged victim, alleged perpetrator and collaterals the person who had access to the victim at or around the time of the incident to give a complete account of the situation; (f) Determines relationships to and attitude toward the alleged victim and the person who had access to the victim at or around the time of the incident; alleged perpetrator; (g)Determines if a pattern of abuse, neglect or exploitation exists; (h)Determines severity and frequency of the abuse, neglect or exploitation; (i) Observes non-verbal communication; (j) Identifies physical and behavioral indicators of abuse, neglect or exploitation; (k) Conducts joint interviews, when possible on joint investigations; (l) Coordinates specialized multidisciplinary teams to investigate reports, when possible. (m) When appropriate, shares findings and observations with the alleged victim and the person who had access to the victim at or around the time of the incident alleged perpetrator sharing details of action plans or recommendations;

Division of Protection and Permanency Page 4 of 29 (n)Keeps the name of the informant confidential; (o)When appropriate, focuses the interview with the person who had access to the victim alleged perpetrator at or around the time of the incident on actions to be taken to remedy the abuse, neglect or exploitation; and, (p)Gives special consideration and accommodation to disabled individuals.

2. Appropriate Certain types of investigations follow the procedures listed below: is based on the following criteria: (a)Alleged Victim: An adult protective services investigation includes a personal interview with the alleged victim and includes a face-to-face contact, if possible. DCBS staff can only make photographs, audio or video recordings with the express permission of the alleged victim. If the alleged victim is unable to provide consent and the responsible party is not present or is the alleged perpetrator, it is preferred that staff request assistance from law enforcement in obtaining photographs or recordings. Digital cameras cannot be used since the photographs are often determined to be inadmissible as evidence in court.

When conducting interviews in an adult protective services investigation the SSW: (1)Determines, through discussion with the victim, his/her wishes and offers alternatives; (2)Ascertains if there are other service needs not stated in the report; and, (3)Provides referral information or services.

(b)Guardian/Conservator: If the alleged victim has a guardian or conservator, an interview with the guardian or conservator may be a part of the investigation. The purpose of the interview is to explain SSW's role and obtain pertinent information.

(c) Individual with Access to the Victim Alleged perpetrator at or Around the Time of the Occurrence of Abuse, Neglect, or Exploitation: (1)An interview with the individual(s) with access to the victim at or around the time of the occurrence alleged perpetrator of abuse, neglect, or exploitation may not be in the best interest of the victim. (2)The SSW advises the alleged victim if this individual the alleged perpetrator is to be interviewed. (3)In spouse/partner abuse investigations the victim must grant permission before this individual the alleged perpetrator is interviewed. (4)If there are concerns about whether to interview or share information with this individual the alleged perpetrator, the SSW may discusses the situation with the FSOS or designee prior to initiation of contact. (5)The SSW advises the individual(s) with access to the victim at or around the time of the occurrence alleged perpetrator of abuse, neglect, or exploitation that an interview is part of a protective services investigation.

Division of Protection and Permanency Page 5 of 29 (6)If this individual the alleged perpetrator makes an admission regarding the abuse, neglect or exploitation the SSW may attempt to get a written statement or have a witness to the admission.

(d)Collaterals: In the course of the investigation collateral contacts may be necessary. Anyone having pertinent information may be interviewed. Collateral contacts may be family members, neighbors, witnesses, the referrals reporting source, physicians, medical personnel, members of a faith based organization of the alleged victim, residents in alternate care facilities, court personnel, or law enforcement officials, etc. The SSW may use the following guidelines when conducting interviews with collateral contacts: (1)Identify yourself; (2)State the purpose of the interview in accordance with confidentiality guidelines; (3)Obtain relevant information; and (4)Determine relationship to and attitude toward the alleged victim and the person with access to the alleged victim alleged perpetrator.

(e)Administrator or Designee: In alternate care facilities, the SSW informs the administrator or designee that a protective services investigation is being conducted. The alleged victim and any other individuals are interviewed in private.

(f) Mental and Physical Health Records: When available, mental and physical health records necessary to complete the investigation are reviewed by the SSW and copies obtained, if possible, to be included in the report. The SSW consults with a regional nurse consultant or a nurse service administrator if necessary. (1)If an institution does not allow access to medical records, the SSW may be able to gain access by using the DCBS-1, Informed Consent and Release of Information and Records and DCBS-1A, Informed Consent and Release of Information and Records Supplement; or, (2)If the SSW has difficulty accessing records, the Office of the General Counsel Legal Services may be consulted with supervisory approval and a petition for a court order to release information needed to complete an investigation may be requested.

(g)Financial Records: In cases of financial exploitation the The SSW may review financial records including savings and checking account statements, financial eligibility and assistance records, disability or retirement income records and property valuation records. (1) If a financial institution does not allow access to financial records, the SSW may be able to gain access by using the DCBS-1, Informed Consent and Release of Information and DCBS-1A, Supplement; or,

Division of Protection and Permanency Page 6 of 29 (2)If the SSW has difficulty accessing records, the Office of the General Counsel Legal Services may be consulted with supervisory approval and a petition for a court order to release financial information needed to complete an investigation may be requested.

(h)Law Enforcement and Court Records: Police records, mental inquest, disability, probate records or other legal documents may be reviewed to complete the investigation and copies may be obtained, if possible, to be included in the investigative report. (1)The SSW may request a criminal records check through the Administrative Office of the Courts (AOC) at any time during the investigation or provision of ongoing services; and, (2)The criminal records check may be requested on any household member, the alleged victim, the individual having access to the victim at or around the time of the occurrence of abuse, neglect, or exploitation, the alleged perpetrator or the caretaker.

