ࡱ> )onqrstu_`abcd k ] ^ -./012345#` <bjbj\.\. >D>DFFFFnnnRRR8<Dj _3:Pfffb4, 2222222$5h7J3nH <"^H H 3FFff3"""H "Ffnf2"H 2""/hTn0f  S?Rj "01</30_307 `7 07n0H H "H H H H H 33!"H H H _3H H H H j j j .$j j j .$,FFFFFF  H07-025 Procedure May 29, 2007 TO: Home and Community Services (HCS) Division Regional Administrators Area Agency on Aging (AAA) Directors Division of Developmental Disabilities (DDD) Regional AdministratorsFROM:Bill Moss, Director, Home and Community Services Division Linda Rolfe, Director, Division of Developmental DisabilitiesSUBJECT: Revised Long-Term Care (LTC) Manual Adult Protective Services (APS) Chapter Purpose:To announce the release of the revised LTC Manual chapter, Adult Protective Services (APS).Background:The APS chapter has been revised.Whats new, changed, or ClarifiedThe APS chapter has been updated in Word format. The web-based format will be available shortly, but due to IT workload, is not available at this time. When it becomes available, a new MB will be issued with the web address and information. Until then, staff should use the attached Word document. Staff had the opportunity to review this chapter and provided comments between December 26, 2006 and January 31st, 2007. This MB supersedes the following MBs: H03-31, H04-097, H04-086, H04-081 H04-022, H04-018, H05-078, H05-061 H05-056, H05-038, H06-018, and H06-015ACTION:Effective immediately, use the updated Adult Protective Services Chapter attached below. Related REFERENCES:ATTACHMENT(S): Revised APS Chapter:  EMBED Word.Document.8 \s  APS Chapter Revision Form:  EMBED Word.Document.8 \s CONTACT(S):Lori Melchiori (360) 725-2531  HYPERLINK "mailto:Melchl@dshs.wa.gov" Melchl@dshs.wa.gov      PAGE 2  +,-012TvbRE8hL?hEnUCJ^JaJhd {hEnUCJ^JaJhd {hEnU5CJ\^JaJ'hd {hEnU5B*CJ\^JaJphhd {hCJ^JaJhd {hCJ^JaJh*p{CJ^JaJhhEnU^JhhEnU5\^Jh*p{5\^JhL?5\^Jhh}Q5\^JhQhEnU5CJ\^JaJhQhEnU5CJ\aJ(jhQhEnUCJUaJmHnHu    ,-2u  !$If $If$a$gd*p{$a$3;T]stv ^ _ h i p r ̼̼̱tfYhL?hhCJ^JaJhd {hEnU;CJ^JaJ!hd {hEnU5;CJ\^JaJhL?hEnU^JaJhL?hd {^JaJhL?hfx^JaJhL?h}Q^JaJhL?hJ'^JaJhd {hEnU5CJ\^JaJhd {hEnUCJ^JaJhL?h}QCJ^JaJhL?hEnUCJ^JaJhL?hL?CJ^JaJ ^ _ i SM$IfJkdm$$IfH0=-% o&4e4 Ha  !0$*$If $IfJkd$$IfH0=-% o&4e4 Ha   ) K UF !$Ifgd}QJkdG$$IfH0=-% o&4e4 Ha  !$If $IfJkd$$IfH0=-% o&4e4 Ha     ( ) - 0 8 = B J K L n        < = ̿yylllbXNXh<CJ^JaJhL?CJ^JaJhEnUCJ^JaJhL?hL?CJ^JaJhL?hCJ^JaJhL?hJ'CJ^JaJhL?hQCJ^JaJhd {hEnU;CJ^JaJ!hd {hEnU5;CJ\^JaJhd {hEnUCJ^JaJhL?hEnUCJ^JaJhL?hfxCJ^JaJhL?hhCJ^JaJhL?hd {CJ^JaJK L d n   = b $Ifgd< $IfgdL? 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" # $ % & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 9 : ; < = > ? @ A B C D E F G H I J K L M N O P Q R S T U V W X Y Z [ \ ] ^ _ ` a b c d e f g h i j k l m n o p q r s t u   !"#$&)*+,-.01234568  FMicrosoft Office Word Document MSWordDocWord.Document.89q@ FMicrosoft Visio DrawingVISIO 6.0 ShapesVisio.Drawing.69qObjInfo&ObjectPool`?8?_1206342219F`?P!?Ole CompObj qObjInfoOlePres000 OlePres001 08winspool\\dshspsoly2001c\HCP_NORTHNe03:\\dshspsoly2001c\HCP_NORTH\WIND4O odXXLetter\W32X86\3\UNIRES.DLLC:\W DINU"43  eO H>  J&--$R*5@KV`jt}~ulbXMC8-! wne\TLD}=t6j0`*V%K @5*  R F 9-!  %*06=DLT\enw~ytplifdcbaaabcd fi!l-p8tCyM~Xblu~ !-9FRR----%R*5@KV`jt}~ulbXMC8-! wne\TLD}=t6j0`*V%K @5*  R F 9-!  %*06=DLT\enw~ytplifdcbaaabcd fi!l-p8tCyM~Xblu~ !-9FRR-- .zArial ww 0w f-2 Box AaRJ%"System ]ww 0w f- .Arial ww 0w f-*2 aFollow the standard APSA<<M<<6<<<<$<GG- .-12 procedures for investigation<$<6<<<$<6<$<6<6<<<- .-*2 cand protective services<<<<$<<66<6<$66<---$a:%a:%aF%`R%_^%^j%\v%Y%V%R%N%I%D%>%7%1%*%"%%% %&& &&&&&"&%&'&)&*&|*&p*&p*&p*&*&*&)&'&%&"&|&p&e&Z&P &E&;&1%(%%%%%%%%%%%%%v%j%^%R%F%:%:%yphaZ(S1M;GEBP=Z9e5p2|/-+****p*p*|+-/259=BGMSZa hpy"*17>DINRVY\^_`aa----%a:%a:%aF%`R%_^%^j%\v%Y%V%R%N%I%D%>%7%1%*%"%%% %&& &&&&&"&%&'&)&*&|*&p*&p*&p*&*&*&)&'&%&"&|&p&e&Z&P &E&;&1%(%%%%%%%%%%%%%v%j%^%R%F%:%:%yphaZ(S1M;GEBP=Z9e5p2|/-+****p*p*|+-/259=BGMSZa hpy"*17>DINRVY\^_`aa-- .zArial ww 0w f-2 Box DaRJ%- .Arial ww 0w f-j2 =BIf the AP is an AAA employee or AAA subcontractor in a CM or nurse$$A<MG<<AMMM<_AA<<<A*MMM<AA<AA$*<<$A*A<MYA*AA*<- .-2 role:*A<- .Arial ww 0w f-=2 >x$1. Apply APSAS administrative lock;<G<<6GGGGG<<Y<6$<6<<66- .-N2 x/2. Report potential crimes to law enforcement;<M<<<$<<<<<6$Y<6<<M<<<$6<Y<<- .-*2 ?x3. Inform HCS RA that:<<<$YMMGMG<<- .-B2 x' a. The AP is an AAA employee; and<A<<GG6<<GGG<Y<<6<<<<- .-R2 @x2 b. The allegation does involve the APs job;<A<<<<<<<<<<<6<6<6<<<GG6<<- .-o2 xE4. Complete an incident report and send it only to the HCS Assistant <M<Y<<<<<<6<<<$<<<$<<<6<<<<<6<<<MMGG666<<- .-2 Ax Director;M$<6<$- .-u2 xI5. APS will investigate allegations of abuse and financial exploitation.<GGGM<6<6<<<<<<<<<6<<<<6<<<<<<<6<<6<<<<<- .-f2 Cx? a. HCS RA notifies the AAA director of APS investigation.<MMGMG<<<6<<GGG<$<6<$<GGG<6<6<<<<- .-m2 xD b. An APS worker without a potential conflict of interest from<G<GGGM<$6<$M<<<<<<<<<6<<6<<<$<6$<- .-c2 Dx= another office or region will do the investigation.<<<<<$<6<<$$<<<<M<<<<<6<6<<<<- .-p2 xF c. Provide APS Outcome Report to only the AAA Director (not CM).6G$<6<<GGGS<6<Y<M<<<$<<<6<<GGGM$<6<$$<<MY$- .-j2 E xB d. Implement due process procedures for an APS substantiated<Y<<Y<<<<<<$<6<66<$<6<<<$<6<$<<GGG6<<6<<<<- .-.2 x initial finding;<<<<<<- .-o2 F xE6. APS will screen-out allegations related to the failure to provide<GGGM66$<<<$<<<<<<<<6$<<<<<<<<<$<<<$<6<- .-F2 x* services under the employees duties;6<$66<6<<<<$<<<Y<<6<<6<<<6- .-o2 H xE7. The HCS RA will refer the screened-out allegation directly to the<A<<MMGMGM$<<$<<66$<<<<<$<<<<<<<<<$<66<<- .-o2 xE AAA Director for investigation as a potential personnel/trainingGGGM$<6<$<$<6<6<<<<<6<<<<<<<<$6<<<<$<<<- .-2 I x matter.Y<<$- .Arial ww 0w f-a2 J <If the AP is an AAA subcontractor not in a CM or nurse rule:$$A<MG<<AMMM<AA<AA$*<<$A*AA$A<MYA*AA*<<*A<- .Arial ww 0w f-N2 x/1. Report potential crimes to law enforcement;<M<<<$<<<<<6$Y<6<<M<<<$6<Y<<- .-K2 Kx-2. Follow standard investigation procedures.<A<<M6<<<<$<<6<6<<<<<$<6<<<$<6---$    $ 0 ; G R ] {h vr q| k e ^ W O G ? 6 - $               K ? 2 &    | } r w h r ] m R i G e ; b 0 _ $ ]  [ Z Z Z Z |Z p[ d] X_ Lb Ae 6i +m r w }     & 2 ? K K $-6?GOW^e kq v+{6ALXdp|----%    $ 0 ; G R ] {h vr q| k e ^ W O G ? 6 - $               K ? 2 &    | } r w h r ] m R i G e ; b 0 _ $ ]  [ Z Z Z Z |Z p[ d] X_ Lb Ae 6i +m r w }     & 2 ? K K $-6?GOW^e kq v+{6ALXdp|-- .zArial ww 0w f-2  Box BaRJ%- .Arial ww 0w f-=2 $1. Apply APSAS administrative lock;<G<<6GGGGG<<Y<6$<6<<66- .-N2 # /2. Report potential crimes to law enforcement;<M<<<$<<<<<6$Y<6<<M<<<$6<Y<<- .-*2 3. Inform HCS RA that:<<<$YMMGMG<<- .-K2 $- a. The AP is a DSHS/AAA employee or AAA<A<<GG6<MGMGGGG<Y<<6<<<$GG- .-?2 % CM/nurse subcontractor; andMY<<$6<6<<6<<$<6<$<<- .-X2 %6 b. The allegations have no nexus to his/her job;<A<<<<<<<<6<<6<<<<<6<6<<6<<$<<- .-@2 &4. Follow standard APS procedures for<A<<M6<<<<$<GGG<$<6<<<$<6<- .-H2 &+ investigation and protective services.A<6<6<<<<<<<<$<<66<6<$66<6---$x                " * 1 8 ? E K Q U Z t] ia ]c Re Fg :h -h !h !h !h zh ng be Vc Ja >] 3Z 'U Q K E ? 8 1 * "                x x wnf^VOHB<72.'*3'>$J"V!b nzz! -!:"F$R']*i.t27<BHOV^fnw  ----%x                " * 1 8 ? E K Q U Z t] ia ]c Re Fg :h -h !h !h !h zh ng be Vc Ja >] 3Z 'U Q K E ? 8 1 * "                x x wnf^VOHB<72.'*3'>$J"V!b nzz! -!:"F$R']*i.t27<BHOV^fnw  -- .zArial ww 0w f-2 rBox CaRJ%- .Arial ww 0w f-B2 }'If the AP is a DSHS/AAA Employee or AAA$$A<MG<<MGMGMMMG_AA<<<A*MM- .-=2 {}$subcontractor in a CM or nurse role:<AA<AA$*<<$A*A<MYA*AA*<<*A<- .Arial ww 0w f-=2 m$1. Apply APSAS administrative lock;<G<<6GGGGG<<Y<6$<6<<66- .-:2 |m"2. Report potential crimes to law<M<<<$<<<<<6$Y<6<<- .-!2 m enforcement; <<<$6<Y<<- .-"2 ~m3. Inform HCS RA:<<<$YMMGMG- .-E2 m) a. The AP is a DSHS/AAA employee or<A<<GG6<MGMGGGG<Y<<6<<<- .-?2 m% CM/nurse subcontractor; andMY<<$6<6<<6<<$<6<$<<- .-F2 m* b. The AP has unsupervised access to<A<<GG<<6<<6<<<$66<<<66<66- .-@2 m& VA/children on the job; andGG6<<$<<<<<<<<<<- .-I2 m, c. The allegation does not involve the6A<<<<<<<<<<<6<<<6<6<<- .-%2 m APs job.GG6<<---$F%F%F%E%D%C%A%>%;%7%3%.%(%#&&&#&,&4&;&B&I&O&U&Z&_&c&g&j&m&o&yq&mr&ar&Ur&Ur&Ur&r&q&o&m&j&g&c&_&Z&U&O&{I&qB&g;&^4&V,&M#&E&>&6&0%)%$%%%%%% % %%%  vl$b)X0N6E>=E4M,V%^gq{ UUamy %,4=ENXb#l(v.37;>ACDEFF----%F%F%F%E%D%C%A%>%;%7%3%.%(%#&&&#&,&4&;&B&I&O&U&Z&_&c&g&j&m&o&yq&mr&ar&Ur&Ur&Ur&r&q&o&m&j&g&c&_&Z&U&O&{I&qB&g;&^4&V,&M#&E&>&6&0%)%$%%%%%% % %%%  vl$b)X0N6E>=E4M,V%^gq{ UUamy %,4=ENXb#l(v.37;>ACDEFF-- .zArial ww 0w f-2 Box EaRJ%- .Arial ww 0w f-32 PKIf the AP is a DSHS employee:$$A<MG<<MGMG<_AA<<<- .Arial ww 0w f-=2 <$1. Apply APSAS administrative lock;<G<<6GGGGG<<Y<6$<6<<66- .-N2 Q</2. Report potential crimes to law enforcement;<M<<<$<<<<<6$Y<6<<M<<<$6<Y<<- .-*2 <3. Inform HCS RA that:<<<$YMMGMG<<- .-B2 R<' a. The AP is a DSHS employee; and<A<<GG6<MGMG<Y<<6<<<<- .-R2 <2 b. The allegation does involve the APs job;<A<<<<<<<<<<<6<6<6<<<GG6<<- .-o2 T<E4. Complete an incident report and sent it only to the HCS Assistant<M<Y<<<<<<6<<<$<<<$<<<6<<<<6<<<MMGG666<<- .-2 < Director;M$<6<$- .-u2 U<I5. APS will investigate allegations of abuse and financial exploitation;<GGGM<6<6<<<<<<<<<6<<<<6<<<<<<<6<<6<<<<<- .-d2 <> a. HCS RA notifies APs DSHS appointing authority of APS<MMGMG<<<6GG6MGMG<<<<<<<<<<<$6<GG- .-+2 V< investigation.<6<6<<<<- .-y2 <L b. An APS worker without a potential conflict of interest from another<G<GGGM<$6<$M<<<<<<<<<6<<6<<<$<6$<Y<<<<<- .-W2 W<5 office or region will do the investigation.<6<<$$<<<<M<<<<<6<6<<<<- .-v2 <J c. Provide APS Outcome Report to only the APs appointing authority.6G$<6<<GGGS<6<Y<M<<<$<<<6<<GG6<<<<<<<<<<<$6- .-s2 Y<H d. Implement due process for an APS substantiated initial finding;<Y<<Y<<<<<<$<6<66<$<<GGG6<<6<<<<<<<<<<<- .-{2 <M6. APS will screen-out allegations related to the failure to provide service<GGGM66$<<<$<<<<<<<<6$<<<<<<<<<$<<<$<6<<6<$66- .-?2 Z<% under the employees job duties;<<<<$<<<Y<<6<<6<<<<<6- .-m2 <D7. The HCS RA will refer the allegation to the APs DSHS appointing<A<<MMGMGM$<<$<<<<<<<<<<<GG6MGMG<<<<<<- .-|2 [<N authority. As per DSHS administrative policies the appointing authority<<<<$6G6<<$MGMG<<Y<6$<6<<<6<6<<<<<<<<<<<<<$- .-y2 <L determines if the matter is address as a personnel or training matter,<<<$Y<<6<<Y<<$6<<<$<66<6<<<$6<<<<<$$<<<<Y<<$- .-m2 \<D or sent to Washington State Patrol for investigation under the<$6<<<e<6<<<<<G<<G<$<<$<6<6<<<<<<<<$<- .-12 < interagency agreement.<<$<<<<66<<$<<Y<<---$UMMU^fnv{ocVH#9#9YL>1#{{##~qeYOE<4-*'$" vnf^UMMULD;3+# " $'*-4<EOYeq~ {           # 1 >L Y Y99HVco{ #+3;DLUU----%UMMU^fnv{ocVH#9#9YL>1#{{##~qeYOE<4-*'$" vnf^UMMULD;3+# " $'*-4<EOYeq~ {           # 1 >L Y Y99HVco{ #+3;DLU----$CCCCBBA?><:8&5-25/D(R _l y%*/35899r9c8U5G39/+*%##yl_RD5-&|m_QD8-"##    +~ 9{ Gy Ux cw rx y { ~      "-8D Q_ m(|/258:<>?ABBCCC----%CCCCBBA?><:8&5-25/D(R _l y%*/35899r9c8U5G39/+*%##yl_RD5-&|m_QD8-"##    +~ 9{ Gy Ux cw rx y { ~      "-8D Q_ m(|/258:<>?ABBCCC-- .zArial ww 0w f- 2  1.J- .Arial ww 0w f-!2 !Is the AP a DSHS/<$A<MG<MGMG- .-2 AAA employee orMMM<_AA<<<A- .-2 "an AAA<AMM- .-2 subcontractor?<AA<AA$*<<$A*--->$uuuuutsqpnkifc_\XT&O-K4FA;N/Z#dnsw{ wj]PC6*   { w s n d Z N A 4 - &  { w t p m j h e c b ` _ ^ ^ ^ ^ ^ ^ ^ _ ` b c e h j m p t w {  { t m ` S H = 3 . * & " "    * 6 C P ] j w        ""&*.3=H#S/`;mFtK{OTX\_cfiknpqstuuuu----<%uuuuutsqpnkifc_\XT&O-K4FA;N/Z#dnsw{ wj]PC6*   { w s n d Z N A 4 - &  { w t p m j h e c b ` _ ^ ^ ^ ^ ^ ^ ^ _ ` b c e h j m p t w {  { t m ` S H = 3 . * & " "    * 6 C P ] j w        ""&*.3=H#S/`;mFtK{OTX\_cfiknpqstuuu----8$,5>FOW`hpxxqqVVJ=1$            r j b Z S E 8 +           x p h ` W O F > 5 , ,  | s j b Y Q H @ 8 0 (        + 8 E S Z b j r r ( #            $ 1 =# J( V( V q x           (08@HQYbjs|----8%,5>FOW`hpxxqqVVJ=1$            r j b Z S E 8 +           x p h ` W O F > 5 , ,  | s j b Y Q H @ 8 0 (        + 8 E S Z b j r r ( #            $ 1 =# J( V( V q x           (08@HQYbjs|-- .zArial ww 0w f- 2 2.J- .Arial ww 0w f-$2 SDoes the AP work inMA<<$A<MGSA*<- .- 2 :a.- .-2 ! position withAA<$AAS$- .-$2 ;unsupervised accessAA<AA<*<<<A<<<<<- .-%2 "_to vulnerable adults$A<AA<*<A<<AA$- .-2 # or children?A*<AA*<A---$$&.7?GPX`hpw{qfZN@2+##m2m2s%x} }xtsgmZmZiibZL?2&wph`XPG?7.&{skbZRJB:2*#&2?LZii4Z4Z.g)t%!!% ).%4242##2@NZfq{#*2:BJRZbks{----"%&.7?GPX`hpw{qfZN@2+##m2m2s%x} }xtsgmZmZiibZL?2&wph`XPG?7.&{skbZRJB:2*#&2?LZii4Z4Z.g)t%!!% ).%4242##2@NZfq{#*2:BJRZbks{----$ 000/.-,*)&$!$ 1>KVakt|| w i[N@ 2 $ |tkaVK>1$}zwurqonmlkkk kklmnoqruwz}rfZOE<844      $ 2 @ N [ i w      48<EOZfr !$&)*,-./0 0 0----% 000/.-,*)&$!$ 1>KVakt|| w i[N@ 2 $ |tkaVK>1$}zwurqonmlkkk kklmnoqruwz}rfZOE<844      $ 2 @ N [ i w      48<EOZfr !$&)*,-./0 0 0-- ._Arial ww 0w f- 2 <3.Y- .Arial ww 0w f-2 s Is the AV<$A<M- .-2 Maffiliated with<$$<$<AS$- .-2  the APs work$A<MG<SA*- .-"2 Orole (e.g., is the*A<$<A<$A- .-2  AV a client)?MG<<<A$$---%Y r5 r---- $B rB @B ----$  y y  -- .- 2  NOM---%   G ---- $S & S S &----$ :S :S -- .- 2  NOM---% N N---- $ h N  ----$     -- .- 2 n' NOM---%G+NN(M4L@KLIWFcCn?y;60+$  u i ] ] ]   $)/5~<uClKcSZ[RdKmDv=71,'"---- $*F----$YY-- .- 2 3YESGG---%XCX ---- $} X 4 } ----$?   ? ? -- .-2 YES, then ask:GGG$A<A<<<---%XX+---- $}!Xk4!}!----$zz-- .-2 TYES, then ask:GGG$A<A<<<---%Lhhtyr kcZ!Q(H/?55;+A!EJ MQSUWXXXXX@X3W'USQMJEA;5/(! ~xqlfa]YVSQPtOhOhOLO@O4P(QSVY]aflqx~~ysnjfc`^]'\3\@\@\\]^`cfj ns!y+~5?HQZckry(4@LL-- .DArial ww 0w f-C2 (Procedure for Investigation of DSHS/AAA/}IrhhrrIh4>rI44rhhh>4rh>4rr4r>4}}4- .-92 !AAA Subcontrator Employee Alleged4}rrhrr>Ih>rI4}r4rhhh444hrh- .-2 a Perpetrator?}hIrh>Ih>r---|%<+NNMMLKIGEB?<840,'"   z p#f(]-U3L:EA>I8R3[.e+j)o(t'y'&&&&---- $&X----$'''-- .Arial ww 0w f- 2 n4YESGG---% aOOPQRRRSTUU---- $----$LL}}L-- .- 2 WZORS---8$$$CEFHIJKKLK K J IHFEC                    TTVWYZ[\\\\ \ [ ZYWVTTSQPON M L LLMNOPQSTT-- .Arial ww 0w f- 2 -PNOTEDI9- .-2 \This flow chart provides a quick reference guide and does not substitute the specific action94/4D/4444/44/444//4444/44444444444/44/44/4444/44//4/4- .-W2 5requirements and responsibilities outlined in policy.4444N44/4444/444/44/44444444//-'NANI 8cjJ      !"#$%&^)*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[]~  fghijklmnopqrstuvwxyz{|}~8cjJ YC   ."SystemF\p9 -@Times New Roman-  2 Z p----  .]+"System---$ #).9>BGKNRUX[]_abczdsdldldlddcba_][XURNKGB>9.z)v#rnkh ec`^]\[ZZZZ[\]^`cehknrvz~{ywutssrrrlsssztuwy{~-- --% #).9>BGKNRUX[]_abczdsdldldlddcba_][XURNKGB>9.z)v#rnkh ec`^]\[ZZZZ[\]^`cehknrvz~{ywutssrrrlsssztuwy{~-- .Arial-2 Box A<1*- .Arial-*2 !Follow the standard APS+$ $1%$$%$%$*+- .-12 lprocedures for investigation%%$%$$$ %$ %$ %- .-*2 and protective services%$%$$% $% $---$ "%(*,.}/v0o0h0a0a0a000/.,*(%" |zxwutttttttuwxzzs|lf`ZTNH>950,(%"ahov}"%(,059>HNTZ`flsz-- --% "%(*,.}/v0o0h0a0a0a000/.,*(%" |zxwutttttttuwxzzs|lf`ZTNH>950,(%"ahov}"%(,059>HNTZ`flsz-- .Arial-2 .Box D=1*- .Arial-j2 KJBIf the AP is an AAA employee or AAA subcontractor in a CM or nurse*%1*$%*010$=**%$%*011$+*%*+$%*+$07++*$- .-2 Jrole:+$- .Arial-=2 $1. Apply APSAS administrative lock;$*%$ +*+*+$%7 $ % % %- .-N2 -/2. Report potential crimes to law enforcement;$0%$%$$$% $  6%$ $1$%$%6%$- .-*2 y3. Inform HCS RA that:$%$611*1+$%- .-B2 ' a. The AP is an AAA employee; and$+$$*+ $%*+*$7$ %%$$%- .-R2 2 b. The allegation does involve the APs job;$+$$$ %$% %$%$% %% %%$+*  %$- .-o2 UE4. Complete an incident report and send it only to the HCS Assistantn$0%7$ %$$$ $ $%$$%$%$$%$$ %$ %%$10++ %$- .-2  Director;0 $$- .-u2 I5. APS will investigate allegations of abuse and financial exploitation. $*+*0  %$ %$%$ $%$ $$$$%$$%$% %$% % %$ $ % %$- .-f2 7? a. HCS RA notifies the AAA director of APS investigation.$10+1*%$  $%$++*% %%%+*+ %$ %$ %$- .-m2 D b. An APS worker without a potential conflict of interest from$+$+*+1$$0 $%$$%$%$ $ $% % %$$$- .-c2 = another office or region will do the investigation.n$%$$$$ %%%$ $$0 $%%$ $% $% $%- .-p2 F c. Provide APS Outcome Report to only the AAA Director (not CM).*$ $%*+*0%%7$1$%$%$% $%*++0 $$%$07- .-j2 _B d. Implement due process procedures for an APS substantiated$7$ %7$%$%$$%%$%%$%$%%$+*+$$%$ %%- .-.2  initial finding; %  %  %$ %$- .-o2 E6. APS will screen-out allegations related to the failure to provide.$*+*0 $%$$%% $%$ $$% $$%%$%% %$$%% %- .-F2 B* services under the employees duties;% $$%$%$$$7$ %%$ $% %- .-o2 E7. The HCS RA will refer the screened-out allegation directly to the.$*%$01*1+0 %%%$$$%$%%$$ %$% %$% % %%- .-o2 E AAA Director for investigation as a potential personnel/training.*+*0 $$$ %$ %$ $$$$%$$$ $ $%%$%$ $ $ %- .-2  matter.7$%- .Arial-a2 J<If the AP is an AAA subcontractor not in a CM or nurse rule:*%1*$%*010$+*%*+%$**++%16+*+$%+%- .Arial-N2 /1. Report potential crimes to law enforcement;$0%$%$$$% $  6%$ $1$%$%6%$- .-K2 L-2. Follow standard investigation procedures.t$*% %0$%$%% $$ %$ %$%%%$$$---$   " ) 1 8 ? E L S Y _ e k p{ {r n h c ^ X R L F @ 9 2 , %      # {pke_YSLE?81)"~yuqnkheca_^ ]\\#\#\ ] ] ^% _, a2 c9 e@ hF kL nR qX u^ yc ~h n r { -- --%   " ) 1 8 ? E L S Y _ e k p{ {r n h c ^ X R L F @ 9 2 , %      # {pke_YSLE?81)"~yuqnkheca_^ ]\\#\#\ ] ] ^% _, a2 c9 e@ hF kL nR qX u^ yc ~h n r { -- .Arial-2  Box B=0+- .Arial-=2 R$1. Apply APSAS administrative lock;$+$$ +*+*+%$7 $ % $ %- .-N2 /2. Report potential crimes to law enforcement;$1$%$$%$% %  7$$ $1$%%%6%$- .-*2 3. Inform HCS RA that:$%$601*0+%$- .-K2 5- a. The AP is a DSHS/AAA employee or AAAt%+$%*+ $0+0++*+$7% $$$$*+- .-?2 % CM/nurse subcontractor; andn16$%%%$$%%%%$- .-X2 6 b. The allegations have no nexus to his/her job;%+$%$ $%$ %$$%%$%$%%$% $$ %$- .-@2  &4. Follow standard APS procedures for$+$ %0%$%$%+*+$$%$%%%- .-H2 ] + investigation and protective services.A %$ %$ $$$%$%%$ %% %---$J\JdJkIsIzGFDB?<962.*! w o h a Z T M F @ : 4 . ( #              z s k d \ z s l f ` Z T N H > 9 4 0# ,( (. %4 !: @ F M T Z a h o w w !%(, 049>!H*N.T2Z6`9f<l?sBzDFGIIJJJ-- --%J\JdJkIsIzGFDB?<962.*! w o h a Z T M F @ : 4 . ( #              z s k d \ z s l f ` Z T N H > 9 4 0# ,( (. %4 !: @ F M T Z a h o w w !%(, 049>!H*N.T2Z6`9f<l?sBzDFGIIJJJ-- .Arial-2 r Box C=0+- .Arial-B2 I'If the AP is a DSHS/AAA Employee or AAA+$1*$%1*1*011*=+*%$%*10- .-=2  I$subcontractor in a CM or nurse role:$+*%*+$$*+$07++*%$*$- .Arial-=2 T $1. Apply APSAS administrative lock;$*%$ +*+*+%$7 $ % $ %- .-:2 "2. Report potential crimes to law$1$$%$%$% %  7$$ $- .-!2  enforcement; $%%%6%$- .-"2 63. Inform HCS RA:$%$601*0+- .-E2 ) a. The AP is a DSHS/AAA employee or$+$%*+ $0+0++*+$7$ $%$$- .-?2 % CM/nurse subcontractor; andA16$%%%$$%$%%$- .-F2 * b. The AP has unsupervised access to$+$%*+%$$%$%$ %$$$- .-@2 ^& VA/children on the job; and+*$ $$$$%%$ %$$%- .-I2 , c. The allegation does not involve the+$$$ %$% %$%$%%$ $$ $$- .-%2  APs job.+*  %$---$ "'26;?CGKNQTVXZ[\\x]q]q]q]m \f \_ [X ZQ XJ VD T= Q7 N1 K+ G% C ? ; 6 2 ' "               y r k c \ U O H B ; 5 / ) $      % + 1 7 = D J Q X _ f m m q x         $)/5;BHOU\ckry-- --% "'26;?CGKNQTVXZ[\\x]q]q]q]m \f \_ [X ZQ XJ VD T= Q7 N1 K+ G% C ? ; 6 2 ' "               y r k c \ U O H B ; 5 / ) $      % + 1 7 = D J Q X _ f m m q x         $)/5;BHOU\ckry-- .Arial-2 P 4Box E=1*- .Arial-32 %If the AP is a DSHS employee: +$0+%$0+0+%<++$%$- .Arial-=2 $1. Apply APSAS administrative lock;%+$% *+*+*%$7 % $ $ $- .-N2 8 /2. Report potential crimes to law enforcement;%1$%$%$%$ $  7$% %0%$%$7$%- .-*2 ~ 3. Inform HCS RA that:%$%710+1*$$- .-B2 ' a. The AP is a DSHS employee; and%*%$+* %1*1*%7$ %$%%$- .-R2  2 b. The allegation does involve the APs job;%*%$% $%$ $%$%$ $$ $$%*+  $%- .-o2 ` E4. Complete an incident report and sent it only to the HCS Assistant.%1$7% $%%$ % %$%$$%$%$$% $% $%$01** $%- .-2  Director;0 $$- .-u2 I5. APS will investigate allegations of abuse and financial exploitation; %+*+1  $% $%$$ %$% %$$%$%%$%$ $%$ $ $% % $ $%- .-d2 C > a. HCS RA notifies APs DSHS appointing authority of APS%01*1+$%  $*+ 1+0+$%$% $ $%$%%$ %+*- .-+2  investigation. $$ $% $%- .-y2 L b. An APS worker without a potential conflict of interest from another%*%*+*0%%1 %$%%$%$% % %$ $ $$%%6%$%%$- .-W2 5 office or region will do the investigation.;$ $$$% $%1 %$$% %$ %$ %$- .-v2 kJ c. Provide APS Outcome Report to only the APs appointing authority.+% %$+*+1$$7%0%$%$%$ %$++ %$%$ % %$%$%$ - .-s2 H d. Implement due process for an APS substantiated initial finding;%6% $7%$$$%%$$%%$*+*$%%$ $%$ $  $  $% $%- .-{2 M6. APS will screen-out allegations related to the failure to provide service %+*+1 $$%%$$ %$% %$$ $%$$$$$ $%%$$ $%% - .-?2 M% under the employees job duties;n%$%$$%%6% $$%  $$$% $- .-m2 D7. The HCS RA will refer the allegation to the APs DSHS appointing%+$%10+1*1 $$$%% $%$ $$$$%+* 0+1*%$%$ % %- .-|2 N authority. As per DSHS administrative policies the appointing authority$%$% +$$1*1*$$7 % $ $$%  %$%$%$% $ $%$%$% - .-y2 *L determines if the matter is address as a personnel or training matter,$%$6 %$ $%7$% %$%$%%%$$%$% $% $ $%6%%- .-m2 uD or sent to Washington State Patrol for investigation under the$$%$=$$ %$$%*$%*%% % $% $% $%%$$%$- .-12  interagency agreement. $%%$%$$%%$7$%---$mQ } }) |3 {= zG wP uY qb mk hs c{ ^ W Q I B : 1 1        w o g ^ V N F > 6 . .      { s zk ub pY lP iG f= d3 b) a a aQ aF a< b2 d) f i l p uz.6>~F|NzVy^xgxoxwyz|~1:BIQW^c h m q u) w2 z< {F |Q }Q }-- - -%lQ } }) |3 {= zG wP uY qb mk hs c{ ^ W Q I B : 1 1        w o g ^ V N F > 6 . .      { s zk ub pY lP iG f= d3 b) a a aQ aF a< b2 d) f i l p uz.6>~F|NzVy^xgxoxwyz|~1:BIQW^c h m q u) w2 z< {F |Q }-- --$m 7 7 7 6 4 2 / + '" #* 2 9 @ G M S X X  i b Z R J B 9 1 ) !        X fS ^M VG N@ G9 @2 :* 4" / * & #        #&*/4:@GNV^ff?;85310/!/)/1091B3J5R8Z;b?i?i #'+/2467 7 7-- - -%m 7 7 7 6 4 2 / + '" #* 2 9 @ G M S X X  i b Z R J B 9 1 ) !        X fS ^M VG N@ G9 @2 :* 4" / * & #        #&*/4:@GNV^ff?;85310/!/)/1091B3J5R8Z;b?i?i #'+/2467 7 7--  .Arial- 2  1.+- .Arial-!2 Is the AP a DSHS/ $*%0+%1*1*- .-2 DAAA employee or110$=**%$$*- .-2 x an AAA%*01- .-2 subcontractor?$+*%*+$$*---$m T _ i s } | w q k e ] V M E < < ( + . 0 2 {3 t4 l5 e5 ]5 V4 N3 G2 ?0 8. 1+ *( #( #  v m e ] V O I C > : 6} 3s 1i /_ .T -T - - . /136:>CIOV]emvH#E*B1@8>?<G;N;V:];e;l<t>{@BEHH< E M V ] e k q w |         -- - -%l T _ i s } | w q k e ] V M E < < ( + . 0 2 {3 t4 l5 e5 ]5 V4 N3 G2 ?0 8. 1+ *( #( #  v m e ] V O I C > : 6} 3s 1i /_ .T -T - - . /136:>CIOV]emvH#E*B1@8>?<G;N;V:];e;l<t>{@BEHH< E M V ] e k q w |        -- --$kG G  G F * D 4 B > > H ; Q 6 Z 1 b + j % r  y        R K D < 5 . &            9 0 ' y r j b Z Q H > 4 *    {s kd^X'R0N9N9&.5<DKRNRX ^ d k s% {+ 1 6 ; > B D F G G G -- - -%kG G  G F * D 4 B > > H ; Q 6 Z 1 b + j % r  y        R K D < 5 . &            9 0 ' y r j b Z Q H > 4 *    {s kd^X'R0N9N9&.5<DKRNRX ^ d k s% {+ 1 6 ; > B D F G G G --  .Arial- 2 M 2.+- .Arial-$2 Does the AP work in1*%$*%0+1*$- .- 2  ap- .-2 5  position with++$*+1- .-$2 unsupervised access*+$+*%%$%*%$%$%- .-%2 to vulnerable adults+%*+$$+$$+*- .-2  6 or children?*$++$+---$lm x x x w u* s4 p= lF hO cW ^_ Xg Rn Kt Dz < 4 + +      y q i a Y P H A 9 1 ) " " z t } n v g o _ i W c O ^ F Y = U 4 Q * N L  J I  I m I c I Y J O L E N < Q 2 U ) Y ! ^  c  i o  v }     ")19AHPYaiqy+4<D K R X ^! c) h2 l< pE sO uY wc xm xm x-- - -%km x x x w u* s4 p= lF hO cW ^_ Xg Rn Kt Dz < 4 + +      y q i a Y P H A 9 1 ) " " z t } n v g o _ i W c O ^ F Y = U 4 Q * N L  J I  I m I c I Y J O L E N < Q 2 U ) Y ! ^  c  i o  v }     ")19AHPYaiqy+4<D K R X ^! c) h2 l< pE sO uY wc xm x-- --$k% 2 2 2 1 / - * & "    % + 1 7 < <  Y R J B : 3 + #     < P 7 G 1 ? + 7 % 0  )  #            %              # ) 0 7 ? G P Y U R O M KJ III#J+K3M:OBRJURYYYY "&*- / 1 2% 2% 2-- - -%k% 2 2 2 1 / - * & "    % + 1 7 < <  Y R J B : 3 + #     < P 7 G 1 ? + 7 % 0  )  #            %              # ) 0 7 ? G P Y U R O M KJ III#J+K3M:OBRJURYYYY "&*- / 1 2% 2% 2--  .Arial- 2 } 3.7- .Arial-2 f Is the AVe%+$0- .-2  affiliated with%$$+1- .-2 e the APs workt+$0+%0+- .-"2 role (e.g., is the+$$*%+- .-2 ) AV a client)?t1+$%%*- - -%))-- -- $Fd) F----$QQ-- .- 2 >NO1- - -%QQPPO-- -- $66----$  A}A} -- .- 2 )NO0- - -%8#-- -- $+7+ +7----$Z ZCC Z -- .- 2 +bNO0- - -%E 8 ? G N U \ c j q w ~    < 5 . '                   # * 1 8 ? F M U \ \  -- -- $   ----$ " |  |  " " -- .- 2 h YES+*-- -% 7 -- -- $    ----$ ]   ] ]-- .-2  YES, then ask:+*++$+%$%-- -% G -- -- $   ----$  N N  -- .-2 8 YES, then ask:+*++$+%$%-- -%\ d k s z      ~ { w t p k b ^ Y S N H B < 6 0 ) "     } w q k f a [ W N I F B ? ; 9 6 4 2z 1s /k .d .\ .\ ..../12469;?~BxFsImNcW^[YaUfQkMqIwF}CA><;:9888889:;<">)A0C6F<IBMHQNUSYY^^cbmkspxt~w{~--  .Arial-C2 z(Procedure for Investigation of DSHS/AAA/I*C==CB+=%B+C<==$C<%CCC$UIUIUUU- .-92 *!AAA Subcontrator Employee AllegedHUUUICC=CB%*=%B+IhBC<==U=C<- .-2  PerpetratorsI=+B=%*=$C- - -R%'   ' 0 8 @ G N T Z _ d h k m n o o o o o p r t v z } } y v t r p o o o o -- -- $ R o R ----$ Cm Cm -- .Arial- 2 + YES+*-- -% w x x x y y y z z z  -- -- $    ----$i7 i  7 i7 -- .- 2 z qOR1--- 8356787653ccb`___`bcc-- .Arial- 2 NOTE+*%- .-2 /\This flow chart provides a quick reference guide and does not substitute the specific action$  +       - .-W2 n5requirements and responsibilities outlined in policy. 1      -''"System|pIuz9-'-VisioDocument(YfVisioInformation"SummaryInformation(DocumentSummaryInformation8 Visio (TM) Drawing Yf6dRl !fffMMM3338 TZ Arial@:NWingdzs@vNuMonotype Sort mSymbol5TA? 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All s reserved.`Vis_SFB.chm!#26527 '#O0,Hd9 l>YUdv W}T /6bRC2N6& B2Ygm24 ?=P?1F%??S911^;66=O= E%2O;zrA BC ^iC(!aO!jg(O _k,OqV(^8A^ F@lL?VVȆ#AQR?_\=C _Too!TSF%[no$joQX3Am5+_l^+TetrtF"}s QsQq?B`Cost6,Enter the cp associated withpis p?rocess# ["?`@qA`vQBbswDu#*u wdH ofsstep# qF%{'s Reosourpz:wnumbp~lpeople oquirptopmtestask# n>&!aP}Y=Jv='# %Properti p Bb fD'_:,^ܑB[!8Aa 7֨BeqAg+=ktTH!vF"QsUr'#hxq,ting,func !,Basic,Flowchart,inform",fӠ,diagram,dataes,joiners,u €F%,C$@mb?ؿ贁N8i6??54 _ Q);M_>m w =_H'-A? !OyaGE5>F<Z#4%MB $r]QaO]@k]P+~qVaTp+"J# UFDf h-TUUU?@ ?6I?d XboqYk*Qu23u` Connector} ` e1Cw \UH ^   -}|5 p`I`V?}`xa833ސ]3σ3u 33?, ?Gxpx^& _Connector that automatically routes betweene shapit cs, using a right-angled line.b?2jZ/0? HD # =hj8>TA YY9 T#FAoU@? P6 u `u bA@]u  .(#DA@uu `h?\hr|uVa>b@-?bDl;'IbE-ho'y( 2rq?@I ?$v%? @j"*5LA-brB  ^vv"m(2u."q28v&"uh9d&<?/M) #145 `Vis_SFB.chm!#26514I`?Copyright (c) 2001 Microsoft Corporation. All $>U@dv5 !\^4 *L1$bC24R(f[[D ZQiAa59 93O'2"q?7g;2GB81aj e/}@~!gdao7 T hh !d2(c1B1@Dynamic,connector,autom[@cally,routes,betweenus,FDw#47B gd=@+C"s_PUFDfP h-RTUUUA@ ?I? 3h Ejd$+1eqYkR bHoQcw Qh2Q` Flowchart` " *u B? "  U^pksVk`YdlĆ{ppjp_WO`A modification to a process, such as settingswitor initializroue.:=H D  # =hj4>TYY9 ։UA@ ??Pn6 u` uLA 8)aP*WB*4e8uUeeV > =@br`U  W/p o)%8"u85 Dw$@J!$5 IP"`?Copyright (c) 2001 Microsoft Corporation. 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FTNPP" FthEMF++@ @ 4@ @<0Nsr?fff@BC CC+DCD2CDZtCDZtCDYtCDYtCD[tCDA5BDUA,D5rA C1rA C0rAB0rAB.rABUABA5BBA5BB[tCB0CBCzBC@( ( 'fff% LdBBIZ?? $$==^t$0T ( UUUU%  ;Y@  ] Z  t v ; <+!)!U!T!p!Mp!Oz!z!p!vp!xT!U! )!+!   O QZ %] &    X&[% Q O` aExEv;;EOEMa`<; v t[XX46X(6QX(PON6X(6NX(NMM6wX(vvu6IX(IHH6,TX(,S,S,RY("",sX(,r,q,q6HX(HII6uX(vvw6xX(xww6<X(;;:6NX(OP Q 6X(Y( X( 6d X(e f g 6 :X( ; ; <6!wX(!w!x!x6>!X(?!?!@!6l!X(l!l!m!6!qX(!q!r!sY(!!!RX(!S!S!T6m!X(l!l!l!6@!X(?!?!>!6!MX(!M!N!N6 X(   6g X(f e d 6 X(   Y$X4  =<>B % $$AA LdBBIZ??% FEMF+@ܩBJCCJC}kCJCDCDmCDmCDmCDmCDmCDJBD&AkCWG@CWG@C~WG@ܩB~WG@1BxWG@W[BAW[BGBW[BJBW[BmCW[BC,BICܩBJC@( $$=='%  ;O6X4 8 . . . .Y$ . X( 22Y$2O2X(E2n nY$nn.X(n8EO=<>6  % $$AAF\PEMF+@<0Nsr?@$$==_888% % ;O6X4 8 . . . .Y$ . X( 22Y$2O2X(E2n nY$nn.X(n8EO=<@5% % $$AA( FEMF+*@$LBQBW[B~WG@@<0> ARIAL NARROW6@thSIs AV living in a RCS licensed facility AND AP is NOT affiliated with facility? OR8>؂>h+>؂>e>؂>r|>؂>r\>؂>r\>؂>r>؂>r>؂>r$>؂>9 ?؂>9?؂>9 ?؂>91?؂>9R8?؂>9??؂>9O?؂>9V?؂>9e?؂>9l?؂>9?؂>[?؂>?؂>?؂>g?؂> ?؂>Y?؂>?؂>?؂>?؂>A?؂>E?؂>?؂>I?؂>?؂>?؂>?؂>-?؂>?؂>1?؂>}?؂>#?؂>M@؂> @؂> @؂> @؂>T@؂>@؂>@؂>Z@؂>@؂>@؂>$@؂>)@؂>-@؂>/@؂>%3@؂>T5@؂>7@؂>V9@؂>);@؂><@؂>@@؂>B@؂>wF@؂>yJ@؂>LL@؂>gQ@؂>:S@؂>iU@؂>kY@؂>>[@؂>m]@؂>a@؂>d@؂>f@؂>_h@؂>2j@؂>al@؂>p@؂> t@؂>u@؂>w@؂>|@؂>??   ( RpArial Narrow%Arial Narrow Bold ?!33333300 Lժ|p|m|Z|m| x 0whg2 ?2Ѫ|p|m|w !s)w 0w xdv% T@D,AAD*SLIs AV living in a RCS licensed facility AND AP is NOT affiliated with facility? OR% FEMF++@ *@$LBQBW[B~WG@6@WIs AV a patient of WSH or ESH AND meets the definition of VA AND AP not affiliated with8>93?h+>93?e>93?r|>93?r\>93?r\>93?r>93?r$>93?9^?93?9f?93?9 ?93?9)?93?91?93?9??93?9O?93?9bX?93?9_?93?9o?93?9rx?93?9?93?A?93??93?y?93??93?#?93?=?93??93??93?c?93??93??93??93?q?93??93??93?9?93?B@93?@93?@93? @93? @93?@93?@93?g@93?:@93?<@93? @93?#@93?$@93?(@93?*@93?,@93?.@93?2@93?6@93?8@93?<@93?>@93?@@93?D@93?I@93?K@93?AP@93?T@93?Y@93?[@93?H`@93?d@93?{f@93?}j@93?n@93?p@93?r@93?'v@93?Vx@93?z@93?X|@93?+~@93?@93?Gҁ@93?@93?Ǽ@93?ǽ@93?G@93?4@93?G@93?5@93???   % TXD:IAADGWLIs AV a patient of WSH or ESH AND meets the definition of VA AND AP not affiliated with  % FEMF++@ *@$LBQBW[B~WG@6@ facility? OR8>Y?(1>Y?k>Y?r>Y?r>Y?r$>Y?r>Y?r4>Y?rd>Y?9?Y?9?Y?9R?Y?9)?Y???   % TCH|WAADU Lhfacility? OR% FEMF++@ *@$LBQBW[B~WG@6@XIs AV an adult with a developmental disability AND living at home; or living at home and8>`?h+>`?e>`?r|>`?r\>`?r\>`?r>`?r$>`?9 ?`?9f?`?9 ?`?91?`?9A?`?9ZH?`?9Q?`?9bX?`?9l?`?9t?`?9|?`?o?`??`?a?`??`? ?`?W?`??`??`??`??`??`?G?`??`??`??`?A?`??`??`??`?@`?@`?g@`?i @`?< @`?@`?@`?@`?@`?@`?F@`?"@`?&@`?(@`?d*@`?7,@`?/@`?1@`?5@`?9@`?;@`?-?@`?\A@`?/C@`?1G@`?3K@`?Q@`?T@`?V@`?X@`?\@`??_@`?a@`?b@`?d@`?^h@`?1j@`?3n@`?5r@`?t@`?w@`?y@`?{@`?@`?Gځ@`?Ą@`?Ǘ@`?G@`?GT@`?GU@`???   % T\DetAADrXLIs AV an adult with a developmental disability AND living at home; or living at home and   % FEMF++@ *@$LBQBW[B~WG@6@th receiving services from DDD? OR8>铦?7>铦?hq>铦?r>铦?r>铦?r>铦?r>铦?rt>铦?9?铦?9?铦?9?铦?9,?铦?9F;?铦?9zE?铦?9T?铦?9^[?铦?9i?铦?9x?铦??铦?9?铦??铦??铦??铦?_?铦??铦?}?铦??铦?m?铦?q?铦??铦??铦??铦???   % T DtAAD Lreceiving services from DDD? OR % FEMF++@ *@$LBQBW[B~WG@6@ZIs AV an adult with a developmental disability living in a certified SL/SOLA AND AP is NOT8>P?h+>P?e>P?r|>P?r\>P?r\>P?r>P?r$>P?9 ?P?9f?P?9 ?P?91?P?9A?P?9ZH?P?9Q?P?9bX?P?9l?P?9t?P?9|?P?o?P??P?a?P??P? ?P?W?P??P??P??P??P??P?G?P??P??P??P?A?P??P??P??P?@P?@P?g@P?i @P?< @P?@P?@P?@P?@P?@P?]@P?0@P?@P?!@P?%@P?)@P?+@P?S-@P?U1@P?(3@P?6@P?8@P?G<@P??@P?zB@P?D@P?|F@P?H@P?~J@P?$N@P?&R@P?S@P?YX@P?[\@P?.^@P?b@P?g@P?k@P?gp@P?:r@P?v@P?{@P?G7@P? @P?~@P?Ǯ@P?G@P?ǁ@P?T@P?G>@P?G@P?)@P???   % ThDAADZLIs AV an adult with a developmental disability living in a certified SL/SOLA AND AP is NOT % FEMF++@ *@$LBQBW[B~WG@6@t!affiliated with the facility? OR8>-?H>-?k>-?r<>-?rԕ>-?rl>-?r>-?r4>-?r>-?r>-?9v?-?9?-?9.+?-?9z2?-?96;?-?9>K?-?9R?-?9F[?-?9Nk?-?9y?-??-??-?C?-??-?5?-?ۚ?-??-?ߢ?-?+?-?/?-?յ?-?{?-??-???   % TDAAD!Laffiliated with the facility? OR% F, EMF++@ *@$LBQBW[B~WG@6@_Is AV age 18 21 and living in a licensed CA foster home AND AP is NOT affiliated with facility?8>I@h+>I@e>I@r|>I@r\>I@r\>I@r>I@r$>I@9 ?I@9?I@9 ?I@9/?I@9.>?I@9L?I@9^[?I@9i?I@9Bq?I@9?I@?I@?I@?I@A?I@?I@3?I@٥?I@ݭ?I@?I@?I@-?I@1?I@?I@#?I@?I@o?I@?I@a?I@?I@?I@?I@$@I@&@I@@I@ @I@q@I@D@I@s@I@u@I@@I@J@I@ @I@}#@I@P%@I@R)@I@T-@I@)3@I@6@I@8@I@^=@I@B@I@F@I@H@I@eM@I@Q@I@S@I@kU@I@Y@I@Z@I@_@I@d@I@h@I@j@I@6n@I@ep@I@r@I@gt@I@:v@I@ x@I@{@I@}@I@GĀ@I@Gł@I@Ǯ@I@G<@I@%@I@G=@I@G>@I@'@I@G?@I@G@I@G@I@ΐ@I@G@I@ǡ@I@G@I@G@I@??   % TDAAD_L Is AV age 18 21 and living in a licensed CA foster home AND AP is NOT affiliated with facility? % F|EMF++@ *@$LBQBW[B~WG@6@H<OR8> @_> @??   % TXDRAADLPOR% FpdEMF++@ *@$LBQBW[B~WG@6@0$Is AV deceased at Intake:8> @h+> @e> @r|> @r\> @r\> @r> @r> @9 ? @9? @9J(? @96? @9zE? @9T? @9d? @9fk? @9y? @]? @? @? @? @ ? @W? @? @? @??   % TDAADLIs AV deceased at Intake:% FEMF++@ *@$LBQBW[B~WG@@8,> WINGDINGS6@@48>[)@??   ( RpWingdingsWingdings Regular: MSrial Narrow%Arial Na ow Bold ?!333330|p|m|Z|m| y 0wL?2( S1|p|m|w !s)w 0w ydv% TTDGAADLP% F$EMF++@ *@$LBQBW[B~WG@@<0> ARIAL NARROW6@%Was AV alive at time of mistreatment?r>[)@r>[)@9 ?[)@9?[)@9 ?[)@93?[)@9>E?[)@9L?[)@9"[?[)@9nb?[)@9i?[)@9Rx?[)@u?[)@?[)@g?[)@Œ?[)@k?[)@ɚ?[)@o?[)@?[)@e?[)@ ?[)@?[)@m?[)@?[)@?[)@c?[)@?[)@ ?[)@'?[)@s?[)@?[)@?[)@@[)@@[)@ @[)@ @[)@??   ( RpArial Narrow%Arial Narrow Bold ingdingsWingdings R ular: MSrial Narr%Arial Na ol|p|m|Z|m| z 0w2 ?2S1|p|m|w !s)w 0w zdv% T,\ AA\%LWas AV alive at time of mistreatment?    % FEMF++@ *@$LBQBW[B~WG@@8,> WINGDINGS6@@48>I3@??   ( RpWingdingsWingdings Regular: MSrial Narrow%Arial Na ow Bold ingdingsingdings R|p|m|Z|m| { 0wL?2H S12|p|m|w !s)w 0w {dv% TTDGAADLP% FEMF++@ *@$LBQBW[B~WG@@<0> ARIAL NARROW6@H<5Did AV died less than 14 days before report was made?r>I3@r>I3@r>I3@9 ?I3@9?I3@9(?I3@99?I3@9@?I3@9P?I3@9.X?I3@9f?I3@9v?I3@9~?I3@?I3@?I3@K?I3@?I3@=?I3@?I3@?I3@?I3@?I3@?I3@?I3@-?I3@?I3@?I3@#?I3@o?I3@?I3@a?I3@e?I3@?I3@@I3@@I3@@I3@ @I3@ @I3@@I3@@I3@@I3@@I3@S@I3@ @I3@U"@I3@p'@I3@+@I3@.@I3@0@I3@d6@I3@ :@I3@ >@I3@A@I3@??   ( RpArial Narrow%Arial Narrow Bold ingdingsWingdings R ular: MSrial Narr%Arial Na ol|p|m|Z|m| | 0w82?2S1|p|m|w !s)w 0w |dv% T\YAA\5LDid AV died less than 14 days before report was made? % FEMF++@ *@$LBQBW[B~WG@@8,> WINGDINGS6@@48><@??   ( RpWingdingsWingdings Regular: MSrial Narrow%Arial Na ow Bold ingdingsingdings R|p|m|Z|m| } 0wL?2 S12|p|m|w !s)w 0w }dv% TTDG"AAD LP% FEMF++@ *@$LBQBW[B~WG@@<0> ARIAL NARROW6@thSAllegation is abuse, abandonment or neglect (notify LE for all reports involving ar><@r><@r><@9?<@9?<@9#?<@9N2?<@9 ;?<@9VB?<@9^R?<@9fb?<@9i?<@9p?<@9?<@q?<@?<@?<@Ś?<@?<@]?<@?<@?<@?<@?<@E?<@I?<@M?<@Q?<@U?<@?<@K?<@'@<@V@<@)@<@+ @<@ @<@ @<@@<@3@<@5@<@@<@@<@T"@<@$@<@V&@<@)(@<@X*@<@Z.@<@\2@<@4@<@^6@<@8@<@3<@<@>@<@B@<@hF@<@;H@<@jJ@<@lN@<@P@<@R@<@rV@<@EX@<@Z@<@[@<@x^@<@b@<@ f@<@"j@<@l@<@n@<@r@<@Wt@<@*v@<@,z@<@}@<@G@<@Ӂ@<@Ǧ@<@G@<@G@<@G@<@{@<@??   ( RpArial Narrow%Arial Narrow Bold ingdingsWingdings R ular: MSrial Narr%Arial Na ol|p|m|Z|m| ~ 0whg2 ?2S1|p|m|w !s)w 0w ~dv% T@\"AA\ SLAllegation is abuse, abandonment or neglect (notify LE for all reports involving a % FEMF++@ *@$LBQBW[B~WG@6@ deceased AV)?r>(}F@r,>(}F@9.?(}F@9?(}F@9^?(}F@9-?(}F@9P@_>P@??   % TXD0R?AAD=LPOR% FEMF++@ *@$LBQBW[B~WG@6@`TQIs the AP a DSHS/AAA/AAA Subcontractor employee? (NOTE: refer to the procedure to8>Ic@h+>Ic@e>Ic@r|>Ic@r>Ic@r>Ic@r4>Ic@r>Ic@9V?Ic@9?Ic@9"?Ic@9)?Ic@91?Ic@9C?Ic@9vU?Ic@9fh?Ic@9y?Ic@?Ic@?Ic@?Ic@?Ic@?Ic@?Ic@?Ic@?Ic@?Ic@u?Ic@y?Ic@}?Ic@?Ic@?Ic@?Ic@/?Ic@I?Ic@@Ic@p@Ic@@Ic@ @Ic@. @Ic@@Ic@@Ic@|@Ic@~@Ic@Q@Ic@S"@Ic@%@Ic@)@Ic@E-@Ic@G1@Ic@3@Ic@I5@Ic@:@Ic@ ?@Ic@"C@Ic@G@Ic@I@Ic@K@Ic@N@Ic@Q@Ic@S@Ic@W@Ic@Z@Ic@[@Ic@^@Ic@b@Ic@c@Ic@f@Ic@!j@Ic@m@Ic@o@Ic@s@Ic@)v@Ic@+z@Ic@}@Ic@ǻ@Ic@Ǽ@Ic@ǽ@Ic@G@Ic@Gׇ@Ic@@Ic@G؉@Ic@??   % T4DM\AADZQLIs the AP a DSHS/AAA/AAA Subcontractor employee? (NOTE: refer to the procedure to % FthEMF++@ *@$LBQBW[B~WG@6@4(3investigate a DSHS/AAA/AAA Subcontractor employee)?8>l@h+>l@k>l@r>l@r$>l@rT>l@r>l@rd>l@9?l@9R?l@9?l@9,?l@93?l@9B?l@9I?l@9\?l@9Fn?l@?l@[?l@?l@y?l@?l@i?l@?l@?l@?l@w?l@?l@?l@?l@?l@1?l@5?l@9?l@@l@X@l@@l@ @l@ @l@@l@b@l@5@l@@l@@l@"@l@$@l@(@l@-,@l@/@l@y3@l@5@l@??   % TD[GjAADh3Linvestigate a DSHS/AAA/AAA Subcontractor employee)? % " F(EMF++@ @ F EMF+@[C DC DlCDrCuDsCcDsCcDsCbDsCbDsCcDsC0CsC+ClC6)CC6)CC7)C[C7)C]AC6)CC*CC0CC0CCcDCuD]ACDZCD3@ *@$LBQC D@?!> &?!>&?5?Y?hv??hv?T>hv?5?!>􀾯Dz=T>)?)Y?)&?Dz=&?!>>?ffffff @$?!L?!b !; $6$X4$Y$X(Y$X(Y$X($$=<C   FTNPPQP"vMP0vM(vMBUUUUUUUUUUUUUUTAAUUUUUUUUUUUUUUT@UUUUUUUUUUUUUUTUUUUUUUUUUUUUUTUUUUUUUUUUUUUUTUUUUUUUUUUUUUUT@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%"vMP$vM(vMVeeegggiiikkkmmmoooppprrrtttvvvxxxzzz{{{}}}                                                                                             !!"""""!!         !"##$$$$$$##"!      !"##$%&&&&&&&&&%%$##!      !#$%&'(())))(('&%$#!      "#%&())**++++*))(&%$#!    !#%&()*+,,----,,+*)(&%#"     !"$%&'()*+,--../////////..-,,+*)('&$#"      #%&(*,-./01111110/.-,*)'%#!    !#%')+,./122344433210.-+)(&#!    !#&(*,-/12345566654321/.,*(&$"    !#$&(*+,.022346777888877654420/.-+)&%$"     !$&)+-/1346789::::9876531/-+)&$"    !$&)+-/13578:;<<<<<;:976420.+)'$"    !#&)+-02468:;<=>>>>==;:86420.,)&$!    "#&'(+,-0124579::<=>?@@@AA@@@??>=<;9875420/.+*)&%$!     #&(+-02479;=?@ABCCCB@?=;97530.+)&#      "%(*-/2479<>@ACDFFFDCB@><:7520-+(%#    !$'*,/1479<>@BDEEGGGEDC@><:752/-*'%"     #&)*,/14579<>?@CFGGHJJJJHGFCBA?<:8741/.,)'$#!    #%(+.0369;>@CFGJKLLKJHECA><9641.+)&#    !$'*-/258;=@CFHILMNMLIHEC@>;8630-*(%"     #&),/147:=?BFHILOPPOMKHFC@=:752/,)&$!    "%&(+,-023679<=>ACDGHILNOQUUUPOMLIGEFB@?<;97541/.+*(%$#      #&),/257:=@CEJLOQTTUOLJECA>;852/-*'$!   "%(+.0369<?BDGIMPRSRQNKHFB?=:741.+(&#      #&),/247:=@CEJKNQRRQOLJEC@>;852/,*'$!    "%(*,-03679;>ACDEJLMNPQPPOLIGEDB?<:9641/.+(%$"      #&),.147:<?BDGJLNOONLIHFB@=:742/,)&#!    !$'*,/257:=@BFGJKLMLKJGFC@=;8530-*'%"    "%(+-0358;=@BFEHIIIIJGFC@>;9631.+(&#      #$&)*+./13569:;=?@BCDEEGHHHHHGEFDBA@>=;986421/-,)(&#"!  !$&),/1469;=@ACDEEEEFCB@>;9741/,*'$"    "$'*,/1469;=?@BCDDDCBA?=;9742/-*(%"      "%'*-/1468:<>?@ABBAA@>=;9742/-+(%#      #%&(*-/014689:;=>>??@@??>=;;:86432/-+)(&#     #&(*-/13579:;<=====;:97541/-+(&#!     #&(*,/124679::;;;;:986531/-+(&#!    !#%(*,.023567899998765420/,*(&#!    !"#%&')*,-./11244566677777665543210/.-,*)(&%#!     #%')+,.01234444443210/-+)'%#!     "$&(*,-.01122222110/-,*)'%#       "$&')*,-.//00000/.-,+)(&$"    !#$%&()**,,--......-,,++)('&%#!       "$%&()*++,,,,++*)('&$"!      !#$%&'())***))((&&$#!       !#$%&&''''''&&%$#"      !""##$%%%%%%%%%%$$###!!      !!"######""!        !!!!!                                                                                              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All 2s reserved.U#`R] >23#\('SR'0@lTV!@Up( V!V!?eB#'01p Ae /C'(zm*?AA?N% 6C?&$RBQ AS# BaR/Ra(Xm*@H'r9CBSK3eS9SRm8m$CiPFWL~?A@vYAYE#1 3bW ?߾I5 3Y;b RRR/ROQ5F_GUPvR#cPWRRT0^[fbX`DPSk?SUcT%RNRA8GeFTUSQAUnjXxBOUKct3w5RSVUbOQEYu|@GTUdr3JOtVtz[3w5AS?OQOcOuOOOOOecODn\ V# 4\ BDV N_`Y_v] \ ^W _cYu Pf Zl jf飯~oKlnm8o eZ^ x1+{! :~͓QJq{1xU^w`tx{բ#6AWS,` 5AU !ń ! !@V!з 1'(kڼgiV  4\ 0Κe(cUu^ \ ZU p5fgvERFfDeDS5?m*6J"#HˆR 12sBvD#NѵBYu0V fJ"#hΒ@MU*ZŎ6VV!N33#TYϑ?6&F&Β`տ6 ϑ  5A&A=Oas߅ߗߩT=EfBJɆ 0U3#, Q2`f3o2Κ̮1QjU1v] P{U3 f650w"933!3m3!AvY0@92^3zL0Am03 3LH,ExK2/ }KFT M4H[2)^4 K+R_@H[3e_30V Qiz;9S;CgFqo!HDO3\!HlkC //2pz p!!Tȁ)F(&prk" &@bb #W`Adjust Frame Thicknessrr dʽ((g ?WUgM @tQNdtQ#bo!0@(bG @cɃԂ!  O^˅U336gi$ʽ((#ڳj+'0U0ӕHD   ;hZ,>THYY9 BAUA󨭿?P6 @#p y?@t`T  b u` nT?hulWB>K ³8a "%>U0zGz?I@b8#<t'_Bq8#I!$5 I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved. >`28#-'=tUS@l> 0>Udd^1^1YU2A P3,( 0ioXY &B,Fkb(:YMϰ?A {TU@??OFT|v2T |BM! ?T OFA5RKAe#r@`P|Hq'qO?_O e#M PO@ˈBQQ|4.?rA0>bDciA2a59 ,9x7$'0AUUF",2HD   ;hZ,>THYY9 BAUA󨭿?P6 @#p y?@t`T  b u` nT?hulWB>K ³8a "%>U0zGz?I@b8#<t'_Bq8#I!$5 I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved. >`28#-'=tUS@l> 0>Udd^1^1YU2A P3,( 0ioXY &B,Fkb(:YMϰ?A {TU@??OFT|v2T |BM! ?T OFA5RKAe#r@`P|Hq'qO?_O e#M PO@ˈBQQ|4.?rA0>bDciA2a59 ,9x7$'0AUUF",2HD   ;hZ,>THYY9 BAUA󨭿?P6 @#p y?@t`T  b u`"T?huWB> 08@a "%>U0z_Gz?@8#<t'WBq8#Ҡ!$5 I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved. `O28#-'=tUS@l>0>Udd^1^1YU2A P3,( 0"ioY &B,Fb(:YM?A TU@??OFT|dv2T E|BM!?T OFA5RKrAe#r@`P|HqqIO?_O e#6M PO@ˈBQQ|4?KrA0>b=DciA 2a59 ,97$'0AUUF",2HD   ;hZ,>THYY9 BAUA󨭿?P6 @#p y?@t`  bk uU` T7?huWBhA%h ah8Na "%>U0zGz?@$8#<t'Bq8#!$5 I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved. `28#-'=etUS]@l>0>Udd^1^1ȀYU2A P3,( 0EiohY &B,Fb(:YM?A T=U@??TOFT|ɀv2T |BM!?T OFA5RKAe#r@`P|HqqO?_O le#M PO@ˈBQQ|4?rA0z>bDci@A2a59 ,97$'0AUUF",2HD $#=h4>TYY9 T3+AUA?Ad?@?['@@l??P} @Ut` o?t3 #uLbd-w@@2.@1ubu7>NaC>#U0zGz?I@qIUe# 4G27q ?/&?盧qd!$i*I`?Copyright (c) 2001 Microsoft Corporation. All 2s reserved. >`a2_$=7"[S@E)l>0>Ud `5 3$!]&&"hbJ)B~4B(EO46OHBV%UNnOI|AIA7NO1OG%OgO_PRi$^ 3V%ʄ v|['2UR0/p0b ; bVXZPVR1PPQTw9S#S___ oo%9oZYoko}ooo*`V%&qaCompany Name j@Aha7;w9 2%#!3r1v%kqm $%f(F [r@?z|.bE^|QzE,VA`?:/Td8H?'-_ ybn ;FFz>F >#t'KB (`edyo@G<)oP+LYO?s͘P`$ _tT$&Č)l,/{4Ǩ3d' l8o'<)-<+ש47(J~|EMDR P~`SE%) **'UFDfP h-RTUUUA@ ?I? 3h EePqYk  BHo1Cw Q2MQ` Flowchartn_` u D??!?T pNsNp_imƉp}wv|lcY?>Decision point between two or more paths in your flowchart..HD # =hj4>TYY9 TkUA@ ?u?P6 u`m uBA" >4)P$*44kULV>A @E E  UrBM-^#%e)%8"k&85 7L!$5 IC"`?Copyright (c) 2001 Microsoft Corporation. All 2s reserved.h`Vis_SFB.chm!#26510' U3m0D)#e!d,9 l> 0>Udd 5 !WZ !0$bA/'ʗ pBB(: n@,)+Db~@A%KmMQO AO: OM}AA52WO#UrA zRS() ^q%H(^!P F1@^UfUf|!G.BaR_aosl%1#:Tc%kHoi,#g"G#b%Nd%.Cam#hdaTr7+T &'" a a"ss%!|bR`Cost6 3,Enter the co associated withis procesYsQ02`/%`FLv:X#4{YB $|]Iatr!Z@lZk"P+?_Va*TCaUFDfP h-RTUUUA@ ?I? 3h  ePqYk  KHo:Lw Q2MQ` Flowchartw_` u D(2OVhz~ WAny processing function.y kind of Double-click to add sub-page.H D  # =hj0>TdYY9 ͉UA@ ??P6 u` 6u e.A&a8 e&0LgH>v5 LSҿ5 I`?Copyright (c) 2001 Microsoft Corporation. All s reserved.`Vis_SFB.chm!#26527 '#O0,Hd9 l>YUdv W}T /6bRC2N6& B2Ygm24 ?=P?1F%??S911^;66=O= E%2O;zrA BC ^iC(!aO!jg(O _k,OqV(^8A^ F@lL?VVȆ#AQR?_\=C _Too!TSF%[no$joQX3Am5+_l^+T&Xt'et^Q^QF"}s QsQq?B`Cost6,Enter the cp associated withpis p?rocess# ["?`@qA`vQBbswDu#*u wdH ofsstep# qF%{'s Reosourpz:wnumbp~lpeople oquirptopmtestask# n>&!aP}Y=Jv='# %Properti p Bb fD'_:,^ܑB[!8Aa 7֨Beqag+=Qs#i$vF"ʭQsUr'#hxq,ting,func !,Basic,Flowchart,inform",fӠ,diagram,dataes,joiners,u €XF%C$@mb?ؿ贁N8i6??54 _ Q);M_>m w =_Hu-A? !OyaGE5>Fėj`#t5MB dQal@ZkP+fQ4aTpUFDf h-TUUU?@ ?6I?d XboqYk*Qu23u ` Connector ` e1Crw UH ^   -}|5 p`I`V?}`xa833ސ]3σ3u 33?, ?Gxpx^& CThis connector automatically routes between the shapi ts.HD @# =h8T YY9 BR#F oU@? P6 u `u bA@]u  .(#DB uu`h?\hr|uVa@-?bl;'bE-ho'$y( 2rq?@I ?$%? @"U*5L -br  ^vv"(2uI."q28v"uh9Bd&</MS~ #145 |`Vis_SE.chm!#20)@E`;Copyright (@1 Microsoft Corporation. All ;Bs reserved.4U#1#7A,@+4j'TvQ8l>$Ud vE \/4 *&1$b24R(a[z[D ZQi a59 93O'2"q?2g;2GHuw* O`EW )F$g#̽h7B tiGdKj@kUFDfP h-RTUUUA@ ?I? 3h d!  eqYk QHoP@Rw Q2Q` Flowchart}` u 6?   Lp<DRbfxapVKB8Shows a process.rruption in the item..H D  # =hj8>T YY9 ZUA@ ?ػ?P6 u`h?u],A.@(.8yP><0O贁Nk?<v?2Ar!񂒱5 `Vis_SE.chm!#29563I`?Copyright (c) 2001 Microsoft Corporation. All ?"s reserved.Ʉ5 nLD 0') #gd$<9U)83Al>0>Udd %=!T F6"0b26 2yB4( =?A%%O>O9LAAplK 6M=E%2O;rA zRSH aiA^p9 9#/'2qPj(da_k(_ oq(^AfY9ՙF@\?xfxf#AeaRmOol%Coqdoog` c%k>j0fa"3m_m w =_H'׏  !OyaEhFϩpm#CCn{B թ]6a<Y]@k]7P+,t4aTd`pU !"#$t4 @t@M#@ wuC- 7AU#$%&'(t4 @t@M#@ u}C-| 7"AU#$&'()t4 @t@M#@ lBv}C-Y7"A*t4 @t@M#@ vA-7U!#$U&'(t4 @t@M#@ dvC- /wA<@uLR@,uIR@[vIR@vAR@wMRH<( H<( H<( H<( H<( <E\Ny RE[y REhy REuy REy R_(|TV]S X&B!sȯ_S!%gSdlS{ /ASew"̩tS?9^w/PDy% YAM1AM1PPTPPT1h/_| A/ll| A/y| A/|A4(U*P(4FD Tey Pah$T 7UI @It@M#@A?I?.CUgs ]B!#H1+"͑U@T-?f-[(0#*#u` F+""u)N#_x$n%#>$7?sUJ1H6B(c? < o!%QN#11 ` Flowchart `2 :1\5??9Connecto rOaJm8O'PD\2B(T(NE:E:A*#4`*Classic;c@temporary;Elegant;Notepad;RetroA0!T C_Theme\TdV~nBb a$E,PQ_eVq^QT<^Q^Q Q^4QnA0 BnAG=a\5IdAHUf%Id!qgId!qgQEhqgaEh%njId)njaEhnj5IdqgQEhqgnAEhnj-aEhnjIdQqg5aEh!qg9aEhQfAePqqX1X1QTaTa!17rq:HFq>UqaaA5o!|!qaqaaAɏۏTae \5Q|QQe5A!EN$ G@@PQn$W@@x$ѕn%;?*B( ҟ)(C [!0EX1Z)3aQXx&@oo)oS=oUqg^lqoIdQoIdoIdaoIdoId1IdQIdnA<Id-aYIdvId5aId9aId^QId^UIdA^i@rq&܍Ь'2J2U9aRR!gOMRCa@J!3"Ԁb!! rB(^Q@& Q'?7AOODTOB(A75\8d^??㬞8N#x&$1@$"UK(\54 ?_tua|\?&x$?B4L 4BNQ j|l*,B(MaT ]ol0Ure"t(HQ˫(A*4Z#Yl/9Z#eA/*e/Q//(/,+;;$`,0;u<,apU4_:TWV?_o oVefoxoccHZl~`؊嵟͟ߟs,>P bt陯gϫϯ);M_q-ܿ 0BTyGϝϯ -?Q cuߟ1߀"4Y'k} 1CU$S5XWq%^L]5tUqi Qp___ۆM{6R+L^p6a^eBoV#(؏ 2aq:O:ZO^0OO2@[9O"O 1$NH ]WUVgS^eu[\XXa1O__'_9_K_1$eg_y_eǕ_0oimqi___oo+o=eFoXoDuoI}qooooo =e&8$U)ő5m sO"AV-%?A.9KU/g/y///// ??-???F5q-ЏI?,A9;FXj|ğ֟ 0~ؒ10Y wr5y̯ޯO0BTfxA1q2Ͻϧ1U@5>EQON1Eߪ߼*#GV;M_qIO9%A̿޿ E>:Yqaq`όAI1A,A@AE?^ -@%/!//.+Z7߂$&h/SԴubtߢd8ۚ1E/W&pt//(-/(CM 4qMM_ aq,es1j@q89Uq3ٖ04&WL~O? 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( RpArial,Monotype:Arial Bold:Versi?033333300 E1`"y`</`<|p|m|Z|m| Xأ43 0w`(%28|p|m|wأ43F !,)w 0w Xdv% TpVhAAeLXSCREEN % FEMF++@ *@$LBQBm9FC̃QD6@THOUT>ff?P>ff??ff???   % T`j|AAyLTOUT % FEMF++@ @BQfDBQfDWBPfDB\cDB`DB`DB`DB`DB`DBZDBe:WDXBpTDBpTDBqTDBqTD(jApTD ]rAd:WD]rAZD]rAZD]rA`D\rA[cDjAPfDBPfD@( % LdRpRbJIZ?? $$==^t$0T ( TE%  ;t96v9X4K98&8&8&8&8Y$&86X(5K"5v"5Y$v"5t"5X("556Y$6&8X(89t9=<>Rp % $$AA LdRpRbJIZ??% FD8EMF+@<0Nsr?fff@BQfDBQfDWBPfDB\cDB`DB`DB`DB`DB`DBZDBe:WDXBpTDBpTDBqTDBqTD(jApTD ]rAd:WD]rAZD]rAZD]rA`D\rA[cDjAPfDBPfD@( ( 'fff% LdQpQcKIZ?? $$==^t$0T ( "UU"UU%  ;t9Y@v999 ~99H[9F]9.9~/98888q8s8%86X6Z66655~55Fn5Hp5L5 M57575u/5t/5(75*75M5L5p5n5m5n5?5A566Z6X66&8s8q888A8?8n/9m.9]9[99~9*9(9v9X4}9999z9s96%9X($9$9#969X(9996r9X(q9q9p96\A9X(\A9[@9[@96,9X(+9+9*968X(8886x8X(w8w8v8Y(&86U6X(T6T6S66 6X( 6 666*5X(+5+5,56[5X([5\5\56[5X(Z5Z5Y5655X(5545456#5X($5$5%5Y(t5x55X(555645X(4555556UY5X(UZ5VZ5W[565X(55565X(55566X( 6 6 66S6X(T6T6U6Y(6(8v8X(w8w8x868X(88869X(9996@9X(@9A9A96Wp9X(Vq9Uq9Ur969X(99969X(999Y$v9t9X4m9h9h9h9m9t9=<>Qq % $$AA LdQpQcKIZ??% FEMF+@(|AcDBcDDBcDB`DBa]DBa]DB`]DB`]DBa]DBWDB6TDDB˃QDB˃QDB̃QD(|ÃQD9^A˃QDG@6TDG@WDG@WDG@a]DG@`D8^AcD|AcD@( $$=='%  ;868X487:87e77e77e77e7Y$7e775X(75a4a4Y$a4a4X(a42525Y$252e7X(2:888=<>Fd % $$AAF\PEMF+@<0Nsr?@$$==_888% % ;868X487:87e77e77e77e7Y$7e775X(75a4a4Y$a4a4X(a42525Y$252e7X(2:888=<@Df% % $$AA( FEMF+*@$LBQBG@̃QD@0$۫*>ARIAL6@pdSCREEN`>ff>>ff>>ff>V-?ff>?ff>:?ff>??   % TpVUhAAeLXSCREEN % F|EMF++@ *@$LBQBG@̃QD6@H<INUU>ff? >ff???   % TX+j9|AA+yLPIN% FEMF++@ @<0Nsr?@<0!CiDD!CJD MBJD MBUOD@$$==_888% % W,1@S 31S 25253% % $$AA( F\PEMF+@<0`BOD MB̃QD$9BOD`BOD@( $$=='%  % V,.<9G35a433%  % $$AAF4(EMF+ @$BGD* BïA( $$=='% % V0Qu61R3ER3E11% % $$AAFEMF+*@$LBQBjBnGD@0$۫*>ARIAL6@THYES>(}R>>(}R>>(}R>??   % T`R!r3AAS0LTYES % FEMF++@ *@$LBQBC_D@0$r=ARIAL6@=This flow chart provides a quick reference guide and does not8>=䠬>=P>=_>=B>=>=?=U} ?=T?=8N)?