pinecrest supports and services center transitional light duty return to work program wynn ware...

Pinecrest Supports and Services Center

TRANSITIONAL LIGHT DUTY RETURN TO WORK PROGRAM

Wynn [email protected] (318) 641-2172

• Falls under Department for Health & Hospitals• The only Developmental Center in the state • Table of Organization of 1300+ employees • Providing supports and services to approximately 420+

individuals with developmental disabilities• Operating budget in excess of $100 million. • Pinecrest is located on approximately 450 acres. We have

over 5 miles of paved streets. There are in excess of 150 buildings on grounds

489 New Claims filed July 2014-January 2016Averages 25 claims per month

Incident Only Claim- indicates that an accident/incident occurred but that no medical treatment was sought and the employee did not miss any time from work.

Medical Only Claim - indicates that the employee received medical treatment but did not miss more than seven days consecutive of work.

Lost Time Claim –indicates that an employee received medical treatment and is unable to work for eight consecutive days or more than eight consecutive days

Category INCIDENT MEDICAL LOST TIME TOTAL

Struck by Resident 122 88 15 225

Slip/Trip/Fall 26 33 12 71

Strain by Lift/Push/Pull 15 30 1 46

Human Bite 16 14 1 31

Struck by Moving Object 13 3 1 17

Miscellaneous 4 11 1 16

Insect Wound 7 7 1 15

Cut/Puncture/Scrape 6 7 1 14

Striking Against Object 7 6 1 14

Auto Accident 7 5 1 13

Pinecrest Procedure III.B.01-01

• All incident/accidents affecting employees or visitors to Pinecrest Supports and Services Center (PSSC) shall be reported and investigated no matter how minor.

REPORTING THE INCIDENT/ACCIDENT TO SUPERVISOR

• When an employee is injured or becomes ill due to an incident/accident directly related to his/her employment at PSSC, he/she must report it to the supervisor of the geographical area where the incident occurred.

• If the affected employee is injured in a common area such as a parking lot, sitting areas located in grassy areas across grounds, etc. or discovers that he/she has incurred an injury that is noticed at a later time, the employee will immediately report it to their immediate supervisor.

• The first supervisor that the incident/accident/injury is reported to or first has knowledge of the incident/accident shall be considered the Reporting Supervisor and shall be held responsible for investigating the incident/accident and shall ensure all paperwork is completed and submitted per this procedure.

Pinecrest Procedure III.B.01-01• Immediately upon having knowledge of the employee incident/accident the Reporting

Supervisor shall ensure that the affected employee receives first aid or 2222 is called if applicable.

• The Reporting Supervisor shall complete the Office of Risk Management’s State Employee Incident/Accident Investigation Form DA-2000 while the affected employee is present, unless the injury is of such severity that he/she is unable to answer questions. The DA2000 packet shall be completed before the end of the affected employee’s shift on the day the Reporting Supervisor first has knowledge of the incident/ accident.

• The Reporting Supervisor shall complete and give to the injured employee the PSSC HRM-063 and PSSC HRM-064 forms available in the DA2000 packet to the injured employee to provide to off grounds medical provider should the employee decide to seek medical attention.

• The original completed DA 2000 packet shall be hand delivered to Team/Department office on or before the next business day and shall be reviewed on the day it arrives in the Team/Department office by the Team/Department head or designee.


RETURN TO WORK• It is the employee’s decision to seek outside medical evaluation/treatment.

Pursuant to Workers’ Compensation Laws, employees filing Workers’ Compensation claims shall be required to submit to a drug test . If the employee chooses to seek outside medical evaluation/treatment he/she shall abide by the following:

• Obtain work status report from the treating physician.• Bring all doctor’s statements/work status reports pertaining to their case until

all follow-up visits with the doctor are complete to the Human Resources Workers’ Compensation Representative (HRRWC). This is to include all employees who are released to transitional/full duty. If an employee cannot bring in their statement due to a major injury, then contact shall be maintained with the HRRWC and the employee’s supervisor. A doctor’s statement will need to be provided via fax to 318-641-2212.


• Employee shall bring work status statements to the HRRWC and be cleared BEFORE returning to duty. Failure to comply with this rule shall be subject to disciplinary action.

• The employee may be cleared to work by their immediate supervisor if the employee returns to work after hours/on weekends and has a full duty release to work. In this case, the employee shall be allowed to work; however, the employee must bring the release/work status report to the HRRWC the next business day.