(i) Voluntary Statements: (1)A written voluntary statement regarding the alleged incident of abuse, neglect or exploitation may be obtained if it is pertinent to the case and the alleged victim, alleged perpetrator, witness(es) or others are willing. (2)The statement is prepared, signed and dated by the person providing the statement and witnessed by the SSW. (3)The SSW advises the person making the voluntary statement that statements may be shared with law enforcement authorized agencies or the court and court testimony may be required.

SAFETY PLANNING

COA STANDARDS:  G8.2 Intake, Assessment, and Service Planning - Assessment Process  S11.2 Adult Protective Services - Service Elements

LEGAL AUTHORITY:  KRS 209.030 Rules and regulations - Reports - Cabinet actions  922 KAR 5:070 Adult Protective Services

PROCEDURE: A Safety planning is the strategy for getting an adult victim and/or minor child(ren) physically away from the abuse. The Safety planning: 1. Increases the victim’s ability to protect self and/or minor children, particularly when a crisis exists and the potential risk is high; 2. Helps to continually assess the degree of danger to victim, SSW, and others; and 3. Confronts the minimization and denial regarding the presence and extent of violence. The plan must be: (a)Client driven; (b)Specific; (c) Detailed; (d)Practical; (e)Practiced and; (f) Revised as necessary.

Safety planning can only be accomplished with the alleged victim's cooperation. 1. The SSW may assist with the development of an Individual Adult safety plan, using the Prevention Plan form, but the plan is only effective if the alleged victim "owns" participates in the process. 2. The Safety planning may be verbal or written, but if a written safety plan is developed and the alleged victim agrees that a copy may be retained by the Department, the SSW documents the safety planning using the Individual Adult Safety Plan Prevention Plan form and files it in the case record.

STATE OPERATED FACILITIES

COA STANDARDS:  S11.1 Adult Protective Services - Access to Service

PROCEDURES: 1. When an alleged victim resides in a state operated facility including; Oakwood, Hazelwood, Outwood, Glasgow State Hospital, Central State Hospital and Western State Hospital and the facility is the reporting source, the SSW contacts the facility's Risk Manager for assistance in arranging access to the alleged victim, the person who had access to the victim at or around the time of the alleged incident alleged perpetrator, witnesses and medical records. 2. When the facility is not the reporting source, the SSW is to proceed to the facility to conduct the investigation.

In both cases, the SSW forwards a copy of the DSS-115 to: 1. Law enforcement; 2. Division of Mental Retardation, if the facility is an ICFMR; 3. Division of Mental Health, if the facility is a psychiatric facility; 4. Office of the Inspector General; and, 5. Office of the Attorney General, Medicaid Fraud and Abuse Control Division 6. County and Commonwealth Attorney.

When an alleged victim resides in a state operated facility and the report does not meet acceptance criteria, the SSW: 1. Enters the report as a Information and Referral or Resource Linkage and documents the reason for not accepting the report; and, 2. Notifies the facility administration using the Reports Not Accepted letter.

Division of Protection and Permanency Page 9 of 29 SOP 4.2.5 SOP 4B.5 R. 8/1/03 R. 11/15/05 FAILURE TO GAIN ENTRY

COA STANDARDS: ● NA

PROCEDURES: 1. If an adult, caretaker or facility staff member does not allow the SSW to enter the premises to conduct the investigation, the SSW informs the FSOS or designee; 2. With the approval of the SRA or designee, the SSW may seek a search warrant or pursue other legal remedies if allegations indicate the need; 3. If possible, the SSW consults with the Office of General Counsel Legal Services prior to seeking a search warrant; and, 4. If issued, a search warrant is served by a law enforcement officer.

If the adult resides in a private residence, the SSW: 1. Notifies the adult, the adult's guardian or the caretaker of the Department's statutory responsibility to investigate and offer to provide a copy of the statute; 2. If that fails, seeks the assistance of law enforcement to gain entry; and, 3. If entry is denied, notifies the FSOS or designee to determine if probable cause exists to pursue a search warrant or other legal remedies.

If the adult resides in a licensed health care facility, the SSW: 1. Notifies the facility representative or operator of the Department's statutory responsibility to investigate and offers to provide a copy of the statute; 2. If that fails, seeks assistance of law enforcement; and,

If entry is denied, notifies the FSOS or designee to determine if probable cause exists to pursue a search warrant or other legal remedies.

INVESTIGATIONS IN ALTERNATE CARE FACILITIES

PROCEDURES: 1. The SSW conducts investigations of alleged abuse, neglect and exploitation in all levels of alternate care; 2. The SSW may consult with Service Region or Central Office staff in any prevention or protection case; 3. DCBS is the lead investigative agency when the alleged victim meets the statutory requirements pursuant to KRS 209.020(4), including reports involving state operated facilities; 4. In addition to the guidelines in SOP 4B.2 - General Interviewing Guidelines, the SSW uses these additional considerations in conducting investigations in alternate care settings: (a)When allegations of neglect involve complex medical or nursing issues, the SSW may consult with a regional nurse consultant or a nurse service administrator; (b)In joint investigations with the Office of the Inspector General (OIG), the SSW may consult with appropriate OIG staff including the dietitian, pharmacist, or nurse; and, (c)In joint investigations, the SSW may refer to the OIG findings in support of DCBS conclusions; 5. When the investigation is completed and approved by the FSOS or designee, the SSW verbally shares these findings and recommendations with the facility administrator or designee; 6. When the investigation is completed and approved by the FSOS, the SSW shares these findings with the appropriate authorized agencies using the Notification of Protective Services Investigative Findings Reporting Form. 7. If any appropriate authorized agency requests a copy of the completed report, the SSW may send a copy of the full report to the requesting agency. (Link to SOP 4B.15) (Tip Sheet for Alternate Care Subprogram)

