Was the person seeing primary care per agency/community standards and the primary care doctors instruction? endstream endobj startxref Did the personrequire agency staff to support him or her in the hospital? What did the PONS instruct for treatment and monitoring (vitals, symptoms)? An authorized provider's written assurance that a person placed in an individualized residential alternative has a plan for appropriate supervision by a qualified party. endobj However, the service coordinator should also include safeguards that pertain to other environments where the person spends time. Who reviewed the bowel records (MD, RN)? Did the person have any history of behaviors that may have affected staffs ability to identify symptoms of illness (individual reporting illness/shallow breathing for attention seeking purposes, etc.)? They are not diseases or causes of death, but rather circumstances. In conjunction with the person and his or her circle of support, the Person-Centered Planning process requires that supports and services are based on and satisfy the person's interests, preferences, strengths, capacities, and needs. The plan shall include provisions for ensuring: (i) The assessment of each person's need for the amount and type of supervision necessary including both staff and/or technology as appropriate to the person and circumstance. 686.16 Certification of the facility class known as individualized residential alternative. Call us at (858) 263-7716. Were there specific plans for specialist referrals or discontinuation of specialists from the provider? It is the Level II SSI payment amount minus the minimum personal allowance in section 131-o of the New York State Social Services Law. provide all necessary documents to the Service Coordinator/Care Manager (SC/CM) to ensure that the Person-Centered Service Plan (PCSP) has all required attachments. A developmental disability as defined in section 1.03(22) of the Mental Hygiene Law. opwdd plan of protective oversightlist of chase merchant id numbers opwdd plan of protective oversight. risk assessment; protective oversight; brain injury; unstaffed time; emergency plan; medication administration; risk assessment; planning tools and products, http://www.advancingstates.org/node/50465. The Office for People with Developmental Disabilities (OPWDD) is responsible for assuring that services rendered are of high quality and effectiveness while engaging in oversight functions with other agencies so that the civil rights . OPWDD 149 - signed and dated by the investigator - mandatory Death certificate and/or autopsy (if performed) (this should be identified as the . When was the last visit to this doctor? INSPECTOR GENERAL . (3) A facility in this class for eight or fewer persons, shall meet the building code listed in section 635-7.1(h)(1)(ii) of this Title or for New York City in section 635-7.1(i)(1)(ii) of this Title and the environmental requirements listed in section 635-7.4(b)(3) of this Title. Seizure? These may be the key questions to focus on in these circumstances: End of Life Planning / MOLST: End-of-life planning may occur for deaths due to rapid system failure or as the end stage of a long illness. Once reviewed and signed by the RRDS, the PPO is returned to the SC, who distributes it to the participant and any waiver service provider listed in the current Service Plan. This posting is not intended to replace official publication of regulations in the New York State Register, published by the New York State Department of State. A copy of the PPO must be provided to the participant by the SC to be maintained in an easily accessible location of the participant's choice within his/her home. If you are not familiar with the MOLST process please see here. Ensure the 1750b surrogate makes informed decisions about end of life care. Due to the timing of the posting process, the regulations posted on the Department of State website may not reflect the most current version of OPWDD regulations. If not, were policies and procedures followed to report medication errors? Did the person have any history of seizures or other neurological disorder? Were the decisions in the person'sbest interest? Site specific Plan of Protective Oversight Individual Plan of Protective Oversight Relevant policies (CPR, Emergency Care, Triage, Fall and Head Injury Protocols) . The investigation needs to state in a clear way what kind of care the person received and describe whether the interventions were or were not timely, per training, procedure, and/or service plans. Were any gastro-intestinal diagnostic tests performed, including upper endoscopy (EGD), diagnostic colonoscopy, abdominal/ pelvic CT scan, abdominal x-rays, etc.? The Centers for Medicare and Medicaid Services (CMS) approved the States Medicaid Plan Amendment to add the Community First Choice Option (CFCO) set of services. Protective Oversight Assisted Living Facility (ALF) Shall mean any premises, other than a residential care facility, intermediate care facility, or skilled nursing care facility, that is utilized by it s owner, operator, or manager to provide twenty-four (24) hour care and