=q80?=8 @=V@=:@=@=F@=@=t2@=X!@=b#@=&@=N*@=-@=0@=2@=v6@=Z9@=??   ( RpArialMonotype:Arial Regular:Ve??!33333300 i|p|m|Z|m| Yأ43 0wB<8(%28b|p|m|wأ43F !,)w 0w Ydv% TAA=LThis flow chart provides a quick reference guide and does not% FEMF++@ *@$LBQBC_D6@@substitute the specific action requirements and responsibilities8>]>r>]>>]>z>]>8^>]>U?]> ?]> ?]>?]>#?]>q1?]>8?]>x??]>qPM?]>'[?]>8b?]>n?]>[|?]>?]>rR?]>9?]>U?]>O?]>?]>?]>?]>!?]>㖮?]>Z?]>qF?]>82?]>T?]>8?]>?]>ƣ?]>?]>TS?]>8x?]>c?]>?]>?]>@]>8@]>@]>8^@]> @]>J@]>@]>rz@]>@]>@]>:@]>@]> #@]>&@]>X)@]><*@]> u.@]>/@]>81@]>̚2@]>ZU4@]>>5@]>"-9@]>??   % TAA@Lsubstitute the specific action requirements and responsibilities% F4(EMF++@ *@$LBQBC_D6@outlined in policy.8>>>>>>k>>z>>Ɖ>>q?>s?>K?>5%?>T*?>8?>??>VM?>7.[?>ŵ`?>S=f?>r?> ?>??   % TAALtoutlined in policy.TB% FEMF++@ @<0Nsr?@<0!CiDD!CJD@`vCJD@`vCUOD@$$==_888% % W,@S 31S 2f2f3% % $$AA( F\PEMF+@<0Z{COD@`vC̃QD{fqCODZ{COD@( $$=='%  % V,<G3fa433%  % $$AAF4(EMF+ @$9CGDAïA( $$=='% % V06 1 R3H R3H 1 1% % $$AAFEMF+*@$LBQBCnGD@0$۫*>ARIAL6@H<NOUU>(}R>U>(}R>??   ( RpArial,Monotype:Arial Bold:Versi?!33333300 E1`Py`P$/`$|p|m|Z|m| Zأ43 0w`8(%28|p|m|wأ43F !,)w 0w Zdv% TX!3AA0LPNO % FEMF++@ @<0Nsr?@, !C^D!C[hD@$$==_888% % W$D\S k$S %% % $$AA( F\PEMF+@<0CD!CvD (CDCD@( $$=='%  % V,Xh %S v& % %%  % $$AAFEMF+@BC CC+DCD2CDZtCDZtCDYtCDYtCD[tCDA5BDUA,D5rA C1rA C0rAB0rAB.rABUABA5BBA5BB[tCB0CBCzBC@( ( '% LdBBIZ?? $$==^t$0T ( DUTU%  ;6X4 !!!!!Y$!!X(! Y$X(..Y$..X(.=<>B % $$AA LdBBIZ??% FD8EMF+@<0Nsr?fff@BC CC+DCD2CDZtCDZtCDYtCDYtCD[tCDA5BDUA,D5rA C1rA C0rAB0rAB.rABUABA5BBA5BB[tCB0CBCzBC@( ( 'fff% LdBBIZ?? $$==^t$0T ( UUUU%  ;Y@  ] Z  t v ; <+!)!U!T!p!Mp!Oz!z!p!vp!xT!U! )!+!   O QZ %] &    X&[% Q O` aExEv;;EOEMa`<; v t[XX46X(6QX(PON6X(6NX(NMM6wX(vvu6IX(IHH6,TX(,S,S,RY("",sX(,r,q,q6HX(HII6uX(vvw6xX(xww6<X(;;:6NX(OP Q 6X(Y( X( 6d X(e f g 6 :X( ; ; <6!wX(!w!x!x6>!X(?!?!@!6l!X(l!l!m!6!qX(!q!r!sY(!!!RX(!S!S!T6m!X(l!l!l!6@!X(?!?!>!6!MX(!M!N!N6 X(   6g X(f e d 6 X(   Y$X4  =<>B % $$AA LdBBIZ??% FEMF+@ܩBJCCJC}kCJCDCDmCDmCDmCDmCDmCDJBD&AkCWG@CWG@C~WG@ܩB~WG@1BxWG@W[BAW[BGBW[BJBW[BmCW[BC,BICܩBJC@( $$=='%  ;O6X4 8 . . . .Y$ . X( 22Y$2O2X(E2n nY$nn.X(n8EO=<>6  % $$AAF\PEMF+@<0Nsr?@$$==_888% % ;O6X4 8 . . . .Y$ . X( 22Y$2O2X(E2n nY$nn.X(n8EO=<@5% % $$AA( FEMF+*@$LBQBW[B~WG@@<0> ARIAL NARROW6@thSIs AV living in a RCS licensed facility AND AP is NOT affiliated with facility? OR8>؂>h+>؂>e>؂>r|>؂>r\>؂>r\>؂>r>؂>r>؂>r$>؂>9 ?؂>9?؂>9 ?؂>91?؂>9R8?؂>9??؂>9O?؂>9V?؂>9e?؂>9l?؂>9?؂>[?؂>?؂>?؂>g?؂> ?؂>Y?؂>?؂>?؂>?؂>A?؂>E?؂>?؂>I?؂>?؂>?؂>?؂>-?؂>?؂>1?؂>}?؂>#?؂>M@؂> @؂> @؂> @؂>T@؂>@؂>@؂>Z@؂>@؂>@؂>$@؂>)@؂>-@؂>/@؂>%3@؂>T5@؂>7@؂>V9@؂>);@؂><@؂>@@؂>B@؂>wF@؂>yJ@؂>LL@؂>gQ@؂>:S@؂>iU@؂>kY@؂>>[@؂>m]@؂>a@؂>d@؂>f@؂>_h@؂>2j@؂>al@؂>p@؂> t@؂>u@؂>w@؂>|@؂>??   ( RpArial NarrowArial Narrow Bold ?!33333300 ||p|m|Z|m| [أ43 0w68 (%28(|p|m|wأ43F !,)w 0w [dv% T@D,AAD*SLIs AV living in a RCS licensed facility AND AP is NOT affiliated with facility? OR% FEMF++@ *@$LBQBW[B~WG@6@WIs AV a patient of WSH or ESH AND meets the definition of VA AND AP not affiliated with8>93?h+>93?e>93?r|>93?r\>93?r\>93?r>93?r$>93?9^?93?9f?93?9 ?93?9)?93?91?93?9??93?9O?93?9bX?93?9_?93?9o?93?9rx?93?9?93?A?93??93?y?93??93?#?93?=?93??93??93?c?93??93??93??93?q?93??93??93?9?93?B@93?@93?@93? @93? @93?@93?@93?g@93?:@93?<@93? @93?#@93?$@93?(@93?*@93?,@93?.@93?2@93?6@93?8@93?<@93?>@93?@@93?D@93?I@93?K@93?AP@93?T@93?Y@93?[@93?H`@93?d@93?{f@93?}j@93?n@93?p@93?r@93?'v@93?Vx@93?z@93?X|@93?+~@93?@93?Gҁ@93?@93?Ǽ@93?ǽ@93?G@93?4@93?G@93?5@93???   % TXD:IAADGWLIs AV a patient of WSH or ESH AND meets the definition of VA AND AP not affiliated with  % FEMF++@ *@$LBQBW[B~WG@6@ facility? OR8>Y?(1>Y?k>Y?r>Y?r>Y?r$>Y?r>Y?r4>Y?rd>Y?9?Y?9?Y?9R?Y?9)?Y???   % TCH|WAADU Lhfacility? OR% FEMF++@ *@$LBQBW[B~WG@6@XIs AV an adult with a developmental disability AND living at home; or living at home and8>`?h+>`?e>`?r|>`?r\>`?r\>`?r>`?r$>`?9 ?`?9f?`?9 ?`?91?`?9A?`?9ZH?`?9Q?`?9bX?`?9l?`?9t?`?9|?`?o?`??`?a?`??`? ?`?W?`??`??`??`??`??`?G?`??`??`??`?A?`??`??`??`?@`?@`?g@`?i @`?< @`?@`?@`?@`?@`?@`?F@`?"@`?&@`?(@`?d*@`?7,@`?/@`?1@`?5@`?9@`?;@`?-?@`?\A@`?/C@`?1G@`?3K@`?Q@`?T@`?V@`?X@`?\@`??_@`?a@`?b@`?d@`?^h@`?1j@`?3n@`?5r@`?t@`?w@`?y@`?{@`?@`?Gځ@`?Ą@`?Ǘ@`?G@`?GT@`?GU@`???   % T\DetAADrXLIs AV an adult with a developmental disability AND living at home; or living at home and   % FEMF++@ *@$LBQBW[B~WG@6@th receiving services from DDD? OR8>铦?7>铦?hq>铦?r>铦?r>铦?r>铦?r>铦?rt>铦?9?铦?9?铦?9?铦?9,?铦?9F;?铦?9zE?铦?9T?铦?9^[?铦?9i?铦?9x?铦??铦?9?铦??铦??铦??铦?_?铦??铦?}?铦??铦?m?铦?q?铦??铦??铦??铦???   % T DtAAD Lreceiving services from DDD? OR % FEMF++@ *@$LBQBW[B~WG@6@ZIs AV an adult with a developmental disability living in a certified SL/SOLA AND AP is NOT8>P?h+>P?e>P?r|>P?r\>P?r\>P?r>P?r$>P?9 ?P?9f?P?9 ?P?91?P?9A?P?9ZH?P?9Q?P?9bX?P?9l?P?9t?P?9|?P?o?P??P?a?P??P? ?P?W?P??P??P??P??P??P?G?P??P??P??P?A?P??P??P??P?@P?@P?g@P?i @P?< @P?@P?@P?@P?@P?@P?]@P?0@P?@P?!@P?%@P?)@P?+@P?S-@P?U1@P?(3@P?6@P?8@P?G<@P??@P?zB@P?D@P?|F@P?H@P?~J@P?$N@P?&R@P?S@P?YX@P?[\@P?.^@P?b@P?g@P?k@P?gp@P?:r@P?v@P?{@P?G7@P? @P?~@P?Ǯ@P?G@P?ǁ@P?T@P?G>@P?G@P?)@P???   % ThDAADZLIs AV an adult with a developmental disability living in a certified SL/SOLA AND AP is NOT % FEMF++@ *@$LBQBW[B~WG@6@t!affiliated with the facility? OR8>-?H>-?k>-?r<>-?rԕ>-?rl>-?r>-?r4>-?r>-?r>-?9v?-?9?-?9.+?-?9z2?-?96;?-?9>K?-?9R?-?9F[?-?9Nk?-?9y?-??-??-?C?-??-?5?-?ۚ?-??-?ߢ?-?+?-?/?-?յ?-?{?-??-???   % TDAAD!Laffiliated with the facility? OR% F, EMF++@ *@$LBQBW[B~WG@6@_Is AV age 18 21 and living in a licensed CA foster home AND AP is NOT affiliated with facility?8>I@h+>I@e>I@r|>I@r\>I@r\>I@r>I@r$>I@9 ?I@9?I@9 ?I@9/?I@9.>?I@9L?I@9^[?I@9i?I@9Bq?I@9?I@?I@?I@?I@A?I@?I@3?I@٥?I@ݭ?I@?I@?I@-?I@1?I@?I@#?I@?I@o?I@?I@a?I@?I@?I@?I@$@I@&@I@@I@ @I@q@I@D@I@s@I@u@I@@I@J@I@ @I@}#@I@P%@I@R)@I@T-@I@)3@I@6@I@8@I@^=@I@B@I@F@I@H@I@eM@I@Q@I@S@I@kU@I@Y@I@Z@I@_@I@d@I@h@I@j@I@6n@I@ep@I@r@I@gt@I@:v@I@ x@I@{@I@}@I@GĀ@I@Gł@I@Ǯ@I@G<@I@%@I@G=@I@G>@I@'@I@G?@I@G@I@G@I@ΐ@I@G@I@ǡ@I@G@I@G@I@??   % TDAAD_L Is AV age 18 21 and living in a licensed CA foster home AND AP is NOT affiliated with facility? % F|EMF++@ *@$LBQBW[B~WG@6@H<OR8> @_> @??   % TXDRAADLPOR% FpdEMF++@ *@$LBQBW[B~WG@6@0$Is AV deceased at Intake:8> @h+> @e> @r|> @r\> @r\> @r> @r> @9 ? @9? @9J(? @96? @9zE? @9T? @9d? @9fk? @9y? @]? @? @? @? @ ? @W? @? @? @??   % TDAADLIs AV deceased at Intake:6% FEMF++@ *@$LBQBW[B~WG@@8,> WINGDINGS6@@48>[)@??   ( RpWingdingsWingdings Regular: MSrial NarrowArial Na x \8||r#0|p|m|Z|m| \أ43 0w`(%28( c1|p|m|wأ43F !,)w 0w \dv% TTDGAADLPC% F$EMF++@ *@$LBQBW[B~WG@@<0> ARIAL NARROW6@%Was AV alive at time of mistreatment?r>[)@r>[)@9 ?[)@9?[)@9 ?[)@93?[)@9>E?[)@9L?[)@9"[?[)@9nb?[)@9i?[)@9Rx?[)@u?[)@?[)@g?[)@Œ?[)@k?[)@ɚ?[)@o?[)@?[)@e?[)@ ?[)@?[)@m?[)@?[)@?[)@c?[)@?[)@ ?[)@'?[)@s?[)@?[)@?[)@@[)@@[)@ @[)@ @[)@??   ( RpArial NarrowArial Narrow Bold ingdingsWingdings R ular: MSrial NarrArial Na \|p|m|Z|m| ]أ43 0w48 (%28c1|p|m|wأ43F !,)w 0w ]dv% T,\ AA\%LWas AV alive at time of mistreatment?    % FEMF++@ *@$LBQBW[B~WG@@8,> WINGDINGS6@@48>I3@??   ( RpWingdingsWingdings Regular: MSrial NarrowArial Na ow Bold ingdingsingdings R|p|m|Z|m| ^أ43 0w`(%28H c148|p|m|wأ43F !,)w 0w ^dv% TTDGAADLP% FEMF++@ *@$LBQBW[B~WG@@<0> ARIAL NARROW6@H<5Did AV died less than 14 days before report was made?r>I3@r>I3@r>I3@9 ?I3@9?I3@9(?I3@99?I3@9@?I3@9P?I3@9.X?I3@9f?I3@9v?I3@9~?I3@?I3@?I3@K?I3@?I3@=?I3@?I3@?I3@?I3@?I3@?I3@?I3@-?I3@?I3@?I3@#?I3@o?I3@?I3@a?I3@e?I3@?I3@@I3@@I3@@I3@ @I3@ @I3@@I3@@I3@@I3@@I3@S@I3@ @I3@U"@I3@p'@I3@+@I3@.@I3@0@I3@d6@I3@ :@I3@ >@I3@A@I3@??   ( RpArial NarrowArial Narrow Bold ingdingsWingdings R ular: MSrial NarrArial Na ol|p|m|Z|m| _أ43 0w 848(%28c1|p|m|wأ43F !,)w 0w _dv% T\YAA\5LDid AV died less than 14 days before report was made? % FEMF++@ *@$LBQBW[B~WG@@8,> WINGDINGS6@@48><@??   ( RpWingdingsWingdings Regular: MSrial NarrowArial Na ow Bold ingdingsingdings R|p|m|Z|m| `أ43 0w`(%28 c148|p|m|wأ43F !,)w 0w `dv% TTDG"AAD LP % FEMF++@ *@$LBQBW[B~WG@@<0> ARIAL NARROW6@thSAllegation is abuse, abandonment or neglect (notify LE for all reports involving ar><@r><@r><@9?<@9?<@9#?<@9N2?<@9 ;?<@9VB?<@9^R?<@9fb?<@9i?<@9p?<@9?<@q?<@?<@?<@Ś?<@?<@]?<@?<@?<@?<@?<@E?<@I?<@M?<@Q?<@U?<@?<@K?<@'@<@V@<@)@<@+ @<@ @<@ @<@@<@3@<@5@<@@<@@<@T"@<@$@<@V&@<@)(@<@X*@<@Z.@<@\2@<@4@<@^6@<@8@<@3<@<@>@<@B@<@hF@<@;H@<@jJ@<@lN@<@P@<@R@<@rV@<@EX@<@Z@<@[@<@x^@<@b@<@ f@<@"j@<@l@<@n@<@r@<@Wt@<@*v@<@,z@<@}@<@G@<@Ӂ@<@Ǧ@<@G@<@G@<@G@<@{@<@??   ( RpArial NarrowArial Narrow Bold ingdingsWingdings R ular: MSrial NarrArial Na ol|p|m|Z|m| aأ43 0w68 (%28c1|p|m|wأ43F !,)w 0w adv% T@\"AA\ SLAllegation is abuse, abandonment or neglect (notify LE for all reports involving a44 % FEMF++@ *@$LBQBW[B~WG@6@ deceased AV)?r>(}F@r,>(}F@9.?(}F@9?(}F@9^?(}F@9-?(}F@9P@_>P@??   % TXD0R?AAD=LPOR% FEMF++@ *@$LBQBW[B~WG@6@`TQIs the AP a DSHS/AAA/AAA Subcontractor employee? (NOTE: refer to the procedure to8>Ic@h+>Ic@e>Ic@r|>Ic@r>Ic@r>Ic@r4>Ic@r>Ic@9V?Ic@9?Ic@9"?Ic@9)?Ic@91?Ic@9C?Ic@9vU?Ic@9fh?Ic@9y?Ic@?Ic@?Ic@?Ic@?Ic@?Ic@?Ic@?Ic@?Ic@?Ic@u?Ic@y?Ic@}?Ic@?Ic@?Ic@?Ic@/?Ic@I?Ic@@Ic@p@Ic@@Ic@ @Ic@. @Ic@@Ic@@Ic@|@Ic@~@Ic@Q@Ic@S"@Ic@%@Ic@)@Ic@E-@Ic@G1@Ic@3@Ic@I5@Ic@:@Ic@ ?@Ic@"C@Ic@G@Ic@I@Ic@K@Ic@N@Ic@Q@Ic@S@Ic@W@Ic@Z@Ic@[@Ic@^@Ic@b@Ic@c@Ic@f@Ic@!j@Ic@m@Ic@o@Ic@s@Ic@)v@Ic@+z@Ic@}@Ic@ǻ@Ic@Ǽ@Ic@ǽ@Ic@G@Ic@Gׇ@Ic@@Ic@G؉@Ic@??   % T4DM\AADZQLIs the AP a DSHS/AAA/AAA Subcontractor employee? 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( RpArialMonotype:Arial Bold:VersirialMonotype:Arial ld:Versi?!333330+|p|m|Z|m| 3 0wLPȟ 3HS1|p|m|w3x !)w 0w dv% TrdqAAro LdDocument per % FEMF++@ *@$LBQB DRD6@ APSAS ManualQ$>>]?|v>>]? 0>>]?!>>]?)7>>]?x ?>]??>]?[*?>]?":?>]?"K?>]?"?]?>]?m?>]???   % Toq~AAp| LdAPSAS Manual % F<0EMF++@ *@$LBQBC_A-wD@0$۫=ARIAL6@\This flow chart provides a quick reference guide and does not substitute the specific action8>ff&>H>ff&>>ff&>:~>ff&>>ff&>:>ff&>>ff&>?ff&> ?ff&>G?ff&>r4!?ff&>+?ff&>r7?ff&>ǙC?ff&>rJ?ff&>ǡP?ff&>V?ff&>qlb?ff&>i?ff&>qdu?ff&>?ff&>9f?ff&>T?ff&>C?ff&>䘓?ff&>?ff&>:~?ff&>t?ff&>c?ff&>;R?ff&>氭?ff&>;?ff&>[?ff&>;R?ff&>߾?ff&>;?ff&>?ff&>?ff&>@?ff&>/?ff&><?ff&>s?ff&>X?ff&>G?ff&>=6?ff&>?ff&>?ff&>@ff&>t4@ff&>+@ff&># @ff&>s @ff&>ȕ@ff&>@ff&>r@ff&>{@ff&>r&@ff&>ǡ@ff&>@ff&>q!@ff&> #@ff&>$@ff&>1'@ff&>)*@ff&>p -@ff&>/@ff&>pF1@ff&>u2@ff&>3@ff&>o6@ff&>c8@ff&>[;@ff&>n<@ff&>Q>@ff&>IA@ff&>m@D@ff&>»E@ff&>mfH@ff&>]K@ff&>UN@ff&>P@ff&>/R@ff&>lS@ff&>T@ff&>lW@ff&>X@ff&>[@ff&>^@ff&>`@ff&>kLa@ff&>Cd@ff&>??   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( RpArialMonotype:Arial Bold:Versi?!33333300 E1`l`^y`^|/`| |p|m|Z|m| 3 0wLTȟ 3|p|m|w3x !)w 0w dv% T`XlAAYLTYES% FEMF++@ @<0Nsr?@, }LCm.DCm.D@$$==_888% % W$   % % $$AA( F\PEMF+@<0\C{DfVCm.D\C_mD\C{D@( $$=='%  % V,| K !| %  % $$AALd//)??" FEMF+@ CompObjqObjInfo#VisioDocumentl |VisioInformation""$  Visio (TM) Drawing |6Rl !fffMMM3338 TZ Arial@:NWingdzs@vNuMonotype Sort mSymbol5T?? Y@-1U$J:DT1EW-hTT<* /Ub bO0zGz?@8@H2!kWbʁk !k9 +k)kO,O, P/8&9$? CAk&,,'5/G%&X$&  E& y  0)^?Tp2    U1?%aUBEEEUEEE@ON7OIJ`2BEEEEEEE@$O9FAY; ,Q*VV,QgTY 1 W-oW?o\o ' `3kulb6`i#l l l ҕY??\ #TD5r|O,O,!O,N/BQ|USME6A_h8OOOOO@O$O _HOZOlI`7rZW?_ep؂fsU妖jȟxҏk)qĬ T %1Wdv i| 9Si'0UP]y??4zy2Y#Q T~0{j :Ǯ/6c!3v!D//?Qp&v?d4,Qk(YU1%1λ-(kp 5 . $5-Bbi`w# *|)/й//??2 44ӶSPt߆27yՅ:]$NԵb}-?Qcuv")/"%)f'!U+%U2qa0?`?r6#!r6; <<7y/I[ײ|Q@й|Qy ??-?%GZ4%*4c bBF:/L/^/qZ?l3?!  "!@)"IAر1@//6aC,=:ɀBK` Rąhq`0lFqB,a%u"2u?uWRLurYuMfuFsuIuxu`u-xxucxux\BYF ۲&xb6رKK%رvZrwg!St҂"ر 8QyqA? OO(O:OI/F@OJ],Q%7b@Q#O[hɠq%{)Ofmooo,$@Rny%qqA4FOd~NWșd0O贁Nk**fDQo_~4@Q_EhvP,j3L^ļgcx!//ϯ$H?l~>X{Uß՟FXjASewRc$6HZl~ߐߢߴ 2DVhzY);M_qOz7!3EWixYq,>Pb//(/:/L/z!k/}//////// ??1?C?U?g?y???????? OO-OzsqLO^OpOOOOOOOO__~$_UrA_af8ui_{________ ow*oPbt߆ߘh,>Pbtç(:L^p[) 1CUg֯ -?Q kN'9Ȉ L1^&$Q4-"N 5JUDovUgQNlj/f4t={/^/p///n 4'a2ODFѠEWqKLGdb/  rcY uY "4F9?\n/0zOOOO __ ooVhQ{! E_W________ o/Ao? D,#>gOb p pppoooooȟ6Hzl~0B'Y5,>PbtΏ@:L^pȯʟܟ$HZu~Tf1 HZM????Ͽ /AYkw߉ߛ߀߿!H?Z? ?cu --o rtVi,dio{dtG`i{},d0UZ"IŪC1" $)/'TfMVa$l "5@@Q,as//6=/?$?6???: 4C odXXLetterO_ fzDINU"4'3T cf%7I[m/!/3/E/W/i/{///-} Display_d81UR%U)* U+-' /4 UFDfP h-RTUUUA@ ?I? 3h EePqYk  BHo1Cw Q2MQ` Flowchartn_` u D??!?T pNsNp_imƉp}wv|lcY?>Decision point between two or more paths in your flowchart..HD # =hj4>TYY9 TkUA@ ?u?P6 u`m uBA" >4)P$*44kULV>A @E E  UrBM-^#%e)%8"k&85 7L!$5 IC"`?Copyright (c) 2001 Microsoft Corporation. All 2s reserved.h`Vis_SFB.chm!#26510' U3m0D)#e!d,9 l> 0>Udd 5 !WZ !0$bA/'ʗ pBB(: n@,)+Db~@A%KmMQO AO: OM}AA52WO#UrA zRS() ^q%H(^!P F1@^UfUf|!G.BaR_aosl%1#:Tc%kHoi,#g"G#b%Nd%.Cam#hdaTr7+T &'" a a"ss%!|bR`Cost6 3,Enter the co associated withis procesYsQ02`/%`F #%B t&߅Ia!Wo@koP+>4aT@aUFDfP h-RTUUUA@ ?I? 3h  ePqYk  KHo:Lw Q2MQ` Flowchartw_` u D(2OVhz~ WAny processing function.y kind of Double-click to add sub-page.H D  # =hj0>TdYY9 ͉UA@ ??P6 u` 6u e.A&a8 e&0LgH>v5 LSҿ5 I`?Copyright (c) 2001 Microsoft Corporation. All s reserved.`Vis_SFB.chm!#26527 '#O0,Hd9 l>YUdv W}T /6bRC2N6& B2Ygm24 ?=P?1F%??S911^;66=O= E%2O;zrA BC ^iC(!aO!jg(O _k,OqV(^8A^ F@lL?VVȆ#AQR?_\=C _Too!TSF%[no$joQX3Am5+_l^+T&Xt'et^Q^QF"}s QsQq?B`Cost6,Enter the cp associated withpis p?rocess# ["?`@qA`vQBbswDu#*u wdH ofsstep# qF%{'s Reosourpz:wnumbp~lpeople oquirptopmtestask# n>&!aP}Y=Jv='# %Properti p Bb fD'_:,^ܑB[!8Aa 7֨Beqag+=Qs#i$vF"ʭQsUr'#hxq,ting,func !,Basic,Flowchart,inform",fӠ,diagram,dataes,joiners,u €XF%C$@mb?ؿ贁N8i6??54 _ Q);M_>m w =_Hu-A? !OyaGE5>FLC#DHKMB 4I3QaO=o@koP+~`2 haTafpUFDf h-TUUU?@ ?6I?d XboqYk*Qu23u ` Connector ` e1Crw UH ^   -}|5 p`I`V?}`xa833ސ]3σ3u 33?, ?Gxpx^& CThis connector automatically routes between the shapi ts.HD @# =h8T YY9 BR#F oU@? P6 u `u bA@]u  .(#DB uu`h?\hr|uVa@-?bl;'bE-ho'$y( 2rq?@I ?$%? @"U*5L -br  ^vv"(2uI."q28v"uh9Bd&</MS~ #145 |`Vis_SE.chm!#20)@E`;Copyright (@1 Microsoft Corporation. All ;Bs reserved.4U#1#7A,@+4j'TvQ8l>$Ud vE \/4 *&1$b24R(a[z[D ZQi a59 93O'2"q?2g;2GHuw* O`EW )F|}!#dI"7B ETGdT@TkUFDfP h> /T6DUmA@ ?ۿI?Y{\ $Oc@SeeeZ? $H S &4G ?rp{ri^ARectangle shape with variabcorner rounding.ers on r.mb?贁N? ?4 HDB $# ?h-(>TT9 AUA@V ?w?Q6 V ApL??[([8u`  u>d7 ; B@S(!-$5 I`?Copyright (c) 2001 Microsoft Corporation. All R"s reserved.`Vis_Sba.chm!#26679l> >Ud]!H!=2?!<zr r<%G"b^bQ6J3 . -3!31 6[2):?AԲ?$6#$3 'i9v20@ur"P6 " Q5 3ҡ2G2GBG22B\ (;? 0D:BE3P81|j)<7G B! D#G"IEBI3A!K):0A6CPHBFAh322p):F%][DR& YR!CI5XZ3k_AE2_3FTUFdB!J\868DcfJDNo3fo6:J\lq!,^!U/&377845" !Ch>]Tb(1{w?w rV75x,r!CY^S(1%qÅ|\}!3dA!a| =.o8 6j0Nd; a09F C B?__^* R O`l׈T ߏ VVI|gDrag to add a company nameyour organization chart. Replace existinex?t with ..mb?ؿE t?BUΕ4 UG D # h0T`UU^UA@ ?ػ?Py F[` j =!VZ&xQ sZ`2<FZ"#$%n؉J @T#T#T#2<F'ZZ!T#!T#!T#("!T#nx"xu`F?2qu9r93@3hk? @w?R*=29!5)*910<9B 2"(0F9\2L)e3ADgK`Vis_SOC.chm!#30211I2`?Copyright (c) 2001 Microsoft Corporation. All Bs reserv?ed.ܪ8`dL[5D)eAXZ@A A|U/Q B @AQHF\5T`WXETWETWUTWJUTWxTWQX2W/UT<WQXFWQXZWET!WX!WQX!WQX"!WXnS,PZq1^-+TClassic;ContemAry;Elegant;Notepad;Retrog/Q _7gRsU<<EFXBZZB!!R@!!x!!bY8Wp4A#(<R A d `C2<(̅u v Y2 !!!"!nm퓈vr< "AXE-ƃ?Ճ߃FOP&^&Z&0d&@:n&O2<F E " &ƒ&В&ڒ& BQ2?rZb"E9s6ՃBwOtQ0t``aUo@A*C This shape ۰used by a soluA)"xsAւCTitle,Drag,add,company,name,orizB,chart,Replace,existing,text,hiechical,diagrams,offiYmanagement,loyee,r elBse:2ʆ$@m-XETskY8̗EчF.G`t(CThe {th forО۶onlyPA`&meMRRp@dRF_/](XE:Ƃ?V45@4H?5[O^.Q: 2A3:t1n]rQ>bCQQb=&L0t+1$G A3.GP3\5e:8xI/bP@m)2b%CwB'CnTߝ\AGAĂR0_D`&Resizo Fit TVfRL0`Width` Sc@ch.X2~`HeAYIS\5J`r C %PropertieI3b BxA( P#_J<+N'UHL9D # h,JT]]MAzOMUAw@@v? P W@(>tA`  ?r@J> B>rb  b #b>tbk4J; uW?cu>aJ#>U0O?贁Nk?9 M> #" <@Sq #w!|$G+I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved.#`2 #/"M%IYSW@lJ0JUhh5151]U<p K'3  ] F5( !7??Ah%)OBOTOA%|K6O?M\$?>rM#=RCSi>M1e%\99 $'0%UR""gPhe_f'>TA"3xc?V6#B$ BA B8hB >2" ,a8%#THc7lchK,2Q5?G?@Y?k?}???a#_^?} й1CbF arBbF I%6zpc `KY oJF1#AJ;~X=X `p_}'UHL9D # h,JT]]MAzOMUAw @v? P W@(>tA`  ?r@J> B>rb  b #b>tb4hM u?u؄>a)J#>U0OρNk?9 %M> #" <@q #w!|$G+I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved.#`'2 #/"xM%IS@UlJ0JUhh5151]U"<p K'3 h C2] 5F5( !7??Ah%)OBOTOA%|K6O?M$?K>rM#=R=CSi>M 1e%\99 $'0UR""gg_*f'>TA"3\c?2@C#B Sf BAzchBG >2 ,a8%#THc7lchK,2Q5?G?Y?k?}???z#ZP@}b|a1CbF rXrbF I6#Zyc `KY KoJF14FJ;~{=X `_~ٌJHD: H ;h,>TYY9 BzAUA[??P6 @#p  y?@t`T  b B>TT SlTYpu`  ?8]{l]v]uNa "%>U0zGz?@$eT<2w$Bq8#!$5 I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved. `28#X-'=et S]@l>0>Udd^1^1ȀYU2A P3,( 0n? |&B|b(M!? LB:T30UA rq?mOȀO I3 ED@Ǔqܾ2 BFA5RK?WO!BA|?wS@GUB@rAj0RSZP"]W<_*!fi@A2a59 ,97$'0BUF",2HD: H ;h,>TYY9 BzAUA[??P6 @#p  y?@t`T  b B>TT SlTYpu`  ?8]{l]v]uNa "%>U0zGz?@$e8#<2w$Bq8#!$5 I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved. `28#X-'=Tt S@l> 0>Udd^1^1YU2A P3,( 0? T|&B|b(M!?S LB:3?AUA rǿq?mOȤO I3 E:@qܾ2 B0FA5RK? WO!BA|?wSP@GB@rA0RSZ"]W<_*!fiA2a59 ,97$'0BUF",2HD: H ;h,>TYY9 BzAUA[??P6 @#p  y?@t`T  b B>TT SlTYp{u`" }?8]{l]v]ua) "%>U0zGz?@$e8#<2w$Bq8#!$5 I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved. `S28#X-'=t S@l>0>Udd^1^1YU2A P3,( 0?M |&B|b(M!9? LB:e#0UA rq?mOȀO Ie#r ED@qܾr2 BaFA5RK?@WO!BA|?wS@GBJ@rA0R SZ"]W <_*!fiA2a59 ,97$7'0BUF",2HD: H ;h,>TYY9 BzAUA[??P6 @#p  y?@t`  b+ B2AKT2 Sl2YpVu`  ?8]{l]v]Lua "%>U0z_Gz?@e8#<2w$WBq8#Ҡ!$5 I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved. `O28#X-'=t S@l>0>Udd^1^1YUp\6A P3,( 0? *|5&B|b(M!r? L*B:e#հ0UA rq?%mOȀO Ie# ED@q2 BFA5RK?WO!BA|@?wS@GB@rA0RSZ"]W<_*!fiATc59 ,97$o'0BUF",2UHXuD" U>ih]0JT@t]]M>U2MUA;@ u?P @NtQ` @RBN rb brJB ~bNtb+#M; u J?ƙuw?NaJQNU0O?贁Nk?QM./pT >GK P_8NpUGKi"M# /LRq!$+I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved.``>b$I S:>@lJiUt U96(/F$`1--t310Ka"A  jFV(!3ONOA%OOOA%KOFO]9<$ONrM`RSy2Q(7U%d 961=( O$DNPa#$V_'!ThC f f fWV(eZNgFfXopodp`oa%[@onXG ogig1q'NTQJJ>>Y"sD?eFcQ;bcQcPwMcQPğMy2U_@__oo(oC<"oio,tojoo(:7^ewz1_q˟LgG)?Qñ篋$], >PbtHkĿֿhe8JϑnϿUiJnIP9#/' 0U "P2HD: # ;hj,>T!YY9 BUAV-@?A.?л?P6 @t`  pit >K** )B>=F`Q`=F~Q~=`YFQu @݀@p~b3Q3L^3j|33 u ɓk$}?u"Sa"%>#U0z_Gz?@#?Bq#21745 I `?Copyright (c) 2001 Microsoft Corporation. All \2s reserved. `S2#.l'=2[Sl>0>Udd 11Y0.?A. 3(!2dn? {#Vu`ʈ%U) (A=J&S?AڱF?A Ge?A%q?P_9@ (&Ū'@K?SBLCՈ%{#Tvը%C :v" W,I? kR@ }|\@ 4Cg?{"4 (B"a_s_Wr #5AEEr(=?AN+?AOO\Lc,\ROyB\c'X___^t_o^)#X5E~ gT!YY9 BUAS@A?AV-@?A9;??P6 @t`z  ?Stm>*I* )B>=F`Q`=F~Q~=YFlQu @@p/b3Q3L^3j|33 u 2գIJu"a"ҧ%>#U0zGz?@#??Bq#21745 I `?Copyright (c) 2001 Microsoft Corporation. All \2s reserved. `2b#.'=2[S*W@l>0>Udd11Y>U* 3(!Akq? {#p#TC(A\EM?A, %8?A\rQ@VT?PfQ >ow@K|%DC%{#Ѯ2rK%C:v" \Fߑ? ʢuH@ }|\@ 0?Cޫ?{"K4(B"a_s_Wr #5AEEJ@yFh @jTE,O\v'W]L4Ts=GVJTcX___^t_o^)#X5E"O*Mq\?A{׈Wf?A`C?P_9@ 7&Ū'\u ?C I3s,\arB\EsևgW,I? rooVdWG#X|EyNAw?A8?N~L\OK/Yx7vJTt [^TiAa59 9$'0UВ"2UHPuD " # U>h:$JT#5 AMzMUA6 @?H@NtQ`  thAO ?):>M; ujX^huzNa@Jq&NUI `?Copyright (c) 2001 Microsoft Corporation. All s reserved. N`SN2b\I[SlJ"aUl~M ^%p !b ʃ#<6#"n!V. E(::  nT=9!Q//////1:?,:7'<H:Oe%!5??????ROdKI9*:Up?;iJAiKQ]+#|'0UR ?IUHTuD" # >hj,JTAeeM oMUA?ؿ@?P @NtQ`  6tU&Nbbr w@"NC.R!~ }: u U8R~ ut NaPJ "%'NU*"LR bDN3#! E1?LK#/| 2" R%q3#149+I`?Copyright (c) 2001 Microsoft Corporation. All 2s reserved.U#`] >2b3#('SR70@SlV!@Up(V!V!?eB#701p Ae /C'(zm*?AA?N% C?&$R~Q AS# BR/Ra(Xm*@H'r9CBFS3e ,9SRm8m$CiPFWL~?A@vYAYE#1 3bW ?߾C5A3Y;b R}R}R}/R0OQ5_GU"PvR#cPWRR0^[fbX`DSk?SUcT%RNRA8GeFTUSQAnjBXx5RcQfBOUKct3wOQEYu|GTUdr3JOtVtz[3w5AS?OQOcOuOOOOOecODn\ V# 4\ DV N_`Y_v] \ ^ \ _cYuPf Zl jf飯~oKlnPm8oeZ^ x1+{ :~͓QJAq{1xU^w`{բux$6AWS,` 5AU !ń ! !V!B 1'(kڼDgixV vP 4\ @0ΚecUu^ \ ZU ϑp5fgvERFfDeDW5?m*6J"#HR12AwD#NѵBYȖu0VfJ"#hΒ@MU*Z/6VV!N33#TYϑ?6&F&ΒJ!տ6 Ü 5Ax=Oas߅Pߩ߻=EIf\JɆ vU3#, Q2f3o2ΚE̮1jU1v] ! P{U3 e650w"933!3m3!AvY092^3zL0Am03 3LH,ExK2/ }KFT M4H[2)^4 K+R_H[3e_30V Qi7CgF{;9S1rn!HDO3\!HlkC /P/2pz N p!!Tȁ)F(&prrX f "" &@b𐃮t? tiN &!`Move to change feature size.dP((g ?[mcfZe ! Q !PHQ^\U336gM @tQNdtRQ#b`h!0@t(bG @Ni$((#|ڳj+'0U 0sHD: H ;h,>TYY9 BzAUA[?ݨP6 @#p  ?n@t`  b B-">TT SlTp[u`  ?8]{l]0v]uvWa "%>U0zGz%?@e8#<}t'B%q8#!$5 I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved. `28#X-'=/t S@l*>0>Udd@^1^1Y>U2.A P3,( 04 TY Z&B,Fb(:{YM?A TU@?C? !OF E2 ߾HBM!? OP$FA5RKAe#r@`P|H?qqO?_O e#M &PO@ˈBQpQ|4?rA0>bDciA2a59 ,97$';0AUUF",2HD: H ;h,>TYY9 BzAUA[?ݨP6 @#p  ?n@t` . b BAT np[u`  ?8]{l]0v]uvWa "%>U0zGz%?@e8#<}t'B%q8#!$5 I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved. `28#X-'=/t S@l*>0>Udd@^1^1Y>U2.A P3,( 04 Y Z&B,Fb(:{YM?A TU@?C? !OF E2 ߾HBM!? OP$FA5RKAe#r@`P|H?qqO?_O e#M &PO@ˈBQpQ|4?rA0>bDciA2a59 ,97$';0AUUF",2HD: H ;h,>TYY9 BzAUA[?ݨP6 @#p  ?n@t`  b B-$>TT SlTp[u`" ?8]{l]v]uWa "%>U0zGz?I@eb8#<t'_Bq8#I!$5 I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved. >`28#X-'=t S@l> 0>Udd^1^1YU2A P3,( 0M TY &B,Fb(:YM?A TU@?P? !OF E%2+ ߾BM!? O$FA5RKAe#r@`뱪P|HqOqO?_O e#M P O@ˈBQQ|\4?rA0>bDciA2a59 ,97$'0AUUF",2HD: H ;h,>TYY9 BzAUA[?ݨP6 @#p  ?n@tQ`  b B%>TT SlTpu`  ?8]{l]v]uW;a "%>U0zGz?@eĉ8#<t'Bq8#!$5 I`?Copyright (c) 2001 Microsoft Corporation. All "s reserved.} `28#X-'=t uS@l>0>Udd ^1^1YU2A P3,( 0 bTY &B,Fb(:=YM?A TU@?? !OFJ E2V ߾B$M!? O$(FA5RKAe#r@`P|HqqOd?_O e#M PO@ˈBQQ|4?rA0>bDciA2a59 ,97$'0AUUF",2HD: )#=h4>TYY9 P3+AUA?Ad?@?['@@l??P6 @Ut`  o?t3 #uLbd-w@@2.@&>  ujhr|u:aC>#U0zGz%?@oAbhgIU!5 f" G2q a?/&?%%q!$5 I`?Copyright (c) 2001 Microsoft Corporation. All 2s reserved. `B2_$l=7"S@*El>0>Ud E 3$!]&&b)B4B(EO46OHB3UNnOI|AIA%NO1O@G%OgO_PRi$^ 33 v|['25UR0/p 0b ; bXՓZPVR1PP@QTw9S#S___ oo%T _RYoko}ooo*`jAha%9 w9 2%#o!3r1Lv%kGYm $%%%^Company Name Depart/mentE_HZ'ׯ l%B\(uF'FĞn.# /+OB <0ddDE1n@+kF8s+=O@asG~Pʨ 9dݨ< /G>C}&d 7B&$(I&%LyEPcY&|UTnY&LfhY$&s[lcD),fD)éi&Щ߷l& ofUFDfP h-RTUUUA@ ?I? 3h EePqYk Ho1C*w Q2Q` Flowchartn`  K?$6߈kdz:< Data that can be read by people, such as printed output. mb?ؿ贁N8i76??<k4 H D # =h 4>TP  ;U'AUA@ ??]Q6 jA >A.. L u` L} U*4aulD>UY !n #?P6 @bhm]r bhub=]% -}"rm"T} }"#)5 ;x@%+1045 II"`?Copyright (c) 2001 Microsoft Corporation. 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APS staff must know and implement state and local policy and procedure. HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34"Chapter 74.34 RCW authorizes the Department of Social and Health Services (DSHS) to investigate reports of abandonment, abuse, financial exploitation, neglect and self-neglect of vulnerable adults, and to provide protective services and legal remedies to protect vulnerable adults. Section Summary  HYPERLINK \l "_Overview_of_the_APS Program" Overview of the APS Program (pg. 5)  HYPERLINK \l "_Scope__Who" Scope Who performs APS investigations within ADSA?  HYPERLINK \l "_APS_Reporting_Requirements" APS Reporting Requirements and Information (pg. 8)  HYPERLINK \l "_Mandated_Reporting_of" Mandated Reporting of Abuse of Vulnerable Adults  HYPERLINK \l "_Permissive_Reporting_of" Permissive Reporting of Abuse of Vulnerable Adults  HYPERLINK \l "_Reporter_Confidentiality_and" Reporter Confidentiality and Immunity  HYPERLINK \l "_Interference_with_Reporting" Interference with Reporting Requirements  HYPERLINK \l "_Safe_Field_Work_Practices" Safe Field Work Practices (pg. 11)  HYPERLINK \l "_APS_Intake" APS Intake (pg. 14)  HYPERLINK \l "_APS_Receipt_of" APS Receipt of Reports  HYPERLINK \l "_Summoning_Emergency_Response_during" Summoning Emergency Response  HYPERLINK \l "_As_an_APS" As an APS Worker, Where do I Enter Information and what do I include in an APS Intake Report?  HYPERLINK \l "_Reporter_Confidentiality_and_Immuni" What do I Tell Reporters during Intake?  HYPERLINK \l "_Sensitive_or_High" Sensitive, Critical or High Profile Cases  HYPERLINK \l "_Intake_and_Coordination" Intake and Coordination of Cross-Region APS Reports & Cases  HYPERLINK \l "_APS_Referrals_to/from_other Investi" APS Referrals to/from other Investigative Authorities (pg. 18)  HYPERLINK \l "_Reporting_to_Law" Law Enforcement  HYPERLINK \l "_Reporting_to_the" The Medicaid Fraud Control Unit (MFCU)  HYPERLINK \l "_Department_of_Health" The Department of Health (DOH)  HYPERLINK \l "_Licensing_Authorities_for" Licensing Authorities for Professions under Title 18 RCW (other than Health Professionals covered by HPQA)   HYPERLINK \l "_DSHS_(RCS,_CPS)" DSHS (RCS,CPS)  HYPERLINK \l "_Indian_Tribes_in" Indian Tribes in Washington  HYPERLINK \l "_APS_or_Law" APS or Law Enforcement in another State  HYPERLINK \l "_Overview_Chart:_Sharing" Overview Chart: Sharing APS Intake Report Information with Others  HYPERLINK \l "_Screening_Reports" Screening Reports (pg. 29)  HYPERLINK \l "_APS_Intake_Report" APS Intake Report Screening Process  HYPERLINK \l "_Overview_Chart_of" Overview Chart of Intake Flow  HYPERLINK \l "_Overview_of_Screening" Overview of Screening Decision Factors  HYPERLINK \l "_Circumstances_under_which" Circumstances under which DSHS will Screen-Out an Intake Report  HYPERLINK \l "_Circumstances_under_which_APS will " Circumstances under which APS will Investigate  HYPERLINK \l "_Unable_to_determine" Unable to determine if the alleged victim was a vulnerable adult  HYPERLINK \l "_The_alleged_victim" The alleged victim goes in and out of vulnerable adult status  HYPERLINK \l "_Allegations_appear_to" Allegations appear to meet the RCW definitions  HYPERLINK \l "_The_vulnerable_adult" Vulnerable adult resides in a licensed or certified setting  HYPERLINK \l "_The_vulnerable_adult_1" Vulnerable adult, alleged victim resides in a NF, BH, or AFH  HYPERLINK \l "_The_vulnerable_adult_2" Vulnerable adult, alleged victim resides in a supported living/SOLA  HYPERLINK \l "_The_vulnerable_adult_3" Vulnerable adult alleged victim resides in a foster home licensed by Childrens Administration  HYPERLINK \l "_The_vulnerable_adult_4" Vulnerable adult alleged victim resides in a DSHS JRA setting  HYPERLINK \l "_The_vulnerable_adult_5" Vulnerable adult alleged victim resides at Western State Hospital or Eastern State Hospital  HYPERLINK \l "_The_alleged_victim_is deceased at t" The alleged victim is deceased at the time of intake  HYPERLINK \l "_Investigation_Response_Priority_Cat" Investigation Response Priority Categories: High, Medium, or Low (pg. 38)  HYPERLINK \l "_Investigation:_Coordinating_with" Investigation: Coordinating with Other Investigative Authorities (pg. 40)  HYPERLINK \l "_Coordinating_with_Law" Coordinating with Law Enforcement  HYPERLINK \l "_Coordinating_Investigations_with" Coordinating Investigations with MFCU  HYPERLINK \l "_Coordinating_with_RCS" Coordinating with RCS or CA for Investigations Involving Residents in a DSHS Licensed or Certified Setting  HYPERLINK \l "_Coordinating_with_the" Coordinating with DOH  HYPERLINK \l "_Coordinating_with_Tribes" Coordinating with Tribes  HYPERLINK \l "_Coordinating_with_the_1" Coordinating with the Long-Term Care Ombudsman Program  HYPERLINK \l "_Investigation:_Procedures_for_ALL A" Investigation: Procedures for All APS Investigations (pg. 44)  HYPERLINK \l "_Overview" Cost of APS Services  HYPERLINK \l "_Consent_to_Investigate" Consent to Investigate  HYPERLINK \l "_Interview_of_the" Interviewing the Reporter  HYPERLINK \l "_Interviews_-_General" Interview- General Protocol for All APS Interviews  HYPERLINK \l "_Interview_Documentation" Interview documentation  HYPERLINK \l "_Interpreters" Interpreters  HYPERLINK \l "_Interview_Behavior" Interview Behavior  HYPERLINK \l "_APS_Worker_Interview" APS Worker Interview Safety  HYPERLINK \l "_When_Is_an_Interview Not Required?" When is an Interview Not Required?  HYPERLINK \l "_Interviewing_the_Alleged" Interviewing the Alleged Victim  HYPERLINK \l "_Timeframe_to_Conduct" Timeframe to Conduct an Interview  HYPERLINK \l "_Timeframe_to_Conduct_the Interview" Scheduled vs. Unscheduled Interviews Alleged Victim  HYPERLINK \l "_Third_Party_Presence" Third Party Presence in an Interview Alleged Victim  HYPERLINK \l "_Interviewing_theAlleged_Perpetrator" Interviewing an Alleged Perpetrator  HYPERLINK \l "_Interviews_-_Unique_Circumstances" Interviews Unique Circumstances (pg. 52)  HYPERLINK \l "_Person_to_be" Person to be Interviewed is Incarcerated  HYPERLINK \l "_Person_to_be_Interviewed is a Minor" Person to be Interviewed is a Minor Under Age 18  HYPERLINK \l "_Person_to_be_1" Person to be Interviewed has a DPOA or Legal Guardian  HYPERLINK \l "_A_Person_is" A Person is Reported to be Non-Interviewable  HYPERLINK \l "_Investigation:_Unique_Circumstances" Investigation: Unique Circumstances (pg. 54)  HYPERLINK \l "_Alleged_Perpetrator_is_a DSHS Emplo" Alleged Perpetrator is a DSHS Employee, AAA Employee, or AAA Subcontractor  HYPERLINK \l "_APS_Investigation_of" APS Investigation of an Alleged Perpetrator Who May have Also Committed a Crime  HYPERLINK \l "_APS_Investigation_of_1" APS Investigation of a Personal Aide Providing Self-Directed Care  HYPERLINK \l "_APS_Investigation_of_2" APS Investigation of a Minor Alleged Perpetrator Under Age 18  HYPERLINK \l "_APS_Investigation_Involving" APS Investigation Involving a Client of a DSHS/AAA/Aging Network Case Manager  HYPERLINK \l "_APS_Investigation_Involving_1" APS Investigation Involving a Client Participating in New Freedom, PACE, WMIP or MMIP  HYPERLINK \l "_Coordinating_with_RCS_or CA for Inv" Alleged Victim Lives in a Setting Certified or Licensed by DSHS  HYPERLINK \l "_Alleged_Victim_is" Alleged Victim is Deceased Before Intake  HYPERLINK \l "_Alleged_Victim_Expires" Alleged Victim Expires While the APS Case is Open  HYPERLINK \l "_Alleged_Perpetrator_Expires" Alleged Perpetrator Expires During Open Case or Due Process  HYPERLINK \l "_Investigation:_Tools" APS Tools (pg. 63)  HYPERLINK \l "_Legal_Injunction" Legal Injunction  HYPERLINK \l "_Photography_to_Document" Photography to Document Evidence  HYPERLINK \l "_APS_Request_for" APS Request for Background Check through BCCU  HYPERLINK \l "_APS_Use_of" APS Use of Accurint to Search for Information  HYPERLINK \l "_Administrative_Subpoena" Administrative Subpoena  HYPERLINK \l "_Declaration_Form" Declaration Form  HYPERLINK \l "_Investigation:_Findings" Investigation: Findings (pg. 71)  HYPERLINK \l "_Meaning_of_Recommended," Meaning of Recommended, Initial, and Final Findings  HYPERLINK \l "_Finding_Options" Finding Options  HYPERLINK \l "_Factors_For_Substantiation" Factors for Substantiation of Neglect or Abandonment  HYPERLINK \l "_Factors_For_Substantiation_1" Factors for Substantiation of Abuse  HYPERLINK \l "_Factors_For_Substantiation_2" Factors for Substantiation of Financial Exploitation  HYPERLINK \l "_Cases_Involving_an_Entity" Factors for Substantiation of Self-Neglect  HYPERLINK \l "_Cases_Involving_an_Entity" Cases Involving an Entity (pg. 75)  HYPERLINK \l "_Panel_Review_of_Recommendations to " Panel Review of Recommendations to Substantiate an Allegation Involving an Individual or an Entity Alleged Perpetrator (pg. 76)  HYPERLINK \l "_Notification_of_APS_Findings" Notification of APS Findings (pg. 78)  HYPERLINK \l "_Summary_Chart_of" Summary Chart of APS Notification: Who Gets What Investigation Outcome Information?  HYPERLINK \l "_A_Substantiated_Initial" A Substantiated Initial Finding  HYPERLINK \l "_An_\Unsubstantiated,\_Inconclusive," An Unsubstantiated, Inconclusive, or Substantiated-Unknown Perpetrator Finding  HYPERLINK \l "_APS_Due_Process_and APS Abuse Regis" APS Due Process and APS Abuse Registry (pg. 90)  HYPERLINK \l "_Administrative_Hearing_to" Administrative Hearing to Challenge an APS Initial Finding  HYPERLINK \l "_Discovery_and_Protective" Discovery and Protective Order Procedure  HYPERLINK \l "_Subpoenas" Subpoenas  HYPERLINK \l "_Dissemination_of_APS" Dissemination of APS Case Record Information  HYPERLINK \l "_Witness_Payment" Witness Payment  HYPERLINK \l "_Change_of_Findings" Change of Findings  HYPERLINK \l "_Other_Administrative_Hearings" Other Administrative Hearings that May Involve APS  HYPERLINK \l "_DSHS_Board_of" DSHS Board of Appeals  HYPERLINK \l "_Judicial_Review" Judicial Review  HYPERLINK \l "_Placing_the_Perpetrator" Placing the Perpetrator on the APS Abuse Registry  HYPERLINK \l "_Case_Status_and_Closure" Case Status and Closure (pg. 96)  HYPERLINK \l "_Protective_Services" Protective Services (pg. 98)  HYPERLINK \l "_Description_of_Protective" Description of Protective Services  HYPERLINK \l "_Authorization_and_Payment_for APS P" Authorization and Payment for APS Protective Services (pg. 100)  HYPERLINK \l "_Overview" Overview  HYPERLINK \l "_Hierarchy_of_Protective" Hierarchy of Protective Services Funding Sources  HYPERLINK \l "_Authorization_and_Payment" Authorization and Payment for Medicaid Services  HYPERLINK \l "_Criteria_for_Use" Criteria for Use of State-Only-Funded Protective Services  HYPERLINK \l "_Authorization_and_Payment_1" Authorization and Payment for State-Only-Funded Protective Services  HYPERLINK \l "_Legal_Protective_Services_and Remed" Legal Protective Services and Remedies (pg. 106)  HYPERLINK \l "_Protection_Orders" Protection Orders  HYPERLINK \l "_Vulnerable_Adult_Protection" Vulnerable Adult Protection Order  HYPERLINK \l "_Domestic_Violence_Protection" Domestic Violence Protection Order  HYPERLINK \l "_Guardianship" Guardianship  HYPERLINK \l "_Petition_under_RCW" Petition under RCW 74.34.067(5)  HYPERLINK \l "_Petition_under_RCW_1" Petition under RCW 11.88.030(2)(a)  HYPERLINK \l "_Procedure_to_Remove" Procedure to Remove or Modify a Guardianship  HYPERLINK \l "_Power_of_Attorney" Power of Attorney  HYPERLINK \l "_Coordination_with_Community_Resourc" Coordination with Community Resources (pg. 113)  HYPERLINK \l "_Domestic_Violence" Domestic Violence  HYPERLINK \l "_Mental_Health" Mental Health  HYPERLINK \l "_APS_Regional_Resource" APS Regional Resource Teams  HYPERLINK \l "_APS_Case_Record_and Documentation" APS Case Record and Documentation (pg. 117)  HYPERLINK \l "_The_APS_Case" The APS Case Record Retention and Documentation Principles  HYPERLINK \l "_Adult_Protective_Services" Adult Protective Services Automated System (APSAS)  HYPERLINK \l "_The_Service_Episode" The Service Episode Record (SER)/Case Notes  HYPERLINK \l "_Internal_Report:_\APS" Internal Report: APS Case Recording and Disposition  HYPERLINK \l "_External_Report:_\APS" External Report: APS Outcome Report  HYPERLINK \l "_HCS_Adult_Protective" HCS Adult Protective Services Intake Report  HYPERLINK \l "_Criminal_Investigation_Request:" Criminal Investigation Request: APS Referral  HYPERLINK \l "_Disclosure_of_APS_Information" Disclosure of APS Information (pg. 122)  HYPERLINK \l "_Within_DSHS:_Sharing" Within DSHS: Sharing APS Information  HYPERLINK \l "_Outside_DSHS:_Routine" Outside DSHS: Routing Sharing of APS Information under RCW 74.34  HYPERLINK \l "_Parameters_for_Every" Public Disclosure of APS Information  HYPERLINK \l "_Subpoena_for_APS" Subpoena for APS Information  HYPERLINK \l "_Discovery" Discovery  HYPERLINK \l "_Summary_Chart_of_1" Summary Chart of Guidelines for Release of Requested APS Case Record Information  Resources  HYPERLINK \l "_Rules_and_Policy_Governing the APS " Rules and Policy Governing the APS Program HYPERLINK "Attachments%20and%20Links/Definitions.doc"Definitions  HYPERLINK \l "_Acronyms_List:_1" Acronyms List Ask an Expert You can contact Lori Melchiori, at (360) 725-2531 or  HYPERLINK "mailto:Melchl@dshs.wa.gov" Melchl@dshs.wa.gov. Overview of the APS Program APS receives reports of allegations of abuse, abandonment, neglect, self-neglect and financial exploitation of vulnerable adults living in the community. APS investigates allegations by gathering information through interviews, observations and review of records, in order to: Provide protective measures for a vulnerable adult alleged victim when necessary; Determine the validity of allegations of abuse, abandonment, neglect, self-neglect and financial exploitation from available information; Determine current risk factors and supports for the vulnerable adult by assessing, as warranted: physical, functional and mental abilities, the conditions of the environment, support systems, and relationships. APS may provide protective services to vulnerable adult alleged victims by: Facilitating access to the legal system and/or law enforcement; Providing or facilitating access to needed and desired services during an investigation or upon an initial finding of substantiated abuse, abandonment, neglect, self-neglect or financial exploitation. Scope Who performs investigations within ADSA? Two divisions within the Aging and Disability Services Administration (ADSA) perform investigations: Home and Community Services (HCS) Division through the Adult Protective Services Program; and Residential Care Services (RCS) Division through their Complaint Investigators, Resident Protection Program Investigators and Certified Services Investigators. Which division investigates depends on where the vulnerable adult is living, and who may have perpetrated the abuse. Home and Community Services Adult Protective Services (APS) receives the intake report, conducts the investigation, and may offer protective services when: The reported allegations are of abandonment, abuse, financial exploitation, neglect or self-neglect; and The alleged victim is a vulnerable adult; and The alleged victim lives: At home; In an unlicensed setting; or In the following residential settings, and: The alleged perpetrator is external to the licensed or certified setting (e.g., is not the licensee, staff, volunteer or another resident); or The alleged client-to-client altercation occurred away from the residential setting while the alleged victim was not under the supervision of the provider. A facility ( HYPERLINK "APS%20List%20of%20Acronyms.doc" AFH,  HYPERLINK "APS%20List%20of%20Acronyms.doc" NF,  HYPERLINK "APS%20List%20of%20Acronyms.doc" BH,  HYPERLINK "APS%20List%20of%20Acronyms.doc" ICF/MR) licensed by HYPERLINK "APS%20List%20of%20Acronyms.doc"RCS; A Supported Living/HYPERLINK "APS%20List%20of%20Acronyms.doc"SOLA setting certified by RCS; A foster home licensed by Childrens Administration; A facility licensed or certified by HYPERLINK "APS%20List%20of%20Acronyms.doc"DOH (e.g., drug treatment facility, etc.); Western State Hospital or Eastern State Hospital. Residential Care Services Complaint Resolution Unit (CRU) receives the intake report and RCS conducts the investigation: When the alleged victim resides in, and is receiving services from, the following providers under a license/certification issued by RCS, and: The alleged perpetrator is affiliated with the licensed or certified setting (e.g., is the licensee, staff, volunteer or another resident); or The alleged client to client altercation occurred away from the residential setting while the alleged victim was under the supervision of the licensed/certified provider. Nursing Facility (NF); Boarding Home (BH)- including BHs with DSHS contracts to provide HYPERLINK "APS%20List%20of%20Acronyms.doc"ARC, HYPERLINK "APS%20List%20of%20Acronyms.doc"EARC, and HYPERLINK "APS%20List%20of%20Acronyms.doc"AL; Adult Family Home (AFH); Soldiers Home (e.g., facilities in Orting and Retsil for Veterans); and Residential Habilitation Center (HYPERLINK "APS%20List%20of%20Acronyms.doc"ICF/MR facilities: Rainier School in Buckley, Francis Haddon Morgan Center in Bremerton, Fircrest in Shoreline, Yakima Valley School in Selah, and Lakeland Village in Medical Lake). Certified supported living/HYPERLINK "APS%20List%20of%20Acronyms.doc"SOLA setting serving clients of DDD. The focus of an RCS complaint investigation in an AFH, BH or NH is on facility practice, and determining whether the facility was in compliance with state and/or federal requirements and provided safe quality care to residents. The investigative focus of the RCS Resident Protection Program in NH's is to investigate allegations made against individuals of resident abuse, neglect or misappropriation of resident property. The investigative focus of the Certified Services Investigators in certified supported living/SOLA residential settings is to investigate allegations made against individuals and assess provider practice. Sometimes APS and the licensing authority (RCS or Childrens Administration) will both conduct an investigation involving a vulnerable adult residing in a facility. Communicate and coordinate activities to minimize duplication and maximize efficiency as each pursue the investigation from their own program perspective. In unlicensed settings that potentially should be licensed by RCS, APS will investigate reported allegations of abuse, neglect, abandonment or financial exploitation and may offer protective services to the vulnerable adults, and RCS will investigate and address the licensure status. Communicate and coordinate activities to minimize duplication and maximize efficiency. If APS workers encounter a vulnerable adult living in an unlicensed setting that potentially should be licensed by RCS as an AFH, BH or NF (for example, when care is being provided to two or more adults unrelated to the provider, an adult family home license is required), APS will immediately call HYPERLINK "APS%20List%20of%20Acronyms.doc"CRU and the local RCS office to report a possible unlicensed facility. APS Reporting Requirements and Information HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.035"RCW 74.34.035 Mandated Reporting of Abuse of Vulnerable Adults When a mandated reporter has reasonable cause to believe that abandonment, abuse, financial exploitation, or neglect of a vulnerable adult has occurred, he or she must immediately submit a report to the department. (Some types of contact between vulnerable adults are not required to be reported to law enforcement, but must still be reported to DSHS - see  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.035" RCW 74.34.035 for details.) If the allegation involves a vulnerable adult living in their own home, call the local or Regional APS Intake line to make a report: RegionAPS Toll-Free Voice LineAPS TTY Line1 1-800-459-0421509-568-30862 1-877-389-30131-800-973-54563 1-800-487-0416 1-800-843-80584 1-866-221-49091-800-977-54565 Pierce: 1-800-442-5129 Kitsap: 1-888-833-49251-800-688-1165 1-800-688-11696 1-877-734-62771-800-672-7091 Call the RCS Complaint Resolution Unit (CRU) toll free at 1-800-562-6078 (TTY= 1-800-737-7931) if the allegation involves a vulnerable adult living in a residential facility (nursing home, adult family home, boarding home, soldiers home, residential habilitation center) or a certified supported living/HYPERLINK "APS%20List%20of%20Acronyms.doc"SOLA setting and the alleged perpetrator is an owner, operator, employee, volunteer, or resident of the facility. When the alleged perpetrator is not in one of these categories, call the appropriate APS regional Intake number above. Mandated reporters are also required to immediately report suspected physical assault or sexual assault to law enforcement. (This is in addition to making a report to the department).  A mandated reporter is not required by statute to report self-neglect by a vulnerable adult. However, reporting is encouraged to facilitate possible intervention. Vulnerable adult reporting is mandatory for all: Employees of the department; Law enforcement officers; Social workers; Professional school personnel; Individual providers (defined in  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 .020.htm" RCW 74.34.020 as a person under contract to provide services in the home under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.09" RCW 74.09 or HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.39A"74.39A.); Employees or operators of any facility required to be licensed by the department (boarding home, nursing home, adult family home, soldiers home, residential habilitation center); Employees of a social service, welfare, mental health, adult day health, adult day care home health, home care, or hospice agency; County coroners or medical examiners; Christian Science practitioners; and Health care providers subject to  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 18 TITLE/RCW 18 .130 CHAPTER/RCW 18 .130 chapter.htm" Chapter 18.130 RCW. (Includes, but is not limited to: physicians, physicians assistants, physical therapists, occupational therapists, nurses, psychologists, podiatrists, dentists, nursing home administrators, optometrists, osteopaths, pharmacists, HYPERLINK "APS%20List%20of%20Acronyms.doc"EMT, paramedics, counselors, naturopaths, nursing assistants, dietitians, massage therapists, radiology technologists, etc.).  Failure of a Mandated Reporter to Make an APS Report Failure to make a mandated report or knowingly making a false report is a gross misdemeanor.  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.053" RCW 74.34.053 When a mandated reporter fails to make a report: If the individual is unaware of the mandatory reporting requirements, provide the individual with information about his or her responsibility to make a report (e.g.,  HYPERLINK "http://www1.dshs.wa.gov/pdf/Publications/22-810.pdf" DSHS brochure 22-810x (revised 8/06) entitled: Partners in Protection A Guide for Reporting Vulnerable Adult Abuse). Consult with the Regional Administrator or designee to determine if APS will file a report with either law enforcement or the prosecuting attorney to tell them of the mandated reporters failure to report alleged abuse, neglect, abandonment or financial exploitation. Considerations include did the person know of his or her duty to report as a mandatory reporter and know that the alleged victim was a vulnerable adult. Permissive Reporting of Abuse of Vulnerable Adults Permissive reporters are strongly encouraged, but are not required, to report to the department or to law enforcement when there is reasonable cause to believe that a vulnerable adult is being or has been abandoned, abused, financially exploited, or neglected, or when the vulnerable adult is self-neglecting. A permissive reporter is anyone not mandated in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW (or required by WAC or contract) to make a report, including: Employee of a financial institution; Attorney; Long-Term Care Ombudsman. A permissive reporter can call 1-866-EndHarm (1-866-363-4276) toll-free to make a report or the permissive reporter can use the  HYPERLINK \l "_APS_Reporting_Requirements" direct numbers listed for APS and HYPERLINK "APS%20List%20of%20Acronyms.doc"RCS.  