Division of Protection and Permanency Page 11 of 29 SOP 4.3.8 SOP 4B.7 R. 8/1/03 R. 11/15/05 INVESTIGATIONS OF RESIDENT TO RESIDENT ALLEGATIONS IN ALTERNATE CARE SETTINGS

PROCEDURES: When a report is received of a resident to resident incident, the SSW, in addition to the normal intake questions, should ask: 1. Was there a physical or mental injury resulting from the incident? 2. What is the cognitive status of the residents involved? 3. Is there a history of incidents involving either of the residents? 4. What actions were taken by the facility to protect from further incidents?

After gathering the intake information, the SSW makes a determination of whether an investigation is required. The initial focus of the investigation is on potential neglect involving the facility.

Completing the Investigation 1. If the SSW determines that neglect did not occur, but abuse or exploitation did occur, the SSW assesses the adult who committed the act. 2. If the SSW finds that the resident had the capacity to understand and control his behaviors the finding is documented as found and substantiated. 3. Allegations of resident to resident abuse are reported as adult abuse or exploitation only when the SSW determines through record review, interview and observation of the residents that the offending resident had the capacity to understand and control his behaviors.

Division of Protection and Permanency Page 12 of 29

SOP 4.3.9 SOP 4B.8 R. 8/1/03 R. 11/15/05

INVESTIGATIONS IN A LICENSED HEALTH CARE FACILITY

PROCEDURES: A. Facility Receiving Medicaid/Medicare Funds The Office of the Inspector General (OIG) licenses all Kentucky facilities that provide health care. Many, but not all, of these licensed health care facilities receive Medicaid/Medicare funds. Facilities that receive Medicaid/Medicare funds include most: 1. Nursing Facilities; 2. Hospitals; 3. Intermediate Care Facilities; and, 4. Home Health Agencies.

The State Long Term Care Ombudsman coordinates a statewide network of ombudsmen. A long term care ombudsman serves every nursing facility in Kentucky. These ombudsmen attempt to resolve complaints on behalf of the residents of long term care facilities.

When an investigation is conducted in licensed health care facility that receives Medicaid/Medicare, the SSW: 1. Sends the DSS-115 to law enforcement, the Office of the Inspector General (OIG), the Medicaid Fraud and Abuse Control Division in the Office of the Attorney General, and the State Long Term Care Ombudsman's office, County and Commonwealth Attorney. When any one of these agencies makes the original report to DCBS it is not necessary to send a DSS-115; 2. May share preliminary findings and recommendations with representatives from all of the above named agencies; 3. Sends a copy of the Notification of Protective Services Investigative Findings Reporting Form upon completion of the investigation to a representative of all the above named agencies; and, 4. Shares a copy of the full investigation upon a faxed, electronic or other written request from any of the above named agencies.

Division of Protection and Permanency Page 13 of 29 B. Facility Not Receiving Medicaid/Medicare Funds Licensed Health Care Facilities that do not receive Medicaid/Medicare funds include, but are not limited to: 1. Personal Care Homes; and, 2. Family Care Homes.

When an investigation is conducted in this type of licensed health care facility, the SSW: 1. Sends the DSS-115 to law enforcement, the Office of the Inspector General, Office of the Attorney General, County and Commonwealth Attorney and the State Long Term Care Ombudsman. When the SSW receives a report from any of the above named sources it is not necessary to send a DSS- 115; 2. May share preliminary findings and recommendations with representatives from all of the above named authorized agencies; 3. Sends a copy of the Notification of Protective Services Investigative Findings Reporting Form upon completion of the investigation to a representative of all the above named sources; 4. Shares a copy of the full investigation upon a verbal, faxed or other written request from any of the above named agencies; and, 5. Submits a full copy of the investigation to the OIG, when abuse, neglect or exploitation is substantiated and a certified nurse aide is involved. The OIG requires documentation of the investigation in order to enter the name of the person with access alleged perpetrator to the alleged victim on the nurse aide abuse registry.

SOP 4.3.10 SOP 4B.9 R. 8/1/03 R. 11/15/05 INVESTIGATIONS IN STATE OPERATED FACILITIES

PROCEDURES: State operated facilities are licensed by the Office of the Inspector General (OIG) and receive Medicaid Funds. They also receive direction from the Department for Mental Health and Mental Retardation Services. State operated facilities include Oakwood, Hazelwood, Central State Hospital, Glasgow State Hospital, and Western

Division of Protection and Permanency Page 14 of 29 State Hospital. When an investigation is conducted in a state operated facility the following procedures apply: 1. The Service Region Administrator or designee reviews the report to determine if it meets standards for investigation pursuant to KRS Chapter 209; 2. If the report meets standards, the SRA or designee assigns the report for investigation using the DSS-115; 3. If the report does not meet the standard, the SRA or designee documents the reason(s) why the report did not meet standards for investigation. Documentation is maintained for one year. Notification not to accept a report is forwarded to the facility administrator using the Report Not Accepted Letter. This step applies only to state operated facilities; 4. The SSW completes the DSS-115 and forwards copies to: (a)Law enforcement; (b)Office of the Inspector General; (c) County and Commonwealth Attorney; (d)Office of the Attorney General; (e)The Division of Mental Health, if it is a mental health facility; or, (f) The Division of Mental Retardation, if it is a mental retardation facility. 5. When the facility is the reporting source, the SSW contacts the Risk Manager/Investigator for assistance in arranging access to the alleged victim, the person with access alleged perpetrator to the alleged victim, witnesses and records; and, 6. When family members, visitors, off duty employees or other individuals are the reporting source, the SSW: (a)Proceeds to the facility to conduct the investigation; (b)Informs the administrator or designee as to the SSW’s presence; and, (c) Proceeds with the investigation.

