MINISTRY OF COMMUNITY AND SOCIAL SERVICES
Ontario Regulation 299/10, Quality Assurance Measures made under theServices and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (SIPDDA)
Q1.In previous compliance reviews completed under the Developmental Services Act there was mention of health assessments and vaccinations for staff upon hire. What is the current expectation for staff medical examinationsunder Regulation 299/10?
A:Regulation 299/10 does not require the development of policy and procedures with respect to staff medical examinations,vaccinations etc.and are not part of the compliance review process.
Q2.Our agency supports some individuals who are very independent.Although we encourage them to eat healthy, maintain clean homes etc., the people we support are aware of their rights and may not give agency staff permission to enter their homes, create menus or assist them with cleaning. How can we make this work with the Quality Assurance Measures' requirements?
- Individuals should be supported in making healthy choices wherever possible. If a person declines such support from an agency, the agency should document its efforts in offering assistance and the response of the person being supported.
Section 7(1)2 of Regulation 299/10 requires agencies to have:
“policies and procedures to monitor the health concerns of persons with developmental disabilities who are receiving services and supports from the agency, where the supports have been identified in their individual support plan.”
As well, Section 12(1) of the regulation requires that:
“In addressing quality assurance measures respecting the safety and security of persons with developmental disabilities, each service agency shall have policies and procedures regarding the personal safety and
security of persons with developmental disabilities who receive services and supports from the service agency.”
Q3.Our agency provides services to both youth and adults. The CFSA and related legislation provides guidelines for physical restraints that restrict their use to situations where thereis imminent risk of harm to self or others. The guide to the regulations on QAM states that physical restraint can be used where there is a need to prevent damage to property. Can you clarify the regulations please?
A:The Child and Family Services Act (CFSA) and its regulations set out requirements for servicesfor children and youth. The Services and Supports to Promote the Social Inclusion of Persons with Developmental Disabilities Act, 2008 (SIPDDA) and its regulations set out requirements for services funded by the Ministry of Community and Social Services for adults with a developmental disability.
The requirements regarding the use of physical restraint differ between the CFSA regulation (Ontario Regulation 70) and the SIPDDA regulation on quality assurance measures (Ontario Regulation 299/10). Consequently, an agency may have different policies and procedures for the use of physical restraint with children and youth, than with adults with a developmental disability
The SIPDDA regulation on quality assurance measures defines “intrusive behaviour intervention” (which includes physical restraint) as “a procedure or action taken on a person in order to address the person with a developmental disability’s challenging behaviour, when the person is at risk of harming themselves or others or causing property damage”.
The SIPDDA regulation sets parameters around the use of intrusive behaviour intervention. These requirements include (butare not limited to), the need for a behaviour support plan for a person with a developmental disability who has challenging behaviour, training for staff on the content ofthe behaviour support plan of the person whom the staff person will be supporting, training on the use of physical restraint for staff who work directly with people with a developmental disability, and policies and procedures regarding the use of behaviour intervention strategies for persons with developmental disabilities who have challenging behaviour”.
Q4.Our regional office is receiving an increased number of serious occurrence reports from group homes related to member-to-member abuse. The QAM regulation appears to be interpreted as requiring agencies to report all types of abuse of individuals they support, not just those allegedly committed by staff or someone acting in a care-giving capacity. Can you please clarify the requirements of Regulation 299/10 as it pertains to situations like this?
A:Regulation 299/10 s. 8 (4) states:
“Where a service agency suspects any alleged, suspected or witnessed incidents of abuse of a person with a developmental disability may constitute a criminal offence,
(a)the service agency shall immediately report to the police the alleged, suspected or witnessed incident of abuse.”
Regulation 299/10 clarifies that service agencies are to report all incidents of alleged, suspected or witnessed abuse, which could include member-to- member abuse, to the police if the service agency believes that the incident may constitute a criminal offence.
Q5.In our region, various developmental services agencies met with our local police services to review and discuss the abuse reporting requirements of Regulation 299/10. In response, the police service provided protocol advice to meet the requirements of the regulation and respects the parameters of appropriate police involvement. The highlights of the discussion included:
- review of what constitutes intent, reasonable and probable grounds;
- clarification and defining of how the police services identify abuse, and
- recommendation for the agency to conduct fact finding (based on established protocols in each agency) supported by documentation, to determine if there is reasonable suspicion of abuse, where it may constitute a criminal offence, prior to making the determination to report an allegation to the police…
Does this understanding and protocol advice meet the regulatory requirements?
A:Regulation 299/10 clarifies that service agencies are to report all incidents of alleged, suspected or witnessed abuse to the police if the service agency believes that the incident may constitute a criminal offence. Only the police have the expertise and authority to determine whether an incident does in fact constitute a criminal offence.
It is understood that some police services may be providing agencies with direction in regards to abuse reporting. Agencies are encouraged to consider developing a protocol with their local police services in this regard.
Protocols developed with local police services to report abuse will comply with the requirements of Regulation 299/10 – Quality Assurance Measures.
Q6.We have a situation in which an individual accuses staff of hitting, pushing and stealing money from her on a daily basis as part of her conversation repertoire. How is this to be reported, if at all?
A:Service agencies should respond to suchaccusations according to their policies and procedures on abuse reporting. As described in the QAM training, it is recommended that agencies document the behaviour (behavioural support plan) and outline how they will address/respond to such accusations.
Q7.Who is responsible for reporting abuse to the police when the person has the capacity to make his/her own decisions and chooses not to call the police to report abuse? Does the staff person go against the individual’s wishes?