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 .035.htm" RCW 74.34.035 Reporter Confidentiality and Immunity APS will attempt to maintain reporter confidentiality to the extent legally possible and will not release the reporters identity unless: The reporter consents to disclosure; or Disclosure is permitted or required by law, examples include: Judicial proceedings (e.g., if the alleged perpetrator asks for a hearing to challenge an APS finding); or APS makes a referral or provides case information to other agencies authorized to investigate the matter (e.g., law enforcement, Medicaid Fraud Control Unit, HYPERLINK "APS%20List%20of%20Acronyms.doc"DOH Health Professions Quality Assurance Division, etc). Persons who report in good faith and/or testify about alleged abuse, neglect, abandonment, financial exploitation or self-neglect are not in violation of confidential communication privileges and are immune from liability as a result of the report or testimony.  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 .035.htm" RCW 74.34.035 Interference with Reporting Requirements Facilities, programs, or agencies providing services for a vulnerable adult may not develop policies or procedures that interfere with mandatory reporting requirements. If APS encounters policies or procedures that interfere with reporting requirements, forward the information to: CRU regarding any facility licensed or certified by RCS (HYPERLINK "APS%20List%20of%20Acronyms.doc"NF, HYPERLINK "APS%20List%20of%20Acronyms.doc"BH, HYPERLINK "APS%20List%20of%20Acronyms.doc"AFH, Soldiers Home, HYPERLINK "APS%20List%20of%20Acronyms.doc"RHC, certified supported living/SOLA setting); Division of Developmental Disabilities (DDD) Regional Administrator or designee regarding any contracted DDD program; Department of Health (DOH) regarding any in-home services agency (home health, hospice, or home care agency). Safe Field Work Practices This information is intended to minimize the potential of occupational hazards to APS staff while working in the field, where unexpected actions or events may occur. This information does not replace staff knowledge, judgment, or common sense in any particular situation.  Prior to making a home or field visit, review information (e.g., from the intake report, related case records, collateral contacts or interview the reporter) to assess if specific hazards may be present. Conduct a background check through the BCCU if it appears warranted and sufficient identifying information is known. See  HYPERLINK \l "_APS_Request_for_a Background Check " APS Request for a Background Check through BCCU. Questions to help assess the situation and determine if specific safety precautions are warranted include, but are not limited to: Is the vulnerable adult in present danger? In what way? Are weapons present? Have weapons ever been used to threaten or harm anyone? Are aggressive animals present? If so, ask the vulnerable adult to secure aggressive animals before arrival; Will anyone else be in the home during the visit? Is there a history of violence in the home? Is anyone in the environment likely to be under the influence of drugs or alcohol? Are illegal drugs used or manufactured in the home or currently being dealt out of the home? Is anyone likely to be present who will exhibit violent, erratic, agitated or bizarre behaviors? Are there any health hazards in the environment such as dangerous chemicals, broken floorboards, human and animal waste? Do conditions exist that may potentially result in harm during a home visit? Does anyone in the home have a criminal record? Are there restraining orders against anyone associated with the household? Is the neighborhood a rough or high crime area? Depending upon the perceived seriousness of the safety risk of a field visit, consult with your supervisor to consider various options to protect your (the APS worker) safety, such as: Request police accompaniment if danger is present or may escalate upon arrival. Law enforcement enters a residence before the APS worker when conducting a joint visit to a location that poses a safety concern, unless an alternate plan is agreed to by APS and law enforcement in a pre-entry meeting. Take another worker on the visit if the presence of two workers may mitigate a risk of danger; Consider conducting the interview in the office or in a neutral location. Each office must: Implement a means to know the approximate whereabouts of APS workers in the field should it become necessary to locate an individual (e.g., workers going on a field visit may indicate the address of the visit and anticipated time of return on an office sign-out board, in a note left on the workers desk calendar, or through a call-in procedure). Implement a means to verify that every APS worker in the field has finished his or her shift safely. All APS workers must carry work identification on field visits (e.g., business card, DSHS picture identification). Each region must provide APS workers with a basic safety kit for field visits to address potential biological hazards. The contents of the safety kit will be determined and provided regionally. Suggested items include: Non-latex gloves; Plastic garbage bags with draw string; HYPERLINK "APS%20List%20of%20Acronyms.doc"CPR mask (for those certified and choosing to perform CPR); 2 plastic, disposable aprons; Waterless hand cleaner; and Paper towels. During a field visit continuously assess the environment and situation for safety risks, including but not limited to: Enter a residence only when given permission or asked to do so; Do not go into a residence if you do not feel safe; Anytime you have reason to believe you are in danger, leave immediately and go to a safe location; Leave a residence when asked to do so. Anytime an APS worker is threatened with harm by an alleged perpetrator, witness, collateral contact, or the alleged victim: Inform the APS Supervisor/Program Manager; Submit a report to law enforcement; Enter the information in APSAS (the safety section, the SER and highlight the safety flag); and Consult with the RA or designee to determine what additional action may be appropriate to the circumstances. For example, the provisions of these (or other) statutes may apply:  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.76.180" RCW 9A.76.180 Intimidating a Public Servant;  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.46.110" RCW 9A.46.110 Stalking;  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.04.790" RCW 74.04.790 Reimbursement for employees being victims of assault. For additional information related to APS worker safety refer to:  HYPERLINK \l "_APS_Worker_Interview_Safety" APS Worker Interview Safety section; The  HYPERLINK "Attachments%20and%20Links/APS%20Field%20Safety%20Checklist.doc" APS Field Safety Checklist tool; and  HYPERLINK "http://adsaweb/APS/documents/APS%20Worker%20Safety%20Training.pps" APS Online Safety Training. APS Intake Intake is the initial gathering of report information about an allegation of abandonment, abuse, financial exploitation, neglect, or self-neglect of a vulnerable adult. APS Receipt of Reports APS may receive reports directly, or, other entities (e.g., HYPERLINK "APS%20List%20of%20Acronyms.doc"RCS, HYPERLINK "APS%20List%20of%20Acronyms.doc"DOH) may receive the initial report and forward it to APS. Within 24 hours of APS knowing that an intake report of suspected abandonment, abuse, financial exploitation, neglect or self-neglect of a vulnerable adult has been received, APS will initiate a response as required under RCW 74.34.063. An initial response may include, but is not limited to: Refer the report to the appropriate agency for investigation; Refer the report to law enforcement; Contact the reporter or collateral sources for additional information; Screen out the report for failure to meet program criteria; or Assign the report for investigation. Note: If assigned as a High Priority investigation, APS must also initiate the investigation and conduct a face-to-face interview with the alleged victim within 24 hours of APS knowledge of the report. (More about HYPERLINK \l "_APS_Intake_Report_Screening Process"Screening Reports). To receive reports, each HCS Region must: Accept reports submitted by telephone/HYPERLINK "APS%20List%20of%20Acronyms.doc"TTY, FAX, in-person, mail or e-mail; Have at least one published toll-free voice line telephone number available for anyone wishing to submit a report; Have a separate TTY number for APS Intake for individuals who are deaf, hard of hearing or have speech impediments to submit a report; All APS Intake staff must be trained in the use of the TTY machine. The regions may use the training video provided by HYPERLINK "APS%20List%20of%20Acronyms.doc"HCS headquarters or contact the Office for the Deaf and Hard of Hearing for training; Have APS staff accept report information during regular office hours, 8:00 a.m. to 5:00 p.m., Monday through Friday, except state holidays; Check the TTY machines/calls at the beginning of each workday, every noon hour, and during the last hour of each workday; Make available a means to receive reports during the evening hours, weekends, or holidays when the office is not open; Within 24 hours of APS knowledge of receipt of a faxed or voicemail report, an intake worker will call the reporter to acknowledge receipt of the report, to gather additional information (or inform the reporter the report has been screened-out for failure to meet program criteria), unless: The report was submitted anonymously; The reporter has indicated he/she does not want to be contacted; or The report was a routine submission by a mandatory reporter without any specific personal knowledge of the situation (e.g., if the report was faxed by the hospital or law enforcement, the assigned APS worker will communicate and coordinate directly with the assigned officer conducting their investigation rather than the APS intake worker calling the clerk who faxed the referral to APS). Enter all reports of alleged abuse, abandonment, neglect, self-neglect or financial exploitation of a vulnerable adult into HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS in a timely manner. If the region that initially received the intake report is not the region that will conduct the investigation,  HYPERLINK "mailto:StranKE@dshs.wa.gov" contact HQ IT to transfer the report from one region to another in HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS. The region that received the intake will inform the investigating region of the transfer. Summoning Emergency Response Situations that require an immediate action to protect the vulnerable adult during intake or anytime the case is open, include: A crime against a person or property is in progress. A restraining order is being violated. Within the preceding 4 hours, a person 16 years old or older is alleged to have assaulted a family or household member (the mandatory arrest provisions under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=10.31.100" RCW 10.31.100 may apply). Safety of the alleged victim is in imminent jeopardy. Safety of an APS Worker is in imminent jeopardy. At intake, the APS Intake worker will: Interrupt the report intake process and call an appropriate emergency first responder, such as law enforcement, emergency medical services or a designated mental health professional. Inform law enforcement if/how APS is involved in the situation. Immediately notify the supervisor that emergency assistance was summoned during intake. Complete the intake process after contacting the emergency first responder. See  HYPERLINK \l "_Coordinating_with_Law_Enforcement" Coordinating with Law Enforcement for additional information on communication and coordination. As an APS Worker, Where do I enter information and what do I include in an APS Intake Report? Enter intake information in HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS. The APS intake report should contain available information pertinent to the situation which may include, but is not limited to: Name, address and telephone number of the vulnerable adult; Condition, needs and descriptive information (e.g., age) of the vulnerable adult; Name, address, telephone number of the alleged perpetrator; Sufficient information to determine if an element of abuse, neglect, financial exploitation, self-neglect, or abandonment is alleged; Any safety considerations that may cause concern or present a hazard to the APS worker assigned to conduct the investigation. Potential concerns include, but are not limited to: weapons, dogs/animals, drug or alcohol usage by victim or perpetrator, history of abuse, uncontrolled or unpredictable behavior by victim or perpetrator, a criminal record, or hazardous conditions or circumstances regarding the residence of the victim; Name, address, and telephone number of any individuals who may have knowledge of the situation. The intake worker must look in APSAS and Barcode for any information on the AV and AP. Check other databases on a case by case basis that are relevant and available (such as the Client Registry, HYPERLINK "APS%20List%20of%20Acronyms.doc"ACES, DDD Quick Client Look-Up tool) for pertinent information on the AV and AP. Document the searches and the information obtained. Create a separate intake report: For each alleged victim and/or each alleged perpetrator involved in a situation; For allegations of self-neglect and allegations of mistreatment by others (i.e., an intake report cannot include allegations of self neglect and allegations of abuse, abandonment, neglect and/or financial exploitation by a known or unknown alleged perpetrator). For additional information and procedures related to gathering and documenting Intake information, refer to: Guide for APS Intake APSAS Users Manual What do I Tell Reporters during Intake? Click  HYPERLINK \l "_Reporter_Confidentiality_and_Immuni" here to find out more....  HYPERLINK "http://asd.dshs.wa.gov/RPAU/documents/Admin-Policy/09-01.htm" Admin Policy 9.01 Sensitive, Critical or High Profile Cases Some APS Intake reports may involve sensitive, critical or high profile situations, which may include, but are not limited to: The alleged victim or the  HYPERLINK \l "_Investigation:_Unique_Circumstances" alleged perpetrator is a DSHS employee, relative of a DSHS employee, or an employee of AAA/Aging Network; The alleged victim or the alleged perpetrator is a relative or family member of HCS staff; The media is involved; or The alleged victim or alleged perpetrator is a public official or other high profile individual. When the report is considered sensitive or high profile: Follow local office procedures, including notification of your Regional Administrator or designee; and Place an administrative lock on the case in HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS. An administrative lock is an APSAS option code that strictly limits viewing and access to the APSAS case record by anyone not assigned to the case. The Regional Administrator or designee will determine who investigates, and may coordinate with another Regional Administrator to transfer the case if appropriate. Intake and Coordination of Cross-Region APS Reports & Cases If an intake report involves individuals or services in multiple regions, the APS region containing the county where the alleged victim permanently resides and the allegation occurred will receive and screen the report and take the lead on investigation and protective service activities. When the county of alleged victim residence and the alleged incident are not in the same region, the APS supervisors/program managers from those regions will coordinate and determine which region takes the lead. If, at the time of intake, the alleged victim is deceased or has left the state, the APS region containing the county where the victim previously permanently resided and/or the county where the allegation occurred should receive and screen the report and, if appropriate, assign the case and take the lead. If the county of alleged victim residence and the alleged incident are not in the same region, the APS supervisors/program managers from those regions will coordinate and determine which region takes the lead. Whenever APS workers from multiple regions or offices become involved in different aspects of a case (such as doing a courtesy interview), the APS supervisors/program managers will communicate to coordinate the logistics as needed.  HYPERLINK "mailto:StranKE@dshs.wa.gov" Contact HQ IT to transfer a report or case from one region to another in HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS. APS Referrals to/from other Investigative Authorities APS receives intake reports from other investigative agencies. APS will forward allegations to appropriate investigative authorities: At intake; and/or During the APS investigation or provision of protective services; and/or At case closure. APS can make an  HYPERLINK \l "_Investigation:_Findings" APS finding using information/evidence provided to APS by another investigative authority. (More information on  HYPERLINK \l "_Investigation:_Procedures_for_ALL A" Interviews and  HYPERLINK \l "_Investigation:_Findings" Findings) APS will attempt to communicate and  HYPERLINK \l "_Investigation,_Protective_Services," coordinate the investigation with other investigative authorities. Law Enforcement HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.063"RCW 74.34.063 Resource Note: Access the HYPERLINK "http://www.atg.wa.gov/vacn.aspx"AGO/MFCU Vulnerable Adult Contact Network (VACN) website to obtain current law enforcement contact information. Regions must provide the VACN website with updates to ensure accurate APS contact information is available to VACN users.  Reporting to Law Enforcement Make an immediate report to law enforcement when the intake report or investigation gives you reason to suspect the alleged abuse, abandonment, neglect or financial exploitation may be criminal. Examples of local, state or federal law enforcement include but are not limited to: police department, county sheriff, Washington State Patrol, FBI, Federal Office of the Inspector General. The department must make a report to law enforcement under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.063" RCW 74.34.063 even if: Another non-department person has already reported the concern to law enforcement; and/or Law enforcement does not want to receive the minor incidents (e.g., possible assault 4). Consent from the alleged victim or reporter is not required for APS to make the report. Provide the name and identifying information of the HYPERLINK "APS%20List%20of%20Acronyms.doc"AV, HYPERLINK "APS%20List%20of%20Acronyms.doc"AP and reporter to law enforcement. And, if known, inform law enforcement of the reporters request for confidentiality, safety concerns as a result of submitting the report, and relationship to the AV. If known, indicate the potential crime(s) in the referral to law enforcement. Allegation to APS:Potential crimes may include, but are not limited to:NeglectCriminal Mistreatment ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.42.020" RCW 9A.42.020) Endangerment with a Controlled Substance ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.42.100" RCW 9A.42.0100) Kidnapping, Unlawful Imprisonment ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.40" Chapter 9A.40 RCW)Financial ExploitationTheft and Robbery ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.56" Chapter 9A.56 RCW) includes the crimes of theft, extortion, robbery, financial fraud etc. Identity Crimes ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9.35" Chapter 9.35 RCW) includes identity theft. Burglary and Trespass ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.52" Chapter 9A.52 RCW) Forgery (HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.60"Chapter 9A.60 RCW) Sexual AbuseSex Offenses ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.44" Chapter 9A.44 RCW) including rape, indecent liberties, voyeurism. Physical AbuseAssault Physical Harm ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.36" Chapter 9A.36 RCW) includes the crimes of assault, coercion, reckless endangerment, malicious harassment. Homicide ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.32" Chapter 9A.32 RCW) includes the crimes of murder, manslaughter, and homicide by abuse.Mental AbuseHarassment ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.46" Chapter 9A.46 RCW) includes the crimes of harassment, stalking, coercion, etc. Indecent Exposure ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.88" Chapter 9A.88 RCW) Malicious Mischief ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9.61" Chapter 9.61 RCW) includes the crimes of cyberstalking, telephone harassment, etc.AbandonmentAbandonment of a Dependent Person ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.42.060" RCW 9A.42.060) Reporting an emergency or life threatening situation? Use 911 to make an immediate report to law enforcement; Document this call in APSAS; and Immediately inform your supervisor. Click  HYPERLINK \l "_Summoning_Emergency_Response_during" here for more information... Reporting a non-emergency situation? Report to law enforcement using the method specified in your regional written protocol (e.g., by phone, fax, e-mail, mail). Document the referral in HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS. Create written referrals using the form generated in APSAS called the Criminal Investigation Request - APS Referral and save a copy in the APS case record. Inform law enforcement if/how APS is involved in the situation. If an APS case is open related to this report, see HYPERLINK \l "_Coordinating_with_Law_Enforcement"Coordinating with Law Enforcement regarding communication and coordination. The Medicaid Fraud Control Unit (MFCU) The HYPERLINK "http://www.atg.wa.gov/ProtectingSeniors/default.aspx"Medicaid Fraud Control Unit (MFCU) is responsible for policing Medicaid providers and Medicaid program expenditures. They are located within the Criminal Justice Division of the Office of the Attorney General. Reporting to the MFCU DSHS has a written memorandum of understanding (MOU) with the HYPERLINK "APS%20List%20of%20Acronyms.doc"MFCU regarding reporting and sharing of information for all suspected cases of Medicaid fraud and allegations of resident abuse, neglect, or financial exploitation in residential care facilities receiving Medicaid funds. When the APS intake report or investigation indicates that a Medicaid provider may have committed fraud involving Medicaid funds (e.g., a COPES provider): Fax a written referral to the MFCU in Olympia at: 360-586-8877 The MFCU central phone number is: 360-586-8888 Do not refer an allegation to the MFCU when the alleged perpetrator of abuse, neglect or financial exploitation of a resident in an AFH, BH, NH is not a Medicaid provider (e.g., if the AP is a family member external to the facility). Department of Health (DOH)  HYPERLINK "http://www.doh.wa.gov/hsqa/fsl/default.htm" DOH - Facilities and Services Licensing (FSL) FSL creates and enforces safety and care standards for state licensing and Medicare certification for medical, health, child and residential care providers, state agency institutions, lodging establishments, and the state ferry system. Services and facilities that are licensed by DOH FSL include, but are not limited to: Acute Care Hospitals ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=70.41" Chapter 70.41 RCW); Childbirth Centers ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=18.46" Chapter 18.46 RCW); Private Psychiatric and Chemical Dependency Hospitals ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=71.12" Chapter 71.12 RCW); Hospice Care Centers ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=70.127" Chapter 70.127 RCW); Residential Treatment Facilities for adults and children with mental illness ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=71.12" Chapter 71.12 RCW); Residential Treatment Facilities for adults and children with chemical dependency (Drug or Alcohol treatment facilities) ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=71.12" Chapter 71.12 RCW); Medical or dental clinics; In-Home Services Agencies (i.e., Home Care Agency, Home Health Agency, Hospice Agency) ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=70.127" Chapter 70.127 RCW). Note: APS does not investigate concerns involving a vulnerable adult alleged victim served in a DOH licensed/certified facility if the alleged perpetrator is affiliated with the facility. Those investigations are conducted by others. APS may conduct the investigation when the HYPERLINK "APS%20List%20of%20Acronyms.doc"AP is not affiliated with the DOH licensed/certified facility. APS does investigate allegations involving abuse, neglect, abandonment or financial exploitation by an individual alleged perpetrator toward vulnerable adults living at home served by a Home Health, Home Care or Hospice Agency licensed by DOH. APS will refer allegations involving the licensed entity to DOH.  Reporting to DOH - FSL APS Intake information: Facility: If a reporter expresses concerns involving care or service to patient/resident in a setting licensed by DOH, complete an intake and screen the report, and also refer the intake report for review and consideration as follows: Hospitals, clinics, residential treatment facilities, etc: DOH FSL Hotline: 1-800-633-6828 DOH FSL Fax number: 360-236-2901 Eastern State Hospital or Western State Hospital: Eastern State Hospital: 509-299-3121 Western State Hospital: 253-761-7599 In-home services (home care, home health, hospice agency) licensed by DOH: Complete an intake and screen the report, and also refer the intake report to DOH FSL for their review and consideration: DOH FSL Hotline: 1-800-633-6828 DOH FSL Fax number: 360-236-2901 APS substantiated initial finding: Provide an Outcome Report with an APS substantiated initial finding to DOH FSL when the APS substantiated finding involved a FSL licensed service or facility (e.g. a home health, home care, or hospice agency).  HYPERLINK "https://fortress.wa.gov/doh/hpqa1/" DOH - Health Professions Quality Assurance Office (HPQA) HPQA regulates the competency and quality of health care providers by working with boards, commissions, and advisory committees to set licensing standards for 57 health care professions (e.g., medical doctors, nurses, nursing assistants, counselors, pharmacists, therapists, psychologists, etc). Under The Uniform Disciplinary Act ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=18.130" Chapter 18.130 RCW), HPQA also processes complaints concerning HYPERLINK "Uniform%20Disciplinary%20Act%20Providers.doc"certain licensed, certified or registered health care providers. Reporting to DOH - HPQA APS Intake information: APS must forward to DOH/HPQA any intake report that alleges that a Health Professional who is professionally licensed, certified, or registered under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=18.130" Chapter 18.130 RCW has abandoned, abused, financially exploited, or neglected a vulnerable adult. The requirement to notify DOH/HPQA of an allegation applies whether or not the vulnerable adult alleged victim is related to the alleged perpetrators professional role. When known by APS that the AP is a Health Professional who is professionally licensed, certified, or registered under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=18.130" Chapter 18.130 RCW, APS will provide DOH/HPQA with APS intake information (i.e., include the name of the reporter, facility/agency, and information about the allegations, name of the alleged victim and the alleged perpetrator). Use the HPQA general reporting numbers: Phone: 360-236-4700 Fax: 360-236-4626 Or, instead of using the general DOH/HPQA number to make the report, if known, use the specific reporting number for the profession of the alleged perpetrator, such as: Nursing and Nursing Assistants: Phone: 360-236-4739 Fax: 360-236-4738 APS substantiated initial finding: Provide DOH/HPQA with a copy of an APS Outcome Report at the completion of the investigation when it is known by APS that the alleged perpetrator is a health professional that is licensed, certified or registered by the HPQA. Resource: Access the DOH  HYPERLINK "https://fortress.wa.gov/doh/hpqa1/Application/Credential_Search/profile.asp" HPQA Provider Credential Search website to assist you in determining if the alleged perpetrator is a professionally licensed, certified or registered health care provider, and their current licensing status.  Licensing Authorities for Professions under Title 18 RCW (other than Health Professionals covered by HPQA) HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.063"RCW 74.34.063(5)  APS Intake information: APS must forward to the proper licensing authority any intake report alleging abuse, abandonment, neglect or financial exploitation by an alleged perpetrator known by APS to be professionally licensed, certified or registered under  HYPERLINK "http://apps.leg.wa.gov/rcw/default.aspx?Cite=18" Title 18 RCW, for the professions listed in the table below. The requirement to notify the proper licensing authority of an allegation applies whether or not the alleged victim of abuse, abandonment, neglect, or financial exploitation is related to the alleged perpetrators professional role. Send, call or fax the APS intake report to the appropriate professional credentialing authority. ProfessionAuthority for License, Registration or CertificationContact Information to Make a ReportCertified Public Accountants  HYPERLINK "http://www.cpaboard.wa.gov/default.htm" Board of Accountancy Board of Accountancy PO Box 9131 Olympia, WA 98507-9131 Phone: (360) 664-9194Architects HYPERLINK "http://www.dol.wa.gov/forms/636016.htm" Dept. of LicensingBoard of Registration for Architects PO Box 9045 Olympia, WA 98507 Phone: (360) 664-1388 Fax: 360.664.1495Art dealers ArtistsAttorneys at law HYPERLINK "http://www.wsba.org/" Washington State Bar Association Washington State Bar Association 2101 Fourth Avenue, Suite 400 Seattle, WA 98121-2330 Phone: (206)727-8207 or (800)945-9722 Fax: 206.727.8325AuctioneersHYPERLINK "http://www.dol.wa.gov/"Dept. of LicensingAuctioneer Program Department of Licensing PO Box 9048 Olympia, WA 98507 Phone: (360) 664-6636 Fax: 360.664.2550Bail bond agentsHYPERLINK "http://www.dol.wa.gov/"Dept. of LicensingBail Bond Licensing Department of Licensing PO Box 9649 Olympia, WA 98507-9649 Phone: (360) 664-6624 Fax: 360.570.7888Contractors HYPERLINK "https://fortress.wa.gov/lni/bbip/" Dept. of Labor & IndustriesDepartment of Labor and Industries PO Box 44810 Olympia, WA 98504 Phone: (360) 902-5799Cosmetologists barbers, and manicuristsDepartment of LicensingDepartment of Licensing Cosmetology Licensing Program PO Box 9026 Olympia, WA 98507-9026 Phone: (360) 664-6626 Fax: 360.664.2550Engineers and land surveyorsDepartment of LicensingBoard of Registration for Professional Engineers and Land Surveyors PO Box 9025 Olympia, WA 98507-9025 Phone: (360) 664-1564Escrow agents HYPERLINK "http://www.dfi.wa.gov/sd/escrow_act_info.htm" Dept. of Financial Institutions  HYPERLINK "http://www.dfi.wa.gov/consumers/complaint.htm" Washington Department of Financial Institutions File a Complaint Fire sprinkler system contractorsDepartment of LicensingBoard of Registration for Professional Engineers and Land Surveyors PO Box 9025 Olympia, WA 98507-9025 Phone: (360) 570-3134GeologistsDepartment of LicensingGeologist Licensing Board PO Box 9045 Olympia, WA 98507-9045 Phone: (360) 664-1497 Fax: 360.664.1495Landscape architectsDepartment of LicensingBoard of Registration for Landscape Architects PO Box 9045 Olympia, WA 98507-9045 Phone: (360) 664-1497 Fax: 360.664.1495Plumbers HYPERLINK "https://fortress.wa.gov/lni/bbip/" Dept. of Labor & IndustriesWA State Department of Labor and Industries Plumber Certification PO Box 44000 Olympia, WA 98504-4000 Phone: (360) 902-5207Private investigatorsDepartment of LicensingPrivate Investigator Licensing PO Box 9649 Olympia, WA 98507-9649 Phone: (360) 664-6611 Fax: 360.570.7888Process serversReal estate brokers, appraisers and salespersons HYPERLINK "http://www.dol.wa.gov/" Dept. of Licensing Department of Licensing Real Estate Licensing Section PO Box 9015 Olympia, WA 98507-9015 Phone: (360) 664-6500 or (360) 664-6488 Fax: (360) 586-0998 Security guardsDepartment of LicensingPrivate Security Guard Licensing PO Box 9649 Olympia, WA 98507-9649 Phone: (360) 664-6611 Fax: 360.570.7888 APS substantiated initial finding: APS may provide the proper professional licensing authority with a copy of the APS Outcome Report involving an alleged perpetrator who is professionally licensed, certified or registered by that authority. Reporting professional conduct concerns that are not related to the investigated allegation or the substantiated finding: APS worker if you identify a potential concern about the professional practice of anyone involved in the case who is licensed, certified or registered under  HYPERLINK "http://apps.leg.wa.gov/rcw/default.aspx?Cite=18" Title 18 RCW, inform your supervisor/program manager of your concern. Also notify your supervisor/program manager of persons claiming to be a professional under Title 18 when APS has reason to believe they are not licensed, certified or registered as required (e.g., someone who was claiming to be a nurse but was not found on the HPQA Provider Credential Search website). APS supervisor/program manager consult with the AAG, to determine if and what APS information to forward to the professional licensing authority. Document the referral in APSAS.  DSHS (RCS, CPS) Several divisions within DSHS conduct investigations. APS will administer the 2003 DSHS Cross-Program Investigation Protocol for investigations involving vulnerable adults or children across administration lines. See the HYPERLINK "Attachments%20and%20Links/DSHS%20Cross-Program%20Investigations%20Protocol.doc"DSHS Cross-Program Investigations Protocol for more information. Who within DSHS can receive information related to an APS finding? APS may share an Outcome Report of a unsubstantiated, inconclusive or substantiated initial finding with others within DSHS who have a need to know the information in order to administer a DSHS program (examples include, but are not limited to: the requestor is involved in investigating a situation that could pose a risk to a child, disabled person, or vulnerable adult; or requires the information to assess an applicant as per a requirement in RCW, WAC or contract). What do I do if the report is made to the wrong place within DSHS? If someone calls APS to make a report, but the report is not intended for APS (e.g., the reporter should have called CRU), APS will implement the no wrong door philosophy by taking the report, screening it out, and immediately forwarding the report to the DSHS division responsible for conducting the investigation of the allegation. If the appropriate division is unknown, the caller may be directed to 1-866-ENDHARM (1-866-363-4276) to make the report. When APS is referring a report to CRU that involves an alleged victim or alleged perpetrator affiliated with a certified supported living/HYPERLINK "APS%20List%20of%20Acronyms.doc"SOLA setting, use the HYPERLINK "Attachments%20and%20Links/APS%20SL%20Fax%20to%20CRU%20form.doc"APS to SL Fax to CRU coversheet to inform RCS whether APS will investigate. When the division that receives the report determines that another DSHS division may also want to investigate the report, the receiving division will forward a copy of the report to the appropriate division within one working day. The division that has primary responsibility for investigating the report will contact law enforcement when necessary. Indian Tribes in Washington Every region shall offer each  HYPERLINK "http://askgeorge.wa.gov/dshs/highlight/index.html?url=http%3A//www1.dshs.wa.gov/dcs/tribal/tribes.shtml&fterm=tribes&la=en&search=../query.html%3Fcharset%3Diso-8859-1%26nh%3D7%26style%3Dsow%26col%3Ddshs%26origin%3Ddshs%26qt%3Dtribes" federally recognized tribe the opportunity to develop a customized negotiated working agreement between APS and the Tribe. APS will negotiate with each tribe who expresses a desire to enter into an agreement for the purposes of establishing protocols for communication and coordination on the topics of intake, investigation and protective services for vulnerable adults, as specified in  HYPERLINK "http://adsaweb/docufind/MB/displayHCS.asp?year=2004" MB H04-059. APS Intake information: Follow the Intake notification and communication protocol specified in the applicable Tribal written working agreement. Investigation and Protective Services: Follow the protocol specified in the applicable Tribal written working agreement that will specify what activities APS will do and what activities the Tribe will do. APS Substantiated Initial Finding: Follow the notification and communication protocol specified in the applicable Tribal written working agreement. APS or Law Enforcement in another State At this time, APS does not have a MOU with APS in another state or country. Intake All in another State: If the reporter calls with a concern about an alleged victim and an allegation in another state, provide the caller with the  HYPERLINK "http://www.elderabusecenter.org/default.cfm?p=apsstate.cfm" \l "al" appropriate reporting information for that state. Part in WA, Part in another State: If an intake report involves allegations or individuals (alleged perpetrator or alleged victim) in Washington and another state/country, the APS region where the alleged victim resides or where the allegation occurred will receive and screen the report. The APS supervisor/program manager, in consultation with the AAG, will determine on a case-by-case basis if APS has jurisdiction to assign the case for investigation or to provide assistance in response to a request from another state or country. Investigation, Protective Services, Sharing Case Record Information After consultation with the AAG, on a case-by-case basis, if it is determined that Washington APS will conduct or participate in an investigation, the APS supervisor/program manager will coordinate with APS in the other state/country to determine what (if any) activity will be conducted by Washington APS workers. Examples of coordination may include, but are not limited to: provide a courtesy welfare check of a vulnerable adult in Washington; provide information of the whereabouts of a specific individual. The APS supervisor/program manager will determine when to forward a Washington APS Outcome Report or other APS case record information to APS in another state. Before sharing any Washington APS case record information with APS in another state or country, APS will verify that their confidentiality laws are roughly equivalent to (or exceed) the confidentiality provisions of Washington law. Overview Chart: Sharing APS Intake Report Information with Others (see text of chapter for details) APS Will Share Intake Report InformationWith:When:Law Enforcement (use APSAS Law Enforcement Referral form)Immediately when a crime is suspected, per HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.063"74.34.063(2)Medicaid Fraud Control Unit (per HYPERLINK "APS%20List%20of%20Acronyms.doc"CFR and HYPERLINK "APS%20List%20of%20Acronyms.doc"MOU)Anytime Medicaid fraud is suspected. CRU/Residential Care Services Anytime the allegation involves an alleged victim who is a resident living in a HYPERLINK "APS%20List%20of%20Acronyms.doc"NH, BH, AFH, ICF/MR, certified HYPERLINK "APS%20List%20of%20Acronyms.doc"SL/SOLA.Department of Health: Health Professions Quality Assurance Division (HPQA)When the alleged perpetrator is a health care professional licensed, certified or registered by DOH under  HYPERLINK "http://apps.leg.wa.gov/rcw/default.aspx?Cite=18" Title 18 RCW, as per  HYPERLINK "http://www.leg.wa.gov/RCW/index.cfm?fuseaction=section§ion=74.34.063" RCW 74.34.063(5).Appropriate proper professional authority When the alleged perpetrator is a licensed, certified or registered by the authority under  HYPERLINK "http://apps.leg.wa.gov/rcw/default.aspx?Cite=18" Title 18 RCW, as per  HYPERLINK "http://www.leg.wa.gov/RCW/index.cfm?fuseaction=section§ion=74.34.063" RCW 74.34.063(5). APS Can Share Intake Report InformationWith:When:HCS/AAA DDD Childrens AdministrationPer this chapter and local procedures, for a purpose consistent with HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34"Chapter 74.34 RCW, APS may share information from the intake report within DSHS. Indian Tribes in WashingtonPer the regional customized negotiated working agreement with a Tribe.ProsecutorWhen a crime is suspected, per  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.063" RCW 74.34.063APS or Law Enforcement in Another StateFollowing review and approval of the AAG. Screening Reports APS determines if an intake report will be investigated. The Intake Worker, or APS Supervisor per regional protocol, screens all intake reports and decides: If APS has jurisdiction under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW, applicable HYPERLINK "APS%20List%20of%20Acronyms.doc"MOUs, etc; Whether an allegation will or will not be assigned for investigation by APS; and The timeframe (priority) for initiation of each assigned investigation. APS Intake Report Screening Process Review the facts and circumstances known at intake; If the information from the reporter is insufficient to determine whether or not to assign the report for APS investigation, then attempt to gather additional information (e.g., make phone calls to collateral contacts and/or check readily available databases). Document this information in APSAS; Compare information provided by the reporter, and any additional preliminary information gathered during the intake process, with the criteria identified in the section:  HYPERLINK \l "_Reaching_a_Decision_to Screen-Out a" Circumstances under which APS will Screen-Out an Intake Report and the section: HYPERLINK \l "_Unable_to_determine_if the alleged "Circumstances Under Which APS Will Investigate; Decide if the report will, or will not, be assigned for an APS investigation based on the screening criteria; If the report meets the criteria for Screen-out: Do not assign the report for investigation; Inform the reporter that APS will not investigate; and Tell the reporter or alleged victim about potential appropriate services, if warranted (e.g., local domestic violence resource); Refer all screened out APS reports to an appropriate resource for follow-up, including: The entity designated to investigate identified concerns (e.g., RCS, CA); HCS/Aging Network, or DDD case management system for their appropriate action when the alleged victim is one of their clients, and: They were the source of the report; or They were not the source of the report, but case management may want to evaluate and address the concerns. Document the screen out decision and referrals in the APSAS intake narrative, and select the appropriate screen-out dropdown designation in APSAS. If an agency or reporter disagrees with the decision to screen-out the intake report, then the APS supervisor or program manager will review the intake report and: Either agree with the original decision to screen-out the report or make a decision to assign the report for investigation; Inform the APS worker or supervisor who made the original decision and the disagreeing party of your decision; and Document your review and decision in HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS. OR-- If the report will be assigned for investigation: Determine the priority and timeframe for the initiation of the investigation; and Assign the case to a specific APS worker. Overview Chart of Intake Flow  EMBED Visio.Drawing.6  Overview of Screening Decision Factors  EMBED Visio.Drawing.6  Circumstances under which DSHS will Screen-Out an Intake Report (not assign for APS investigation) Review the facts and circumstances known at intake; Do not assign the report for APS investigation (i.e., screen-out the report) when any one of the conditions on the following  HYPERLINK \l "_Screen_Out_Decision" Screen Out Decision Criteria Chart are present. Screen Out Decision Criteria Chart APSAS DesignationCriteria for Screen-OutNot a Vulnerable AdultIt is clear that at the time of the alleged incident the alleged victim did not meet the definition of a vulnerable adult in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 or  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.021" RCW 74.34.021 Note: If the alleged victim goes in and out of vulnerable adult status, go  HYPERLINK \l "_The_alleged_victim" here for more screening decision information). Not an AllegationThe allegations do not contain elements of abandonment, abuse, financial exploitation, neglect, or self-neglect as defined in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 Other Invest. AuthorityThe alleged victim is a vulnerable adult but another investigative authority has jurisdiction (per statute, HYPERLINK "APS%20List%20of%20Acronyms.doc"WAC, HYPERLINK "APS%20List%20of%20Acronyms.doc"MOU, contract, working agreement or DSHS protocol, etc.) based on the location of the alleged incident or the nature of the alleged perpetrator, and APS has forwarded the intake to them. Note: If the alleged perpetrator is a DSHS/AAA/Aging Network employee, go  HYPERLINK \l "_Alleged_Perpetrator_is" here for more screening decision information. Insufficient Info.The report contains insufficient information to locate the alleged victim and APS has been unable to obtain clarification. Isolated medication errorThe allegation is of an isolated medication error that did not result in injury to the alleged victim (e.g., wrong medication, dose, route, time of day, or patient). Isolated no/superficial injuryThe allegation is of an isolated incident (e.g., not a pattern) that resulted in no injury or only superficial injury. Case management, caregivers, or providers have intervened. Examples include, but are not limited to: Alleged, isolated incident of financial exploitation of nominal value (e.g., borrowing money for a tank of gas that was paid back, or damage to property). Alleged isolated incident of physical abuse between clients of HYPERLINK "APS%20List%20of%20Acronyms.doc"DDD in a contracted program that resulted in no injury or only superficial physical injuries limited to surface layers of the skin, easily treated with minor first aid, did not require medical examination, and are located in areas generally susceptible to trauma (e.g., such as a hair pull; being hit by a thrown object; bruise or scratch from a kick to the shins). Alleged Victim DeceasedThe alleged victim is deceased at the time of APS intake and: The allegation is of financial exploitation or self-neglect; or The allegation is of abandonment, abuse, or neglect, but the victim died more than 14 calendar days before the intake report was made to APS.  