After the investigation has been completed and approved the SSW: 1. Conducts an exit interview with the administrator or designee to discuss results of the investigation and recommendations; 2. Following the exit interview forwards a Results of the Investigation Letter to the facility administrator. This step applies only to State Operated Facilities. 3. Forwards a copy of the Notification of Protective Services Investigative Findings Reporting Form to: (a)Law enforcement; (b)Office of the Inspector General; (c) County and Commonwealth Attorney; (d)Office of the Attorney General; (e)Division of Mental Health if it is a mental health facility; or, (f) Division of Mental Retardation if it is a mental retardation facility. 4. Provides verbal information to the alleged victim or legal guardian as to the results of the investigation and action(s) DCBS will take, if any, to remedy the abusive, neglectful or exploitative situation.

Division of Protection and Permanency Page 15 of 29 SOP 4.3.11 SOP 4B.10 R. 8/1/03 R. 11/15/05 INVESTIGATIONS IN ASSISTED LIVING FACILITIES, REGISTERED BOARDING HOMES, AND SUPPORTS FOR COMMUNITY LIVING

PROCEDURES: When the SSW receives a report on an individual residing in an Assisted Living Facility, a Registered Boarding Home or in a Supports for Community Living placement, the SSW reviews the allegations to see if the information meets the acceptance criteria. The Office of the Inspector General does not license these types of facilities; therefore, a DSS-115 is not sent to them, unless the report indicates the facility may be operating as an illegal health care facility.

1. Assisted Living Facilities The Office Division of Aging Services (DAS) certifies Assisted Living Facilities The SSW: (a)Forwards a copy of the DSS-115 to OAS (DAS) upon intake; (b)Forwards a copy of the DSS-115 to law enforcement, County and Commonwealth Attorney Office of Attorney General; (c) Forwards a copy of the Notification of Protective Services Investigative Findings Reporting Form to OAS DAS, law enforcement, County and Commonwealth Attorney and Office of Attorney General upon concluding the investigation; and, (d)Shares a copy of the full investigation with the OAS DAS, law enforcement, County and Commonwealth Attorney and Office of Attorney General upon receipt of a faxed, electronic or other written request from that office.

2. Registered Boarding Homes The Department of Public Health, Food Safety Branch registers Boarding Homes. The SSW: (a)Forwards a copy of the DSS-115 to DPH upon intake; (b)Forwards a copy of the DSS-115 to law enforcement, County and Commonwealth Attorney and Office of Attorney General ;

Division of Protection and Permanency Page 16 of 29 (c) Forwards a copy of the Notification of Protective Services Investigative Findings Reporting Form to DPH, law enforcement, County and Commonwealth Attorney and Office of Attorney General upon concluding the investigation; and, (d)Shares a copy of the full investigation with the DPH, law enforcement, County and Commonwealth Attorney and Office of Attorney General upon receipt of a faxed, electronic or written request from that office. 3. Supports for Community Living (SCL) The Division of Mental Retardation (DMR) certifies Supports for Community Living. The SSW: (a)Forwards a copy of the DSS-115 to DMR upon intake; (b)Forwards a copy of the DSS-115 to Office of the Attorney General (OAG); (c) Forwards a copy of the DSS-115 to law enforcement, County and Commonwealth Attorney; (d)Forwards a copy of the Notification of Protective Services Investigative Findings Reporting Form DMR, law enforcement, County and Commonwealth Attorney, and Office of Attorney General upon concluding the investigation; and, (e)Shares a copy of the full investigation with the DMR, law enforcement, County and Commonwealth Attorney, and Office of Attorney General upon receipt of a faxed, electronic or other written request from that office.

SOP 4.3.12 SOP 4B.11 R. 8/1/03 R. 11/15/05 CONDUCTING INITIAL AND SEMI-ANNUAL ASSESSMENTS OF FAMILY CARE HOMES AND PERSONAL CARE HOMES

COA STANDARDS: ● N/A

LEGAL AUTHORITY:  KRS 209.030 Rules and regulations - Reports - Cabinet actions  922 KAR 5:100. Alternate care for adults.

PROCEDURES: Initial and Semi-Annual Assessments of Family Care Homes and Semi-Annual Assessments of Personal Care Homes focus on the home, not on the individual residents. If upon assessment, a SSW determines that protective services or preventive services are indicated, the SSW considers Adult Protective Services or General Adult Services acceptance criteria. Committed children cannot be placed in a Personal Care or Family Care Home without the express written permission of the Service Region Administrator or designee.

Division of Protection and Permanency Page 17 of 29 Family Care Homes When a prospective FCH operator obtains an application from the Office of the Inspector General, the SRA notifies the FSOS in the local office and requests that a SSW visit the home to complete a profile of the prospective home using the DSS- 278, Profile of Family Care Home.