• The employee may not be cleared to work by their supervisor if the employee brings a transitional/light duty release to work after hours/on weekends. The employee shall report to the HRRWC the next business day to obtain clearance to return to work if the restriction can be accommodated by their supervisor.


Transitional Duty

• Transitional duties are defined as those duties an employee is physically able to perform prior to his/her return to full health and as determined by the treating physician.

• Upon receipt of notification that the employee has been released to return to work with restrictions, the HRRWC will contact the employee’s supervisor to determine if the restrictions can be accommodated in the work area.

• An effort will be made to place the employee in his/her original work area, however, if this is not possible, the HRRWC will seek a suitable work station and work schedule for the transitional duty period.

• An employee cannot work more than 6 months outside their original position however may be detailed to special duty for a period not to exceed one year.

• NOTE: That the length of the Transitional Work Program will be until maximum medical improvement has been achieved and not to exceed one year.

Pinecrest Procedure III.B.01-01• The Area Manager or Department Manager of the work area in which the

“transitional” duty assignment is identified must approve the proposed placement prior to further action being taken.

• The HRRWC and the employee will discuss each assigned duty to include the consequences if he/she fails to comply with the Transitional Duty Plan; i.e., disciplinary action as stated in Civil Service Rules and Regulations.

• All parties sign the plan and the employee is notified of the date, time, and place to report for duty.

• All Administrative and supervisory personnel shall adhere to the provisions of the Transitional Duty Plan.

• The HRRWC shall maintain contact with the employee to monitor the status of the employee throughout the worker compensation process until the claim is closed.

• Regular contact shall be maintained with the claims adjuster with Sedgwick and rehabilitation counselors contracted by Sedgwick who will coordinate with the physician the employee’s return to work.

Memo to Injured Employee

When injured on the job, before you leave work:

1. Notify your supervisor of your need to leave work for medical treatment.

2. Notify the Workers’ Compensation Representative in H.R. Dept at Ext 2172 or 2156 with the date of injury, physician/clinic you plan to visit, and the department/team you are assigned.

3. If your healthcare provider needs verification, call Pinecrest’s Workers’ Compensation Representative at (318) 641-2172 or (318) 641-2156, or Sedgwick at (225) 368-3500 or Toll Free at (844) 717-5566.

HRM – 064 Instructions to Employee After you have been seen by the physician you will

need:1. A doctor’s statement/work status report regardless of status.2. You MUST clear through the Workers’ Compensation Representative in the Human Resources

Dept before you can report to duty.Note: On weekends and holidays, supervisors may authorize your return to duty if you have been

released to work Full Duty with No Restrictions. If you have restrictions you must wait to be cleared the next business day by the Workers’ Compensation Representative in the Human Resources Dept. If you are not able to return to work you must notify your supervisor.Communication with your supervisor and workers’ compensation representative throughout the workers’ compensation process is mandatory.You must submit a doctor’s statement to the Workers’ Compensation Representative in Human Resources Dept whether or not you lose time from work. This is to ensure that your claim is reported timely as well as to expedite prompt payment on your claims when the Sedgwick Representative receives requests for payment.

FAILURE TO COMPLY WITH THESE INSTRUCTIONS COULD RESULT IN DISCIPLINARY ACTION.

HRM -063 Memo to Healthcare Provider• On (date) ___________________

• Employee: ___________________________

• Reporting Supervisor’s Signature: __________________________________ Date: ________________

The above named employee was injured while working at Pinecrest Supports and Services Center (PSSC) on the dated noted. He/She is eligible for treatment under our Workers’ Compensation Insurance. PSSC has a policy that any employee seeking medical treatment for an injury is subject to a drug screen. The employees of PSSC are covered under Workers’ Compensation Insurance by Sedgwick.

Initial authorization for treatment, verification of employment, date of injury and type of injury should be obtained from the Workers’ Compensation Representative at (318) 641-2172 or (318) 641-2156.

Please forward all bills and medical reports to: Sedgwick, P. O. Box 14775, Lexington, KY 40512

To contact a Claims Adjuster with Sedwick, call (225) 368-3500 or Toll Free (844) 717-5566.

In accordance with Act 617, September 9, 1988, the maximum non-emergency diagnostic testing or treatment any one healthcare provider may charge without mutual consent of the payer and the employee is $750.00. Please be aware that payments of medical claims by Sedgwick are based on a fee schedule.