Circumstances under which APS will Investigate Unable to determine if the alleged victim was a vulnerable adult When the allegations appear to contain elements of the  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 definitions of abandonment, abuse, financial exploitation, neglect or self-neglect, but intake is unable to determine whether or not the alleged victim was a vulnerable adult as defined in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 or  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.021" RCW 74.34.021 at the time of the allegation: Assign the report for APS investigation; Determine if the alleged victim was/is a vulnerable adult; and If the alleged victim is not a vulnerable adult, close the APS investigation and refer the individual to other resources for appropriate services. In APSAS, document the case closure as Closed No APS and document any referral. The alleged victim goes in and out of vulnerable adult status If the alleged victim was a vulnerable adult prior to the current allegation, but at the time of the current allegation does not specifically meet any of the  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW vulnerable adult criteria: Assign the report for investigation when it appears that actions by the alleged perpetrator or others are the reason the alleged victim no longer meets the vulnerable adult criteria and APS has a good faith belief that the alleged victim would still meet the vulnerable adult criteria were it not for the intervention of others (e.g., is no longer receiving home care services, no longer has an IP, no longer lives in a facility, the deceased guardian was not replaced). Do not assign the report for investigation if the person had the status of a vulnerable adult under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW because he or she was admitted to a facility, but is not a vulnerable adult at the time of the current allegation because he or she chose to leave the facility. Allegations appear to meet the RCW definitions When the allegations appear to contain elements of the  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 definitions of abandonment, abuse, financial exploitation, neglect or self-neglect, and the alleged victim appears to be a vulnerable adult as defined in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 or HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.021"RCW 74.34.021, then assign the report for APS investigation if: The alleged victim is living at home; or The alleged victim is living in a setting that is not required to be licensed (e.g., a retirement community) or a setting that should be licensed but isnt (e.g., if care is being provided to two or more people unrelated to the provider, an AFH license is required). The vulnerable adult resides in a licensed or certified setting The vulnerable adult alleged victim resides in a NF, BH, or AFH licensed by RCS APS will conduct investigations when the alleged perpetrator is not affiliated with the  HYPERLINK \l "_APS_List_of" NF, HYPERLINK "APS%20List%20of%20Acronyms.doc"BH, or HYPERLINK "APS%20List%20of%20Acronyms.doc"AFH (e.g., APS will investigate when the alleged perpetrator is a family member of the victim, a visitor, friend, or community member). HYPERLINK "APS%20List%20of%20Acronyms.doc"RCS will conduct investigations when the alleged perpetrator is the licensee/operator, staff, volunteer, or another resident. In some instances, both APS and RCS may be involved in an investigation for different purposes. Communicate and coordinate the investigations as appropriate. The vulnerable adult alleged victim resides in a supported living/SOLA setting certified by RCS APS will conduct investigations when the alleged perpetrator is not affiliated with the residential setting (e.g., APS will investigate when the alleged perpetrator is a family member of the victim, a visitor, friend, or community member). Client-to-client altercations: APS will conduct investigations when the alleged client-to-client altercation occurred while the alleged victim was not under the supervision of the supported living/HYPERLINK "APS%20List%20of%20Acronyms.doc"SOLA provider (e.g., at a vocational program or on a community outing). RCS will conduct investigations when the alleged perpetrator is the licensee/operator, staff, volunteer, or if another resident who is under the supervision of the provider. In some instances, both APS and RCS may be involved in an investigation for different purposes. Sometimes the investigations may occur simultaneously, or sometimes they may occur one after the other based on the initial findings.  HYPERLINK \l "_Coordinating_with_RCS_or CA for Inv" Communicate and coordinate investigations with RCS, appropriate to the circumstances of the case. The vulnerable adult alleged victim resides in a Foster Home licensed by Childrens Administration When the alleged victim is a client of  HYPERLINK "APS%20List%20of%20Acronyms.doc" DDD age 18-21, still in school and receiving services while living in a foster home licensed by Childrens Administration: APS will conduct investigations when the alleged perpetrator is not affiliated with the residential setting (e.g., APS will investigate when the alleged perpetrator is a family member of the victim, a visitor, friend, or community member). Childrens Administration (CA) (either HYPERLINK "APS%20List%20of%20Acronyms.doc"DLR or HYPERLINK "APS%20List%20of%20Acronyms.doc"CPS) will conduct investigations when the alleged perpetrator is the licensee/operator, staff, volunteer, or another resident. In some instances, both APS and CA may be involved in an investigation for different purposes.  HYPERLINK \l "_Coordinating_with_RCS_or CA for Inv" Communicate and coordinate the investigations as appropriate. As per the HYPERLINK "Attachments%20and%20Links/DSHS%20Cross-Program%20Investigations%20Protocol.doc"DSHS Cross-Programs Investigation Protocol, ADSA will be available, as requested by CA, to identify and provide consultation to address the needs of the 18-21 year-old alleged victims. The vulnerable adult alleged victim resides in a DSHS JRA setting Childrens Administration (CA) (either HYPERLINK "APS%20List%20of%20Acronyms.doc"DLR or HYPERLINK "APS%20List%20of%20Acronyms.doc"CPS) will conduct investigations for all vulnerable adult clients of HYPERLINK "APS%20List%20of%20Acronyms.doc"JRA. As per the HYPERLINK "Attachments%20and%20Links/DSHS%20Cross-Program%20Investigations%20Protocol.doc"DSHS Cross-Programs Investigation Protocol, ADSA will be available, as requested by CA, to identify and provide consultation to address the needs of the 18-21 year-old alleged victims. The vulnerable adult alleged victim is a patient at Western State Hospital or Eastern State Hospital APS will investigate if the alleged perpetrator is not affiliated with the hospital, and the allegations are of abuse, abandonment, neglect, or financial exploitation (i.e., APS will not investigate when the alleged perpetrator is staff, a volunteer, or another resident; or the alleged victim is not a vulnerable adult as defined in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 and HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.021"RCW 74.34.021). The alleged victim is deceased at the time of intake Refer all intake reports of abuse, abandonment, neglect and financial exploitation to law enforcement. Do not refer allegations of self-neglect; Screen-out all reports of self-neglect and financial exploitation; Assign the report for APS investigation when: The alleged victim was a vulnerable adult at the time of the allegation; and The allegations are of abuse, abandonment or neglect; and The vulnerable adult was alive at the time of the alleged event; and The alleged victim died less than 14 calendar days before the report was made to APS. The purpose of an APS investigation is to attempt to determine the validity of the allegation of abuse, abandonment, or neglect. And if the allegation is substantiated, per  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-0110" WAC 388-71-0110(3), identify other vulnerable adults who are at risk of abuse, abandonment or neglect from the same perpetrator (create a new APS Intake Report for each newly identified vulnerable adult). Determinations about the cause of death or factors that may have contributed to a death are made by the Coroner, Medical Examiner, law enforcement and/or medical personnel not APS. Investigation Response Priority Categories: High, Medium or Low APS Intake Worker or Supervisor/Program Manager per regional protocol: Review the facts and circumstances known at intake; Assign the report for investigation and give it a priority, based on the severity and immediacy of actual or potential physical, mental or financial harm; Immediately notify the investigator and the Regional Administrator/designee when a Priority High assignment is made. Name of PriorityMaximum Response TimeframeCriteria and some examples High 24 hoursSerious or Life Threatening harm is occurring or appears to be imminent.  HYPERLINK \l "_Summoning_Emergency_Response_during" Emergency response summoned during intake (e.g., police, HYPERLINK "APS%20List%20of%20Acronyms.doc"EMT, HYPERLINK "APS%20List%20of%20Acronyms.doc"CDMHP). Physical wounds such as a possible fracture, severe burn, laceration requiring sutures, head injury, internal injuries, bruising on the face or trunk. Possible sexual assault within past 72 hours. Self-neglect or neglect resulting in risk of freezing, starvation, or hemorrhaging or individual is in need of urgent medical attention and is refusing or unable to consent to medical care. Caregiver has abandoned a vulnerable adult without a means to protect or care for self (e.g., individual with dementia). Living environment has serious biological or physical hazards or major structural damage (e.g. drug lab on the premises, tree fell through the roof). Report alleges forced isolation or imprisonment or use of restraints. Medium 5 working daysHarm that is more than minor, but does not appear to be life threatening at this time, has occurred, is on going, or may occur. Stable physical or mental condition that is not acute (e.g., depression, disease or illness, poor nutrition). Chronic self-neglect. Exploitation. Low 10 working days Harm that poses a minor risk at this time to health or safety, has occurred, is ongoing, or may occur. Physical injury that is superficial, minor or healed, and without an imminent risk of reoccurrence (e.g., the alleged perpetrator has left). Allegation of an event that occurred weeks ago without apparent risk of reoccurrence. Verbal abuse such as harassment or cursing. Unkempt or filthy living conditions. Lack of appropriate contribution to food and shelter expenses by household members or failure to pay the vulnerable adults bills.  On a case-by-case basis, the supervisor/program manager or designee may specify a response time shorter than the standard maximum response time for the priority level. Document the reason for the unique response time in the APSAS assignment notes. Begin calculation of response time at intake when APS first has knowledge of the report (not at the point of assignment when the investigator first has knowledge). Within the designated response time (i.e., before the end of the 5th working day after the date of intake of a report prioritized as medium) the APS investigator will: Initiate the investigation by gathering information pertinent to the allegation; and Conduct a face-to-face interview with the alleged victim  HYPERLINK \l "_Timeframe_to_Conduct_the Interview" within the appropriate timeframes unless there is an approved and unavoidable reason that the first face-to-face interview must be conducted at a later date or cannot be conducted at all. NOTE: Please refer to these sections when  HYPERLINK \l "_A_Person_is" the person is reported to be non-interviewable or to determine  HYPERLINK \l "_When_Is_an" when an interview is not required. Investigation: Coordinating with Other Investigative Authorities Statewide:  HYPERLINK \l "_Reporting_to_the_MFCU" Coordinating with the Medicaid Fraud Control Unit (MFCU)  HYPERLINK \l "_DSHS_(RCS,_CPS)" Coordinating with other divisions in DSHS  HYPERLINK \l "_Coordinating_with_the" Coordinating with DOH  HYPERLINK \l "_Coordinating_with_the_1" Coordinating with the Long-term Care Ombudsman Program Regions:  HYPERLINK \l "_Indian_Tribes_in_Washington" Coordinating with Federally Recognized Indian Tribes Coordinating with Law Enforcement Each Region must have written protocols to facilitate APS contact with local law enforcement agencies. Attempt to collaborate with law enforcement in the development of the protocols, which must include: Where and how to report suspected crimes (e.g., which jurisdiction); Where and how to request emergency assistance related to APS safety concerns and/or access, or a welfare check of the alleged victim. Law enforcement enters a residence before the APS worker when conducting a joint visit to a location that poses a safety concern, unless an alternate plan is agreed to by APS and law enforcement in a pre-entry meeting. If law enforcement informs APS that they are conducting an investigation involving a vulnerable adult alleged victim, APS will: Attempt to obtain the name of the assigned officer and law enforcement case reference number. Record this information in APSAS. Attempt to communicate with law enforcement to determine if coordination of any activity is needed (e.g., law enforcement may want to interview the alleged perpetrator or vulnerable adult alleged victim before APS, or may want to conduct a joint interview or joint visit with APS). Delay or defer specific investigative activities at the explicit request of law enforcement conducting a criminal investigation; Continue to assist the vulnerable adult alleged victim in obtaining the protection offered through the courts or other protective services; Inform the law enforcement investigator of any change in residence or circumstances of the vulnerable adult alleged victim; If possible, conduct and complete the APS investigation while accommodating any requests from law enforcement to delay or eliminate specific investigation activities. APS may make an initial finding based wholly or partially on information provided by law enforcement. If APS closes a case with an inconclusive finding pending the completion of a law enforcement investigation, APS must follow-up and request a copy of the law enforcement investigation report. Based on the information in the law enforcement investigation report, APS may reopen the case for investigation and/or change the APS finding from inconclusive to substantiated or unsubstantiated. APS does not have legal authority to conduct or participate in a criminal investigation and should not do so, even if requested by a law enforcement officer or a prosecuting attorney. APS can share case record information with law enforcement for a purpose consistent with the  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.095" Abuse of Vulnerable Adults statute, and will: Send the APS Outcome Report to law enforcement for the cases that were referred by APS to law enforcement when an allegation is substantiated. Upon request, provide an APS Outcome Report for cases with unsubstantiated or inconclusive findings. Upon request, provide an unredacted copy of the APS Case Record to law enforcement. Coordinating Investigations with Medicaid Fraud Control Unit (MFCU) MFCU sends the APS statewide program manager a list of newly opened investigations each month. If the APS program manager determines that the target of MFCU investigation is identified in APSAS as an alleged perpetrator, and APS is not already coordinating with MFCU on this matter, the APS statewide program manager will direct the region to contact MFCU to determine if any coordination is needed between APS and MFCU at the present time. If requested, APS shall provide MFCU an unredacted copy of the APS case record. Coordinating with RCS or CA for Investigations Involving Residents in a DSHS Licensed or Certified Setting Several divisions within DSHS conduct investigations. Administer the HYPERLINK "Attachments%20and%20Links/DSHS%20Cross-Program%20Investigations%20Protocol.doc"2003 DSHS Cross-Program Investigation Protocol for investigations involving vulnerable adults or children across administration lines. APS may conduct an investigation in a facility licensed or certified by the department (i.e., HYPERLINK "APS%20List%20of%20Acronyms.doc"AFH, BH, NF, ICF/MR, CA Foster Home) if the alleged victim meets the definition of a vulnerable adult and the alleged perpetrator is not affiliated with the licensed setting. The licensing authority may concurrently investigate licensing issues. APS should communicate and coordinate with the licensing authority, including: Notifying the licensing authority of the receipt of an APS intake report involving their facility or licensee, if the licensure status is known; If needed, consulting with the licensing authority to determine if the alleged victim meets the definition of a vulnerable adult; Informing the licensing authority as to whether or not APS will investigate; Determining when coordination of activities can and should occur (e.g., conducting a joint interview); Routinely providing a copy of the APS Outcome Report to the DSHS licensing authority (e.g., RCS, CA) when the allegation is substantiated and: The event occurred in the licensed setting (or in a setting that should be licensed); or The event did not occur in the licensed setting, but APS learns the event may impact the licensed setting where the APS client resides. (E.g., financial exploitation of a facility resident by a family member is substantiated. APS learns that as a result of the family members failure to pay the residents bills, the facility is actively moving toward the discharge of the APS client); or The event did not occur in a licensed setting, but APS learns the perpetrator is affiliated with a licensed setting. (E.g., the abuse may have occurred at home between family members, but APS learns that the perpetrator works in a facility). NOTE: Upon request, APS will send the licensing authority the APS Outcome Report for allegations not substantiated. Providing a copy of the APS Outcome Report to the licensed facility in which the substantiated abuse, abandonment or financial exploitation occurred (as per  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.067" RCW 74.34.067(8)). Coordinating with the Department of Health (DOH) APS will share unredacted Intake Reports and Outcome Reports with DOH as specified in the  HYPERLINK \l "_Department_of_Health_(DOH)" Department of Health (DOH) section of this chapter. APS does not have a Memorandum of Understanding (MOU) with DOH to permit sharing of APS investigative information at this time. Provide APS case record information to DOH only after DOH obtains a judges order to access the APS case record information. Coordinating with Tribes -  HYPERLINK \l "_Indian_Tribes_in_Washington" Click here to learn more... Coordinating with the Long-Term Care Ombudsman Program As authorized by federal law, the Washington Long-Term Care Ombudsman program provides education, consultation, advocacy and complaint resolution to adult family home, boarding home and nursing home residents. The Ombudsman program receives, investigates and resolves thousands of complaints each year. They are not mandatory reporters under RCW 74.34.035. The Ombudsman can report allegations to DSHS and/or share information with DSHS only with the permission of the alleged victim/resident. It is possible that APS and the Ombudsman may both conduct an investigation or have information about a situation involving a resident of a long-term care facility. If APS is aware that the ombudsman is conducting an investigation, attempt to communicate and coordinate the investigation with the ombudsman to the extent possible. APS shall share investigative information with the ombudsman: If the alleged victim or legal representative consents; or If the alleged victim lacks capacity but has no legal representative; or If the legal representative will not consent but the information is necessary for the ombudsman to investigate a complaint and there is reasonable cause to believe the legal representative is not acting in the best interest of the alleged victim. Do not share APS information with the ombudsman if the resident has capacity and does not consent to disclosure. Investigation: Procedures for All APS Investigations APS workers gather and evaluate information from observations, review of pertinent records, and interview of key persons including the reporter, the vulnerable adult alleged victim, the alleged perpetrator, and collateral contacts. Refer to the APSAS Users Manual for policy and procedure on documentation and use of the Adult Protective Services Automated System. Refer to the APS Training Academy materials for suggested techniques and application of investigative knowledge, skill and ability. Implement these procedures for all investigations conducted by APS: Cost of APS Services -  HYPERLINK \l "_Overview" Click here to learn more... Consent to Investigate Investigation: Consent of the alleged victim or legal representative is not required in order to conduct an APS investigation or interview. However, if known by APS that an alleged victim or alleged perpetrator has a legal representative, APS will attempt to provide a courtesy verbal notification to the legal representative that an investigation/interview is being conducted. APS will not provide the courtesy notification if the legal representative is an alleged perpetrator or APS has reason to believe that notification would compromise the safety or well-being of the alleged victim or the investigation. Also see section on  HYPERLINK \l "_Third_Party_Presence_in an Intervie" Third Party Presence during an interview. Protective Services: The alleged victim and/or legal representative must provide written consent prior to APS provision of protective services. See the  HYPERLINK \l "_Protective_Services" Protective Services section for more information. Interviewing the Reporter Without delaying other activities related to the case, the APS worker assigned to investigate the case shall attempt to contact and interview the reporter for verification, clarification, additional information related to the allegations and any safety concerns, unless: The report was submitted anonymously; The reporter has indicated that he or she did not want to be contacted by the APS worker during an investigation; The report was submitted by a person without any specific personal knowledge of the situation (e.g., if the report came from law enforcement, the APS investigator will communicate and coordinate with the assigned officer conducting their investigation rather than the clerk who faxed the referral to APS). Interviews - General Protocol for All APS Interviews Interview Documentation Document interviews in writing. APS shall not audio or video tape the contents of an APS interview, nor consent to another party audio or video taping the APS interview. Document the date and time of all attempted and successful telephone calls and interviews pertinent to the case. Record notes during the interview or shortly thereafter in sufficient detail to accurately document each interview relevant to the APS investigation and provision of protective services. Enter your notes in the  HYPERLINK "APS%20List%20of%20Acronyms.doc" SER within 10 working days of the date of the activity, and include the date, time, method (e.g., scheduled or unscheduled; face-to-face or telephone) and content of each interview. If more than one APS worker participated in the home visit or a joint interview, determine which worker will enter the information that you have in common into the SER. If each worker made unique observations or conducted an independent interview, then each worker must independently enter that information into the SER. Follow documentation policy and procedure in the APSAS Users Manual. Interpreters Never use family members or friends of the interviewee to interpret or translate. If you or your co-workers are not fluent in the primary or preferred language of the alleged victim, alleged perpetrator or a collateral contact (i.e. the language the person has identified as the language he or she wishes to communicate in), then obtain an interpreter. Document in the APSAS SER that an interpreter was used and where the service was obtained: Follow DSHS procedures to obtain a certified interpreter through the statewide contract. See  HYPERLINK "http://adsaweb/docufind/CoreServices/" LTC Manual Chapter 15, Limited English Proficient Persons for more information on interpreter services; If the interpreter brokerage (DSHS mandatory contract) could not provide the service then go to the  HYPERLINK "http://www.ga.wa.gov/pca/contract/06806c.doc" General Administration website and determine if their contract can provide the services; If that contract cannot provide the service, then go off contract. Refer to  HYPERLINK "http://adsaweb/docufind/CoreServices/" Chapter 15 of the LTC manual and use Appendix A Documentation for Using Non-contracted Vendors Form; Or Use the Language Line for telephonic interpretation services. Obtain the 6 digit account code and 3 digit personal code assigned to your region from your business office. See  HYPERLINK "http://adsaweb/docufind/CoreServices/" Chapter 15 of the LTC manual. Interview Behavior Disclose your identity and role; Identify the purpose of the interview in a language and level of detail appropriate to the situation; Do not disclose the identity of the reporter or witnesses (as per  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.035" RCW 74.34.035;  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.068" 74.34.068;  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.095" 74.34.095;  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.180" 74.34.180); Terminate the interview if: You have reason to believe your safety is at risk; You are asked to leave or the person being interviewed says they do not want to continue the interview; Behaviors by any party are impeding the interview process. Document the reason for termination of the interview. Ask the person being interviewed if he/she would like another opportunity to tell his/her side of the story (e.g., attempt to reschedule the interview or ask the person being interviewed if he/she would like to submit a written statement). APS Worker Interview Safety Do not conduct a private, face-to-face interview with an alleged victim, alleged perpetrator, or collateral contact when you have reason to believe it is unsafe for you to do so. Consider the environment, the person to be interviewed, and the circumstances, including but not limited to: history of allegations or incidents, the severity of any single incident, previous examples of aggressive or unpredictable behavior, substance abuse, biological hazards, structural hazards or any other factors that indicate a likely risk of harm. Discuss your concerns with your supervisor/program manager to determine appropriate precautions and options for obtaining information that may include but are not limited to: Conduct the interview in a neutral public setting rather than a private home (e.g., APS office); Conduct the interview over the telephone; Ask the interviewee to submit a written statement in lieu of an interview; or Request stand-by assistance from law enforcement at the home during the face-to-face interview. For additional information, see  HYPERLINK \l "_Safe_Field_Work_Practices" Safe Field Work Practices and APS Training Academy materials. When Is an Interview Not Required? If the following circumstances exist, an interview with the alleged victim or alleged perpetrator is not required. Document in APSAS that an interview is not required and the specific reason why. Consult with your supervisor on these cases to identify and determine other options for obtaining information. The person to be interviewed: Is deceased; Cannot be located by APS; Eludes or refuses to communicate with APS;  HYPERLINK \l "_Interviews_-_Unique_Circumstances" Is incarcerated. Conducting an interview poses a  HYPERLINK \l "_APS_Worker_Interview_Safety" serious safety risk to the APS worker or to others and the risk cannot be diffused.  HYPERLINK \l "_Reporting_to_Law_Enforcement" Notify law enforcement if criminal activity has occurred. Law enforcement or medical staff request APS to not interview the alleged victim or alleged perpetrator because of a compelling legal or medical reason. Another investigative authority (e.g., law enforcement, RCS) already completed an interview on the same subject matter as the allegation, and has provided their interview documentation to APS. The APS worker has already obtained sufficient investigation information to determine that the alleged mistreatment was not possible and will be found unsubstantiated (e.g., allegations by the person with dementia, of financial exploitation, are unsubstantiated because no funds are missing and the alleged perpetrator did not have any access to them). Consult with your supervisor before closing a case with an unsubstantiated finding under this circumstance. The allegation can be substantiated by APS based on completed proceedings, such as a judges order that addresses the matter (e.g., criminal conviction, RCS final finding). Interviewing the Alleged Victim Interview the alleged victim, except when the circumstances described in the  HYPERLINK \l "_When_Is_an_Interview Not Required?" When Is an Interview Not Required? section are met. The standard protocol is an unannounced, private, face-to-face interview with the alleged victim within the response priority timeframe. Please refer to the alleged victim Interview Sections regarding determination, on a case-by-case basis, that circumstances warrant scheduling, having a third party present, obtaining information in a manner other than in-person and /or making an exception to the response timeframe. Timeframe to Conduct the Interview Alleged Victim Timeframe Requirement: Conduct a face-to-face interview with the vulnerable adult alleged victim within the  HYPERLINK \l "_Investigation_Response_Priority_Cat" maximum response time allowed by the priority designation, unless one of the following Timeframe Exception circumstances is met. Timeframe Exceptions: Not requiring supervisor/program manager review and approval. The following circumstances result in an authorized exception to the alleged victim first interview timeframe: The alleged victim of a high priority report has been admitted to the hospital for medical intervention and there is no immediate need for protective services by APS; Law enforcement or medical staff request APS to delay the interview for a compelling legal or medical reason; A visit was attempted, but the alleged victim was not home, not available or refused to meet at that time; The visit was attempted, but interference by another person prevented APS from accessing the alleged victim; The visit was delayed as a direct result of a temporary safety concern (e.g., blizzard conditions prevented travel; worker chose not to proceed into the yard until someone could remove the ferocious dogs); The interview was delayed because an interpreter was not available; or The timing of the interview was selected to accommodate the specific request of the alleged victim (e.g., to not conflict with his or her other pre-scheduled activity, or to make arrangements to have a third party present). Requiring supervisor/program manager review and pre-approval. Additional information obtained by APS after the case was assigned for investigation indicates the harm/risk of harm is not as great as was initially believed when the report was screened and prioritized at intake. Document this as more info less urgency in APSAS, and provide a brief explanation. Any other reason not considered a pre-authorized exception or more info less urgency. Document this as other in APSAS, and provide a brief explanation. When the circumstances do not meet the interview not required criteria and the face-to-face interview of the alleged victim did not occur within the designated priority response timeframe: Document each attempted visit to conduct an interview; Document the Timeframe Exception circumstances in the SER and the appropriate APSAS Interview field; If the Timeframe Exception criteria does not apply and the alleged victim was not home when the APS worker made an unannounced visit for an initial face-to-face interview on a high priority report, then, before the end of the next working day following the unsuccessful visit, attempt a second unannounced or a scheduled visit. At the discretion of the program manager/supervisor, contact law enforcement to request a welfare check of the alleged victim; For all other circumstances in which the interview did not occur within the designated response timeframe, attempt/conduct the interview with the alleged victim as soon as possible. If APS worker is having difficulty getting to meet the alleged victim for an interview, consult with the supervisor to determine an alternative approach for access (e.g., depending on the circumstances, consider involving law enforcement to address safety concerns, obtaining an injunction if access was denied, interviewing collateral contacts to determine the whereabouts of the APS alleged victim, or calling the alleged victim and scheduling a visit); After three separate, documented, unsuccessful attempts at various times to locate the alleged victim (e.g., in-person, telephone call) send a letter to his/her last known address. If there is no reply, consult with your supervisor to determine whether the case may be closed without contacting the alleged victim, and whether other approaches or referrals are appropriate. In APSAS use the Interview Not Required field with dropdown choice: Unable to locate. Make an inconclusive finding if the case is closed without locating the AV. Scheduled versus Unscheduled Interview - Alleged Victim The initial home visit to interview the alleged victim should be unannounced. However, as determined on a case-by-case basis, it may be appropriate to schedule the initial face-to-face interview, when: Scheduling will not jeopardize the safety of the alleged victim; Scheduling will not compromise the investigation; The allegation was self-reported by the alleged victim; The alleged victim is in a facility or hospital; Earlier unannounced attempts to meet with the alleged victim were unsuccessful or it is highly unlikely the alleged victim will be available without scheduling; Scheduling is needed to accommodate a third party presence or non-residential location (e.g., if the interview will be conducted at a worksite); Scheduling will mitigate concerns about safety. If the APS worker calls the alleged victim to attempt to schedule an interview, but the alleged victim is unable or unwilling to set a date, time and location for a meeting: The APS worker will make an unannounced visit within the required response time to attempt a face-to-face interview. (Note: In person, the alleged victim may again decline the request for a visit. Document the attempt and pertinent observations such as the environment and condition of the alleged victim.) Conversation with the alleged victim during the scheduling telephone call will not replace the face-to-face interview. Third Party Presence in an Interview- Alleged Victim Interview the alleged victim in private, except under the following circumstances: More than one investigator is present; An interpreter or communication resource is present; The alleged victim requests the presence of a third party (for example, a friend, family member, guardian). If the third party requested by the alleged victim is the AP in this or a related case, ask to speak first to the alleged victim in private to ensure the AV knows the nature of the interview and verify that he/she still wishes to have the AP present while speaking to the APS worker; If a third party makes the request to participate in the interview, before proceeding with the interview, ask the alleged victim, in private, if he or she agrees to the presence of the third party. Adhere to the expressed wishes of the alleged victim unless APS has reason to believe the presence of the third party could compromise the safety or well-being of the vulnerable adult; Document in the SER narrative the name and role of the third party (e.g., he/she was present during the interview at the request of the alleged victim). The third party can ask and answer questions during the interview. If he/she responds to questions about the allegation, attempt to verify with the alleged victim that the third party is speaking for, or on behalf of, him/her; Clearly document the comments of the third party whenever he/she is speaking for, or on behalf of, the alleged victim. Interviewing theAlleged Perpetrator Attempt to interview the alleged perpetrator, except when the circumstances described in the  HYPERLINK \l "_When_Is_an_Interview Not Required?" When Is an Interview Not Required? section are met. Document in the SER any successful and unsuccessful attempts to interview the alleged perpetrator. If the alleged perpetrator was not interviewed during the investigation, document the specific reasons why. There is no required timeframe in which to interview the alleged perpetrator. During the course of the investigation determine the appropriate time to conduct the interview based on relevant considerations that include, but are not limited to: safety of the alleged victim and not compromising the investigation. For example, if law enforcement has requested APS to wait to conduct the interview then communicate with law enforcement and conduct the interview if the APS case is still open when law enforcement indicates there is no longer a concern that an APS interview with the alleged perpetrator will interfere with a criminal investigation. An interview with an alleged perpetrator may be scheduled to accommodate the alleged perpetrators work schedule, desire to have a third party present, address APS worker safety concerns, etc. A face-to-face interview is preferred, however APS will attempt to obtain information using alternate methods when the alleged perpetrator: Has declined requests by the APS worker to meet in person; Is not in Washington; Is incarcerated; Is located a great geographic distance from the office of the assigned APS worker (e.g., in a remote location within the region) Presents a safety hazard to the APS worker. Consult with your supervisor/program manager to determine alternate methods to use to attempt to obtain information from the alleged perpetrator in lieu of a face-to-face interview, such as a telephone interview or requesting a written statement. Inform the alleged perpetrator that he/she does have the option of inviting a third party to be present during the interview (for example, a friend, family member, guardian, attorney, union representative). The third party must not be an alleged perpetrator in this or a related case. If the AP wants a third party present, continue the interview after the third party has had the opportunity to accept or decline the alleged perpetrators invitation to participate. Document in the SER narrative the name and role of the third party, and that he/she was present during the interview at the request of the person being interviewed. The third party can ask and answer questions during the interview. If he/she responds to questions about the allegation, verify with the AP that the third party is speaking for, or on behalf of, him/her; Clearly document the comments of the third party whenever he/she is speaking for, or on behalf of, the AP; If there are questions that APS cant/wont answer (e.g., who was the reporter), document the fact that these specific questions were asked and APS provided an explanation of why that information could not be provided; Do not include third party issues (e.g., comments or questions about employment or personnel matters) in the APS SER narrative. Interviews - Unique Circumstances Person to be Interviewed is Incarcerated Do not conduct an in-person interview with an alleged perpetrator, alleged victim or collateral contact while that person is in jail or prison. Consult with your supervisor/program manager to determine if APS will write the person a letter seeking a voluntary written statement or voluntary telephone interview. Before proceeding, verify with law enforcement/prosecutor that they have no objections to APS communicating with the incarcerated person. The voluntary statement can be written on the HYPERLINK "Attachments%20and%20Links/Declaration%20Form%203%202006.doc"APS Declaration Form. Person to be Interviewed is a Minor Under Age 18 Consent of the parent/legal representative is not required in order for APS to interview a minor under age 18. However, if known by APS that the alleged perpetrator or collateral contact is a minor under age 18, APS will attempt to provide a courtesy verbal notification to the parent/legal representative that an investigation/interview is being conducted. Do not provide the courtesy notification if the parent/legal representative is an alleged perpetrator in this or a related case, or APS has reason to believe that notification would compromise the safety or well-being of the alleged victim or the investigation. If the minor has a case manager (e.g., DDD, CA) attempt to notify the case manager before your interview of the minor. Check with Law Enforcement and/or the prosecutor to determine if criminal charges are pending or filed related to this case. Proceed only if they have no objections to APS interviewing the minor. If you want to interview the minor at school: Contact the school principal or counselor in advance to notify them of the APS investigation and request their assistance in arranging the meeting with their student; When you arrive at the school, inform school personnel who you are and what you are doing there. Clearly explain to the minor who you are, what your role is and why you will be asking questions; Make clear that their participation in the conversation is voluntary and the minor is free to leave at any time they choose; If the parent/legal representative is not attending the interview, inform the minor he/she can have an adult third party present during the interview. Ask the person selected by the minor to participate. If that person declines, ask the minor if there is anyone else he/she would like present. Person to be Interviewed Has a DPOA or Legal Guardian Consent of the DPOA/legal guardian is not required in order to conduct an APS investigation or interview. However, if known by APS that an alleged victim, alleged perpetrator or collateral contact has a DPOA/legal guardian, APS will attempt to provide a courtesy verbal notification to the legal representative that an investigation/interview is being conducted. APS will not provide the courtesy notification if the legal representative is an alleged perpetrator or APS has reason to believe that notification would compromise the safety or well-being of the alleged victim or the investigation. A Person is Reported to be Non-Interviewable In some cases, it is not possible to interact with and interview the alleged victim (e.g., the alleged victim is decreased, has moved across the country, or is in a coma). Document these situations in APSAS using the interview not possible code. If the alleged victim is available (i.e., does not meet the criteria for not possible) but is reported to be non-interviewable because he or she is unable to verbally communicate (e.g., has severe dementia, a profound developmental disability, mental illness, or physical illness): Consult with the case manager, provider or reporter to determine if the person can communicate using sign language or adaptive equipment or procedures. If so,  HYPERLINK \l "_Interpreters" arrange for a certified interpreter or appropriate assistance and conduct the interview; or If not, conduct a face-to-face visit and document the face to face visit in the APSAS first interview section and in the SER document your observations of the environment and the person you went to meet (verbal and non-verbal communication). Investigation: Unique Circumstances In addition to implementing the policy and  HYPERLINK \l "_Investigation:_Procedures_for_ALL A" procedures for all investigations , also implement the additional APS policy and procedures that apply to these unique circumstances: Alleged Perpetrator is a DSHS Employee, AAA Employee, or AAA Subcontractor In addition to the standard procedures, follow the protocol in this section when the alleged perpetrator is a DSHS employee, a contracted agent of the state (AAA employee), or an AAA subcontractor. As soon as it is suspected during intake, or the investigation, that the alleged perpetrator may work for DSHS, AAA or an AAA subcontractor, APS will follow the process outlined in the Flow Chart to obtain answers to key questions and determine the appropriate procedures to implement. Question #1: Is the alleged perpetrator a DSHS/AAA employee or an AAA subcontractor? Response: If the answer is no, implement the  HYPERLINK \l "_Investigation:_Procedures_for_ALL A" standard investigation procedures (see Flow Chart: Box A); -or- If the answer is yes, ask the second question Question #2: Does the alleged perpetrator work in a position with unsupervised access to vulnerable adults or children? NOTE: To find out if a DSHS-employed, alleged perpetrator has unsupervised access to vulnerable adults or children on the job, the APS Supervisor/Program Manager can call the Human Resources Manager of the DSHS Human Resources Division (HRD). Identify yourself as being with APS and ask if the DSHS employee is in a covered position. Provide the Human Resources Manager with available identifying information for the DSHS Employee (e.g., full name, date of birth, position number). A person working in a covered position has unsupervised access to vulnerable adults or children. Response: If the answer is no, implement the procedures identified in Flow Chart Box B; -or- If the answer is yes, ask the third question Question #3: Is the alleged victim affiliated with the alleged perpetrators work role? (e.g., is the alleged victim a client of the alleged perpetrator or the alleged perpetrators agency?) Response: If the answer is no, implement the procedures identified in Flow Chart, Box C; -or- If the answer is yes, implement the procedures identified in: Flow Chart Box D when the AP is an AAA employee or AAA subcontractor; or Flow Chart Box E when the AP is a DSHS employee.  