services and protective oversight to three (3) or more residents who are The New York State Office for People With Developmental Disabilities and all of its administrative subdivisions. Text Size:product owner performance goals examples jefferson north assembly plant. (3) OPWDD shall verify that each person has a plan for protective oversight, based on an analysis of the person's need for same, and that such need has periodically, but at least annually, been reviewed, revised as appropriate, and integrated, as appropriate, with other services received. Was nursing and/or the medical practitioner advised of changes in the person? Did he or she have neurological issues (disposed to early onset dementia/Alzheimers)? Any signs of possible aspiration (wheezing, coughing, shortness of breath, swallowing difficulty, possible cyanosis)? The written document that is developed by an individual's chosen service coordinator, the individual and/or the parties chosen by the individual, often known as the persons circle of support, that describes the services, activities and supports, regardless of the funding source, and that constitutes the person's individualized service environment. However, evidence of failure to comply with the principles may be the basis for decertification in accordance with article 16 of the Mental Hygiene Law. Were there signs that nursing staff were actively engaged in the case? Was the preventative health care current and adequate? If the person arrives at day program sick, how did he or she present at the residence during the morning and previous night? Did the person start a narcotic pain medication? (5) Each facility in this class shall ensure the provision of, or provide as its minimum responsibility, protective oversight (see glossary) appropriate to the person's needs. When was his or her last EKG? Were appointments attended per practitioners recommendations? Was it implemented? When was his or her last lab work (especially if acute event)? Did plan address Pica as a choking risk? Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, James V. McDonald, M.D., M.P.H., Acting Commissioner, Multisystem Inflammatory Syndrome in Children (MIS-C), COVID-19 Excelsior Pass/Excelsior Pass Plus, Addressing the Opioid Epidemic in New York State, Drinking Water - Boiling Water and Emergency Disinfection Info, Health Care and Mental Hygiene Worker Bonus Program, Learn About the Dangers of "Synthetic Marijuana", Maternal Mortality & Disparate Racial Outcomes, NYSOH - The Official Health Plan Marketplace, Help Increasing the Text Size in Your Web Browser. Was there loose stool reported in the week before the obstruction (can be a sign of impaction)? Did the person receive any blood thinners (if GI bleed)? endstream endobj 169 0 obj <>stream Were decisions regarding care and end-of-life treatment made in compliance with the regulations regarding consent? Individualized Plan of Protective Oversight. Reassessment of the person's functional needs. W t|C'TCT3W0 `A-][-|xA;f!Z}gV42`C!M_dgeLvkZeE~2 20 6WiyH9XBAOwSQpyv4(v[l|rt~/[ <3t>MW_KG7;b7AVTW'`YW z (3) OPWDD shall verify that each person has a plan for protective oversight, based on an analysis of the person's need for same, and that such need has periodically, but at least annually, been reviewed, revised as appropriate, and integrated, as appropriate, with other services received. %%EOF (ii) The use of appropriately trained substitute personnel when the primary assigned personnel are unavailable. about ADM #2015-02 Service Documentation for Community Transition Services, about ADM #2018-06R2 Transition to People First Care Coordination, about ADM #2022-05 Medication Administration Training Curriculum for Direct Support Staff, Office for People With Developmental Disabilities, Title 14 of the New York Codes, Rules andRegulations (NYCRR), 1915(c) Childrens Waiver and 1115 Waiver Amendments, Management of Communicable Respiratory Diseases. What is the pertinent staff training? The fact that a correspondent is providing advocacy for a person as a correspondent does not endow that party with any legal authority over person's affairs. Artificial hydration/ nutrition? Was there a diagnosed infection under treatment at home? Person-Centered Service Plans are expected to change and to adjust with the personover time. Were there previous episodes of choking? Exhibit any behavior or pain? Were established best practice guidelines used to determine that appropriate consults and assessments were completed when appropriate? If the individual resides in a developmental center or is on conditional release, this shall be done with notice to the Mental Hygiene Legal Service. Thus, an individual may be capable of participation in planning for his/her services and programs but still require assistance in the management of financial matters. Falls. Death certificate and/or autopsy (if performed) (this should be identified as the Source of Cause of Death in the Report of Death) mandatory, but investigation should be submitted if death certificate/autopsy is still pending. The PPO must be sent to the RRDS for review and signature. Were changes in vitals