Employees are required to submit a release/work status report from their physician to the Workers’ Compensation Representative in the Human Resources Dept BEFORE THEY CAN RETURN TO WORK. This release must be an original with the physician’s legible name, original signature and telephone number.

Please note: Pinecrest Supports and Services Center has a “LIGHT DUTY PROGRAM”

Physician’s Modified Work Information SheetTo All Employees:Please return this completed report directly to your supervisor within 24 hours of your injury or illness, and prior to the start of your next scheduled work shift.

Attending Physician: The State of Louisiana, Office of Risk Management is committed to a modified/alternate duty work program to accommodate the timely return to productive, beneficial work that facilitates recovery. In order for the return to work to be successful, it is important that the accommodation fits the appropriate restriction(s) and limitation(s) that the employee should be observing. To assist us in identifying suitable duties, please indicate your patients work capabilities and any other comments you may have. The State of Louisiana has the ability to provide duties that accommodate almost all restrictions. Please fax a copy of the completed form to (225)368-3490.

1 to 2 lbs 3 to 5 lbs 6 to 10 lbs 11 to 20 lbs 21 to 30 lbs 31 to 40 lbs 41 + lbs

Lifting

Carrying

Push/pull

Minimal Under 1 Hr 1-2 Hrs 2-3 Hrs 3-4 Hrs 4-5 Hrs 5-6 Hrs 8 hrs 12 hrs

Sitting

Standing

Walking

YES NOSquatting / KneelingBend/Twist at WaistReachingWork above Shoulder Climbing

List any other restrictions

Restrictions effective until (date) Diagnosis: __________________________________________Treatment Plan: ___________________________________________________________________________________________________

Date________________ Signature of Attending Physician: ________________

Date of Follow Up Appointment: ________ Patient signature_____________________________________________

Employee Name: _ ________________ DOB:_____ __ Injury/Illness date: __Doctor Name (Printed): ___ ___Phone Number: Claim#:________

RETURN TO WORK FULL DUTY WITH NO RESTRICTIONS? YES NO DATE:

Pincrest Supports and Services CenterTransitional Light Duty Plan

NAME: WYNN WARE EMPLOYEE ID #: 175372 AREA/DEPT: Team 6 Home 404 DATE OF INJURY: 11/28/15 SHIFT: 8a-8p PASS DAYS: A-Days DATE RETURN TO WORK: 12/3/15 DATE PLAN OBSOLETED:

PINECREST SUPPORTS AND SERVICES CENTER PINEVILLE, LOUISIANA

TRANSITIONAL DUTY PLAN – December 3, 2015

Transitional duty will be performed on T6/H404 working A-Day shift 8am-4pm Tasks:

1. Assist clients during meals. 2. Set tables for meals, put out nutritional management plans and food supplements. 3. Clean dining area after meals. 4. Assist clients to get dressed. 5. Assist clients with personal hygiene (comb hair, oral hygiene, shave, etc.) 6. Assist clients with doctor appointments. 7. Assist with client training. 8. Perform laundry duties (wash, dry, fold clothes and put clothes away). 9. Assist to sweep, mop, and clean the entire building which includes bathrooms. 10. Make and straighten beds.

Restrictions: Light Duty Work - No lifting over 20lbs; no squatting,climbing, bending, pushing or pulling; can stand, walk, and drive 1-4 hours; can sit for 8 hours. **CAN ONLY WORK FOR 8 HOURS/DAY MAX **

Acknowledgment:



I certify that I have read this plan or it has been read to me. I understand that failure to abide by this plan may result in disciplinary action as stated in Civil Services Rules and Regulations. I understand that I cannot work more than 6 months outside my job description; however, if a position for which I qualify is available, I may be detailed to special duty not to exceed (1) one year. I understand that the length of the Transitional Work Program will be until maximum medical improvement has been achieved and not to exceed one year. I understand that I am to submit medical updates relative to the work related injury as indicated by the Human Resources Representative for Workers’ Compensation. I also understand that failure to comply with the Transitional Duty Policy and Procedure may result in termination of my participation in the return-to-work program and return to regular duty.

If problems arise in carrying out this plan contact the Human Resource Representative for Workers’ Compensation at 641-2172 or 641-2169.