1. The SSW submits a copy of the DSS-278 to the FSOS within thirty (30) working days; 2. Six months after notification of licensure, the SSW begins semi-annual assessments using the DSS-277 ; 3. The SSW has face to face contact with all residents initially and at least once a year after that. Ideally, the worker is to have face to face contact with a resident at each semi-annual assessment, however, if a resident is away from the FCH at the time of a semi-annual assessment the SSW may conduct a face to face interview at the next semi-annual assessment; and, 4. If it becomes necessary to provide the adult residing in a FCH with protective services or if General Adult Services are needed and requested, the SSW opens a case.

Personal Care Homes 1. Six (6) months after notification of PCH licensure, the SSW begins semi-annual assessments using the DSS-277A ; 2. The SSW has face to face contact with at least four residents during each semi- annual assessment; and, 3. If it becomes necessary to provide the adult residing in a PCH with protective services or if General Adult Services are needed and requested, the SSW opens a case.

SOP 4.3.13 SOP 4B.12 R. 8/1/03 R. 11/15/05 ADULT FATALITY INVESTIGATION AND REVIEW

PROCEDURES: Receiving the Report

Division of Protection and Permanency Page 18 of 29 The SSW accepts all reports of adult fatalities that occur due to alleged abuse, neglect or exploitation.

Investigation/Assessment Investigations involving the death of an adult follow the guidelines in SOP 4.3.2 - General Guidelines for Interviewing . Collateral contacts with medical personnel, a coroner and other appropriate persons may be made to assess potential danger to staff. Upon request by the FSOS, the SRA or designee meets with all DCBS staff involved in the case. Central Office staff is also available for consultation during this process. Additionally: (a) The FSOS or designee assigns staff to investigate and is responsible for coordinating the investigation. (b) The FSOS may request assistance from the SRA or designee. In this case, the SRA or designee assumes responsibility for coordinating Department activities. The SRA or designee determines the appropriate staff person to investigate. It may be advisable that staff who have had prior direct involvement with the case not be assigned to conduct the investigation. If feasible, the assigned investigator consults with staff that has direct knowledge of the case prior to initiating the investigation. (c) Law enforcement is notified of all fatalities alleged to be a result of abuse or neglect and a joint investigation is conducted, whenever possible. The SSW or the designated investigator cooperates with law enforcement or the coroner, but does not interfere with their respective investigations. The SSW contacts the appropriate law enforcement agency and coroner, when indicated, to clarify roles and establish a common channel of communication, particularly if the intake information indicates other adults or minor children are present in the facility or household; (d) The SSW attempts to interview the person with access alleged perpetrator to the alleged victim as soon as possible without interfering with the law enforcement investigation. If the person with access alleged perpetrator to the alleged victim refuses to be interviewed, this is documented. (e) When the Office of the Inspector General (OIG) is involved in an investigation as outlined in SOP 4.3.7 - Investigations in Alternate Care Facilities, the Department and the OIG share responsibility for investigating the report. Whenever possible, the investigation is coordinated and conducted jointly; however this may not always be possible. The SSW gathers all information from the OIG regarding previously cited deficiencies on the involved facility. If the investigation cannot be coordinated with the OIG in the designated time frames, the SSW proceeds with the investigation. (f) The SSW completes the Adult Continuous Quality Assessment (CQA) on the investigation of an adult fatality. All information is entered and submitted to the FSOS within thirty (30) working days unless the FSOS or designee grants an extension to complete the investigation. Reasons

Division of Protection and Permanency Page 19 of 29 for delays in the investigation or interview with the person with access alleged perpetrator to the alleged victim are documented.

Adult Fatality Investigation Internal Review - Local Office While the adult fatality investigation is in progress, the FSOS reviews the investigation to ascertain that all KRS, KAR and SOP have been followed. Specifically the FSOS or designee ascertains that: 1. Law enforcement was notified; 2. Collaboration on the investigation has occurred with law enforcement and appropriate regulatory agencies; 3. Caregivers and collaterals have been interviewed; 4. Determination has been made regarding the safety of other potential victims in the household or facility in compliance with KRS 209.030 and KRS 620.030; 5. The coroner's office has been contacted and the coroner's report was examined; 6. The physician of the alleged victim has been interviewed and/or any applicable report has been obtained; 7. The adult's family members or guardian have been notified, preferably through a home visit; 8. The designated SSW worker has been notified of the investigation, if the adult is a client of the State Guardianship office; 9. All efforts to notify the family or guardian have been documented; and 10. All media inquiries have been referred to the Central Office (CO) Office of Communications at 502-564-6180.

During review, if abuse, neglect or exploitation is likely to be substantiated, the FSOS contacts the SRA or designee. The SRA or designee then notifies the Director of the Division of Protection and Permanency or designee. This notification includes: 1. Name and age of victim; 2. If the death involves an alternate care investigation, the number and/or names of other vulnerable clients in the facility; 3. Names of family member, guardian or individual having to access to the victim at or around the time of the incident; 4. Known circumstances surrounding the fatality; 5. Description of the victim's physical injuries or medical condition at the time of death; 6. Description of the Department’s history with the adult, if any; 7. Current actions taken by the Department and future actions to be taken, including initiation of an investigation; and, 8. Involvement of other professionals in the case.

Internal Review - Service Region Within two weeks of completion of the investigation, the FSOS or designee submits a copy of the final report to the SRA. The report includes: 1. The Adult CQA; 2. Court documents;

Division of Protection and Permanency Page 20 of 29 3. Police reports; 4. Criminal records checks; 5. Medical records; and, 6. Coroner and autopsy reports.