reported to the provider/per the plan, addressing possible worsening of condition? Were staff trained on relevant signs/symptoms? endstream Section 8.ATTACHMENTS. (2) For individualized residential alternatives of eight or fewer beds, OPWDD shall verify that each person's individualized services plan (see glossary) contains a current evaluation of the fire evacuation capacity of the person based on actual performance. Addressed in the plan: money management, medication management, kitchen safety, back-up staffing for unscheduled staff absences. Were problems identified and changes considered in a timely fashion? Did staff follow plans in the non-traditional/community setting? (4) An individualized residential alternative shall meet the requirements of this Part as set forth in sections 686.1, 686.2, 686.3, 686.4, 686.5, 686.9, 686.15(a)(1)-(3) (as appropriate) and 686.16 of this Part. The provision of intermittent, temporary, substitute care of a person with developmental disabilities on behalf of a primary caregiver. ",#(7),01444'9=82. What communication mechanisms are in place to transfer information on health and status from residence to day program or community based servicesand vice versa? What was the treatment? $.' The information provided in this Plan for Protective Oversight summarizes alternatives so that the participant's health and welfare can be maintained in the community and that he/she is not at risk for nursing home placement. The death investigation is always the responsibility of the agency. NY Department of State-Division of Administrative Rules. The Person-Centered Planning process should empower people with intellectual and/or developmental disabilities to have an active voice in the development of their Person-Centered Service Plan (PCSP) and in shaping their futures. <> Revised Protocols for the Implementation of Isolation and Precaut Protocols for the Management of mpox (monkeypox) in OPWDD Certifi ADM #2022-06 Direct Provider Purchased/Agency Supported/Contract ADM#2021-04R Crisis Services for Individuals with Intellectualand ADM #2015-02 Service Documentation for Community Transition Servi ADM #2018-06R2 Transition to People First Care Coordination. Can they describe the plan? Were appointments attended per practitioners recommendations? 0 Medical, about Management of Communicable Respiratory Diseases, about Revised Protocols for the Implementation of Isolation and Precautions for Individuals Exposed to COVID-19 Residing in OPWDD Certified Facilities, about Protocols for the Management of mpox (monkeypox) in OPWDD Certified Facilities, about ADM #2022-06 Direct Provider Purchased/Agency Supported/Contract Services Delivered by Providers Who Are Not The Fiscal Intermediary. Not all documents may be relevant to your investigation. How and when was the acute issue identified? Circumstances? When was his or her last consultation with a cardiologist? stream OPWDD assumes no responsibility for any error, omissions or other discrepancies between the electronic and printed versions of documents. Did it occur per practitioners recommendation? Self-Direction, Was there a valid Health Care Proxy (HCP) completed if a MOLST/checklist was not completed? It is the responsibility of the individual's chosen service coordinator to ensure that the ISP is reviewed at least semi-annually and includes consideration of the information obtained from other-than-OPWDD providers (if any), who are providing services (. 8M\XPJ\Cm\Jrk'[1zt;3;7''U=}(5'u]=6/~>Le=]n]>Tp:8bd`q1dqfv* Determination of the nature of the material is that of the agency/facility. Training records (CPR, Plan of Nursing Services, Medication Administration, individual specific plans). individuals For receiving Individualized Residential Alternative (IRA) Residential Habilitation, the Residential Habilitation Staff Action Plan must meet the requirements of the Plan for Protective Oversight in accordance with 14 NYCRR Section 686.16. If the person was diagnosed with dysphagia, when was the last swallowing evaluation? %PDF-1.6 % OPWDD's regulations are included in Title 14 of the New York Codes, Rules and Regulations (NYCRR). Was food taking/sneaking/stealing managed? (2) A facility in this class housing nine or more persons shall meet the physical plant, Life Safety Code and environmental requirements for supervised community residences listed in sections 635-7.1, 635-7.2 and 635-7.3 of this Title. The Individual Plan of Protective Oversight (IPOP) is a documented and approved plan used for the sole purpose of enhancing individual safety. If the participant's situation has changed and he/she now has a legal guardian, the SC will request and obtain the guardian documentation. The Person-Centered Planning process should also incorporate the following: The Person-Centered Service Plan must include and document the following: Once the Person-Centered Service Planis completed and signed, the SC/CM is responsible for implementing and monitoring the plan as outlined in the OPWDDs ADM #2010-03 and ADM #2010-04. Last annual physical, blood work, last consults for cardiology, neurology, gastroenterology, last EKG? Any history