Communicate and coordinate with Law Enforcement or the Washington State Patrol using the standard procedures, including: Whenever the intake report or investigation indicates that the alleged abuse, neglect, abandonment or financial exploitation may be criminal, make an immediate report to law enforcement, as required under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.063" RCW 74.34.063(2); If a report has been made to law enforcement/Washington State Patrol, attempt to communicate and coordinate with them on a case-by-case basis and determine what/when APS should investigate; Conduct the APS interview with the alleged perpetrator with the presence or authorization of law enforcement and/or Washington State Patrol; Inform law enforcement/WSP of any APS protective services provided to the vulnerable adult. Notification Letters: Implement standard alleged perpetrator notification procedures; Send a DSHS employee union member alleged perpetrator a substantiated finding notification letter that has been modified by removing the following text from the template: You may be represented by an attorney or other person at the hearing. Reason: A DSHS employed shop steward can represent a DSHS employed alleged perpetrator union member in pre-hearing and hearing activities to challenge an APS substantiated initial finding. The collective bargaining agreement (CBA) states that an employee has the right to union representation in matters that may affect his/her employment. Provisions of the CBA prevail over  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-02-0155" WAC 388-02-0155 that prohibits DSHS employees from representing an appellant against the Department. APS Investigation of an Alleged Perpetrator Who May Have Also Committed a Crime Need more information about this section? Click on any of the links below:  HYPERLINK \l "_Person_to_be_Interviewed is Incarce" Person to be Interviewed is Incarcerated  HYPERLINK \l "_Coordinating_with_Law_Enforcement" Coordinating with Law Enforcement  HYPERLINK \l "_Coordinating_Investigations_with_Me" Coordinating Investigations with Medicaid Fraud Control Unit (MFCU) APS Investigation of a Personal Aide Providing Self-directed Care An individual with a functional disability who is living at home and self-directing a personal aide to perform health care tasks is a vulnerable adult per HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.021"RCW 74.34.021. Self-directed care may be provided through a state-funded program or private payment. Use the following criteria to determine if the alleged perpetrator is a personal aide providing care that is self-directed by the client per  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.39" Chapter 74.39 RCW. If the response to every question is yes, then the personal aide is providing self-directed care: Does the client live in a residence that does not require licensure? Is the client without a legal guardian for medical decisions? (I.e. is the client legally competent to direct his or her own health care?) Does the client have a functional disability that prevents performance of a health care task for him or herself? Does a personal aide provide the health care task? (Note: The personal aide may also be performing other personal care functions for the client). Is the personal aide being paid/compensated to perform the task? Does the client, who would otherwise be performing these health care tasks for him or herself, personally direct the task? Is the task under treatment orders from a licensed health care provider? Did the client inform the health care provider that he or she would be self-directing a personal care aide to perform the task? Additionally, if the client is receiving services through a state-funded program, then in addition to a yes response to all of the questions above, the following information will assist APS in identifying situations that involve a self-directed care relationship: The Comprehensive Assessment and service plan or ISP (Individual Service Plan for clients of HYPERLINK "APS%20List%20of%20Acronyms.doc"DDD) should describe the specific self-directed health care tasks; For clients of DDD: The case manager should have substituted an S for the Y in the client identifier in item #3 of the  HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/adobe/14_154.pdf" SSPS 154/159 for IP services to reflect that that provider is authorized to do self-directed care; For clients of HCS/AAA: The case manager should have registered the Individual Provider under SSPS objective code B [B = Self-Directed Care (the client chooses to self-direct)] for the IP program under COPES, MPC, Chore and the Medically Needy Waiver. Investigation Follow the  HYPERLINK \l "_Investigation:_Procedures_for_ALL A" standard APS procedures when the investigation does not include allegations related to a specific health care task. When the investigation involves an allegation related to a specific health care task being self-directed by the vulnerable adult alleged victim and under the treatment order of a health care provider: Review the health care task with the alleged victim; If the alleged victim receives care through a state-funded program, review the comprehensive assessment and service plan for a description of the services; Contact the health care professional who ordered the treatment to determine the specific treatment orders; and Request assistance from a HCS Community Nurse Consultant, if needed, for the investigation or review of the medical aspects of the case. APS Investigation of a Minor Alleged Perpetrator Under Age 18 When the minor AP is age 16 up to age 18: Follow the  HYPERLINK \l "_Person_to_be_Interviewed is a Minor" interview procedures for interviewing a minor under age 18; Implement standard protective services procedures for the alleged victim; Document the initial finding as "substantiated - recommended" in APSAS when all the elements of the  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34 020 definitions of abuse, neglect, abandonment or financial exploitation are met; Note: Just like all other investigations where capacity may be an issue, an APS substantiation decision should include consideration of what the alleged perpetrator knew or understood and whether or not the behavior was willful. Even though the 16 18-year old may not seem to have a cognitive impairment or any functional incapacity, APS should be prepared to address it in testimony in the event the AP's defense at hearing involves the argument of incapacity due to age. Send a notice letter, addressed to the alleged perpetrator, with a courtesy copy to the parent or legal representative, and cc the HYPERLINK "APS%20List%20of%20Acronyms.doc"DDD or HYPERLINK "APS%20List%20of%20Acronyms.doc"CA case manager, if the alleged perpetrator has one; The alleged perpetrator has the opportunity to request a hearing to challenge the initial finding and APS will forward a substantiated final finding to HYPERLINK "APS%20List%20of%20Acronyms.doc"BCCU. When the minor AP is less than 16 years old: Follow the  HYPERLINK \l "_Person_to_be_Interviewed is a Minor" interview procedures for interviewing a minor under age 18; Implement standard protective services procedures for the alleged victim; Document the initial finding as "youth finding" in APSAS when the behavior is consistent with the elements of the  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34 020 definitions of abuse, neglect, abandonment or financial exploitation; If the alleged perpetrator has a DDD or CA case manager, provide the case manager with a courtesy copy of the APS Outcome Report (this ensures that the case manager is aware of the APS identified concerns and has an opportunity to address their client's needs); The alleged perpetrator does not have the opportunity to request a hearing to challenge a "youth finding." A "youth finding" will not be forwarded to BCCU. APS Investigation Involving a Client of a DSHS/Aging Network Case Manager If an APS investigation involves an alleged victim or alleged perpetrator receiving case management from HYPERLINK "APS%20List%20of%20Acronyms.doc"HCS/Aging Network, HYPERLINK "APS%20List%20of%20Acronyms.doc"DDD, or HYPERLINK "APS%20List%20of%20Acronyms.doc"CA: Follow the intake, screening, and investigative procedures found elsewhere in this chapter as applicable to the situation; Follow the procedures in this section regarding communication and coordination between APS and the DSHS/Aging Network case manager of the alleged victim or alleged perpetrator. Also, follow  HYPERLINK \l "_Notifying_the_DSHS_(HCS, DDD, CA)/A" procedures for sharing APS information within DSHS; and Follow any additional established regional protocols for communication and coordination with case management. While conducting an investigation involving an alleged victim or alleged perpetrator known by APS to be receiving case management from HCS/Aging Network, DDD or CA: APS will inform the designated contact person within the case management system that an investigation is occurring; The case manager will continue on-going case management functions while APS conducts the APS investigation; APS will maintain contact with the case manager, as needed, during the investigation to inform the case manager of safety concerns, legal interventions, or progress of the investigation; Consent from the DSHS client is not required for APS and HCS, Aging Network, DDD or CA to share confidential information pertinent to the investigation, case planning or services (However, written consent is required before discussing information about the vulnerable adult unrelated to the APS report, investigation, related case planning or protective services). A case staffing may be requested by case management or APS to facilitate understanding and resolution when there are complex issues, multiple APS reports, or disagreements regarding the investigation findings. Include APS and case management supervisors in the case staffing. APS may review or request all pertinent records, such as the current CARE, service plan, and/or financial records maintained by the case management system; APS and the case manager will coordinate activities as needed (e.g., conduct a joint home visit); APS may communicate with the case management system regarding identified issues and options for the continued protection of the client (e.g., protection order); The APS worker may provide a verbal courtesy notice to the case manager or designated case management contact person that the APS worker is going to forward, for HYPERLINK \l "_Panel_Review_of_Recommendations to "panel review, the recommendation for a substantiated finding of abuse, abandonment, neglect or financial exploitation. Following an investigation: APS will  HYPERLINK \l "_Notifying_the_DSHS_(HCS, DDD, CA)/A" provide the designated case management contact person with an Outcome Report (unsubstantiated, inconclusive or substantiated initial finding) when it involves an alleged victim or alleged perpetrator receiving their case management services; APS will provide a copy of the Outcome Report with a substantiated initial finding to an agency or program specified in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.068" RCW 74.34.068 providing direct services to the alleged victim receiving case management services; Upon request, HCS and AAA staff may have access to sections 1-3 of APS case records involving their clients. The case record will remain in the APS office, but is available for review and copying. Note in the SER when the APS case record is reviewed and/or copied by the case manager; As a result of the APS investigation findings, HCS, DDD, CA or Aging Network may determine the provider is unsuitable and terminate the contract of a provider. APS may be requested to testify at fair hearings regarding how they reached their decision to substantiate the APS findings. NOTE: If the alleged victim is not a client of HCS/Aging Network or DDD, but may be eligible for programs and case management services, with the consent of the alleged victim, APS will make a referral. APS Investigation Involving a Client Participating in New Freedom, PACE, WMIP or MMIP If an APS investigation involves an alleged victim or alleged perpetrator known by APS to be involved in  HYPERLINK "http://adsaweb/docufind/LTCManual/NewFreedom/" New Freedom,  HYPERLINK "APS%20List%20of%20Acronyms.doc" PACE,  HYPERLINK "APS%20List%20of%20Acronyms.doc" WMIP or  HYPERLINK "APS%20List%20of%20Acronyms.doc" MMIP, APS will: Communicate and coordinate as necessary with the HCS HQ Program Manager for the New Freedom, PACE, WMIP or MMIP programs; Communicate and coordinate with the provider on a need to know basis for the purpose of case planning and provision of protective services. Alleged Victim Lives in a Setting Certified or Licensed By DSHS -  HYPERLINK \l "_Coordinating_with_RCS_or CA for Inv" Click here... Alleged Victim is Deceased Before Intake - Click on these links below:  HYPERLINK \l "_The_alleged_victim_is deceased at t" The alleged victim is deceased at the time of intake  HYPERLINK \l "_Coordinating_with_Law_Enforcement" Coordinating with Law Enforcement Alleged Victim Expires While the APS Case is Open If law enforcement is already involved in the situation, inform law enforcement of the death of the vulnerable adult and coordinate as per HYPERLINK \l "_Coordinating_with_Law_Enforcement"standard APS protocol. If law enforcement is not yet involved, make a referral to law enforcement when there is reason to suspect criminal activity; If the allegation was self-neglect, immediately close the case and note in the SER the investigation is terminated following the death of the alleged victim. APS does not determine if the death was related to self-neglect; or Continue investigation of allegations of abuse, abandonment, neglect or financial exploitation for the purpose of determining if the allegation is substantiated, unsubstantiated or inconclusive. APS does not determine if the death was related to abuse, abandonment, neglect or financial exploitation. If the allegation is substantiated, per HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-0110"WAC 388-71-0110(3), determine if other vulnerable adults are at current risk of abuse, abandonment, neglect or financial exploitation from the same alleged perpetrator. Create a new APS Intake Report for each newly identified vulnerable adult alleged victim. Alleged Perpetrator Expires During Open Case or Due Process Continue investigation of allegations of abuse, abandonment, neglect or financial exploitation for the purpose of determining if the allegation is substantiated, unsubstantiated or inconclusive. Provide protective services to the alleged victim as appropriate. Follow the regular processes for making a finding. If the alleged perpetrator expires before the opportunity to request a hearing to challenge a substantiated finding, the finding will remain an initial finding. APS Tools HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.080"RCW 74.34.080 Legal Injunction If access is denied to an employee of the department seeking to investigate an allegation of abandonment, abuse, financial exploitation, or neglect of a vulnerable adult, the department, represented by the Attorney Generals office, may seek an injunction prohibiting interference with the investigation. Consent of the vulnerable adult alleged victim is not required. Access is not defined or limited in the statute. It may be broadly interpreted as access to: The vulnerable adult; Documents; Financial information; or Any other information relevant to the investigation. To obtain an injunction, the department must persuade the court of the following facts: There is reasonable cause to believe the person is a vulnerable adult and is or has been abused, abandoned, neglected, or exploited; and The employee of the department seeking to investigate the report has been denied access. Contact the regional HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG to request their assistance to obtain an injunction. Provide information to the AAG as necessary. NOTE: At this time there is not a standard statewide form to use to document necessary information. The 1984 form, Referral to AAG for Injunction to Prevent Interference with Investigation, DSHS 10-160 (X), is no longer available. Document all proceedings in the APS case record. Photography to Document Evidence  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.067" RCW 74.34.067 (7) allows the department to photograph the vulnerable adult alleged victim and his or her environment for the purpose of providing documentary evidence of the physical condition. Consent to Photograph Obtain consent from the vulnerable adult or his or her legal representative prior to photographing the vulnerable adult, unless: Immediate photographing is necessary to preserve evidence; or The legal representative is the alleged perpetrator. No consent is required for photographing the environment. Use the HYPERLINK "Attachments%20and%20Links/Release%20for%20Photographing.doc"Release for Photographing form to document permission or refusal. Photography Guidelines: Respect the dignity of the subject when taking any photograph. Do not photograph the breasts of a woman or the genital area of either a man or woman. When this is necessary, request assistance from law enforcement, licensed staff in a care setting, or a rape crisis center in the case of possible sexual abuse. Documentation and Tracking Photographs: Each office must implement a system (e.g., the HYPERLINK "Attachments%20and%20Links/Photograph%20Ledger.doc"Photograph Ledger) to ensure that the following information is maintained for every photograph: Who took the picture; Where the photo was taken and what is the subject of the photograph; Date and time the picture was taken; and The APSAS case number. Document the chain of custody from the time the photo was taken to the time a copy of the photo was placed in the APS case record. The HYPERLINK "Attachments%20and%20Links/APS%20Evidence%20Custody%20Form.doc"APS Evidence Custody Form must accompany all film sent for processing. Store photographs, and negatives or disks in a secure manner (e.g., in a location precluding access by unauthorized persons). If copies of photographs taken by APS are provided to others (e.g., prosecutor), document in the SER the name of the recipient and sufficient information to identify what photograph was shared (e.g., describe contents or refer to the HYPERLINK "Attachments%20and%20Links/Photograph%20Ledger.doc"Photograph Ledger). APS Request for a Background Check through BCCU Purpose The APS program can request a background check through the  HYPERLINK "http://www1.dshs.wa.gov/msa/bccu/" DSHS Background Check Central Unit (BCCU): On any individual who may be interviewed or encountered by an APS worker during an APS investigation when there are concerns for APS worker safety; On a prospective guardian when the alleged incapacitated person is a vulnerable adult alleged victim in an open APS case (whether or not the petition for guardianship was filed by APS or another interested party); On any individual whom the Legal Benefits Advisor/Attorney may interview or call to testify at an APS hearing in order to develop evidence pursuant to Washington Rules of Evidence. Each region will determine which staff affiliated with the APS program will be trained and authorized to submit an APS program-related Background Check request to BCCU. How to Submit a Request for an APS Background Check Through BCCU Fill out the  HYPERLINK "http://www1.dshs.wa.gov/word/ms/forms/09_653.doc" Background Authorization form: (a). When the subject of the background check is a prospective guardian, APS completes Section 1 as described below, and the prospective guardian completes and signs Section 2; or (b). For all other background checks, APS must know the name and date of birth of the subject and APS completes Sections 1 and 2 of the form as described below: Background Authorization form Section 1- Item 1. Name of Entity Requesting Background Check Enter the name of your account exactly as it appears on the HYPERLINK "http://www1.dshs.wa.gov/word/ms/bccu/ADSA%20HCS%20APS.doc"BCCU Account intranet site. For example: APS Spokane or APS Vancouver. Item 2. Name and Signature of Person Requesting Background Check to be Completed by DSHS Print your name and write your signature where indicated. Item 3. Purpose of Background Check Under ADSA, check the box that says Subject involved in (or related to) APS investigation per  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW. Item 4. BCCU Account Number Write the  HYPERLINK "http://www1.dshs.wa.gov/word/ms/bccu/ADSA%20HCS%20APS.doc" APS account number for your office. Go to Background Authorization form Section 2 - Item 7. Date of Birth Fill in the date of birth of the subject of the background inquiry. Item 8. Print Your Complete Name(s) Fill in the name(s) of the subject of the background inquiry. NOTE: Fill this section out to the best of your ability. You may know 8A - current name, but not 8B - birth name. Optional -- complete these items in Section 2, if you have the information: Item 6: Social Security Number; Item 9: Other last names; Item 10: Nicknames and Other First Names. Fax the  HYPERLINK "http://www1.dshs.wa.gov/word/ms/forms/09_653.doc" Background Authorization form to BCCU at (360) 902-0292. BCCU will call the contact number designated on your account if there are questions about your request (e.g., if BCCU is unable to fax results). BCCU will process APS requests ahead of other programs generally within two hours of receipt. BCCU will fax results to the secure fax number designated on your account. Results HYPERLINK "APS%20List%20of%20Acronyms.doc"BCCU will provide APS with a results letter indicating whether or not the identified subject of the background check has: A record (sources of the information may include: prior self-disclosure by the subject of the background inquiry, a prior finger print check processed by BCCU, or Washington State conviction information/RAP sheet from the Washington State Patrol. Conviction data means actual conviction information, arrests less than one year old with dispositions pending, dependency proceedings, and information regarding registered sex and kidnap offenders); or Another type finding (HYPERLINK "APS%20List%20of%20Acronyms.doc"RCS, APS, CPS, DOH). The background check will provide Washington State data. The BCCU check for APS does not access other states or nations criminal records. APS will not do fingerprint checks. When a background check indicates that an individual has a criminal history, APS should treat the situation as if the individual does have a criminal record, even in the absence of fingerprint verification. If the criminal history raises concerns about safety issues (e.g., convictions involving violence, threats of violence, or weapons), consult with your supervisor to determine appropriate measures that may include, but are not limited to, requesting a police escort, inviting the individual to a DSHS office or neutral location to conduct the interview, or canceling the face-to-face interview and seeking information over the telephone or in writing. Even if the background check returns no records, the subject of the search may have a criminal history. Errors in the identifying information used in the search, name changes, aliases, or database entry errors may have resulted in a record not being identified. Out-of-state and federal convictions will not appear. Confidentiality of Background Check Information from BCCU APS-requested background check information from the  HYPERLINK "http://www1.dshs.wa.gov/msa/bccu/" Background Check Central Unit (BCCU) is confidential. File the original fax sent to BCCU requesting the background check and the printed background check results in section four of the APS case record. When held by APS it becomes part of the APS case record and is confidential under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.095" RCW 74.34.095. APS Use of Accurint to Search for Information Purpose Accurint is a Florida-based corporation that serves as a clearinghouse/database for information on individuals, businesses and entities. Accurint is used by law-enforcement, government agencies, and private corporations for restricted uses under the Gramm-Leach-Bliley Act. APS has established a statewide account with Accurint ( HYPERLINK "http://www.accurint.com/" www.accurint.com ) to obtain information that is pertinent to an APS investigation or action related to an APS investigation under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW. Access to Accurint Each region will designate the account administrator(s) and determine which workers associated with the APS program will be authorized to submit search requests to Accurint. Regional account administrator(s) will: Provide Accurint with the information needed to activate each user (note: obtain information on IP address ranges from the APS statewide program manager); Provide each user with log in and password information; Monitor the regional use of Accurint; and Contact Accurint and deactivate individual users when they are no longer authorized to perform searches. Prior to accessing Accurint, each region will ensure that all authorized users understand this policy and have been trained how to submit requests. Training can be conducted by the region or is available through Accurint. Prior to submitting a request to Accurint, users of this account must first attempt to obtain the needed information from other available resources and databases. Use the most cost effective source to obtain the desired information. All search requests that are submitted to Accurint must be done in the most cost-effective manner and for the minimum amount of needed information. All search requests must include the appropriate mandatory reference code, as follows: Region 1: APS01 Region 2: APS02 Region 3: APS03 Region 4: APS04 Region 5: APS05 Region 6: APS06 State Office: APSHQ Types of Searches: An APS worker shall submit only Person Search requests to Accurint. If an APS worker determines that, in order to complete an investigation, the worker needs access to sensitive or confidential information about a person involved in the investigation, other than the information available in a Person Search, the APS worker shall: Recommend a specific Accurint search type to his/her supervisor; The supervisor shall evaluate the recommendation and determine what, if any, search beyond a Person Search will be conducted. The supervisor shall submit the search request to Accurint and obtain the information for the APS worker; or If an APS supervisor is not available, the APS worker should make the recommendation to the APS Program Manager first, or in the absence of a supervisor and the APS Program Manager, the Legal Benefits Advisor/Attorney. The Regional Administrator, Deputy Regional Administrator, APS Program Manager, APS Supervisor, and Legal Benefits Advisor/Attorney may submit a request for any of the search types available through the APS Accurint account when the information is necessary for an APS investigation or subsequent action under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW related to an investigation. Confidentiality of Information Obtained through Accurint File the printouts of any Accurint reports in Section four of the APS case record. When held by APS, it becomes part of the APS case record and is confidential under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.095" RCW 74.34.095.  HYPERLINK \l "_This_information_may_only be divulg" Click here to find out when this information may be shared. Administrative Subpoena Purpose An administrative subpoena: Is a legal tool that APS may use under certain circumstances to obtain access to pertinent records during an investigation. It is issued by the department as authorized under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=43.20A.605" RCW 43.20A.605 and  HYPERLINK "http://asd.dshs.wa.gov/RPAU/documents/Admin-Policy/04-08.htm" DSHS Administrative Policy 4.08. Should be used when the APS worker is seeking access to documents such as bank records, medical records, a will, the Durable Power of Attorney (DPOA), etc., rather than access to an individual. (When access to an individual is denied, consider use of an injunction.) Should only be used after reasonable attempts to obtain the documents have been exhausted. Process to Issue an Administrative Subpoena The APS worker seeking an administrative subpoena shall consult with his or her supervisor to determine if reasonable attempts to obtain the documents have been exhausted. Reasonable attempts may include, but are not limited to, a release of information from the individual, a request for the documents under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW or a request for medical records pursuant to  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=70.02" Chapter 70.02 RCW. Unsuccessful attempts to obtain the documents shall be documented in the case record. If the APS worker and supervisor determine that reasonable attempts to obtain the documents have been exhausted, the supervisor or LBA shall consult with his or her regional Assistant Attorney General (AAG) to see if he/she agrees that appropriate alternative means of obtaining the documents have been attempted. If the AAG does not agree that reasonable attempts to obtain the documents have been exhausted, the APS worker will explore the recommendations of the AAG. Notify the AAG if his/her recommendations were not successful. If the AAG agrees that all of the reasonable alternative means of obtaining the documents have been exhausted, the Legal Benefits Advisor (LBA) will draft the administrative subpoena documentation. Sample HYPERLINK "Attachments%20and%20Links/administrative%20subpoena%20template%203%202006.doc"Administrative Subpoena Document Template Sample  HYPERLINK "Attachments%20and%20Links/Adm%20%20Sub%20%20certificate%20of%20authenticity3%202006.doc" Certificate of Authenticity Note: Prior to obtaining records, determine if there are costs associated with the request and what the amount will be. Follow your regional procedure for review, approval and payment of these costs. The LBA shall obtain the signature of a delegated issuing authority on the administrative subpoena document. Issuing authority has been delegated to: the HCS Director, the Assistant Director, and the HCS Regional Administrators. APS staff or the LBA may serve the subpoena by giving it (hand delivering, faxing or mailing US Mail Postage Prepaid via Consolidated Mail Service) to the individual or entity from whom the documents are being sought, or by leaving it at the individual's place of abode. The person serving the subpoena shall complete  HYPERLINK "Attachments%20and%20Links/Affidavit%20of%20Service.doc" an Affidavit as proof of service. Note: When service by APS staff or the LBA is either not feasible or not desirable, use a paid process server. File a copy of the administrative subpoena and associated paperwork in the APS case record. The LBA shall track the response to the subpoena. If the individual or entity from whom the documents are being sought refuses to comply with the subpoena, the HYPERLINK "APS%20List%20of%20Acronyms.doc"LBA shall forward the subpoena to the regional HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG for enforcement of the subpoena. Declaration Form APS may seek and obtain a statement from any individual, in writing, if it appears the declarant is able to tell the truth from a lie and otherwise be a competent witness. When an alleged victim, alleged perpetrator or collateral contact would like to provide APS with information in writing: Ask if the person would provide and sign the written statement on a HYPERLINK "Attachments%20and%20Links/Declaration%20Form%203%202007.doc"Declaration Form. Request the declarant to use pen to write the statement; Upon request of a declarant who is unable to write his or her statement, the APS worker will write the statement word for word as told by the declarant. Read the entire contents of the document back to the declarant, including the signature block statement, prior to requesting his or her signature or mark on the declaration form. If the APS worker writes out a statement for another person, the APS worker shall add a sentence to the end of the declarants statement clarifying This statement was written on behalf of the declarant by [APS worker name] due to [state the reason why declarant was unable to write the statement him or herself]. If a copy machine is available at the time the form is signed, provide the individual with a copy of his or her statement. If not, offer to copy and mail the declarant a copy after you return to the office. Investigation: Findings Meaning of Recommended, Initial and Final Findings Recommended finding means the APS worker has concluded the investigation and, based on a preponderance of the evidence, is making a recommendation to substantiate an allegation of abandonment, abuse, financial exploitation or neglect by an identified individual perpetrator or an entity perpetrator. "Initial finding" means a determination made by the department upon investigation of an allegation of abandonment, abuse, financial exploitation, neglect or self-neglect. If the department determines it is more likely than not the incident occurred, the department shall document the finding as "substantiated." If the department determines it is more likely than not that the incident did not occur, the department shall document the finding as "unsubstantiated." If the department cannot make a determination about whether the incident occurred or did not occur on a more probable than not basis, the department shall document the finding as "inconclusive." A youth finding or an initial substantiated finding of abuse, neglect, abandonment or financial exploitation by an identified individual perpetrator or entity perpetrator is  HYPERLINK \l "_Regional_Review_Panel:" made only by a panel following review of the APS workers recommendation to substantiate. The APS worker makes the initial finding determination when: The allegation is self-neglect; or The allegation involves an unidentified alleged perpetrator (e.g., APSAS does not have his or her name); or The finding for an allegation involving an individual perpetrator or entity perpetrator is unsubstantiated or inconclusive. "Final finding" means the department's substantiated finding of abandonment, abuse, financial exploitation or neglect is upheld through the administrative appeal process specified in  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-01205" WAC 388-71-01205 through HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-01280"388-71-01280, or is not timely appealed to the office of administrative hearings. The alleged perpetrator can appeal a final finding to Superior Court and the Court of Appeals under the Administrative Procedure Act,  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=34.05" Chapter 34.05 RCW. Finding Options  HYPERLINK \l "_Other_Definitions_Used_by APS" Substantiated- There are three types of substantiated findings: Specific types of substantiated findings:Meaning:a. Substantiated Unknown PerpetratorThe identity of the perpetrator is undetermined. Note: This finding is never made with an allegation of self-neglect or when an alleged perpetrator is identified in the case record perpetrator screen (i.e., create a new case record when the substantiated finding is not against the reported alleged perpetrator). b. Youth FindingThe alleged perpetrator is under age 16 and the behavior is consistent with the elements of the  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 definitions of abuse, neglect, abandonment or financial exploitation. Note: The alleged perpetrator does not have the opportunity to request a hearing to challenge a "youth finding" and the name will not be forwarded to BCCU. c. Substantiated Individual PerpetratorThe identity of the individual (non-entity) perpetrator is known. Note: This category is also used to indicate a substantiated finding of self-neglect, although the victim is not identified as the perpetrator in APSAS. d. Substantiated Entity PerpetratorThe  HYPERLINK \l "_Definitions" perpetrator is an entity. Note: The name of the entity is listed as the perpetrator in APSAS. If known, also document the name under which they did business (For example: XYZ Corporation d/b/a ABC Program) Unsubstantiated  HYPERLINK \l "_Other_Definitions_Used_by APS" Click here for the definition. Inconclusive  HYPERLINK \l "_Other_Definitions_Used_by APS" Click here for the definition. Factors For Substantiation of Neglect or Abandonment Factor 1The victim is a  HYPERLINK \l "_Vulnerable_Adults" vulnerable adult per the definition in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 or  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.021" RCW 74.34.021.Factor 2The perpetrator is a person or entity with a duty of care, as per the definition in  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-0105" WAC 388-71-0105.Factor 3The findings are a result of action or inaction by the perpetrator. Factor 4The findings relate to the scope of duty of the individual or entity, and the action or inaction of the perpetrator is a breach of that duty (i.e., What should have occurred, but did not happen? Or, what should not have occurred, but did?)Factor 5A preponderance of evidence supports all elements of the (a) subpart or (b) subpart of the  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 definition of neglect or abandonment as follows: Elements of Neglect -  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020(9)(a) or (b) (a) A pattern of conduct or inaction by a person or entity with a duty of care that fails to provide the goods and services that maintain the physical or mental health of the Vulnerable Adult, or that fails to avoid or prevent physical or mental harm or pain to the Vulnerable Adult. Or (b) An act or omission that demonstrates a serious disregard of consequences of such a magnitude as to constitute a clear and present danger to the Vulnerable Adults health, welfare or safety, including but not limited to conduct prohibited under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.42.100" RCW 9A.42.100. Elements of Abandonment- HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020(1) (1) The Vulnerable Adult did not have the means or ability to obtain necessary, food, clothing, shelter, or health care. Factors For Substantiation of Abuse Factor 1The victim is a vulnerable adult per the definition in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 or  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.021" 021. Factor 2The findings are a result of willful action or inaction by the perpetrator. Factor 3A preponderance of evidence supports all elements of the appropriate  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" 74.34.020(2)(a)-(d) definition of abuse as follows: Elements of Abuse  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" 74.34.020(2) (2) Willful action or inaction that inflicts injury, unreasonable confinement, intimidation, or punishment on a vulnerable adult. In instances of abuse of a vulnerable adult who is unable to express or demonstrate physical harm, pain, or mental anguish, the abuse is presumed to cause physical harm, pain, or mental anguish. Abuse includes  HYPERLINK \l "_Types_of_Abuse" sexual abuse,  HYPERLINK \l "_Types_of_Abuse" mental abuse,  HYPERLINK \l "_Types_of_Abuse" physical abuse, and  HYPERLINK \l "_Types_of_Abuse" exploitation of a vulnerable adult.  