A designee of the SRA conducts the Service Region review. The review determines if employees have followed appropriate policies and procedures and the results of the review are submitted to the SRA, who determines what action, if any, needs to be taken as a result of the review.

Internal Review - Division of Protection and Permanency - Central Office A review may be requested by the Director of the Division of Protection and Permanency at any time during the investigation. This review determines if Department employees followed appropriate policies and procedures. 1. The review is submitted to the Commissioner by the Director within sixty (60) calendar days of the date that Central Office staff receives all required documentation. 2. A staff person from the Division of Protection and Permanency is designated to coordinate the receipt of case information in Central Office from the date the report is received until the Central Office review is completed.

External Review Upon completion of the Service Region review all adult fatality reports are forwarded to the Director of the Division of Protection and Permanency or designee. An external committee consisting of Division of Protection and Permanency staff and members of the community may submit a sample of these reports each quarter for review. The purpose of this external review is to prevent future injuries and deaths by analyzing and refining the community's response to adult abuse, neglect or exploitation. Through analysis and review of adult abuse, neglect or exploitation resulting in fatalities, the external review committee will: 1. Identify gaps in services; 2. Recognize patterns that may indicate escalating violence and the threat of death; 3. Assess the current responses of the criminal justice and social service systems to victims of adult abuse, neglect or exploitation; and 4. Formulate findings and recommendations aimed at improving the community's system of prevention and intervention services. All reports submitted to the external review committee will be redacted and subject to confidentiality provisions pursuant to KRS 209.140.

1. Receiving the Report: The SSW accepts all reports of adult fatalities that occur due to alleged abuse, neglect or exploitation, including Domestic Violence reports. In addition, if an abused and / or neglected adult dies during the course of a DCBS investigation, the case shall be treated as an Adult Fatality.

Division of Protection and Permanency Page 21 of 29 However, if Service Region staff feel strongly that the death during investigation was unrelated to abuse, neglect, or exploitation, contact should be made with the Director of the Division of Protection and Permanency (DPP) or designee in Central Office to determine if the case should be treated as an Adult Fatality and be subject to the various levels of review. In this circumstance, the decision whether to take a report as a fatality is made in consultation with the regional staff and the Director of DPP or designee. Documentation of this contact should be noted on the Adult Fatality Review Form when a determination was made not to treat the case as an Adult Fatality. A copy shall be kept in the case file and a copy shall be forwarded to the Director of DPP or designee for tracking purposes.

2. Prior to the Investigation: (a)Investigations involving the death of an adult follow the guidelines in SOP 4B.2 - General Guidelines for Interviewing. (b)Collateral contacts with law enforcement, medical personnel, coroner, and other appropriate persons may be made to assess potential danger to staff. (c) Upon request by the FSOS, the SRA or designee meets with all DCBS staff involved in the case. Central Office staff is also available for consultation during this process. (d)Upon acceptance of the adult fatality allegation, the FSOS or designee notifies the SRA and the Director of the Division of Protection and Permanency in writing (fax or e-mail) of the adult fatality. (e)The FSOS or designee assigns staff to investigate and is responsible for coordinating the investigation, which includes reviewing databases to determine any prior DCBS involvement or other information pertinent to the case. (f) The FSOS may request assistance from the SRA or designee. In this case, the SRA or designee assumes responsibility for coordinating Department activities. The SRA or designee determines the appropriate staff person to investigate. It may be advisable that staff who have had prior direct involvement with the case not be assigned to conduct the investigation. If feasible, the assigned investigator consults with staff who have direct knowledge of the case prior to initiating the investigation.

3. Investigation: (a)Law enforcement is notified of all fatalities alleged to be a result of abuse or neglect. A joint investigation is conducted, whenever possible. The SSW or the designated investigator shall initiate phone contact with law enforcement and the coroner to clarify roles and establish a common channel of communication. (b)The SSW attempts to interview the alleged perpetrator as soon as possible without interfering with the law enforcement investigation.

Division of Protection and Permanency Page 22 of 29 If the alleged perpetrator refuses to be interviewed, this is documented. (c) When the Office of the Inspector General (OIG) is involved in an investigation as outlined in SOP 4B.6 - Investigations in Alternate Care Facilities, Department and OIG staff share information regarding the facility history and the investigation. Whenever possible, the investigation is coordinated and conducted jointly. If the investigation cannot be coordinated to perform an on-site visit with OIG staff within the designated time frames, the SSW proceeds with the investigation. However, on-going communication with OIG staff regarding the case shall be maintained. (d)The SSW completes the Adult Continuous Quality Assessment (CQA) on the investigation of an Adult Fatality. All information is entered and submitted to the FSOS within thirty (30) working days unless the FSOS or designee grants an extension to complete the investigation. Reasons for delays in the investigation or interview with the alleged perpetrator or the alleged victim are documented. CQA’s completed during the course of an Adult Fatality investigation are not finalized and approved until all levels of review have been completed and notification is received from Central Office regarding findings of the review process and recommendations/comments.