of aspiration? Phone: 202-309-7504 . A bed made available to a person with developmental disabilities for short-term purposes. If seizures occurred, what was the frequency? Was there a MOLST form and checklist in place? %PDF-1.5 Individual Plan of Protective Oversight. What to expect; First visit; FAQ; General notes, staff notes, progress notes, nursing notes, communication logs. OPERATION OF COMMUNITY RESIDENCES, The agent or operator of a facility operated or certified by OPWDD. The New York State Office for People With Developmental Disabilities and all of its administrative subdivisions. If the person required pacing while dining, was this incorporated into a dining plan? OPWDD shall verify that staff and persons residing in the facility are trained and evaluated regarding their performance of said plan. Specialist care, per recommendations? What is the pertinent past medical history (syndromes/disorders/labs/consults)? C. Plan for Protective Oversight (PPO) The PPO (refer to Appendix C - form C.4) indicates all key activities that directly impact the health and welfare of the participant and clearly identifies the individual (s) responsible for providing the needed assistance to the participants in the event of an emergency or disaster. (iii) The establishment of qualifications and training requirements of those responsible for supervision. What PONS were in effect and were staff trained? Could missed doses be of significance in the worsening of the infection? Hospital Deaths: If death occurs in the hospital the following are general questions to consider: See End of Life Planning/MOLST, below Expected Deaths, end-stage disease: With certain conditions like Alzheimers, COPD, or heart failure, symptoms are expected to worsen over time and death becomes increasingly likely. 0 A condition of a person, or lack thereof, which, when addressed, enhances the person's quality of life and/or ability to cope with his or her circumstances or environment. Site specific Plan of Protective Oversight. They must be designed to empower the person by fostering development of skills to achieve desired personal relationships, community participation, dignity, and respect. Did it occur per practitioners recommendations? Was the person receiving medications related to the cardiac diagnosis and were there any changes? Did staff follow orders/report as directed? <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Title: Nursing Home Tansition and Diversion Medicaid Waiver Manual - Plan for . Plain Language document providing information and guidance about mpox. Were the medications given as ordered? food-stuffing, talking while eatingor rapid eating? Were there staffing issues leading to unfamiliar staff being floated to the residence? Were staff trained on the PONS? OPWDDs regulations are included inTitle 14 of the New York Codes, Rules andRegulations (NYCRR). If there are incidents or concerns that arise which are directly Did the person receive sedation related to a medical procedure? Life-threatening sepsis causes the blood pressure to drop and the heart to weaken, leading to septic shock. hVKo8+ ~ bTuaJiNws)zof8C?KC2%D(pmZdhD$IB$gWhp*U> OGW9ZTkz6EE'#1i> |DwK,]~]#NG[:(]U%RYSwqxwu0"c.Cg,m6~bY!qSPT}32^W0wvv_&br5;P&vP/UYmrvb[^Bka>XBL)%Z WO It is an individualized approach to service planning, structured to focus on the unique values, strengths, preferences, capacities, interests, desired outcomes, and needs of the person. (4) service coordination, including assessment, service planning and coordination, linkage and referral, follow-up and monitoring. Diet orders and swallow evaluation, if relevant. The form contains two pages. It is a means of providing relief from the responsibilities of daily caregiving. 0/u`_(|F!F. Were the actions in line with training? If monitoring urine output report what amount, or qualities? What were the PONS in place at the time? For the purpose of this regulation, this shall mean residents of New York State or neighboring states living within general proximity of one or more of the community residences operated by an agency. New York, NY. Was there evidence of MD or RN oversight of implementation? (1) OPWDD shall verify that each individualized residential alternative has implemented a facility evacuation plan. OPWDD 149 signed and dated by the investigator - mandatory. Could it have been identified/reported earlier? Capability as stipulated by this definition does not mean legal competency; nor does it necessarily relate to a person's capacity to independently handle his or her own financial affairs; nor does it relate to the person's capacity to understand appropriate disclosures regarding proposed professional medical treatment, which must be evaluated independently. Short URL: http://www.advancingstates.org/node/50465, Leadership, innovation, collaboration for state Aging and Disability agencies, ADvancing States 2 0 obj 5 0 obj Start or increase another medication that can cause constipation? Was it communicated? hbbd``b`@q?`]bX=l $@C @dJ0~ n8)f\.Feq2o` 1101H.)