A.Alleged, suspected or witnessed abuse must be reported by the service agency to the police in all cases where abuse of a person with a developmental disability may constitute a criminal offence. It is the role of the police to determine whether an incident of alleged, suspected or witnessed abuse constitutes a criminal offence.
The Regulation does not state who is required to report abuse, only that it must be immediately reported to the police. Therefore, service agencies
will need to develop their own policies and procedures on abuse reporting. The following, however, should be considered:
- Many police departments have policies that will not accept a report from a person who was not involved;
- As soon as a staff member reports to another person before notifying the police, contamination of evidence has begun, and
- The police must complete their investigation before a service agency begins any internal investigation.
As a best practice, it is expected that the person who suspects or witnessed the abuse should document the incident, call the police and then report the incident to his or her manager/supervisor in order to ensure there is no contamination of evidence.
For additional training on abuse reporting please see Segment 7 of the QAM training video.
Service agencies should inform the person receiving services and supports that any alleged, suspected or witnessed abuse will be reported to the police.
Q8.Many of the QAM requirements require an annual review. For example, Section6. (3) requires that an agency have each person's books of accounts and financial records reviewed by a third party annually. Agencies have interpreted this as giving them a year to have the books of accounts of their clients reviewed, rather than having to have had this completed on January 1, 2011 when Regulation 299/10 came into force.
Similarly, the requirement for mandatory education and awareness of abusefor clients in Section 8.2(c), is being interpreted as an annual requirement rather than having hadto be completed by January 1, 2011.
Can you clarify these requirements?
A:Service agencies need to comply with Sections 6(1) and 6(2) immediately (policies and procedures, separate books of account, etc.), but the first annual review should occur at the end of the first year – in January 2012 or thereabouts.
Section 8(2)c, which deals with mandatory education and awareness building for people receiving services and supports is to happen when a person begins receiving services and supports and every year thereafter. Service agencies need to comply with the first requirement (mandatory education and awareness building) immediately, but do not need to have a refresher until January 2012.
Q9.Does each agency providing services and supports to the same individual need to develop their own individual support plan?
A.All service agencies will develop an individual support plan (ISP) for each person with a developmental disability who receives services and supports from the agency.
Where more than one agency provides services and supports, one ISPcan be developed and shared to reflectall services and supports provided by all MCSS adult funded service agencies.
Example:Where aperson receives residential services and supports from a service agency and specialized behavioural supports from another, the residential provider would be responsible for developing the ISP. The behavioural supports providerwould have a copy of the ISP and their services and supports would be reflected in the plan.
Q10.The QAM legislation requires in Section 5 4(h) that:
“The individual support plan shall identify,
(h) amount of allocated resources;
It would be helpful to have greater clarity around this item, specifically for those that do not have individualized funding.
- The requirement intends for the individual support plan to address/list MCSS funding amounts (i.e. ODSP, Passport , SSAH, community participation support, residential support).
Q11.Do agencies require a fire plan for the Family/Associate Family Homes program and Supported Independent Living (SIL)?
A.Regulation 299/10 states in section 11. (1):
“In addressing quality assurance measures respecting safety around agency owned and operated premises, each services agency shall have the following:
1. An approved fire safety plan, where required under Ontario Regulation 213/07 (Fire Code) made under the Fire Protection and Prevention Act, 1997, for each of the premises that the service agency owns or operates.”
If the Family home (known as “host family residence” in the SIPDDA) and/or SIL sites are directly agency owned or agency operated, then they require an approved fire safety plan and an annual inspection where required under Ontario Regulation 213/07 (Fire Code); however there are no expectations in terms of the Quality Assurance Measures compliance reviewif the sites are not directly agency owned or agency operated.
Q12. Regulation 299/10 states that "where a service agency contracts with a third party to provide services and supports to persons with developmental disabilities . . . ".Our agency purchases psychological and psychiatric services. Are considered third parties?
A:A third party is a service provider that is contracted by a service agency to provide services and supports to a person with a developmental disability. Examples include private operators that provide residential or respite care on behalf of a ministry-funded service agency. This requirement does not apply to contracts with third parties providing professional or specialized services on a one-time or time-limited basis.
During a compliance review,the followingrequirement of Regulation 299/10 will be reviewed:
(2)Subject to subsection (3), where a service agency contracts with a third party to provide services and supports to persons with developmental disabilities, the service agency,
(a) shall ensure that the contract requires that the third party comply with the quality assurance measures that would apply to the service agency if it were providing the services and supports; and
(b) shall monitor the performance of the contract to ensure that the third party complies with the quality assurance measures.
The reviewfocuses on thecontract between aservice agency thatis providing fundingto a third party,such asprivate operators, nursing homes, etc.todetermine that the contract captures the provision of supports and services based on the quality assurance measuresapplicable to the third partyand the monitoring process. We also look to see if the contract has been reviewed and updated as required.
Q13.Under Reg.299/10 agencies are required to retain client files for a minimum of 7years after the last entry (death or discharge). If a client has been with a service agency for 30years can they purge the first years?
A:Section 14(3) of the SIPDDA requires that service agencies “retain a person’s service record for a minimum of seven years after the person is no longer receiving services and supports from the agency”.
Section 14(2) of the regulation states that a service record, at minimum, contains a copy of the individual’s Application for Developmental Services and Supports, Supports Intensity Scale needs assessment, and the individual support plan.
Section, 14(1)(b) stipulates that agencies “have policies and procedures on service record retention and secure storage”.
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