ADULT FATALITY REVIEW PROCESS

First Level Review (FSOS or Designee): 1. While the adult fatality investigation is in progress, the FSOS reviews the investigation to ascertain that all KRS, KAR and SOP have been followed and documents the results of the review on the Adult Fatality Review Form. Specifically, the FSOS or designee ascertains that: (a)Law enforcement was notified; (b)Collaboration on the investigation has occurred with law enforcement and other authorized agencies; (c) Caregivers and collaterals have been interviewed, and a prompt effort was made to interview the alleged perpetrator; (d)Determination has been made regarding the safety of other potential victims in the household or facility in compliance with KRS 209.030 and KRS 620.030; (e)The coroner's office has been contacted, the coroner's report was examined and a copy of the death certificate has been obtained; (f) The physician of the alleged victim has been interviewed and pertinent medical records, if available, have been reviewed; (g)If the adult is a ward of the State Guardianship office, the guardian has been notified; (h)All media inquiries have been referred to the Director of the Division of Protection and Permanency, who will make appropriate contact with the Office of Communications; (i) History of substance abuse or mental illness of the alleged victim or the alleged perpetrator exists, if it played a role in the fatality;

Division of Protection and Permanency Page 23 of 29 (j) There was a history of Domestic Violence or not; and (k) If there was previous DCBS involvement with the alleged victim or the alleged perpetrator. If previous referrals reports were received on the alleged victim or alleged perpetrator, these reports (whether accepted for investigation or not) were reviewed and included with the packet sent to Central Office for Third Level Review.

2. Within two weeks of completion of the investigation, the FSOS or designee submits a copy of the final report to the SRA. The report includes: (a) The Adult CQA and any previous CQA’s or referrals reports on the Adult or the alleged perpetrator; (b) Court documents; (c) Police reports; (d) Criminal records checks; (e) Medical records and Death Certificate; (f) Coroner and autopsy reports, and (g) An Adult Fatality Review Form with the First Level Review section completed.

Second Level Review (SRA or Designee): 1. The SRA or designee conducts the Second Level Review. This review determines if workers and supervisors have followed appropriate KRS, KAR, SOP and documents any concerns identified during the review, with particular emphasis on any issues noted with prior DCBS involvement that may have had an impact on the Adult Fatality case. 2. The SRA or designee documents concerns identified and corrective actions taken, if any, on the Second Level Review section of the Adult Fatality Review Form. Upon completion of the Second Level Review, the Adult Fatality Review Form and all case information provided to the SRA or designee by the FSOS shall be forwarded to the Director of the Division of Protection and Permanency in Central Office.

Third Level Review (Director of P&P or Designee): 1. The Director of the Division of Protection and Permanency or designee conducts the Third Level Review on the Adult Fatality Review Form. This review determines if Department employees followed appropriate KRS, KAR, SOP and if appropriate corrective actions were taken, if needed. This review should also focus on any concerns noted with Community Partner responses in previous cases related to the current case or with the current case. 2. The written review is submitted to the Commissioner and to the appropriate Director of Service Regions (East or West) by the Director of DPP within sixty (60) calendar days of the date that Central Office staff receives all required documentation. 3. The Director of Service Regions will be responsible for notifying the Service Region staff regarding any recommendations or concerns noted,

Division of Protection and Permanency Page 24 of 29 and whether the CQA can be approved or if further actions are required prior to finalizing the CQA. 4. A copy of the Adult Fatality Review Form, which should be labeled “Confidential Attorney-Client Privileged Correspondence”, should also be sent to the CHFS Office of Legal Services from field staff through the SRA.

Fourth Level Review (External): 1. Upon completion of the Third Level Review, the Director of the Division of Protection & Permanency may request that an external review be conducted by the Adult Health Care Advisory Committee, if appropriate and approved by the Office of Legal Services. (Link to Fourth Level Adult Fatality Review Protocol) The purpose of this external review is to prevent future injuries and deaths by analyzing and refining the community's response to adult abuse, neglect or exploitation. 2. All reports submitted to the external review committee will be redacted and subject to confidentiality provisions pursuant to KRS 209.140.

SOP 4.3.14 SOP 4B.13 R. 8/1/03 R. 11/15/05 DETERMINING THE FINDINGS OF AN ADULT ABUSE/NEGLECT/EXPLOITATION INVESTIGATION

PROCEDURES: Upon completion of a thorough investigation, which may include interviewing all relevant parties, gathering supportive facts, obtaining written documentation, and assessing risk, a SSW makes a written report of the investigative findings and if necessary, a recommendation for further action. The FSOS or designee reviews and approves the investigative finding. The SSW’s investigative findings are only used to determine whether an adult has been abused, neglected, or exploited and whether Department services are necessary for the alleged victim. (Link to KRS 209.020 definitions of adult, abuse, neglect and exploitation). Upon completion of an investigation, a SSW documents the investigative findings as follows:

Division of Protection and Permanency Page 25 of 29 1. Substantiated – Substantiated means that a SSW has determined that an adult is the victim of abuse, neglect, or exploitation. A substantiated finding is made as a result of a personal interview with the alleged victim and one of the following conditions: (a) An interview with the individual having access to the victim at or around the time of the alleged incident alleged perpetrator, if conducting the interview does not pose a threat to the victim, in which the individual admits to abusing, neglecting, or exploiting the victim; or (b) A personal interview with the victim and The presence of strong evidentiary or supportive facts, such as medical evidence, observation of injuries, or witness testimony that reveals a preponderance of evidence. These examples are combined with other strong collaborating facts and documented in the Adult CQA. 2. Found and Substantiated – An investigative finding is found and substantiated when a SSW discovers during the course of an investigation, or through a routine service contact, that an adult was the victim of abuse, neglect, or exploitation, and the incident was not previously reported through the Department’s intake process. The SSW uses the same standards for a finding of found and substantiated as for a substantiated finding. 3. Unsubstantiated – A finding of unsubstantiated is used when: (a)Contact with the alleged victim reveals no evidence, fact(s), indicator(s) or justification to substantiate abuse, neglect, exploitation; or (b)The location of the adult is known and attempts at contacting or conducting a personal interview with the alleged victim have been unsuccessful, and there is a lack of supportive evidence to indicate abuse, neglect, or exploitation. 4. Unable to Locate – An investigative finding of unable to locate is used when the SSW cannot locate an alleged victim after repeated, diligent efforts. 5. If the investigation is substantiated, but the case will be closed, completion of an Aftercare Plan is offered and the case is closed. (Used for both Substantiated and, Found and Substantiated). 6. If the investigation is unsubstantiated and there are concerns, completion of an Aftercare Plan is offered and the report is closed.