Factors For Substantiation of Financial Exploitation Factor 1The victim is a vulnerable adult per the definition in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 or  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.021" 021.Factor 2The perpetrator is a person (NOTE: Because the current wording of the statute limits the definition of financial exploitation to acts by any person, an entity is excluded by definition from substantiation of financial exploitation.) Factor 3A preponderance of evidence supports all elements of  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 definition of financial exploitation as follows: Elements of Financial Exploitation  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020(6) (6) Illegal or improper use of property, income, resources, or trust funds of the Vulnerable Adult, by any person for any persons profit or advantage. Factors for Substantiation of Self Neglect An allegation of self-neglect must appear alone in an intake report and an outcome report (i.e., when there are also concurrent allegations of abuse, abandonment, neglect or financial exploitation by a known or unknown alleged perpetrator, create an intake report, case record and outcome report separate from the allegation of self-neglect.) Factor 1The victim is a vulnerable adult not living in a facility.Factor 2The neglect is not the result of inaction by a home health, hospice, or a home care agency, or an individual provider. Note: If the action or inaction is by a person with a duty of care then consider neglect rather than self-neglect.Factor 3The vulnerable adult failed to provide him or herself with the goods and services necessary for his or her physical or mental health.Factor 4The absence of the goods and services impairs or threatens the vulnerable adults well-being. Cases Involving an  HYPERLINK \l "_Other_Definitions_Used_by APS" Entity An investigation involving an  HYPERLINK \l "_Other_Definitions_Used_by APS" entity may result in any of the following combinations of possible dispositions: Neither the individual nor the entity is found to have committed the allegation (i.e., both unsubstantiated and/or inconclusive). Either the individual or the entity is found to have committed the allegation (i.e., one substantiated and the other unsubstantiated/inconclusive). Both the individual and the entity are found to have committed the same allegation (i.e., both substantiated). Both the individual and the entity are found to have committed different allegations related to the same event (i.e., both substantiated). Before reaching a conclusion that an entity committed abuse, neglect or abandonment, determine that within the context of the entities Duty of Care (e.g., may be specified in contract, statute, WAC, standards of professional practice, etc.): (a) The entity knew, or should have known, about the event or possibility for the event to occur; and The entity failed to provide adequate supervision, management or oversight. Examples may include, but are not limited to: The occurrence of multiple incidents (e.g., involving the same individual over time or involving multiple individuals all at once). The issue was previously identified in the client assessment. There have been previous incident reports concerning the client, staff or issue. The entity failed to do a proper background check on staff which would have yielded a disqualification for staff to have access to vulnerable adults. Lack of pertinent policy or failure to implement existing policy. Lack of adequate staff training. Failure to prevent or adequately correct (respond to) the situation. Failure to develop or implement an appropriate plan of care/service plan. Panel Review of Recommendations to Substantiate an Allegation Involving an Individual or Entity Alleged Perpetrator APS Worker: If you recommend substantiation of an allegation of abuse, neglect, abandonment or financial exploitation by an identified individual or entity alleged perpetrator: In APSAS: Enter the date in the Investigation Completed field; Select Sup. Review in the Status field; In the Disposition section of APSAS, enter a finding for each allegation as: inconclusive, unsubstantiated or substantiated/subcategory recommended. Your Supervisor will receive an auto-notification from APSAS when you have selected the finding category of substantiated/subcategory recommended. Forward your completed APS case record to your supervisor within two working days. Supervisor: Review APSAS and the APS case record. Discuss any questions or concerns related to the case with the worker. If needed: Erase the date in the Investigation Completed field, Return the case record to the worker to gather additional information or documents related to any of the allegations, provide documentation or conduct other activities related to the case, and resubmit the case for your review using the above steps. In the SER briefly document your review and finding decision for each allegation. If you disagree with a finding recommendation: Change the allegation results section of APSAS to reflect your decision of an inconclusive or unsubstantiated finding, Select Closed in the Status field, Enter the date of your decision as the case Closed date, and Inform the worker of your decision. If you recommend a substantiated finding following your case review, select Panel Review in the Status field and follow the regional protocol to schedule the case for panel review. Regional Review Panel: Each region will convene a panel as frequently as necessary to timely review and accept or change the recommendation to substantiate an allegation by an identified individual or entity alleged perpetrator. The panel will: Consist of at least three members, and must include an APS Program Manager/Supervisor and an HYPERLINK "APS%20List%20of%20Acronyms.doc"LBA. Meet in person to review the case record (e.g., was the investigation thorough, objective and did it follow appropriate procedures? Is the documentation complete?); Review the evidence and determine if each element of the allegation is supported by a preponderance of the evidence. The panel may also: Request the APS worker to gather and provide additional information or documents or documentation, or conduct other specific activities related to the case; and/or Consult with others about a topic or issue (e.g., the Attorney Generals office, etc.). By majority vote, the review panel will determine if a preponderance of the evidence supports a youth finding or a substantiated initial finding, inconclusive finding or unsubstantiated finding. If there is not a majority decision, the RA will make the determination. (Note: In some cases, the determination may be that a different allegation than the one recommended should be substantiated.) Enter information in HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS to reflect the review panels determination: If the panel determines that the behavior by an alleged perpetrator under the age of 16 was consistent with the definitions of abuse or financial exploitation, the panel will make a youth finding; If the allegation is substantiated and the alleged perpetrator is age 16 or older it becomes an initial finding. Enter substantiated/subcategory Initial in the APSAS Disposition section for the allegation; If the allegation is not substantiated, enter the finding as unsubstantiated or inconclusive as determined by the panel; Select Closed in the case Status field; Enter the date of the review panel decision as the case Closed date; Document in the HYPERLINK "APS%20List%20of%20Acronyms.doc"SER that the review occurred and the panel decision to concur with or alter the recommendations of the APS worker; and Inform the APS worker of the review panels finding decision and reason for any change. Notification of APS Findings APS provides different types of information regarding the outcome of the investigation based on the recipients role in the case, statute and HYPERLINK "APS%20List%20of%20Acronyms.doc"WAC. As described in this section: APS provides some notification routinely and some is provided upon request; Information may be provided verbally, or in writing via a letter or Outcome Report. APS Outcome Reports: Include the names of the alleged victim and the alleged perpetrator; Must not disclose the identity of the reporter or any witnesses; Are faxed, sent, mailed or e-mailed per local procedures to pre-identified recipients. Notification letters: Will not disclose the identity of the alleged victim, the reporter or any witnesses; Will be translated into the preferred language of the alleged perpetrator/legal representative; and Will be created using the appropriate required template wording, that includes direction for: Who signs the letter: APS worker; or APS Supervisor or Program Manager How it is mailed: Regular mail only; or Both regular mail and certified mail/return receipt requested.  HYPERLINK \l "_Summary_Chart_of_APS Notification: " Who receives a routine courtesy copy of the letter?  Summary Chart of APS Notification: Who Gets What Investigation Outcome Information? Role in the APS CaseType of FindingType of Information Provided by APSWhen is it provided? Alleged Victim, and/or, if known, Legal Guardian or Attorney in fact (acting DPOA) HYPERLINK \l "_Other_Definitions_Used_by APS" Unsubstantiated or HYPERLINK \l "_Other_Definitions_Used_by APS"  InconclusiveVerbal: Disclose the investigation finding. Note: If desired, provide a copy of the HYPERLINK "Attachments%20and%20Links/Letter%20Unsub%20%20Inc%20%20Finding%203%202006.doc"Outcome Report. Upon Request HYPERLINK \l "_Other_Definitions_Used_by APS" Substantiated Recommended Verbal: Disclose that a recommendation will be forwarded to panel for review. Offer appropriate protective services.Upon Request  Youth Finding or Substantiated Initial Verbal: Disclose the Youth Finding or the Initial finding. Inform the HYPERLINK "APS%20List%20of%20Acronyms.doc"AV/legal representative that APS will be sending a letter to the alleged perpetrator with an initial finding. Upon request, APS will provide the Alleged Victim (AV)/legal representative with a copy of the Outcome Report. Exceptions: If the legal rep. is also the perpetrator, then do not provide this verbal notification or a copy of the Outcome Report, instead provide his/her notification via the HYPERLINK "Attachments%20and%20Links/Letter%20AP%20sub%20notification%203%202006.doc"standard Alleged Perpetrator (AP) notification letter. Verbal notification to the alleged victim is not required if he/she is unable to understand (e.g., due to advanced dementia). Routine (see exceptions)Substantiated FinalVerbal: Disclose the final finding.  Upon Request  Alleged Perpetrator Unsubstantiated or Inconclusive or Closed no APSVerbal: Disclose the final finding. Upon request, provide the alleged perpetrator with a HYPERLINK "Attachments%20and%20Links/Letter%20Unsub%20%20Inc%20%20Finding%203%202006.doc"courtesy AP letter documenting the finding. Note: APS is required to inform all alleged perpetrators who are employees, contractors or volunteers of the specific agencies & programs listed in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.068" RCW 74.34.068(1); For all other alleged perpetrators APS is not required to, but will, inform any alleged perpetrator who requests to be told verbally or in writing of an unsubstantiated or inconclusive finding for their investigation.  Upon Request & Routine (see note) HYPERLINK \l "_Other_Definitions_Used_by APS" Substantiated RecommendedVerbal: Disclose that a recommendation will be forwarded to panel for review. Upon RequestYouth FindingVerbal: Disclose that APS made a youth finding. RoutineSubstantiated Initial Perpetrator Notification Letter: Use the appropriate substantiated finding notification letter template ( HYPERLINK "Attachments%20and%20Links/Letter%20AP%20sub%20notification%203%202006.doc" Individual alleged perpetrator or HYPERLINK "Attachments%20and%20Links/Letter%20Entity%20sub%20notification%203%202006.doc"Entity alleged perpetrator) to create the letter. Send it via regular and certified mail to the last known residence of the alleged perpetrator. Note: If the alleged perpetrator is a DSHS employee union member,  HYPERLINK \l "_Notification_Letters:" modify the template per instructions in this chapter. Routine Substantiated FinalVerbal: Disclose the final finding. Upon RequestCurrent DSHS / AAA / Aging Network Case Manager  AllWritten: APS Outcome Report Note: The APS worker may verbally inform the case manager that a recommendation for a substantiated finding will be forwarded to review panel; Upon request, for a purpose consistent with  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW, APS may provide additional case record information.  Routine Law Enforcement  Youth Finding or Substantiated InitialWritten: APS Outcome Report Notes: Upon request, provide an Outcome Report for an investigation with a finding that was inconclusive, unsubstantiated, sub-unknown AP, or the case was closed-no APS.; Upon request, for a purpose consistent with  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW, APS may provide additional case record information.  Routine when a crime is suspected.  Prosecuting Attorney AllWritten: APS Outcome Report Note: Upon request, for a purpose consistent with  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW, APS may provide additional case record information.  Upon Request Medicaid Fraud Control Unit Substantiated InitialWritten: APS Outcome Report Note: Upon request, for a purpose consistent with  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW, APS may provide additional case record information. Routine when Medicaid Fraud is suspected. The agency / program where the perpetrator is an employee, contractor or volunteer under: DOH  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=70.127" Chap.70.127RCW DDD -  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=71A.12" Chap.71A.12 RCW RSN - Chap.71.24 RCW  Substantiated Initial Written: APS Outcome Report  Routine if the AV is a client of the agency or program. Substantiated InitialAgency Courtesy Letter: Use the appropriate part of this template to create a HYPERLINK "Attachments%20and%20Links/Letter%20Agency%20notification%20sub%203%202006.doc"courtesy notification letter to send to an agency or program under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.068" RCW 74.34.068 to inform them that their employee, volunteer or contractor has a substantiated initial finding against a vulnerable adult who is not their client.  Routine - if the AV is not a client of the agency or program, and APS knows the AP is associated with the agency or program. Home Care Quality Authority Substantiated InitialPerpetrator Notification Letter: Send a courtesy copy of the perpetrator notification letter to the statewide Program Manager of the HCQA Caregiver Referral Registry at the same time it is sent to the alleged perpetrator.Routine when APS knows that the AP is on the HCQA caregiver referral registry.DOH: Division of Facilities and Services Licensing Substantiated InitialWritten: APS Outcome Report Note: Upon request, provide an Outcome Report with inconclusive or unsubstantiated findings if APS made a referral to HPQA on this matter. Judges order required to access to additional case record information. Routine - when the allegation involved an agency or program they license or certify.DOH: Division of Health Professions Quality Assurance Substantiated InitialWritten: APS Outcome Report Note: Upon request, provide an Outcome Report with inconclusive or unsubstantiated findings if APS made a referral to HPQA on this matter. Judges order required to access to additional case record information. Routine - when the allegation involved a perpetrator they professionally license, certify or register. RCS/CA (the facility licensing authority)  Substantiated Initial Written: APS Outcome Report Note: Upon request, for a purpose consistent with  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW, APS may provide additional case record information. Routine when: The event occurred in a licensed (or unlicensed) facility; or The event did not occur in a facility, but may impact the facility.The operator/licensee of an AFH, BH, NF, ICF/MR, or CA foster home. Substantiated Initial Written: APS Outcome Report Routine if the abuse, abandonment, or financial exploitation occurred in their facility.Long-Term Care Ombudsman  AllWritten: APS Outcome Report Note: Also provide the name of the facility.Routine when the Ombudsman was involved in the case.HCS HQ Prog. Mgr. (Candace Goehring) responsible for Adult Day Care and Adult Day Health certifications Substantiated InitialWritten: APS Outcome Report Note: Also provide the name of the facility or entity. Upon request, for a purpose consistent with  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW, APS may provide additional case record information.  HYPERLINK "http://adsaweb/hcs/documents/WA%20ADH%20Roster.doc" Medicaid ADC/ADH contracted providersRoutine when the allegation occurred at an ADH/ADC program with a Medicaid contract. A Substantiated Initial Finding If the panel review of the recommended finding results in a determination that an allegation is substantiated, provide the following notifications of the youth finding or initial finding. Notifying the Alleged Victim/Legal Representative In person or over the telephone, attempt to verbally inform the alleged victim and/or legal representative (legal guardian, attorney-in-fact [HYPERLINK "APS%20List%20of%20Acronyms.doc"DPOA]that: The allegation was substantiated; and If the alleged perpetrator is age 16 or older, tell the alleged victim that APS intends to send a letter to notify the identified alleged perpetrator of the initial finding and his/her opportunity to request an administrative hearing to challenge the finding. Exceptions - Do not verbally notify: The vulnerable adult alleged victim if, during the course of the investigation, it was determined that an interview with the alleged victim was not possible (e.g., due to severe dementia); The legal representative if he or she is the alleged perpetrator in this or a related case. Instead, provide the appropriate written perpetrator notification letter rather than a verbal notification. If the alleged victim and/or legal representative express objections to a letter being sent to the alleged perpetrator because of fear for the alleged victims physical safety, attempt to problem solve and offer protective services (e.g., protection order) or suggest a referral to other resources (e.g., domestic violence program) before sending the letter to the alleged perpetrator. Consult with the HQ APS program manager in extreme cases. Upon request, APS will provide the alleged victim/legal representative with a copy of the APS Outcome Report or a courtesy copy of the notification letter APS sends to the alleged perpetrator (redact the address of the alleged perpetrator before giving the copy of the letter to the alleged victim/legal representative). Document all attempted and actual notification conversations with the alleged victim/legal representative in the HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS HYPERLINK "APS%20List%20of%20Acronyms.doc"SER. Notifying the Alleged Perpetrator The requirements for Notification and Administrative Appeal of a Substantiated Finding are specified in  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71" WAC 388-71-01205 through 388-71-01280. Within 10 working days of the panel decision to make a substantiated initial finding, send a notification letter signed by the APS supervisor or program manager to the alleged perpetrator(s) via regular mail and certified mail/return receipt requested. Exceptions Do not send a notice letter to the alleged perpetrator: Of a youth finding; or When the allegation was substantiated but the identity of the perpetrator over age 16 is unknown; or When, despite reasonable efforts, APS has been unable to determine the alleged perpetrators last known place of residence; or The 10-day notification timeframe may be extended when necessary to: Accommodate the time it takes to translate the notification letter; Arrange for or provide safety precautions for the alleged victim; or When APS is adhering to a specific request by law enforcement/prosecutor to not contact the alleged perpetrator (e.g., if a criminal investigation is in process). Document the reason for the notification delay in the Service Episode Record (SER). Use the required wording of the appropriate notification letter template and letter attachments as the basis to create a letter to: The HYPERLINK "Attachments%20and%20Links/Letter%20AP%20sub%20notification%203%202006.doc"Individual alleged perpetrator The HYPERLINK "Attachments%20and%20Links/Letter%20Entity%20sub%20notification%203%202006.doc"Entity alleged perpetrator  HYPERLINK "Attachments%20and%20Links/Request%20to%20OAH%20for%20APS%20Hearing%20Form.doc" Request the APS Hearing Form from OAH The HYPERLINK "Attachments%20and%20Links/List%20of%20OAH%20Field%20Offices.doc"List of OAH Field Offices The notification letter shall not divulge the identities of the alleged victim, reporter or witnesses. Translate the notification letter into the preferred language of the alleged perpetrator. Access translated APS notification letter templates (Korean, Russian, Spanish, Tagalog, Ukranian, Vietnamese) posted on the ADSA Intranet. Follow  HYPERLINK "http://adsaweb/docufind/CoreServices/" Chapter 15 procedures to obtain translation of the customized text in for these letters, and for translation into other languages. More information on  HYPERLINK "http://adsaweb/docufind/CoreServices/" translation... Address the notification letter to the alleged perpetrator, and provide a courtesy copy of the notification letter to the parent/legal representative when the alleged perpetrator: Is age 16 up to age 18; or Is over age 18 and known by APS to have a legal guardian/active attorney-in-fact (Durable Power of Attorney); Translate the courtesy copy of the letter for the parent/legal representative when their preferred language is not English (in some cases the alleged perpetrator may receive the letter in the English language, but the courtesy copy will be translated into another language for the parent/legal representative). If the address of the last known place of residence of the alleged perpetrator is not available in HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS, make a reasonable attempt to ascertain it by checking readily available databases/records and asking people who might know his or her current/last known place of residence. Enter the address into APSAS or document unsuccessful attempts to obtain this information. If the notification letter cannot be sent to the alleged perpetrator, document the explicit reason in the SER (e.g., APS was unable to obtain an address). If the notification letter is returned undelivered, file it in Section 2 of the APS case record. If the letter is returned by the post office with a forwarding address, re-send the notification letter using the updated address. In unusual situations, consider attempting to provide notification via personal service. Notifying the Agency/Program Employer of the Alleged Perpetrator APS is authorized by RCW  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 .068.htm" 74.34.068 to provide a written report of the outcome of an investigation with a substantiated finding, to the following specific agencies or programs when the alleged perpetrator is their employee, contractor, or volunteer: In-home services agencies licensed under  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW%20%2070%20%20TITLE/RCW%20%2070%20.127%20%20CHAPTER/RCW%20%2070%20.127%20%20chapter.htm" Chapter 70.127 RCW (e.g., home health agencies, hospice agencies, and home care agencies); Programs authorized under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=71A.12" Chapter 71A.12 RCW (i.e., residential or vocational programs serving clients of DDD); Adult day care or day health programs; Regional support networks authorized under  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 71 TITLE/RCW 71 . 24 CHAPTER/RCW 71 . 24 chapter.htm" Chapter 71.24 RCW; and Other agencies; Managed care organizations such as Molina Healthcare ( HYPERLINK "APS%20List%20of%20Acronyms.doc" WMIP), Evercare Premier ( HYPERLINK "APS%20List%20of%20Acronyms.doc" MMIP), or Providence Elderplace ( HYPERLINK "APS%20List%20of%20Acronyms.doc" PACE). The type of information that APS provides depends on whether the alleged victim is a client of the agency/program: When the alleged victim is a client of the agency/program: Provide an Outcome Report to the agency/program; The appropriate parts of this optional  HYPERLINK "Attachments%20and%20Links/Letter%20Agency%20notification%20sub%203%202006.doc" employer agency/program letter may be used as a cover letter when transmitting the report; Fax, e-mail, or regular mail the letter to a pre-identified contact person within the agency/program; File a copy of the Outcome Report and optional cover letter/fax transmittal sheet in Section 2 of the APS file. OR-- When the alleged victim is not a client of the agency/program (i.e., it was not an on-the-job allegation), but it has become known to APS that the alleged perpetrator is a current employee, contractor, or volunteer in an agency/program that serves vulnerable adults or children: The APS worker will recommend, and APS supervisor/program manager will determine, when to send a letter to inform an agency/program under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=70.127" Chapter 70.127 RCW,  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=71A.12" Chapter 71A.12 RCW or  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=71.24" Chapter 71.24 RCW. The supervisor/program manager, in consultation with the HQ APS program manager, will determine when to send a letter to inform another agency providing services to vulnerable adults or children; Use the appropriate parts of this template to create the HYPERLINK "Attachments%20and%20Links/Letter%20Agency%20notification%20sub%203%202006.doc"employer agency/program letter (do not divulge the name of the alleged victim); Send only the letter, do not send the Outcome report; Fax, e-mail, or regular mail the letter to a pre-identified contact person within the agency/program; File a copy of the letter in Section 2 of the APS file. Notifying the DSHS (HCS, DDD, CA)/AAA/Aging Network Case Manager The APS worker may provide a verbal courtesy notice to the case manager or designated case management contact person that the APS worker intends to forward for panel review the recommendation for a substantiated finding of abuse, abandonment, neglect or financial exploitation. APS shall provide an Outcome Report with a youth finding or substantiated, initial finding to case management whenever it is known by APS that the alleged victim or alleged perpetrator is case managed by DSHS/Aging Network. Fax, e-mail, or regular mail per your regional procedures, a copy of the Outcome Report to case management at approximately the same time APS sends the written, substantiated, initial finding notification letter to the alleged perpetrator. Notifying the Home Care Quality Authority If, during intake or during the course of the investigation, APS becomes aware that the alleged perpetrator is a caregiver currently listed on the HYPERLINK "APS%20List%20of%20Acronyms.doc"HCQA Caregiver Referral Registry, APS will notify HCQA when the investigation results in an initial, substantiated finding. APS shall provide this notification at the same time APS sends the initial, substantiated finding notification letter to the alleged perpetrator. Send or fax a copy of that letter to the HCQA Referral Registry Program Manager (MS: 40940 or Fax: 360-456-0786). Notifying Law Enforcement Provide law enforcement with a copy of the Outcome Report of an investigation that resulted in a youth finding or substantiated initial finding of abuse, neglect, abandonment or financial exploitation. Notifying the DSHS Facility Licensing Authority When the allegation occurred in a facility licensed or certified by DSHS, provide a copy of the Outcome Report with a substantiated, initial finding to the DSHS Division responsible for licensure or certification of that setting. Notifying the Facility in Which the Incident Occurred When the allegation occurred in a facility licensed or certified by DSHS, provide a copy of the Outcome Report with a substantiated, initial finding to the owner/operator of that setting (e.g., HYPERLINK "APS%20List%20of%20Acronyms.doc"AFH, BH, NF, CA Foster Home). An Unsubstantiated, Inconclusive, or Substantiated-Unknown Perpetrator Finding The Alleged Victim/Legal Representative Upon request, APS will inform the alleged victim and/or legal representative that the investigation finding was unsubstantiated, inconclusive, or substantiated unknown perpetrator or the case was closed- no APS. Provide the finding verbally (in-person or phone call) and document the notification in HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS; and/or If desired by the alleged victim or legal representative, provide a copy of the Outcome Report. The Alleged Perpetrator When the investigation results in an unsubstantiated, or inconclusive finding or the case as closed no APS, verbally inform the identified alleged perpetrator of the finding (in person or by phone) and document the notification in HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS. APS must notify the alleged perpetrator of the outcome of the investigation if the alleged perpetrator is an employee, contractor, or volunteer of an agency/program specified under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.068" RCW 74.34.068. If the alleged perpetrator is not an employee, contractor, or volunteer of an agency/program specified under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.068" RCW 74.34.068, then, if desired by the alleged perpetrator, APS will provide the alleged perpetrator a courtesy notification of the outcome of the investigation. AND/OR-- Upon request, provide the alleged perpetrator with a letter identifying the investigation finding; Create the letter using the  HYPERLINK "Attachments%20and%20Links/Letter%20Unsub%20%20Inc%20%20Finding%203%202006.doc" courtesy AP letter template; The letter must not contain the name of the vulnerable adult alleged victim nor disclose the identity of the reporter or any witnesses without their written consent; Either the APS worker or supervisor/program manager may sign the letter; Send the letter via regular mail to the alleged perpetrators last known place of residence or the address he or she provides; File a copy of the letter in Section 2 of the APS case record. The Agency/Program Employer of the Perpetrator APS will not provide notification to an agency/program when the investigation determines the allegation is not substantiated (i.e., unsubstantiated or inconclusive). Under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.068" RCW 74.34.068, APS may only notify the agency/program employer of a substantiated finding. Note: The alleged perpetrator may request a courtesy AP letter from APS that identifies the finding of the allegation against him or her as unsubstantiated, inconclusive, or the case being closed-no APS. If the alleged perpetrator shares this letter with their agency/program employer, and if the employer calls APS to inquire, APS may verify the validity of the information. Notifying the DSHS (HCS/DDD/CA)/AAA/Aging Network Case Manager APS shall provide an Outcome Report to case management whenever it is known by APS that the alleged victim or alleged perpetrator is case managed by DSHS/Aging Network. Notifying Law Enforcement Upon request, provide law enforcement with a copy of the Outcome Report of an investigation that resulted in a finding that was unsubstantiated, inconclusive, substantiatedunknown perpetrator, or the case was closed-no APS. APS Due Process and APS Abuse Registry Administrative Hearing to Challenge an APS Initial Finding The requirements for Notification and Administrative Appeal of a Substantiated Finding are specified in the APS program rules ( HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-01205" WAC 388-71-01205 through  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-01280" WAC 388-71-01280), the Administrative Procedures Act ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=34.05" Chapter 34.05 RCW), and the DSHS Hearing rules ( HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-02" Chapter 388-02 WAC). An alleged perpetrator may request an administrative hearing to challenge an APS substantiated initial finding made on or after October 1, 2003. To request an administrative hearing the alleged perpetrator must send, deliver, or fax a written request to the office of administrative hearings. OAH must receive the written request within thirty calendar days of the date the department's letter of notice is mailed or personally served upon the alleged perpetrator, whichever occurs first. APS is represented in the administrative hearing by the regional Legal Benefits Advisor/Attorney (LBA) and APS workers testify as necessary. The LBA shall not assist alleged perpetrators in their defense. Discovery and Protective Order Procedure Providing the alleged perpetrator with relevant APS Case Record information is a required aspect of due process and is permitted under HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.095"RCW 74.34.095(2) when the alleged perpetrator has requested a hearing to challenge APS decision to substantiate abuse, abandonment, neglect or financial exploitation. If the alleged perpetrator makes a timely request to HYPERLINK "APS%20List%20of%20Acronyms.doc"OAH for an APS hearing, APS will implement the discovery and protective order procedure: The HYPERLINK "APS%20List%20of%20Acronyms.doc"LBA will obtain a protective order for APS Case Record information released under all methods of discovery which may include, but are not limited to: exchange of documents, depositions or interrogatories; and The protective order will limit the appellants use of the APS Case Record information to challenging the APS finding in the administrative hearing. When APS receives notice that a hearing has been requested by an alleged perpetrator to challenge an APS substantiated finding, the LBA will find out if the alleged perpetrator is represented by an attorney. If the alleged perpetrator is not represented by an attorney, the LBA will: Offer the alleged perpetrator the opportunity to have a pre-hearing meeting with APS (prior to the pre-hearing conference with the HYPERLINK "APS%20List%20of%20Acronyms.doc"ALJ); and Inform the alleged perpetrator of the ability to request APS Case Record information and explain that the department will seek an agreed protective order before providing the alleged perpetrator with any APS Case Record information. If the alleged perpetrator/attorney requests discovery, the LBA will provide the alleged perpetrator/attorney with the stipulated protective order and ask the alleged perpetrator/attorney to sign it (see HYPERLINK "Attachments%20and%20Links/Sample%20Protective%20order.doc"Sample Agreed Protective Order). If the alleged perpetrator/attorney refuses to sign the protective order, the LBA will contact OAH and request a discovery conference to address the issue of a protective order. Do not provide APS Case Record information to the alleged perpetrator/attorney pending the outcome of the discovery conference with the ALJ. OR-- If the alleged perpetrator/attorney signs the protective order: The LBA will send the executed stipulated protective order to the ALJ for signature and entry. (The ALJ may enter his/her own wording or form for the protective order instead of the Sample Agreed Protective Order.); and The LBA may disseminate APS case record information after both parties and the ALJ assigned to the case have signed the agreed protective order. Subpoenas Refer all subpoenas to the HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG for review and response. Dissemination of APS Case Record Information When Discovery Has Been Requested The HYPERLINK "APS%20List%20of%20Acronyms.doc"LBA, in consultation with the HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG, when appropriate, will review the discovery requested by the alleged perpetrator/attorney andprovide only those documents that are responsive to the request. If the request is limited to certain documents in the file, provide only those documents; or If the request is for the entire file, provide the entire file (but consistent with civil rules of discovery, consider withholding any irrelevant documents that may be contained in the file; notify the alleged perpetrator/attorney of any documents withheld and the basis for doing so). Redact attorney-client privileged communication, work-product and confidential reporter information. Review the other information requested for relevancy and special concerns. For example, if disclosing certain information may place the vulnerable adult in danger, do not provide it to the alleged perpetrator in discovery. Provide discovery with a cover letter summarizing any information/documents being redacted/withheld from discovery and the basis for doing so, and reiterate that the information provided is covered by a protective order. If the alleged perpetrator/attorney wishes to pursue obtaining the withheld material. APS should seek a protective order from the ALJ, fully informing the ALJ of its concerns with disclosure. When Discovery Has Not Been Requested If the alleged perpetrator/attorney does not request discovery, in a pre-hearing conference, the LBA will request that the Administrative Law Judge (ALJ) sign a protective order to preserve the confidentiality of documents submitted by APS as exhibits in the hearing. The ALJ may enter his/her own wording or form for the protective order instead of the HYPERLINK "Attachments%20and%20Links/Sample%20Protective%20order.doc"Sample Protective Order. Provide the alleged perpetrator/attorney with a list of APS witnesses and any exhibits APS will use at hearing on the date set by the ALJ in the scheduling order. Witness Payment The LBA and regional staff will identify and determine appropriate potential DSHS-affiliated witnesses to testify for APS at an APS administrative hearing. DSHS-affiliated witnesses are not paid beyond their current salary for their testimony time and expertise. Other expenses are paid at the discretion of the region. The LBA and regional staff will identify and determine appropriate potential witnesses who are not affiliated with DSHS who will testify without payment for their time and expertise. Mileage can be reimbursed at the standard state rate. If the LBA is considering using the testimony of a paid expert witness during an administrative hearing, the LBA must consult with the Statewide APS Program Manager who will facilitate the necessary review, approval and formal contracting process. Change of Findings The APS program shall make findings based on the evidence. If additional information related to a case is presented during a pre-hearing meeting or pre-hearing conference, APS may determine that a previously substantiated initial finding should be changed to inconclusive or unsubstantiated. A change in the finding will be based on new evidence or information that relates to the preponderance of evidence decision. APS does not compromise findings that are supported by a preponderance of evidence following a pre-hearing meeting and/or discovery in return for an action by the alleged perpetrator. The LBA will consult with the APS Program Manager to determine whether or not APS will modify the initial substantiated finding. If they are not in agreement, the RA will make the decision. In cases where DSHS concedes it cannot prove the findings by a preponderance of the evidence due to newly discovered or mitigating information, the Department shall enter into a Stipulation and Order of Dismissal with the alleged perpetrator. APS does not send a change of findings letter to the alleged perpetrator when both parties have entered into the agreement and the judge issues an order dismissing the hearing. For Example: APS will not agree to remove a substantiated finding in exchange for a benefit to the victim/some other potentially desirable outcome, such as, the alleged perpetrator may offer to immediately pay back the alleged victim and relinquish guardianship, if APS will agree to change the finding from substantiated to inconclusive or unsubstantiated. Other Administrative Hearings that May Involve APS Whenever possible, the alleged perpetrators administrative hearing to challenge an APS substantiated initial finding will occur before any other administrative hearing that may have a nexus to the finding (for example the clients administrative hearing to challenge the termination of the IP). The LBA will communicate and coordinate as needed with the DSHS Fair Hearing Coordinator, or the hearing representative of an agency external to DSHS, regarding scheduling. A DSHS Fair Hearing Coordinator may request information from the APS case record when the information is pertinent to a decision made by the department for which a DSHS client has requested a fair hearing. The HYPERLINK "APS%20List%20of%20Acronyms.doc"LBA, in consultation with the HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG, when appropriate, will work with the Fair Hearing Coordinator regarding access to, and protection of, APS case record information; At the request of a Fair Hearing Coordinator, and after consultation with the APS LBA, an APS worker will testify for the department at a fair hearing regarding the APS investigation and finding. A state agency external to DSHS (e.g., HYPERLINK "APS%20List%20of%20Acronyms.doc"DOH or HCQA) may contact APS to obtain investigation and finding information for use in their proceedings. The LBA, in consultation with the AAG, when needed, will communicate to the organization that APS will provide case record information or testimony, upon receipt of a court order as per  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.095" RCW 74.34.095(3). If APS has no concerns or objections to a court order to disclose, APS will ask the AAG to execute a stipulated order to release the records. DSHS Board of Appeals As per  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-02-0215" WAC 388-02-0215(4), APS or the alleged perpetrator may request that the DSHS HYPERLINK "APS%20List%20of%20Acronyms.doc"BOA review the initial decision of the HYPERLINK "APS%20List%20of%20Acronyms.doc"ALJ. The region determines when APS will appeal, and may consult with the AAG or statewide APS program manager when making the decision. The LBA represents APS for all BOA matters. All BOA final decisions involving the APS program will be added by BOA to the BOAs Index of Significant Decisions developed under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=42.17.260" RCW 42.17.260(5). Judicial Review Judicial review is the process of appealing a final order to Superior Court. The alleged perpetrator may file a written petition for review as per  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=34.05.546" RCW 34.05.546. DSHS may not request judicial review. To determine if the alleged perpetrator also served the Secretary of DSHS or the Board of Appeals with notice of the judicial appeal as required under WAC 388-02-0650: DSHS: Call (360-725-2261) or email your inquiry to the Executive Secretary of the ADSA Assistant Secretary. He or she will obtain the information from the log maintained by the Office of the Secretary of DSHS and provide the response to you. BOA: Call (360-664-6187) or email the Legal Secretary at the DSHS BOA with your inquiry. He or she will obtain the information from the log maintained by the BOA Office and provide the response to you. The regional HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG represents APS in all Superior court cases. Notify the regional AAG and the statewide APS Program Manager when you become aware that a petition for judicial review has been filed. Obtain oral or e-mail verification from your AAG that they are in receipt of or would like a copy of the petition, and provide copies per any request. The decision of whether or not to appeal a Superior Court order is made by HYPERLINK "APS%20List%20of%20Acronyms.doc"HCS headquarters, in consultation with the AAG and region. Placing the Perpetrator On The APS Abuse Registry The department will maintain a registry of final findings and, upon request of any person may disclose the identity of a person or entity with a final finding of abandonment, abuse, financial exploitation or neglect. The substantiated, initial finding becomes a final finding: If the alleged perpetrator did not contact the Office of Administrative Hearings to request an administrative hearing within 30 calendar days of notification of the substantiated, initial finding; or When the HYPERLINK "APS%20List%20of%20Acronyms.doc"ALJ dismisses the hearing following default or withdrawal by the alleged perpetrator; or When the ALJ issues an initial order upholding the substantiated finding and the alleged perpetrator fails to file a request for review of the ALJ's initial decision with the department's board of appeals consistent with the procedures contained in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=34.05" Chapter 34.05 RCW and  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-02" Chapter 388-02 WAC; or When the board of appeals issues a final order upholding the substantiated finding when a request for review to the department's HYPERLINK "APS%20List%20of%20Acronyms.doc"BOA is made consistent with the procedures contained in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=34.05" Chapter 34.05 RCW and  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-02" Chapter 388-02 WAC. When the finding is final, designated regional staff will: Enter into the APS Abuse Registry the case specific information (e.g., case ID, region) and as much of the following identifying information as possible about the perpetrator substantiated by APS for abuse, abandonment, neglect, or financial exploitation: Full name Date of birth; and Social Security Number Each alias (different first or last name, birthdate or social security number) receives a unique registry entry. When an alleged perpetrator is affiliated with multiple names or multiple case numbers, list the other names (not common truncations of names) and case numbers in the notes box as a cross reference to alert others that this individual has multiple entries in the registry. Make a note in the HYPERLINK "APS%20List%20of%20Acronyms.doc"SER that the name of the perpetrator has been added to the Abuse Registry. The information in the APS Abuse Registry will upload to BCCU nightly for inclusion in DSHS-affiliated background check results. The designated regional staff will ensure the information in APSAS and the Abuse Registry match, and will update entries in either system as needed. Case Status and Closure Use the Status field in HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS to differentiate between several different phases of the APS case, as follows: Case Status APSAS FieldMeaningInvestigatingThe case is open and assigned for investigation. Investigation pendingThe case remains open and under investigation, but HYPERLINK "APS%20List%20of%20Acronyms.doc"APS is not actively working on the investigation while awaiting information from another investigative entity (e.g., law enforcement, HYPERLINK "APS%20List%20of%20Acronyms.doc"MFCU). APS may be providing protective services during this time.  