Employee Signature: _____________________________ Date:___________________ Supervisor Signature: _____________________________Date:___________________ Workers Comp Designee: _________________________ Date: ___________________


NAME: WYNN WARE Employee #: 175372 AREA/DEPT: Team 5 Home 303 DATE OF INJURY: 10/3/2015 SHIFT: 8p-8a PASS DAYS: A-NIGHTS DATE RETURN TO WORK: 12/9/15 DATE PLAN OBSOLETED: * Transitional Duty will be performed at Dispatch (7p-7a A-Nights)

Tasks: 1. Answer all incoming calls and direct them to the right place. 2. Give local and long distance lines for employees and individuals. 3. Monitor the fire board and call homes to make sure there is no fire. 4. Log runs from drivers in Daily log book. 5. Log Call-ins from employees. 6. Dispatch drivers for pickups and delivery. 7. Additional office duties that do not exceed restrictions.

Restrictions: NO USE OF RIGHT HAND; SEDENTARY DUTY –no pushing/pulling, grasping, manipulating with right hand

Acknowledgment:







NAME: Wynn Ware EMPLOYEE ID #: 175372 AREA/DEPT: Team 6 Home 413 DATE OF INJURY: 1/14/16 SHIFT: 8a-8p PASS DAYS: A-Days DATE RETURN TO WORK: 1/19/16 DATE PLAN OBSOLETED: Transitional Duty will be performed in T6/H413working A-Day shift Tasks: Work regular assigned duties with the following restrictions: LIGHT DUTY – 10 lb max lift.

Acknowledgment:






Duties• Assist clients during meals.• Set tables for meals, put out nutritional management plans and food supplements.• Clean dining area after meals.• Assist clients to get dressed.• Perform laundry duties (wash, dry, fold clothes and put clothes away).• Assist with client training.• Make and straighten beds.• Assist clients with personal hygiene (comb hair, oral hygiene, shave, etc.)• Perform required documentation on behavior and /or objective sheets.• Assist individuals during snack time with supplements and in toileting. • Basic housekeeping duties: light cleaning of bathrooms, kitchen, living areas.• Complete any required paperwork.• Answers phones, receives and relays messages, greets visitors.

Duties• Picks up mail twice daily.• Filing and other general clerical duties.• Runs errands, makes warehouse pick-ups.• Light typing• Shreds paper• Clean and wipe down furniture in living room• Clean refrigerator in kitchen/record temps• Clean microwave• Fold sheets from laundry• Put all clothes in correct closets• Bed checks are to be done every two hours unless otherwise prescribed by the doctor• Put up the milk when delivery day and ensure that we keep enough milk on a daily basis• Clean wheelchairs

Duties• Dress the individuals for early Dr. appointments or trips• Assist with individuals• Make sure the home is neat/clean• Make sure documentation is complete• Assist individuals with doctor appointments• Train a group of individuals in a classroom (as needed)• Check on individuals and change adult briefs (as needed)• Required to walk the halls and monitor to ensure active treatment is being provided for the

individuals we support• Set up the water and juice pitchers for snack time each morning and take these to each class with

snack choices during snack time• Responsible for ordering and picking up supplies as needed such as juice, applesauce, pudding

cleaning supplies, etc.• Required to help sweep, mop and clean the entire building, which includes the bathrooms• Attend classes at Staff Training and Accreditation as mandated or required.

Duties• Demonstrates activities such as bathing and dressing to training individuals in daily self-care practices

and provides other personal care for individuals as needed. • Converses with individuals to reinforce positive behavior and promote social interaction.• Accompanies individual on shopping trips and assist in purchasing of items.• Aids staff in administering therapeutic activities, such as physical exercises, occupations arts and crafts,

and recreational games to individuals.• Observes and documents individuals’ behavior such as speech productions, feeding patterns, toilet

training, and facilitate assessment and development of treatment goals.• Attends to routine health-care needs of individuals under supervision of medical personnel.• Performs socialization, motor training, and communication skills to conform to ICF/MR standards. • Maintain daily records of same and meets, the required objectives as assigned individually to each client. • Provides recreational activities at the team level for individuals, such as playing games, swinging, simple

amusement activities or forms of entertainment for the purpose of motivating the clients• Escorts individuals to the park, recreation hall, church activities and other related activities. Meet each

individual’s established socialization and communication objectives

Duties• Trains, teaches, and assist individual to develop good personal hygiene habits such as brushing teeth,

dressing, care of the hair, toilet training, etc.• Attends training sessions as required.• As needed will work in other areas/sections/divisions, etc.• Performs other related duties as required and/or assigned• Perform home manager duties (ensure logbook entries are accurate, assign tasks, order supplies as needed,

work assigned group, in-service staff, ensure meaningful activities are done)• Check support folders• Complete paper work such as employee productivity files, and PPR’s. • Trains and guides individuals in routine and elementary self-help skills such as good hygiene, good

housekeeping, money management and other activities providing personal and social growth, ensuring that people use their environment.