SOP 4.3.15 SOP 4B.14 R. 8/1/03 R. 11/15/05

DETERMINING THE FINDINGS OF AN ALTERNATE CARE INVESTIGATION

LEGAL AUTHORITY:

Division of Protection and Permanency Page 26 of 29  KRS 209.030 Rules and regulations - Reports - Cabinet actions  922 KAR 5:070 Adult Protective Services

PROCEDURES: Upon completion of a thorough investigation, which may include interviewing all relevant parties, gathering supportive facts, obtaining written documentation, and assessing risk, a SSW makes a written report of the investigative findings and if necessary, a recommendation for further action. The FSOS or designee reviews and approves the investigative finding. The SSW’s investigative findings are only used to determine whether an adult has been abused, neglected, or exploited and whether Department services are necessary. Upon completion of the investigation, a SSW documents the investigative findings as follows: 1. Substantiated – Substantiated means that a SSW determined that a resident of an alternate care facility was the victim of abuse, neglect, or exploitation. A substantiated finding is made as a result of a personal interview with the resident and one of the following conditions: (a) An interview with the individual having access to the victim at or around the time of the alleged incident alleged perpetrator, if conducting the interview does not pose a threat to the victim, in which the individual admits to abusing, neglecting, or exploiting the resident; (b)A personal interview with the resident and The presence of strong evidentiary or supportive facts, such as medical evidence, observation of injuries, or witness testimony that reveals a preponderance of evidence. These examples are combined with other strong collaborating facts and documented; or,; or, (c) A systems failure that may have contributed to the occurrence of abuse, neglect or exploitation. 2. Found and Substantiated – An investigative finding is found and substantiated when a SSW discovers during the course of an investigation, or through a routine service contact, that a resident of an alternate care facility was the victim of abuse, neglect, or exploitation, and the incident was not previously reported through the Department’s intake process. The SSW uses the same standards for a finding of found and substantiated as for a substantiated finding. 3. Unsubstantiated - A finding of unsubstantiated is used when contact with the alternate care facility resident or other party that reveals no evidence, fact(s), indicator(s) or justification for suspicion of abuse, neglect, exploitation.

Division of Protection and Permanency Page 27 of 29 SOP 4.3.17 SOP 4B.15 R. 8/1/03 R. 11/15/05 COMPLETION AND DISTRIBUTION OF THE NOTIFICATION OF PROTECTIVE SERVICES INVESTIGATIVE FINDINGS REPORTING FORM

PROCEDURES: Within twenty-four (24) hours of completion of an investigation, a SSW sends a Notification of Protective Services Investigative Findings Reporting Form to law enforcement, the Commonwealth's or County Attorney or any other regulatory agency all authorized agencies with a legitimate interest in the case. The Notification of Protective Services Investigative Findings Reporting Form is used to inform law enforcement and other appropriate authorized agencies of the Cabinet’s investigative findings, including whether an adult accepted or refused Cabinet services. In addition, the SSW records on the Notification of Protective Services Investigative Findings Reporting Form the name, if known, of any individual who had access to the victim at or around the time of the occurrence of adult abuse, neglect, or exploitation the alleged perpetrator.

When the investigation is complete, the SSW submits a copy of the Notification of Protective Services Investigative Findings Reporting Form to (Link to SOP 4A.4): 1. The appropriate law enforcement agency; 2. The Commonwealth's Attorney (when appropriate); 3. The County Attorney (when appropriate); 4. The Office of Inspector General-Regional Office(when appropriate) when the alleged victim resides in or receives services from the following: a) Nursing Facility, b) Hospital, c) Intermediate Care Facility or,

Division of Protection and Permanency Page 28 of 29 d) Home Health Agency 5. The State Long Term Care Ombudsman (when appropriate); 6. Appropriate licensure/certification boards (when appropriate); 7. The Office of Attorney General for possible investigation and prosecution of reports involving facilities that receive Medicaid funding which includes Home Health Agencies, Medicaid Fraud and Abuse Control Division (when appropriate); 8. The Division of Mental Retardation when the alleged victim resides in a Support for Community Living facility; and 9. The Division of Mental Health when the alleged victim resides in a State Operated Facility. 10. If during the course of an investigation the SSW believes there are sufficient grounds to seek disciplinary action against a doctor, the SSW notifies the: Kentucky Board of Medical Licensure 310 Whittington Parkway Suite 1B, Louisville, KY 40222 Phone 502-429-8046, FAX 502-429-9923. 11. If during the course of an investigation, the SSW believes there are sufficient grounds to seek disciplinary action against another professional, they may contact the Kentucky Division of Occupations and Professions. The SSW may seek the appropriate professional disciplinary board at the following website: http://ky.gov/agencies/finance/occupations/. 12. The SSW attempts to minimize the involvement of the adult victim in the legal proceedings and hearings.

Division of Protection and Permanency Page 29 of 29