Closed No APS With drop down choices of: Not a HYPERLINK "APS%20List%20of%20Acronyms.doc"VA HYPERLINK "APS%20List%20of%20Acronyms.doc"SN and HYPERLINK "APS%20List%20of%20Acronyms.doc"AV deceased SN already resolved Other Invest. AuthorityUse this code to close the case when: Additional information indicates the alleged victim was not a vulnerable adult as defined in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW at the time of the allegation; or The allegation was self-neglect, but the alleged victim has expired. (Do continue any related investigation involving this same alleged victim and allegations of abuse, neglect, abandonment or financial exploitation by an alleged perpetrator); or The allegation was self-neglect, but the issues were already seemingly permanently resolved before APS assigned the case for investigation (e.g., the alleged victim had already permanently moved into a facility or with family members). Additional information indicates APS does not have jurisdiction as described in the Circumstances under which APS will Screen Out a Report. In these cases, APS will: Terminate the investigation without a finding in APSAS, uncheck the allegation in the disposition section that transferred from the intake report, and complete the not a VA section in APSAS (if appropriate); Refer the non-vulnerable adult alleged victim elsewhere for assistance, if appropriate; and Document any APS activity conducted to that point, the reason for case closure, and any referrals made by APS.  Supervisor Finding ReviewThis code used by the worker to indicate the case has been forwarded to the supervisor for review of the workers recommendation to make an initial substantiated finding.  Panel Finding ReviewThis code is used by the supervisor to indicate the case has been forwarded to the panel for review of the recommendation to make an initial substantiated finding. Protective ServicesUse this code when the investigation is complete and APS has made a finding - but the case remains open for the purpose of providing protective services to the alleged victim (for example, a guardianship proceeding is pending).  Case ClosedUse this code when all investigation and protective service activities have been completed by APS (even if due process activity is continuing on the case). Quality ReviewThe case is closed, but is currently being reviewed. This will lock the case and prevent any changes for the duration of the review. The status of the case is independent of hearing activity (i.e., a case may be open or closed at the time of a hearing, depending on whether APS is providing protective services for the alleged victim). Cases should be closed within 90 days of assignment, unless necessary investigation or protective services activity continues on the case. If a case remains in investigating or investigation pending status 90 days after intake, review the case at that time and review it again at least every 30 days after that (e.g., at 120 days, etc.) for the duration of the case. Document the review in the HYPERLINK "APS%20List%20of%20Acronyms.doc"SER. The purpose of the review is to document the status of the vulnerable adult and determine if any additional or different activity is warranted. Protective Services During or following the investigation, offer to facilitate access to appropriate protective services for vulnerable adult alleged victims of abuse, abandonment, neglect, self-neglect or financial exploitation. Coordinate service delivery, as appropriate, with the case management systems already involved with the vulnerable adult (e.g., Aging Network/DDD). Description of Protective Services Specific protective services may be provided after APS determines: The services are necessary to protect the vulnerable adult alleged victim from harm resulting from abuse, abandonment, neglect, self-neglect, or financial exploitation; and There are no other adults currently involved with the vulnerable adult that are willing and capable of providing the assistance to protect the alleged victim. Protective services must be provided in the least restrictive environment appropriate and available to the vulnerable adult. Protective services may be provided only after the vulnerable adult or appropriate legal representative (guardian, HYPERLINK "APS%20List%20of%20Acronyms.doc"DPOA) gives express written consent after being fully informed about the services and right to withdraw or refuse services. Use the APS Consent to Receipt of Services Form, DSHS 15-198, Rev. 8/2003 This multi-part form is not maintained in stock by DSHS Forms and Records. Regional APS must contact the printer to place an order for printing as needed. To order: Go to the ADSA Internet Click Forms DSHS Internet Forms Non-stocked DSHS Forms (along the left side of the page) Ordering non-stocked forms) follow the directions to submit an order. For: Form DSHS 15-198 (Rev. 8/2003) Your order must be in multiples of 250 (i.e., they must print a batch of 250 or 500 or 750 forms at a time); Allow three weeks for delivery Protective Services APS-Case Management Activities Core Program Services Legal Protective ServicesRefer for services of private social work/case management agency; Refer to community agency (e.g., domestic violence, mental health); Refer for protective payee; Relocation to a HYPERLINK "APS%20List%20of%20Acronyms.doc"NH, BH, AFH (private pay) Refer for medical or psychological evaluation or follow-up examinations; Refer for other services (e.g., Adult Day Care/Day Health)In-Home HYPERLINK "APS%20List%20of%20Acronyms.doc"COPES MPC Chore  HYPERLINK "APS%20List%20of%20Acronyms.doc"AFH  or HYPERLINK "APS%20List%20of%20Acronyms.doc"BH  COPES MPC (Per the procedure in  HYPERLINK "http://aasaweb/docufind/CoreServices/default.htm" chapter 8) State -only Nursing Facility Medicare Medicaid (Per the procedure in  HYPERLINK "http://aasaweb/docufind/CoreServices/default.htm" chapter 10) State-onlyAAG involvement: Obtain a protection order; Guardianship (establish, remove, or modify); * Intervene in a power of attorney.* APS referral for legal assistance without the involve-ment of the HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG (e.g., private attorney)* = Vulnerable adult consent is not required for APS to engage in this activity. Authorization and Payment for APS Protective Services Overview An APS investigation is conducted without cost to the alleged victim vulnerable adult. Some protective services may be provided without cost to the alleged victim, some may be provided without regard to the income or resources of the alleged victim, and some require the alleged victim to meet financial and functional eligibility criteria. The APS alleged victim does not pay participation for state-only-funded protective services (In-home, HYPERLINK "APS%20List%20of%20Acronyms.doc"AFH, BH or NF). State-only-funded APS services are: Not subject to estate recovery ( HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.025" RCW 74.34.025); Provided by DSHS on a discretionary basis and are not a benefit and not an entitlement. Termination of state-only funded, temporary, protective services is exempt from notification and appeal requirements. Hierarchy of Protective Services Funding Sources First Option: Medicare Use Medicare or other community-based resources when appropriate; Second Option: Client Funds The APS client must use his or her own money or resources to pay for services whenever his/her own resources are available and the individual is not eligible for regular Medicare or Medicaid-funded services; Third Option: Medicaid Program Services Utilize regular Medicaid services (HYPERLINK "APS%20List%20of%20Acronyms.doc"MPC, COPES) whenever the APS client is functionally and financially eligible for these programs; Fourth Option: Consider other funding sources that may be available for specialized purposes, including the Intervention Services Fund, or Assistive Technology Project.  HYPERLINK "http://adsaweb/docufind/MB/displayHCS.asp?year=2005" Intervention Services Funds ( HYPERLINK "http://adsaweb/docufind/MB/displayHCS.asp?year=2005" MB H05-099) Intervention Services funds can be used by APS to contract services not available through Medicaid or waiver services, including, but not limited to: Certified public accountant (CPA) or forensic accountant to aid in the investigation of financial exploitation (this service does not require direct client contact) Capacity evaluations when it is difficult to determine if a person is at significant risk of personal or financial harm because of diminished capacity. If you need to request a capacity evaluation, do so prior to any court involvement Home environment evaluations (e.g., occupational therapist) One-time home hazardous cleanup (this services does not require direct client contact) Medical consultation not available through Medicaid or waiver services Subsidized housing or housing options evaluation Nursing rehabilitation evaluation Physical or occupation therapy evaluation Intervention Services funds are also appropriate for Independent Living consultation contracts for (but not limited to): Interviewing skills training, e.g., train an individual who is having difficulty keeping a provider on how to interview, hire and firing process and effective supervision of personal assistant services Mobility Training, i.e., maneuvering techniquesin inaccessible areas and accessing public transportation Money management training and or referring to protective payee services Training an individual on how to identify and the tools to assist an individual in avoiding and or addressing abusive situations Provide peer support to an individual to be able to manage their health care needs and to assist in acceptance of the disability. Connect the individual with local resources and assist in establishing the person to become independent in the community Provide housing assistance, i.e., help in application process for a variety of housing options, including home ownership Assistive Technology evaluation, i.e., identifying potential barriers in housing, transportation, communication and durable medical equipment needs Intervention Services funds may NOT be used for: Psychotherapy or counseling Ongoing adult family home (AFH), boarding home (BH), or in-home provider training. Last Option: State-only Funds Only if none of the above sources of payment are an option, APS may authorize state-only-funded protective services up to a cumulative maximum of 90 days during any 12-month period of time. Authorization and Payment for Medicaid Services To authorize Medicaid services (In-home, HYPERLINK "APS%20List%20of%20Acronyms.doc"AFH, BH) for the vulnerable adult alleged victim: Follow the standard procedures in the  HYPERLINK "http://adsaweb/docufind/CoreServices/" LTC Manual to determine functional and financial eligibility and authorize MPC or COPES; Open the SSPS service code:  HYPERLINK "http://asd.dshs.wa.gov/ssps/APPENDICES/AppendixA/4500-TOC.htm" 4500 codes when using HYPERLINK "APS%20List%20of%20Acronyms.doc"MPC;  HYPERLINK "http://asd.dshs.wa.gov/ssps/APPENDICES/AppendixA/5200-TOC.htm" 5200 codes when using HYPERLINK "APS%20List%20of%20Acronyms.doc"COPES. Criteria for Use of State-Only-Funded Protective Services State-only-funded In-home personal care/household services and state-only-funded placement in an HYPERLINK "APS%20List%20of%20Acronyms.doc"AFH, BH, or HYPERLINK "APS%20List%20of%20Acronyms.doc"NF may be authorized without regard to the functional status or income/resources of the vulnerable adult alleged victim, if all of the following criteria are met: The alleged victim is the subject of an open APS case with an element of abuse, abandonment, neglect, self-neglect or financial exploitation; and The services would help protect the alleged victim from harm; and APS (or on-going case management) cannot verify alternative resources or options for payment for services available to the alleged victim at the time; and These services are provided in the least restrictive and most cost-effective setting available to appropriately meet the needs of the alleged victim; and APS is actively pursuing other service alternatives and/or resolution to the issues that resulted in the need for protective services (or working with on-going case management to do so); and State-only funded services are temporary and provided only with the consent of the alleged victim only until the situation has stabilized; and State-only funded services to an individual vulnerable adult alleged victim shall be based on assessed need and limited to only: Up to one hundred forty-three hours of in-home personal care/household services per month; and A cumulative maximum total of ninety days service in any twelve-month period of time, with nursing facility services not exceeding thirty days of the ninety-day total. An exception to rule cannot be used to grant an extension to the time or the number of hours. Authorization and Payment for State-Only-Funded Protective Services In-home, HYPERLINK "APS%20List%20of%20Acronyms.doc"AFH and HYPERLINK "APS%20List%20of%20Acronyms.doc"BH (ARC, EARC or HYPERLINK "APS%20List%20of%20Acronyms.doc"AL) settings: Ensure all of the criteria for use of APS state-only funds (above) are met; Document the need for these services in the HYPERLINK "APS%20List%20of%20Acronyms.doc"SER; Obtain written consent from the vulnerable adult alleged victim before authorizing services; Clearly inform the APS client that this service is time limited. Add the maximum number of days of state-only funded service to be authorized to the  HYPERLINK \l "_Description_of_Protective" APS Client Consent to Receipt of Services form; Complete or obtain a HYPERLINK "APS%20List%20of%20Acronyms.doc"CARE assessment, as outlined in the  HYPERLINK "http://adsaweb/docufind/CoreServices/" LTC Manual (to verify the provider can meet the clients needs, and to establish payment rate for a facility). The state-only-funded rate of reimbursement for services in an AFH or BH is determined the same way it is determined for non-APS clients receiving Core services: based on the assessed classification (CARE), type of setting, and county in which the services are provided; Authorize the lowest payment rate unless the assessment results in eligibility for another higher level/classification; The maximum number of in-home hours that can be authorized is 143. An exception to rule (ETR) is not possible. If the combined amount of formal and informal support will not meet the identified need, offer the vulnerable adult other options consistent with the procedures in this chapter; Obtain and document in the APS Case Record SER, the APS supervisor/program managers approval of the use of this funding option; and Follow the standard procedures in the  HYPERLINK "http://adsaweb/docufind/CoreServices/" LTC manual to locate or contract with a provider. Open the appropriate HYPERLINK "APS%20List%20of%20Acronyms.doc"SSPS service code. The 4400 series of SSPS codes designate state-only-funded services provided only to APS vulnerable adult alleged victims, as follows: Service NameSSPS CodeAdditional Information (see the  HYPERLINK "http://asd.dshs.wa.gov/SSPS/BasicManual/TOC.htm" SSPS manual for complete information)APS Individual Provider -Hourly4403IP must have a contract, pass a criminal history background inquiry and provide documentation of ability to work in the U.S. The plan of care requires one to 143 hours of care per month. Payment is made directly to the IP after service is given. Do not enter a reason code. Do enter the appropriate objective code indicating self-directed care status, if applicable. Because the vulnerable adult is the employer, the SSPS authorization form for code 4403 must include a Social Security Number (SSN) for him or her. Enter the vulnerable adults Social Security Number if known. If unknown, assign a unique identifier in place of the SSN using the seven digit client ID from BarCode preceded by either: a) 97 if the vulnerable adults ID is a negative number (not known to HYPERLINK "APS%20List%20of%20Acronyms.doc"ACES); or b) 98 if the vulnerable adults ID is an ACES assigned (positive) number. APS Individual Family Provider Parent/Child (IRS) - Hourly4404The IP is either the parent or child (age 18-21) of the vulnerable adult. IP must have a contract, pass a criminal history background inquiry and provide documentation of ability to work in the U.S. The plan of care requires one to 143 hours of care per month. Payment is made to the IP and FICA/FUTA tax is not withheld. Do not enter a reason code. Do enter the appropriate objective code indicating self-directed care status, if applicable. Because the vulnerable adult is the employer, the SSPS authorization form for code 4404 must include a Social Security Number for the vulnerable adult. Enter the vulnerable adults Social Security Number, if known. If unknown, assign a unique identifier in place of the SSN using the seven digit client ID from BarCode preceded by either: a) 97 if the APS vulnerable adults ID is a negative number (not known to HYPERLINK "APS%20List%20of%20Acronyms.doc"ACES); or b) 98 if the ID is an ACES assigned (positive) number.APS In-Home Agency - Hourly4421Service provided by a home care agency contracted by the AAA. The plan of care requires one to 143 hours of care per month.APS Adult Family Home4413The AFH or BH is licensed and contracted by the department. Do not enter a reason or objective code.APS ARC4424APS EARC4428APS AL4430Nursing Facility (Medicaid-approved): Authorize this service only if there are no other options and immediate placement in a nursing facility is the only available and appropriate residential setting to meet the vulnerable adults needs. Ensure all of the criteria for use of HYPERLINK "APS%20List%20of%20Acronyms.doc"APS state-only funds (above) are met; Document the need for these services in the HYPERLINK "APS%20List%20of%20Acronyms.doc"SER; Obtain written consent from the vulnerable adult before authorizing services; Clearly inform the vulnerable adult that this service is time-limited to a maximum of 30 days in the HYPERLINK "APS%20List%20of%20Acronyms.doc"NF. Add the maximum number of days of state-only-funded service to the  HYPERLINK \l "_Description_of_Protective" APS Client Consent to Receipt of Services form; Complete or obtain a HYPERLINK "APS%20List%20of%20Acronyms.doc"CARE assessment as outlined in the  HYPERLINK "http://adsaweb/docufind/CoreServices/" LTC Manual (to verify the provider can meet the clients needs); Obtain, and document in the APS Case Record HYPERLINK "APS%20List%20of%20Acronyms.doc"SER, the APS supervisor/program managers approval of the use of this funding option; Follow the standard procedures in the  HYPERLINK "http://adsaweb/docufind/CoreServices/" LTC manual to locate a provider; Provide the NF with the  HYPERLINK "http://adsaweb/documents/BlankA191A.xls" A19-1A Invoice Voucher sample and  HYPERLINK "http://adsaweb/docufind/MB/MB2003/APS%20NF%20A-19%20instructions.DOC" instructions for reimbursement. Reimbursement is at the Medicaid rate for that particular facility. Legal Protective Services and Remedies  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 chapter.htm" Chapter 74.34 RCW recognizes that some vulnerable adults are unable to represent themselves in court or retain legal counsel to obtain remedies available through court. The legislature has authorized the department to seek protection orders on behalf of vulnerable adults under  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 chapter.htm" Chapter 74.34 RCW and  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 26 TITLE/RCW 26 . 50 CHAPTER/RCW 26 . 50 chapter.htm" Chapter 26.50 RCW, the domestic violence statute, and to bring guardianship actions for vulnerable adults who have been abandoned, abused, financially exploited or neglected, lack capacity to consent to protective services, and need the protection of guardians. APS may also pursue remedies relating to powers of attorney under HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=11.94"Chapter 11.94 RCW. This section describes these legal remedies more fully and outlines the procedures for obtaining them. HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.110"RCW 74.34.110 Protection Orders Ascertain from the vulnerable adult whether a protection order against the alleged perpetrator already exists. If so, get a copy of the order currently in place. Determine if it needs to be expanded or modified to fit the current situation. A protection order may be necessary to protect a vulnerable adult from a variety of acts by another. A vulnerable adult may seek a protection order on his or her own with or without the assistance of the APS worker. If the APS worker assists, he or she may accompany the vulnerable adult to court and provide support through the process, but may not provide legal advice. The APS worker may offer testimony if the worker has personal knowledge of the vulnerable adults need for protection or events constituting abuse, neglect or financial exploitation. Alternatively, APS may seek protection orders on behalf of the vulnerable adult with his or her consent. APS is represented by the Attorney Generals Office when it seeks protection orders on behalf of vulnerable adults. If a vulnerable adult requires protection, but appears to lack capacity to consent to APS obtaining a protection order on his or her behalf, the APS worker should consider the need for a guardianship. Under a guardianship action, discussed later in this chapter, the court may order necessary protection for the vulnerable adult, including immediate protection orders even before a guardianship is established. This section outlines procedures for APS to obtain protection orders under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW and  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=26.50" Chapter 26.50 RCW, the domestic violence statute. The relationship between the vulnerable adult and person to be restrained and the nature of the action to be restrained determine which kind of protection order should be sought. Contact the Attorney Generals Office for assistance in making this determination. Vulnerable Adult Protection Order Protection Orders under HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34"RCW 74.34.110-150 These orders require the department to establish that it is petitioning on behalf of a vulnerable adult who has been abandoned, abused, financially exploited, or neglected, or is threatened with the same by the respondent (person to be restrained). The APS worker and/or other witness with relevant personal knowledge must provide an affidavit stating the specific facts and circumstances demonstrating the need for the protection order. The Assistant Attorney General assists in preparing this and other necessary pleadings for the court. The court may order relief as it deems necessary for the protection of the vulnerable adult, including the following: Restraining respondent from committing acts of abandonment, abuse, neglect, or financial exploitation; Excluding the respondent from petitioners residence for a specified period or until further order of the court; Prohibiting contact by respondent for a specified period or until further order of the court; Requiring an accounting by respondent of the disposition of petitioners income or other resources; or Restraining the transfer of property for a specified period not exceeding ninety days. The period fixed for a protection order shall not exceed one year. An immediate temporary protection order may be obtained. A hearing on the petition must be held within 14 days, with proper service on the respondent. Violation of protection orders restraining a respondent from committing acts of abuse, contacting the vulnerable adult, or coming within a specified location or distance of a location are punishable as a crime and subject the respondent to arrest if he or she has knowledge of the order. Refer a case to the Attorney Generals Office for a protection order when the alleged victim: Is a vulnerable adult; Is unable to represent him or herself; Is unable to retain private counsel; and Consents to the department petitioning for a protection order on his or her behalf. Use the HYPERLINK "Attachments%20and%20Links/Referral%20To%20AAG%20for%20Protection%20Order.doc"Protection Order AAG Referral Form to provide the Attorney Generals Office with the following information: The APS workers name, address, and telephone number; The name, address, telephone number, and birth date of the vulnerable adult; The description of circumstances requiring a protection order; A reason why the vulnerable adult is unable to obtain a protection order on his/her own behalf; The name, address, and telephone number of the person from whom protection is being requested; and Any additional information requested by the HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG. Domestic Violence Protection Order Domestic Violence Protection Orders under HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=26.50"Chapter 26.50 RCW These orders are available to protect vulnerable adults who have been victims of domestic violence from family or household members as described in (b) and (c) below. Domestic violence is defined as follows: Physical harm, bodily injury, assault, or the infliction of fear of imminent physical harm, bodily injury or assault, between family or household members; Sexual assault of one family or household member by another; or Stalking, as defined by law, of one family or household member by another family or household member. Family or household members mean spouses, former spouses, persons who have a child in common regardless of whether they have been married or have lived together at any time, adult persons related by blood or marriage, adult persons who are presently residing together or who have resided together in the past and who have or have had a dating relationship, persons sixteen years of age or older with whom a respondent sixteen years of age or older has or has had a dating relationship, and persons who have a biological or legal parent-child relationship, including stepparents and stepchildren and grandparents and grandchildren. These orders require the department to establish that it is petitioning on behalf of a vulnerable adult who has been the victim of domestic violence. The APS worker files an affidavit stating the specific facts and circumstances from which relief is sought. The HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG assists in preparing this and other necessary pleadings for the court. The court may provide relief as follows: Restrain the respondent from committing acts of domestic violence; Exclude the respondent from the dwelling the parties share or the vulnerable adults residence, workplace or school; Require the respondent to participate in batterers treatment; Restrain the respondent from contact with the vulnerable adult; Require the respondent to submit to electronic monitoring; Order possession and use of essential personal effects; Order use of a vehicle; Order other relief as it deems necessary for the protection of the vulnerable adult. An immediate, temporary protection order may be obtained upon a showing that irreparable injury could result from domestic violence if an order is not issued immediately without prior notice to the respondent. A hearing on the petition must be held within 14 days, with proper service on the respondent. The period fixed for a protection order may be permanent or for a fixed time period. If the order expires within a fixed time period, the department may apply for renewal of the order by filing a petition for renewal at any time within the three months before the order expires. Notice and hearing on the petition is required. Violation of a domestic violence protection order when the respondent knows of the order is punishable as a crime and subjects the respondent to arrest. Follow the procedures in subsections 1(f) and (g) of this section when a protection order is necessary.  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=11.88" Chapter 11.88 RCW Guardianship Petition under RCW 74.34.067(5) The department may bring a guardianship action under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.067" RCW 74.34.067(5) if it has reason to believe the vulnerable adult: Has experienced abuse, neglect, self-neglect, abandonment, or financial exploitation; Lacks the ability or capacity to consent; and Needs the protection of a guardian. Note: APS may pursue guardianships for clients of HYPERLINK "APS%20List%20of%20Acronyms.doc"DDD and residents of facilities, as well as other APS alleged victims, when the criteria of 1(a), (b), and (c) are all met. Consider other options for protection of the vulnerable adult before filing for a guardianship. Consult with the Attorney Generals Office as necessary in the determination of whether a petition under the guardianship statute is an appropriate course of action and the vulnerable adult appears to meet the criteria for guardianship under RCW 11.88.010. Determine whether there are family members, friends, advocates or others who may petition for guardianship on behalf of the vulnerable adult. When other suitable persons are not present, able, or willing to bring a guardianship action, refer the case to the Attorney Generals Office. Use  HYPERLINK "http://asd.dshs.wa.gov/forms/wordforms/10_162.doc" DSHS form 10-162(X), Referral to Attorney General for Guardianship or a similar form prepared by the AAG. Provide the Assistant Attorney General with information and documentation as requested. Assist the HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG, as needed, in completing necessary pleadings. Be prepared to testify in court if necessary. Upon the filing of the guardianship petition, the court will appoint a guardian ad litem to represent the best interests of the alleged incapacitated person. The HYPERLINK "APS%20List%20of%20Acronyms.doc"GAL must investigate and report to the court on the need for the appointment of a guardian or limited guardian. To aid the GAL in his or her responsibilities, when APS has filed the guardianship petition the APS worker will provide the case record to the GAL, upon request, after the Regional Public Disclosure Coordinator has redacted confidential reporter identities and any other information protected by law. If APS did not petition for the guardianship, refer the GAL to the HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG to discuss how he or she can obtain APS records. Note: If served with a court order or subpoena to provide APS records, immediately contact the Regional Public Disclosure Coordinator who will contact the AAG to determine a response. The GAL has the authority to consent to emergency, life-saving, medical services if the alleged incapacitated person is unable to consent due to incapacity pending the hearing on the petition for appointment of a guardian. While an action to establish a guardianship or limited guardianship is pending, the department (through the Attorney Generals Office), the GAL, or any person, may move the court for temporary relief to protect the alleged incapacitated person from abuse, neglect, abandonment, or exploitation or to address any other emergency needs of the alleged incapacitated person. A hearing on the petition must be held within 60 days of the filing of the petition unless an extension is granted for good cause shown. Petition under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=11.88.030" RCW 11.88.030(2)(a)  When APS workers have reason to believe that a vulnerable adult alleged victim in an APS case is in harm's way, lacks capacity, and is in need of a guardian (and there is no one else to petition) but the circumstances don't fit the APS criteria for filing under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.067" RCW 74.34.067(5)), then: Complete the regular guardianship referral paperwork, and refer the recommendation to HCS HQ. Clearly indicate that this referral is not under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.067" RCW 74.34.067(5); HCS HQ will review the information and either decline or forward the request to AAG HQ for review and consideration of filing under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=11.88.030" RCW 11.88.030(2)(a); Following consideration, the AGO HQ will either decline the referral or forward it to a regional AAG for filing of the petition. Procedure to Remove or Modify a Guardianship The court may, for good reason, modify or terminate the guardianship, or replace the guardian at any time after establishment of a guardianship. APS, through the Attorney Generals Office, may petition the court for an order to modify or terminate a guardianship or to replace a guardian. Make a referral to the Attorney Generals Office when the APS worker determines there is need to modify or terminate a guardianship or replace a guardian. Provide the HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG with any court documents from the original guardianship that are available. The AAG may move the court, on behalf of the department, for an order to show cause why the relief requested (modification, termination, replacement) should not be granted. The court may schedule a hearing, appoint a GAL to investigate the issues raised, or to take necessary emergency action to protect the incapacitated person until a hearing can be held or deny the application.  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=11.94" Chapter 11.94 RCW Power of Attorney APS may petition the court, through the Attorney Generals Office, to review actions of an attorney-in-fact under a power of attorney. APS may petition when the vulnerable adult is incapacitated or otherwise unable to protect his or her own interests. APS must satisfy the court that it is interested in the welfare of the principal (the vulnerable adult) and has a good faith belief that the courts intervention is necessary. APS may petition the court to determine, among other things, the following: Whether a HYPERLINK "APS%20List%20of%20Acronyms.doc"POA is in effect or has been terminated; Compel the attorney in fact (the person appointed by the POA to act on behalf of the client) to submit an accounting or report on actions if the attorney in fact refuses or fails to submit an accounting on written request; Order the attorney in fact to exercise or refrain from exercising authority; Modify the authority of an attorney in fact; Remove an attorney in fact upon a determination by the court that: The attorney in fact has violated or is unfit to exercise his or her fiduciary duties; and Removal of the attorney in fact is in the best interest of the principal (the vulnerable adult alleged victim). Confirm the authority of a successor attorney in fact upon removal of the previous attorney in fact. Consult with the Attorney Generals Office to determine whether a petition under the power of attorney statute is an appropriate course of action. Provide the Assistant Attorney General with information and documentation, as requested. Coordination with Community Resources Each field office is encouraged to develop and maintain cooperative agreements between APS and community entities providing services to vulnerable adults. These community agencies or entities may include, but are not limited to, the local: Law Enforcement; HYPERLINK "APS%20List%20of%20Acronyms.doc"AAA; HYPERLINK "APS%20List%20of%20Acronyms.doc"DDD; Domestic Violence Programs; Rape Crisis Centers; Animal Shelters; The Fire Marshall. Per  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 .070.htm" RCW 74.34.070, the written working agreements shall address: Appropriate roles and responsibilities of the department and community-based agencies or entities in identifying and responding to reports; The provision of case-management services; Standardized data collection procedures; and Related coordination activities. Domestic Violence Refer appropriate circumstances to a Domestic Violence program by either giving the client information for a self-referral or obtain consent from the APS client before making a referral. Coordinate with local Domestic Violence program staff in order to advise the client regarding services available in his or her community. When appropriate, assist the client in obtaining a domestic violence protection order, harassment order, or no contact order.  