@ I am pleased to present the Environmental Protection Agency Office of U.S. For purposes of this Part, a child or adult with a diagnosis of developmental disability, who has been or is being served by a State, private or voluntary operated facility certified by OPWDD. Had the person received sedative medication prior to the fall? :@-S[!v:q~|lUsoo=e1aj\,;+Dt]QNN~U0iOuxabJ,cdVM>/gN>+NhS>/}aM]4g=H TtV0M19NK.MU/oNM>$C In New York City, this unit is called the Borough Developmental Services Office (BDSO); elsewhere in the State it is called the Developmental Disabilities Services Office (DDSO). protective oversight measures staff need to implement or ensure for the individual. 241 18th Street S, Suite 403, Arlington, VA 22202 What did the bowel records show? Were there any changes in medication or activity prior to the obstruction? When was the last blood level done for medication levels? Comments: Name of RRDS Signature Date. What was the diagnosis at admission? What were the symptoms which sent the person to the hospital? Sudden changes: If the change was reported to you as sudden or within 24-hours of an ER or hospital admission, review notes a few days back and consider interviews regarding staff observations during that time. Were there any issues involving other individuals that may have led to staff distraction? respective service environment. Any predispositions? Questions for persons with particular medical histories/diagnoses: Listed below are some situations which can influence the focus of questions. Were they followed or not? Was the plan clear? Investigation should start from the persons baseline activity, health, and behavior, and ALWAYS start at home (before hospitalization). When was the last neurology appointment? Was the person on any medications that could cause drowsiness/depressed breathing? The commissioner of the New York State Office for People With Developmental Disabilities, or his or her designee. Were the orders followed? Did the plan address refusal of food, vomiting, and/or distended abdomen? Did the team identify these behaviors as high risk and plan accordingly? The PPO must be completed by the SC with the applicant during the development of the ISP. When was the last lab work with medication level (peak and trough) if ordered? 665 0 obj <> endobj Was a specific doctor assuming coordination of the persons health care. Billing, HCBS, If a GI or surgical consultation was requested by the primary care doctor, when was it done and when was the most recent follow up if applicable? P3T{$0\C-yA8|}xE OX A payment (as of this date) of up to $250 per year, per person residing in a voluntary-operated community residence which may be available to the operator of the facility for one or more of the following individuals needs: (2) personal requirements and incidental needs; and. schedule meetings at times and locations that are convenient to the person, sign the person-centered habilitation plan(s), and. While the New York State Office for People With Developmental Disabilities makes every effort to post accurate and reliable information, it does not guarantee or warrant that the regulations posted on this web site are complete, accurate or up-to-date. U.S. Environmental Protection Agency . 257 0 obj <>stream Washington, D.C. What is the policy for training? Determine the necessary medical criteria. Developing strategies to address conflicts or disagreements in the planning process, including a clear conflict of interest guidelines for people, and communicating such strategies to the person. Once this happens, multiple organs may quickly fail and the patient can die. Person-Centered Service Plans are expected to change and to adjust with the person over time. Were staff aware of the risks/ plan? Were staff involved trained? How quickly did they appear? 243 0 obj <>/Filter/FlateDecode/ID[<6BDD22F527B3170CE5AAFF59FE59009A>]/Index[199 59]/Info 198 0 R/Length 132/Prev 149963/Root 200 0 R/Size 258/Type/XRef/W[1 2 1]>>stream A copy is also provided by the SC to each waiver service provider listed in the RSP. endobj Guidance, Transfer of Oversight/Service Provision Between Programs. The policymaking authority of a community residence responsible for the overall operation and management of one or more community residences operated by an agency. What were the safeguards for safe dining e.g. Did this occur per the plan? Were there any surgeries or appointments for constipation and/or obstruction? Was staff training provided on aspiration and signs and symptoms? In determining certified capacity, the commissioner takes into consideration all other persons residing in the community residence in relation to utilization and availability of space and accommodations. What were the diagnoses prior to this acute issue/illness? Plan(s) of Nursing Service as applicable. When was the last GYN consult? This Plan must also be submitted to the Regional Resource Development Specialist with all Service Plans, and reviewed, at lease every six months by the Service Coordinator. This Inventory is a tool that can help to generate meaningful conversations with a person regarding the possible risk areas in his/her life. about ADM#2021-04R Crisis Services for Individuals with Intellectualand/or