• Assist individual with daily living activities such as bathing, dressing and oral hygiene.• May accompany individual to activities outside of PSSC, such as church, recreational activities or doctor

appointments, ensuring that people interact with others.• Observes behavior and health of people and reports sudden or unusual changes to higher authority.• Clean living areas and washed, dries and folds resident’s clothing and linens to maintain a proper

environment for the people.

Duties• Ensure that individual’s records are maintained with current and precise documentation in

accordance with applicable regulations, standards and guidelines• Reports incidents/accidents and suspected cased of abuse and neglect immediately to supervisor,

investigation unit and client rights, ensuring that people are safe.• Supervise RSS’s in carrying out active treatment plans and basic care for persons with

developmental disabilities in order to promote continuity and security for individuals. • Direct subordinates in training and guidance of individuals in routine and simple self-help skills

such as good hygiene, feeding and dressing, good housekeeping and other activities providing personal and social growth.

• Direct subordinates to ensure individuals are supported in personal and social growth by supporting friendships and activities in the community which promote integration and fulfill personal goals.

• Direct subordinates to ensure that individuals are treated respectfully and fairly. • Will be required to make nightly rounds in homes within assigned Teams when not working a

group of individuals.

Duties• Will be required to work a group of individuals to ensure adequate supervision.• Assist in interviewing, selecting and training RSS’s, scheduling work, evaluating

performance and resolving problems in order that individuals experience continuity and security.

• Participate with interdisciplinary team in development of active treatment programs for each individual, and in person-centered planning to accomplish personal outcomes. Interpret directives and policies of a higher authority to subordinate staff including information related to attainment of personal outcomes.

• Observe living areas for cleanliness and check individuals to assure proper care to support the best possible health for individuals.

• Requisition needed supplies, equipment and repairs for living areas. • Monitor physical environment to ensure individuals are able to use their environments. • Review and report on progress of individuals in specific training programs. • Ensure individuals’ records are maintained with current and precise documentation in

accordance with all federal, state and agency regulations.

Duties• Supervise implementation of behavior management programs. • Organize individuals’ training opportunities in accordance with their needs, personal goals, and as

prioritized in the active treatment plan. • Report and assist in investigation of all cases of accidents, injuries and suspected case of

abuse/neglect to ensure individuals have the best possible health and are free from abuse and neglect.

• May be required to testify at Civil Service hearings regarding disciplinary action taken in cases of abuse/neglect.

• Directs subordinates in training, guidance, and implementation of the people we serve in areas of habilitation, enrichment, and routine self-help skills in the day programs such as personal hygiene and housekeeping in providing personal and social growth.

• Ensure that nutritional, behavioral, and physical support plans developed by the team are implemented as intended by the direct care staff in the day services area.

• Ensure that each individual’s day program records are maintained with current and precise documentation in accordance with all applicable regulations, standards, and guidelines.

Duties• Assists in training new employees, scheduling work, and resolving technical problems in the day

programs. • Request needed supplies, equipment, and repairs in day program areas to ensure that the people we

serve are safe. • Observe day programs for cleanliness and supervises subordinates in maintaining proper learning

environment for people attending the day programs.• Plans activities, community orientation trips for people attending the day services program, ensuring they

have an opportunity to interact with other members of the community. • Incorporate skills learned in day services with the community. • Reports and assists in investigation of all instances of alleged abuse or neglect of people attending day

services. • Initiate schedule changes of individuals to appropriate day service courses when necessary to enhance

their independence of making daily routine choices. • Assist classroom facilitators with required training materials to implement the scheduled course activity

in the day service areas.• Reconcile clients’ personal inventories.

Tracking Employees On Workers CompAll forms are electronically scanned and saved in files arranged alphabetically by the year in which the injury occurred.All claims are stored in an Access Database utilized for tracking and researching individuals by Name; SS#; Demographic Information; Date of Injury; Type of Injury; Injury Description; Incident Type: Reporting Only, Medical, and Lost Time; Claim Number; Date Out of Work; Date Returned to Work; Date of Doctor Follow-up Appointments and General Comments and notes.Case notes are also stored in an Excel Database used to discuss with Sedgwick at monthly Return To Work meetings.

Any Questions?

pinecrest supports and services center transitional light duty return to work program wynn ware...

Documents