HYPERLINK "http://mhdintranet.mhd.dshs.wa.gov/MHDScripts/asp/general/MHD_Home_Page.asp" Mental Health Emergency: When an APS client requires an immediate assessment, contact the local mental health crisis response system (i.e., the mental health center or the CDMHP office) for determination of grave disability or when the client poses a threat to self or others. Contact local law enforcement when necessary. In emergency circumstances, client consent is not necessary. Non-emergency: Obtain the written consent of the APS client for mental health services prior to referral for counseling, medication management, or an evaluation through a private or public mental health counseling agency, a psychologist, or a psychiatrist. APS Regional Resource Teams Overview The purpose of an HYPERLINK "APS%20List%20of%20Acronyms.doc"APS Regional Resource Team is to assist Adult Protective Services to improve outcomes in some of the most challenging APS cases. Each region must operate at least one APS Regional Resource Team or participate in a similar forum, for discussion, collaboration, and shared decision-making on select difficult and high-risk APS cases. Another local multidisciplinary team may be used in lieu of a Regional Resource Team facilitated by APS, if: The group is willing to review an APS case when requested by APS (e.g., get on the agenda of an on-going group, or convene an ad-hoc meeting for groups that only gather as needed); The group includes members with appropriate knowledge and expertise (including law enforcement or the prosecutors office); Members maintain case confidentiality; and The group is willing to make and document group recommendations regarding the presented APS case. APS Regional Resource Team Function Teams will meet regularly for approximately two hours, at least every other month, to review, make intervention recommendations, and act in an advisory capacity to APS on up to three cases identified by the APS supervisor as high risk. These situations include: When the client is refusing intervention after APS has determined that serious harm has occurred and is likely to reoccur; When serious professional disagreements exist with other community agencies/service providers that are not able to be resolved at the first line supervisor level, and there is continued risk of abuse, neglect, self- neglect, financial exploitation or abandonment of the vulnerable adult alleged victim; or When there have been multiple investigations and the potential for serious harm remains present. Five members, including the APS supervisor or program manager, constitute a quorum for making recommendations. Recommendations may include: Locating relevant community resources; Determining if legal intervention is necessary; Assessment of future risk to the client; and Suggestions to enhance the protective services plan. In cases where there are unresolved professional disagreements with regard to a case recommendation, the Regional Administrator will resolve the disagreement, and/or make a decision regarding the intervention recommendation. APS Regional Resource Team Membership and Appointments Each team will consist of 10 to 15 community members: Having expertise in issues, services and resources for vulnerable adults; and Representing a balanced, multidisciplinary composition of community members that may include law enforcement officers, physicians, mental health representatives, substance abuse counselors, HYPERLINK "APS%20List%20of%20Acronyms.doc"DDD advocacy group members, prosecuting attorneys, HYPERLINK "APS%20List%20of%20Acronyms.doc"AAA supervisors, health department officials, housing authority officials, fire department personnel, clergy, Long-Term Care Ombudsman, sexual assault advocacy group members, animal control officials, and Assistant Attorneys General. The Regional Administrator (RA), based on recommendations by the APS supervisor/program manager, will appoint each member of the team to participate for a suggested two-year commitment. Regional Administrators have the authority to replace or include additional team members, as needed. On a case-by-case basis, the APS program manager, in conjunction with the supervisor, may invite other pertinent resource people to attend a meeting if they have knowledge or expertise related to specific circumstances of a case. These resource people will have varying levels of involvement in the team (e.g., presenting information, answering questions and/or participating in the recommendation). All team members and invited resource people must sign and abide by a Confidentiality Agreement. When presenting and discussing an APS case, team members shall not use or divulge the names of the alleged victim, reporter and witnesses. Use only initials or identifiers as a means to protect the identities of the alleged victim, reporter and witnesses. Duties and Responsibilities of the Facilitator The program manager or designee will: Establish and provide the meeting agenda or case consultation outlines, invite additional pertinent resource persons, facilitate group process, and do the case consultation summary with recommendations; Provide orientation and training to new and existing team members; Maintain records of cases presented to the Regional Resource Team. Duties and Responsibilities of the APS Worker The APS worker will: Notify the supervisor of high-risk or difficult cases for consideration of review by the Regional Resource Team; Complete a Regional Resource Team referral form and submit the form to the supervisor one week prior to the team meeting; Coordinate with other professionals involved in the case to solicit their input; Formally present the case at the Regional Resource Team meeting and follow up on recommendations made by the team. Update the HYPERLINK "APS%20List%20of%20Acronyms.doc"RRT referral form and file it in the APS case record; and Communicate the continuing status of the case to the supervisor/program manager to provide feedback to the Regional Resource Team at future meetings. APS Case Record and Documentation APS documentation related to intake, investigation, and protective services is maintained locally in a hard file APS case record and electronically in the statewide Adult Protective Services Automated System (APSAS). The APS Case Record- Retention and Documentation Principles File all activity pertaining to an alleged victim in the same hardcopy record, whether there is only one investigation or multiple investigations involving different alleged perpetrators. File information in chronological order. Ensure documents in the case record indicate when they were received by APS. Methods to date a document include: Staple the postmarked envelope to a letter; Stamp the date of receipt on incoming documents; The date stamp automatically generated on a faxed document; or Hand date and sign a document received in the field. Divide the APS case record into four sections: Narrative Section #1 containing HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS printouts: Intake Report, APS Case Recording & Disposition, and Service Episode Record (SER). Document Section #2 including: Letters and correspondence, Release of Information or consent forms, copy of Consent for Services forms, copy of Law Enforcement Referral, copy of all distributed versions of the APS Outcome Report, legal documents such as copies of guardianship, injunctions, protection orders. Case Management Section #3 including: HYPERLINK "APS%20List%20of%20Acronyms.doc"CARE, Service Plan, HYPERLINK "APS%20List%20of%20Acronyms.doc"SSPS payment authorizations. AAG Consultations Section #4 including: any communication with the HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG and any privileged work product communication with the Legal Benefits Advisor/Attorney. Cover this section with a face sheet stating, Confidential Attorney/Client or Work Product Privileged Information. DO NOT DISCLOSE. Also file BCCU Background Check results and Accurint results in this section. Establish a means in each office to securely store, readily identify, and retrieve evidence, material, or documentation that does not physically fit into the APS case record. While housed in the region, all APS closed case records for cases that were under Administrative Lock must be stored in a locked or secured record area. Access to the secured record is only upon APS supervisor, APS program manager or RA approval. Ensure all documents containing confidential information (e.g., drafts of reports, field notes) are discarded in a manner that preserves the confidentiality of the information. For example, use a shredder or contracted confidential recycling service. The APS case record may be temporarily removed from the office by an authorized APS worker if: All contents remain confidential; The record remains in the possession of the worker who removed it from the office; and The record can be accessed by the office upon short notice. Upon case closure, ensure that all documentation in the APS case record is up to date. APS Case Record Retention For all hardcopy records and related materials that involve substantiated findings that are appealed (administrative hearings and/or superior court): Retain for a total of 10 years after the last activity on the case, and then destroy. Retain the hardcopy record in the local office for 2 years after the last activity, then Retire to the record retention center for the remaining 8 years. For all other hardcopy records: Retain the APS hardcopy record (and all volumes) for a total of 6 years after the last activity, and then destroy. Retain the hardcopy record in the local office for 2 years after the last activity on the case, then Retire the hardcopy case record to the records retention center for the remaining 4 years. E-mails Print case record-related e-mails and file in the case record. The e-mail then becomes part of the case record and follows the APS record retention schedule as outlined above. Delete the electronic e-mail. *Last activity is defined as any action involving the alleged victim, including documentation of phone calls, receipt of documentation, etc. Documentation Principles Written communication generated by APS, including the HYPERLINK "APS%20List%20of%20Acronyms.doc"SER, reports, and letters will adhere to the following principles to ensure clarity, accuracy, and relevance of documentation. Indicate the date written and the author on all documentation created by APS. Write in a style that facilitates communication and understanding by others: Utilize journalistic recording, addressing: who, what, where, when, how, and why in an objective, factual, and descriptive manner; Write succinctly. Use simple language without jargon; Use correct grammar, sentence structure, and punctuation; When writing about several people with the same last name, include the first name, middle initial, and if still identical, number the individuals; Use pronouns only when it is obvious who is being referred to. Avoid using this, that, these, those, and it. Use of first person may enhance clarity; Indicate the relationship of individuals to the situation; Use descriptive factual language. Avoid emotional terms (such as resistive, non-compliant, abrasive, caustic), sarcastic remarks, discriminatory, emotional, sexist, and racist language; Avoid opinions. If included in documentation, opinions must be identified as opinion, relevant, and professional not personal; and Identify the source of information (e.g., review of a specific record; reported by __, quote during an interview). Adult Protective Services Automated System (APSAS) APS information and activity is documented in APSAS. Refer to the APSAS Users Manual for information about APSAS. Enter APS activity into APSAS within 10 working days of the date of the event. The Service Episode Record (SER)/Case Notes Contents of the SER: Include all pertinent information from interviews, observations, and review of records related to specific allegations under APS investigation and the provision of protective services. NOTE: Document this information even if it is obtained after the case is closed. Do not include: Hand written notes or sticky notes. Type all SER entries into APSAS. Details of a privileged conversation with the AAG or LBA. Type these notes in Word and file them in section 4 of the APS case record. Indicate in the SER that an interaction with the AAG occurred and refer the reader to section 4 of the APS case record for detailed content. SER Business Rules: Follow the  HYPERLINK \l "_APS_Case_Record_and Documentation" Documentation Principles. Follow the directions in the APSAS Users Manual. Enter all notes into the HYPERLINK "APS%20List%20of%20Acronyms.doc"SER within 10 working days of the date of the activity being written about in the entry. Destroy hand written or computer notes after the content has been entered into the SER. If a field note cannot be represented in the SER (e.g., a diagram), retain and file it in the APS case record. In the SER, state that the documentation exists and where it is filed. If any APS investigation evidence, material or documentation is being retained and does not physically fit into the APS case record (e.g., photos), in the SER state that it exists and where it is being securely stored. Document only one activity in each SER entry (e.g., one field visit or one telephone conversation). An author can make an unlimited number of SER entries each day. Use an acronym only if it is: On the HYPERLINK "APS%20List%20of%20Acronyms.doc"list of statewide APS acronyms; or Defined the first time it is used in each distinct SER entry. The author can alter the text of a saved SER entry at anytime on the same calendar date that the SER note was created. At midnight, the calendar date changes and the SER note becomes permanently locked and uneditable. To modify an SER entry, use the Append Daily Note or Strikethrough Daily Note feature. An SER entry made in an incorrect case record can be deleted. This occasionally occurs when an APS worker is working on multiple cases simultaneously (e.g., an investigation involving two alleged victims require documentation in two separate case records) and a note related to the wife will be inadvertently placed in the husbands SER. Use this process to remove the entry: The worker informs the supervisor of the entry in the incorrect record; The supervisor/program manager e-mails the APSAS HQ Systems & Programming designee ( HYPERLINK "mailto:StranKE@dshs.wa.gov" Keith Strandberg) with the request to remove the specific entry; Keith removes the entry and replaces it with a note documenting removal: Note made in wrong case record, entry deleted (date) by (name of person requesting deletion). Internal Report: APS Case Recording and Disposition Create an APSAS document called the APS Case Recording & Disposition for all investigated APS cases. The document, for internal use only, combines a print out of the SER with a three-section report that succinctly summarizes key aspects of the APS case. File a copy of the document in the APS Case Record. Refer to the APSAS Users Manual for details and direction regarding the contents and creation of the APS Case Recording and Disposition. External Report: APS Outcome Report For every case that was assigned for investigation, create, print and file in the APS case record an APSAS document called the APS Outcome Report that succinctly summarizes key aspects of the APS case. Distribute the report to authorized recipients. The document must adhere to the disclosure provisions of  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW. See: The APSAS Users Manual for details and direction regarding the contents and creation of an APS Outcome Report; and The  HYPERLINK \l "_Outside_DSHS:_Routine_Sharing of AP" Disclosure section for information about distribution of the APS Outcome Report. HCS Adult Protective Services Intake Report Information obtained during intake is entered into HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS to create the Intake Report. It is printed and filed in the APS case record. Criminal Investigation Request: APS Referral An HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS document entitled Criminal Investigation Request: APS Referral will be created, customized, and disseminated to law enforcement whenever APS notifies law enforcement of a potential crime. It is printed and filed in the APS case record. More information about Referrals to Law Enforcement?  HYPERLINK \l "_Reporting_to_Law_Enforcement" Click here... Disclosure of APS Information Intake, investigation, and related protective services activities are documented in the APS case record and APSAS. APS reports, the identity of the reporter, and all files, records, communications, and working papers used or developed in the investigation or provision of protective services are  HYPERLINK \l "_Other_Definitions_Used_by APS" confidential under  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 .095.htm" RCW 74.34.095. Who has access to what APS information depends on the persons role and whether the need for the information is for a purpose consistent with  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW. This must be evaluated on a case-by-case, per request, basis. Within DSHS: Sharing APS Information For Case Planning and Consultation While conducting an investigation or providing protective services, APS may need to obtain or share information about the vulnerable adult alleged victim and the situation. For purposes of case planning and consultation related to the investigation or the provision of protective services,  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.067" RCW 74.34.067(3) permits non-privileged information to be shared between APS and: Mandated reporters or the person who made the report; Case managers; HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 .067.htm"  Contracted consultants; and Designated representatives of Washington Indian tribes. APS does not need APS client consent to share non-privileged information from the APS case record for the purposes of coordinated planning and service delivery. However, consent by the APS client is required prior to disclosing any information not directly related to the case under investigation or the provision of protective services. Privileged information must not be divulged without a valid written waiver of the privilege, unless the information is directly related to reports required to be made under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW (mandatory reports to the department, law enforcement, county prosecutors). Consult with the Attorney Generals Office to identify privileged information as needed. Also refer to the  HYPERLINK \l "_A_Substantiated_Initial_Finding" Notification section of this chapter for specific information about notification of a substantiated, initial finding. For Administration of DSHS Programs In situations involving clients of DSHS/Aging Network or facilities licensed by DSHS, APS may share intake, investigation and protective service information within DSHS/Aging Network, as needed, to administer DSHS programs, facilitate investigation, case planning, provide protective services, and implement state and federal law. Consent by the individuals involved in the APS case is not required prior to sharing this information within DSHS/Aging Network. Document as appropriate in the APS case record and/or HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS all DSHS/Aging Network information requests and information sharing. Do not share APS attorney-client privileged information (e.g., section 4 of the APS case record). Caution against secondary disclosure by the recipient, by including a notice on written material informing the recipient that the information from the APS case record is confidential and protected from further disclosure under HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.095"RCW 74.34.095. Also refer to the other applicable sections in this chapter for additional information about sharing information in these situations, including:  HYPERLINK \l "_APS_Investigation_Involving_a Clien" APS Investigation Involving a Client of a DSHS/AAA/Aging Network Case Manager  HYPERLINK \l "_Notification_of_APS_Findings" Notification of APS Findings Outside DSHS: Routine Sharing of APS Information under RCW 74.34 APS Intake Reports, Outcome Reports, or case record information may be shared with others as specifically mandated or permitted by statute, including: Law enforcement, prosecuting attorney, or DOH professional licensing authority, under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.063" RCW 74.34.063; Specific agencies and programs, under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.068" RCW 74.34.068; A facility in which a substantiated allegation occurred, under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.067" RCW 74.34.067(8); and As above, APS information may be shared for purposes of case planning and consultation with mandated reporters or the person who made the report, case managers, contracted consultants, and designated representatives of Washington Indian tribes, under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.067" RCW 74.34.067(3). Also refer to the other applicable sections in this chapter for additional information about sharing information in these situations, including:  HYPERLINK \l "_Coordinating_with_Other_Investigati" Coordinating with Other Investigative Authorities  HYPERLINK \l "_Notification_of_APS_Findings" Notification of APS Findings  HYPERLINK \l "_Other_Definitions_Used_by APS" Public Disclosure of APS Information In addition to information outlined in this chapter, HCS/Aging Network must also follow the confidentiality and disclosure requirements found in  HYPERLINK "http://aasaweb/docufind/CoreServices/default.htm" Chapter 2 of this manual (e.g., response timeframes). Parameters for Every Public Disclosure Request for APS Information: When APS receives a  HYPERLINK \l "_Other_Definitions_Used_by APS" public disclosure request for the contents of an APS case record (APSAS or hardcopy case record), communicate with the regional HCS public disclosure coordinator and/or HCS statewide public disclosure coordinator to evaluate and respond to each request. The HCS public disclosure coordinators will communicate and coordinate with the Attorney Generals Office and/or DSHS Public Disclosure Coordinator prior to disclosure, if needed. When responding to public disclosure requests for information from an APS case record, APS will: Not release the identity of the reporter, per HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.035"RCW 74.34.035(5), HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.040"74.34.040,  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.095" 74.34.095(1)(b), and HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.180"  74.34.180(1). [Note: The name of the reporter can be released only if the reporter consents to releasing his/her identity; a judge has ordered the identity released; or the information is being shared with law enforcement/HYPERLINK "APS%20List%20of%20Acronyms.doc"MFCU or the HYPERLINK "APS%20List%20of%20Acronyms.doc"DOH Division of Health Professions Quality Assurance.]; Regardless of whether the information in the APS case record originated inside or outside of the department, adhere to the most restrictive federal or state law governing the disclosure of specific kinds of information when determining what may be released from the APS case record; State and federal laws, in addition to provisions in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW, may protect certain information from disclosure. For example,  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=70.24.105" RCW 70.24.105 prohibits the disclosure of information about HIV/AIDS or sexually transmitted diseases; HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=70.96A.150"RCW 70.96A.150 prohibits disclosure of records about alcohol/drug abuse or treatment; HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=71.05.390"RCW 71.05.390 prohibits the disclosure of information in records involving mental health services, etc. Special authorization is needed to disclose these types of information. Not share attorney-client privileged information unless court-ordered to do so (including section 4 of the APS case record); Caution against secondary disclosure, by the recipient, by stamping a notice on every page informing the recipient that the information from the APS case record is confidential and protected from further disclosure under HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.095"RCW 74.34.095; and Document public disclosure requests and release of APS case record information in the public disclosure log and the HYPERLINK "APS%20List%20of%20Acronyms.doc"SER of the case record being accessed. Subpoena for APS Information Immediately forward to the regional Public Disclosure Coordinator all subpoena requests for disclosure of APS case record information. The regional Public Disclosure Coordinator will immediately contact the HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG to determine a response to the subpoena. Discovery If APS case record information is being sought in conjunction with a legal proceeding (administrative hearing or court), refer the request to the regional Legal Benefits Advisor/Attorney. Refer to  HYPERLINK \l "_APS_Due_Process_and APS Abuse Regis" APS Due Process and APS Abuse Registry for specific information about disclosing information under these circumstances. Summary Chart of Guidelines for Release of Requested APS Case Record Information All requests for information must be evaluated on a case-by-case basis. The table below provides a general guideline for the dissemination of information from the APS case record. This Requestor:Under These Circumstances:May Have Access to This APS Case Record Information: Medicaid Fraud Control Unit (MFCU)  Upon request, when HYPERLINK "APS%20List%20of%20Acronyms.doc"MFCU is considering/ conducting an investigation. Provide the MFCU with all requested APS information, unredacted if desired (per federal law  HYPERLINK "http://a257.g.akamaitech.net/7/257/2422/09nov20051500/edocket.access.gpo.gov/cfr_2005/octqtr/pdf/42cfr455.21.pdf" 42 CFR 455.21 and DSHS HYPERLINK "APS%20List%20of%20Acronyms.doc"MOU).  Law Enforcement DSHS/Aging Network Case Manager DSHS Investigator DSHS Fair Hearing Coordinator APS alleged victim, HYPERLINK "APS%20List%20of%20Acronyms.doc"DPOA / Legal Guardian HYPERLINK "APS%20List%20of%20Acronyms.doc"GAL in a guardianship action filed by DSHS/HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG Upon written or verbal request from someone with a need to know the information for a purpose consistent with  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW. APS must ask for and evaluate the reason that information is being requested in order to determine if disclosure of the information is for a purpose consistent with  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW. In general, purposes consistent with  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW are: Investigation of abuse, abandonment, neglect, or financial exploitation of vulnerable adults by the department or law enforcement; Case planning and consultation under RCW 74.34.067; Referral to law enforcement or prosecuting attorney under RCW 74.34.063; The provision of protective services by the department, including protection orders or guardianship; or The pursuit of legal remedies under RCW 74.34 including causes of action under  HYPERLINK "http://www.leg.wa.gov/RCW/index.cfm?fuseaction=section§ion=74.34.200" RCW 74.34.200.  Provide the APS case record after redacting information not specifically needed by the requestor and as required by state or federal law. Do not share attorney-client privileged communication or work product of the Legal Benefits Advisor/Attorney; For non-APS hearings, APS workers will testify to the finding decision. A court order or order of a presiding officer in an administrative proceeding is required prior to APS testimony or release of case record documentation for submission into evidence. Someone involved in the APS case: Alleged victim/Legal Guardian/ HYPERLINK "APS%20List%20of%20Acronyms.doc"GAL/HYPERLINK "APS%20List%20of%20Acronyms.doc"DPOA Perpetrator Collateral Contact Reporter Upon written or verbal request for purposes other than those consistent with  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW. Provide the requestor with a copy of any specific documents or items in the case record that the requestor had provided to APS (such as: a letter, a photo, medical record, video, etc). Do not disclose information in the APS case record that was provided by others, even if it is about the requestor. APS will provide the requestor with additional information only after receiving an order from a judge or presiding officer in an administrative proceeding [as per  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.095" RCW 74.34.095(3)].  Please also see the  HYPERLINK \l "_Discovery" Discovery section regarding alleged perpetrator access to case record information for due process.  All other requests, including but not limited to: GAL in a guardianship action not filed by DSHS/AAG Media Legislative Inquiry Non-DSHS Attorney Public  Upon court order or the order of a presiding officer in an administrative proceeding.  APS will release the information from the APS case record that the judge or presiding officer has specifically ordered to be released. The HYPERLINK "APS%20List%20of%20Acronyms.doc"GAL will probably have this order incorporated at the time of appointment; The HYPERLINK "APS%20List%20of%20Acronyms.doc"AAG may provide the requestor with a sample order to take to the judge to request access to the APS case record. If APS has reason to believe access to case record information may compromise the safety or well-being of someone involved in the case, then APS may challenge the requested access.  HYPERLINK "APS%20List%20of%20Acronyms.doc"DOH Investigator HYPERLINK "APS%20List%20of%20Acronyms.doc"HCQA   Except for the information indicated below, a judges order is needed to disclose APS case record information because APS currently has no written agreement for sharing investigation information between our agencies. Note: Sharing Intake and Outcome Reports with DOH is permitted under HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.063"RCW 74.34.063(5) and  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.068" RCW 74.34.068. Note: Providing HCQA a copy of the alleged perpetrator notification letter is permitted when that person is a caregiver listed on the Caregiver Referral Registry.  Rules and Policy Governing the APS Program The content in this chapter is based on the following laws, regulations, DSHS Administrative Policies, and the Executive Order:  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW ABUSE OF VULNERABLE ADULTS HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71" WAC 388-71-0100-01280 ADULT PROTECTIVE SERVICESHYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.39.050"RCW 74.39.050 SELF-DIRECTED CARE HYPERLINK "http://asd.dshs.wa.gov/RPAU/documents/Admin-Policy/08-02.htm" DSHS Administrative Policy 08-02CLIENT ABUSEHYPERLINK "http://asd.dshs.wa.gov/RPAU/documents/Admin-Policy/09-01.htm"dSHS Administrative Policy 09-01 INCIDENT REPORTINGHYPERLINK "http://hrd.dshs.wa.gov/HRMS/Index.htm"Personnel Policy No. 545 HYPERLINK "http://www.governor.wa.gov/execorders/eoarchive/eo96-01.htm"EXECUTIVE ORDER 96-01CRIMINAL AND MAJOR ADMINISTRATIVE INVESTIGATIONS OF DSHS EMPLOYEESWashington State Patrol/Department of Social and Health Services Interagency Agreement and Protocol for Complying with  HYPERLINK "http://www.governor.wa.gov/execorders/eoarchive/eo96-01.htm" Executive Order 96-01. Definitions  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 chapter.htm" Chapter 74.34 RCW and  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-0105" WAC 388-71-0105 provide definitions that apply to the APS program. Vulnerable Adults A vulnerable adult is defined in  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34" Chapter 74.34 RCW as a person who is: 60 years of age or older with the functional, mental, or physical inability to care for himself or herself; Or Over age 18 and: Has a guardian appointed through superior court as per  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 11 TITLE/RCW 11 . 88 CHAPTER/RCW 11 . 88 chapter.htm" Chapter 11.88 RCW; or Has a developmental disability as defined in HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=71A.10.020"RCW 71A.10.020, such as mental retardation, cerebral palsy, epilepsy, autism, or a condition similar to mental retardation which originated prior to age eighteen; or Lives in a facility licensed by DSHS (e.g., adult family home, boarding home, nursing home, soldiers home, residential habilitation center, childrens foster home); or Receives services from an individual provider as defined in  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 .020.htm"  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 .020.htm" RCW 74.34.020; or Receives in-home services through a licensed home health, hospice, or home care agency; or Self-directs his or her own care by a personal care aide who performs that care for compensation ( HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 .021.htm" RCW 74.34.021). Types of Abuse under RCW  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" 74.34.020  Abandonment means action or inaction by a person or entity with a duty of care for a vulnerable adult that leaves the vulnerable person without the means or ability to obtain necessary food, clothing, shelter, or health care. Abuse means the willful action or inaction that inflicts injury, unreasonable confinement, intimidation, or punishment on a vulnerable adult. In instances of abuse of a vulnerable adult who is unable to express or demonstrate physical harm, pain, or mental anguish, the abuse is presumed to cause physical harm, pain, or mental anguish. Abuse includes sexual abuse, mental abuse, physical abuse, and exploitation of a vulnerable adult which have the following meanings: Sexual abuse means any form of nonconsensual sexual contact including, but not limited to, unwanted or inappropriate touching, rape, sodomy, sexual coercion, sexually explicit photographing, and sexual harassment. Sexual abuse includes any sexual contact between a staff person, who is not also a resident or client, of a facility or a staff person of a program authorized under HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=71A.12"Chapter 71A.12 RCW, and a vulnerable adult living in that facility or receiving service from a program authorized under HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=71A.12"Chapter 71A.12 RCW, whether or not it is consensual. Physical abuse means the willful action of inflicting bodily injury or physical mistreatment. Physical abuse includes, but is not limited to: striking with or without an object, slapping, pinching, choking, kicking, shoving, prodding, or the use of chemical restraints or physical restraints unless the restraints are consistent with licensing requirements, and includes restraints that are otherwise being used inappropriately. Mental abuse means any willful action or inaction of mental or verbal abuse. Mental abuse includes, but is not limited to: coercion, harassment, inappropriately isolating a vulnerable adult from family, friends, or regular activity, and verbal assault that includes ridiculing, intimidating, yelling, or swearing. Exploitation means an act of forcing, compelling, or exerting undue influence over a vulnerable adult causing the vulnerable adult to act in a way that is inconsistent with relevant past behavior, or causing the vulnerable adult to perform services for the benefit of another. Financial exploitation means the illegal or improper use of the property, income, resources, or trust funds of the vulnerable adult by any person for any persons profit or advantage. Neglect means: A pattern of conduct or inaction by a person or entity with a duty of care that fails to provide the goods and services that maintain physical or mental health of a vulnerable adult, or that fails to avoid or prevent physical or mental harm or pain to a vulnerable adult; or An act or omission that demonstrates a serious disregard of consequences of such a magnitude as to constitute a clear and present danger to the vulnerable adults health, welfare, or safety, including but not limited to conduct prohibited under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=9A.42.100" RCW 9A.42.100. Self-neglect means the failure of a vulnerable adult, not living in a facility, to provide for himself or herself the goods and services necessary for the vulnerable adults physical or mental health, and the absence of which impairs or threatens the vulnerable adults well-being. This definition may include a vulnerable adult who is receiving services through home health, hospice, or a home care agency, or an individual provider when the neglect is not a result of inaction by that agency or individual provider. Other Definitions Used by APS APS Client means the vulnerable adult alleged victim of an APS case. (RCW 74.34. APS Outcome Report means a document created in HYPERLINK "APS%20List%20of%20Acronyms.doc"APSAS that is a succinct summary of the APS case. APSAS means Adult Protective Services Automated System. Basic necessities of life under  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-0105" WAC 388-71-0105 means food, water, shelter, clothing, and medically necessary health care, including but not limited to: health-related treatment or activities, hygiene, oxygen, and medication. Collateral Contacts means independent sources of relevant information. Client Consent under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 means express written consent granted after the vulnerable adult or legal representative has been fully informed of the nature of the services to be offered and that the receipt of services is voluntary. Confidential means no information can be disclosed verbally, in writing, or electronically, except under specified circumstances. Consultant means a person contracted by ADSA headquarters to provide consultation services. Entity under  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-0105" WAC 388-71-0105 means any agency, corporation, partnership, association, limited liability company, sole proprietorship, for-profit or not-for-profit business that provides care and/or services to vulnerable adults under a license, certification or contract issued by DSHS or DSHS' contractor. An entity does not include a boarding home licensed under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=18.20" Chapter 18.20 RCW, an adult family home licensed under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=70.128" Chapter 70.128 RCW, or a nursing home licensed under HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=18.51"Chapter 18.51 RCW, but does include such facilities if they are required to be licensed but are not currently licensed. Facility under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 means a residence licensed or required to be licensed under HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=18.20"Chapter 18.20 RCW, boarding homes; HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=18.51"Chapter 18.51 RCW, nursing homes; HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=70.128"Chapter 70.128 RCW, adult family homes; HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=72.36"Chapter 72.36 RCW, soldiers homes, or HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=71A.20"Chapter 71A.20 RCW, residential habilitation centers; or any other facility licensed by the department. Final finding means the department's substantiated finding of abandonment, abuse, financial exploitation or neglect is upheld through the administrative appeal process specified in  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71" WAC 388-71-01205  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71" through 388-71-01280, or is not appealed timely to the office of administrative hearings. The alleged perpetrator can appeal a final finding to Superior Court and the Court of Appeals under the Administrative Procedure Act,  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=34.05" Chapter 34.05 RCW. Inconclusive means the evidence is unreliable, not credible, unavailable, or insufficient to determine at this time whether or not abuse, abandonment, neglect, self-neglect, or financial exploitation occurred, on a more probable than not basis. Individual Provider under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 means a person under contract with the department to provide services in the home under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.09" Chapter 74.09 RCW or  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.39A" Chapter 74.39A RCW. Initial finding under  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-0105" WAC 388-71-0105 means a determination made by the department upon investigation of an allegation of abandonment, abuse, financial exploitation, neglect or self-neglect. (1) If the department determines it is more likely than not the incident occurred, the department shall document the finding as "substantiated." (2) If the department determines it is more likely than not, the incident did not occur, the department shall document the finding as "unsubstantiated." (3) If the department cannot make a determination about whether the incident occurred or did not occur on a more probable than not basis, the department shall document the finding as "inconclusive." Last activity is defined as the final action, documentation, phone call, etc. involving the case (this could occur after the case has closed). Legal representative under  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-0105" WAC 388-71-0105 means a guardian appointed under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=11.88" Chapter 11.88 RCW. Person or entity with a duty of care under  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-0105" WAC 388-71-0105 includes, but is not limited to the following: (1) A guardian appointed under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=11.88" Chapter 11.88 RCW; or (2) A person named in a durable power of attorney as the attorney-in-fact as defined under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=11.94" Chapter 11.94 RCW. (3) A person or entity providing the basic necessities of life to a vulnerable adult where: (a) The person or entity is employed by or on behalf of the vulnerable adult; or (b) The person or entity voluntarily agrees to provide, or has been providing, the basic necessities of life to the vulnerable adult on a continuing basis. Preponderance of evidence means the greater weight of the evidence based on the more convincing evidence and its probable truth or accuracy, not the amount of evidence. Protective Services under  HYPERLINK "http://apps.leg.wa.gov/RCW/default.aspx?cite=74.34.020" RCW 74.34.020 means any services provided by the department to a vulnerable adult with the consent of the vulnerable adult, or the legal representative of the vulnerable adult, who has been abandoned, abused, financially exploited, neglected, or in a state of self-neglect. These services may include, but are not limited to: case management, home care, options for placement, arranging for medical evaluation, psychological evaluations, daycare, or referral for legal assistance. Public disclosure means sharing information with the public verbally or in writing. Reasonable cause to believe means it is probable that an incident of abuse, abandonment, neglect, or financial exploitation happened. Probable means that, based on evidence or information readily obtained from various sources, it is likely the incident occurred. Reason to suspect means it is possible that an incident of sexual or physical assault occurred. Possible means that, based on information readily obtained from various sources, the incident could have happened. Regional Resource Team means a multidisciplinary adult protection team including community members having expertise in issues, services and resources for vulnerable adults (e.g., law enforcement officers, health care and social service professionals, domestic violence specialists) to provide consultation on select challenging APS cases in each region. Substantiated means a preponderance of the evidence indicates that, more likely than not, abuse, abandonment, neglect, self-neglect or financial exploitation occurred. Unsubstantiated means a preponderance of the evidence indicates that, more likely than not, abuse, abandonment, neglect, self-neglect, or financial exploitation did not occur. Willful under  HYPERLINK "http://apps.leg.wa.gov/WAC/default.aspx?cite=388-71-0105" WAC 388-71-0105 means the non-accidental action or inaction by an alleged perpetrator that he/she knew or reasonably should have known could cause harm, injury or a negative outcome. APS List of Acronyms AAA Area Agency on Aging AAG Assistant Attorney General ADSA Aging & Disability Services Administration AAG Assistant Attorney General ACES Automated Client Eligibility System ADL Activity of Daily Living AFH Adult Family Home AGO Attorney Generals Office AL Assisted Living ALJ Administrative Law Judge ALTC Aging & Long Term Care AP Alleged Perpetrator APPT - Appointment APS Adult Protective Services APSAS Adult Protective Services Automated System APT - Apartment ARC Adult Residential Care ATTY - Attorney AV Alleged Victim BH Boarding Home BOA Board of Appeals BRO - Brother BRO-I-L Brother-in-law CA Comprehensive Assessment CA Childrens Administration CARE Comprehensive Assessment Reporting and Evaluation Tool CC Collateral Contact CDMHP County Designated Mental Health Professional CFH Childrens Foster Home (private) CFR Code of Federal Regulations CIT Crisis Intervention Team CL Client CM Case Manager COPES Community Options Program Entry System CPR Cardio Pulmonary Resuscitation CPS Child Protective Services CRU Complaint Resolution Unit CSO Community Service Office DCFS Division of Children & Family Services DDD Division of Developmental Disabilities DLR Department of Licensed Resources DOH Department of Health DOH FSL Department of Health, Facilities and Services Licensing DMV Department of Motor Vehicles DPOA Durable Power of Attorney DTR Daughter D-I-L Daughter-in-law DVR Division of Vocational Rehabilitation DX - Diagnosis EARC Enhanced Adult Residential Care EMT Emergency Medical Technician FH Foster Home (DCFS) FV Field Visit GAL Guardian Ad Litem GAU General Assistance Unemployable GDTR Granddaughter GSON - Grandson HCS Home & Community Services Division HV Home Visit HX - History ICF/MR Intermediate Care Facility/Mentally Retarded I&A Information & Assistance IP Individual Provider ITS Intensive Tenant Support (now called supported living) JRA Juvenile Rehabilitation Administration L&I Division of Labor & Industries LBA Legal Benefits Advisor/Attorney LE Law Enforcement LM Left Message LPN Licensed Practical Nurse LTCO Long-Term Care Ombudsman MFCU Medicaid Fraud & Control Unit MH Mental Health MMIP Medicare/Medicaid Integration Project MOU Memorandum of Understanding MPC Medicaid Personal Care NH Nursing Home NF Nursing Facility OV Office Visit PACE Program of All-Inclusive Care for the Elderly PGR - pager POA Power of Attorney QAN Quality Assurance Nurse RA Regional Administrator RCS Residential Care Services RHC Residential Habilitation Center RN Registered Nurse RRT Regional Resource Team SER Service Episode Record SI&A Senior Information & Assistance S-I-L Son-in-law SIS - Sister SIS-I-L Sister-in-law SL Supported Living (DDD contracted services, formerly included ITS as one type) SOLA State Operated Living Alternative (DDD) SSA Social Security Administration SSI Supplemental Security Income SSPS Social Service Payment System SW Social Worker SX - Symptoms TC Telephone Call TTY - Teletypewriter TX - Treatment VA Veterans Administration VM Voice Mail WAC Washington Administrative Code WMIP Washington Medicaid Integration Partnership y/o years old     Adult Protective Services Rev. 5/07  PAGE 3 Adult Protective Services Rev. 5/07  PAGE 134  EMBED Visio.Drawing.6  NOTE: The department must immediately report to law enforcement when the initial report or the investigation indicates the alleged abuse, abandonment, neglect or financial exploitation may be criminal. ( HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 74 TITLE/RCW 74 . 34 CHAPTER/RCW 74 . 34 .063.htm" RCW 74.34.063) The department must make this report to law enforcement even if others have already made a report. NOTE: All department employees are also mandated to report suspected child abuse and neglect (See  HYPERLINK "http://search.leg.wa.gov/wslrcw/RCW 26 TITLE/RCW 26 . 44 CHAPTER/RCW 26 . 44 .030.htm" RCW 26.44.030). To make a report, call toll free 1-866-EndHarm (1-866-363-4276) or the local Child Protective Services (CPS) office. NOTE: Consult with your supervisor if you have reason to believe, before, during or after a home or field visit, that the situation may be dangerous; Call 911 to request immediate assistance from law enforcement when the safety of the vulnerable adult alleged victim, safety of other vulnerable adults under the care of the alleged perpetrator, or the safety of the APS worker may be in imminent jeopardy. 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Summary: Many sections have been reworded and rearranged in addition to the changes noted above.  MB/Chapter Name: Adult Protective Services Superseded or Rescinded?H03-31 Superseded?  FORMCHECKBOX  Rescinded?  FORMCHECKBOX  H04-097 Superseded?  FORMCHECKBOX  Rescinded?  FORMCHECKBOX  H04-086 Superseded?  FORMCHECKBOX  Rescinded?  FORMCHECKBOX  H04-081 Superseded?  FORMCHECKBOX  Rescinded?  FORMCHECKBOX  H04-022 Superseded?  FORMCHECKBOX  Rescinded?  FORMCHECKBOX  H04-018 Superseded?  FORMCHECKBOX  Rescinded?  FORMCHECKBOX  H05-078 Superseded?  FORMCHECKBOX  Rescinded?  FORMCHECKBOX  H05-061 Superseded?  FORMCHECKBOX  Rescinded?  FORMCHECKBOX  H05-056 Superseded?  FORMCHECKBOX  Rescinded?  FORMCHECKBOX  H05-038 Superseded?  FORMCHECKBOX  Rescinded?  FORMCHECKBOX  H06-018 Superseded?  FORMCHECKBOX  Rescinded?  FORMCHECKBOX  H06-015 Superseded?  FORMCHECKBOX  Rescinded?  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