Developmental Disabilities (CSIDD) Service Requirements and Billing Standards. Were there visits, notes, and directions to staff to provide adequate guidance? This plan for Protective Oversight must be readily accessible to all staff and natural supports. h240W0P04P0TtvvJ,NMQ04;. DNR? Summary Job Description: The Residential Manager for our OPWDD-funded Individualized Residential Alternatives (IRAs) is an essential position and is responsible for the daily operations of 2 to 3 residential programs, by supervising, leading, and developing a competent and professional workforce, ensuring compliance with all federal, and state . Life Plan/CFA and relevant associated plans. The1915(c) Childrens Waiver and 1115 Waiver Amendments can be found on the Department of Health website. Was there an order for Head of Bed (HOB) elevation? Did the person require staff assistance to stand, to walk? 704 0 obj <>stream Were there any previous swallowing evaluations and when were they? What occurrence brought the person to the hospital? The "Individual Plan for Protective Oversight" can be referenced in the safeguards section for people who live in an Individualized Residential Alternative (IRA). On the agencys part? consistency, support, storage, positioning? Were there plans to discontinue non-essential medications or treatments? unusually agitated, progressive muscle weakness, more confused? Were appointments attended per practitioners recommendations? xU]k@|?T? Was written information related to choking risk and preventive strategies available to staff? Who was the doctor/provider managing the illness? The maximum number of beds available to be occupied by people with developmental disabilities for respite purposes, as indicated on the operating certificate issued by the commissioner. endstream endobj 666 0 obj <. The tool identifies risk factors and the services needed to mitigate them, and assigns specific persons who will be responsible for providing the necessary service and oversight. 3 0 obj There are several resources to support the planning process and the delivery of exceptional care in the most integrated community settings. It is attached with the ISP packet and sent to the RRDS for review and signature. Community residences are designed to accomplish two major goals: (2) provide a setting where persons can acquire the skills necessary to live as independently as possible. , progressive muscle weakness, more confused medication levels readily accessible to all and. Should also include safeguards that pertain to other environments where the person received sedative medication prior to this acute?. For Head of bed ( HOB ) elevation person spends time especially if acute )... Individuals with Intellectualand/or developmental Disabilities for short-term purposes persons residing in the plan, addressing possible worsening of condition )! The morning and previous night guardian documentation to stand, to walk during morning! The use of appropriately trained substitute personnel when the primary care per agency/community standards and delivery. Opwdd shall verify that each individualized residential alternative, coughing, shortness of breath, swallowing,! Amount minus the minimum personal allowance in section 1.03 ( 22 ) of the New York Office. Sign of impaction ) be sent to the hospital, # ( 7 ),01444 ' 9=82 treatment made compliance... The New York State Office for People with developmental Disabilities and all of its administrative subdivisions with dysphagia, was... Individuals with Intellectualand/or developmental Disabilities and all of its administrative subdivisions Service coordinator should also include safeguards that pertain other. An order for Head of bed ( HOB ) elevation change and to adjust the! Expected to change and to adjust with the regulations regarding consent if there are incidents or that. Of those responsible for the individual enhancing individual safety more community RESIDENCES, Service! Cpr, plan of protective oversightlist of chase merchant id numbers opwdd plan of protective oversight measures staff to! The MOLST process please see here to support the planning process and the patient can die was person. Were completed when appropriate missed doses be of significance in the week the... Primary care per agency/community standards and the heart to weaken, leading to unfamiliar staff floated. Annual physical, blood work, last EKG and approved plan used for the overall operation and of! Of documents written information related to choking risk and preventive strategies available to a person developmental... Oversightlist of chase merchant id numbers opwdd plan of protective oversight must be sent to the residence other! Unusually agitated, progressive muscle weakness, more confused or appointments for constipation and/or obstruction generate... Sepsis causes the blood pressure to drop and the delivery of exceptional care in the class... Review and signature arise which are directly did the person arrives at day program sick, how did or. To report medication errors NYCRR ) the focus of questions the primary assigned are... 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