Abuse Allegations - page 2
by txdon 13,979 Views | 48 Comments
Just curious have other DON's handle abuse allegations. What is your process? Also, how are incident reports handled? The DON at my facility handles all of these and a lot are getting lost or not being investigated.... Read More
- 1Jun 8, '11 by debRN0417Here are the regulations (not all of it)
The facility must ensure that all alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source and misappropriation of resident property are reported immediately to the administrator of the facility and to other officials in accordance with State law through established procedures (including to the State survey and certification agency).
The facility must have evidence that all alleged violations are thoroughly investigated, and must prevent further potential abuse while the investigation is in progress.
The results of all investigations must be reported to the administrator or his designated representative and to other officials in accordance with State law (including to the State survey and certification agency) within 5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken.
Use F226 for deficiencies concerning the facility's development and implementation of policies and procedures.
The facility must develop and operationalize policies and procedures for screening and training employees, protection of residents and for the prevention, identification, investigation, and reporting of abuse, neglect, mistreatment, and misappropriation of property. The purpose is to assure that the facility is doing all that is within its control to prevent occurrences.
Guidelines: §483.13 (c)
The facility must develop and implement policies and procedures that include the seven components: screening, training, prevention, identification, investigation, protection and reporting/response. The items under each component listed below are examples of ways in which the facility could operationalize each component.
I. Screening (483.13(c)(1)(ii)(A)&(B): Have procedures to screen potential employees for a history of abuse, neglect or mistreating residents as defined by the applicable requirements at 483.13(c)(1)(ii)(A) and (B). This includes attempting to obtain information from previous employers and/or current employers, and checking with the appropriate licensing boards and registries.
II. Training (42 CFR 483.74(e)): Have procedures to train employees, through orientation and on-going sessions on issues related to abuse prohibition practices such as:
- Appropriate interventions to deal with aggressive and/or catastrophic reactions of residents;
- How staff should report their knowledge related to allegations without fear of reprisal;
- How to recognize signs of burnout, frustration and stress that may lead to abuse; and
- What constitutes abuse, neglect and misappropriation of resident property.
III. Prevention (483.13(b) and 483.13(c)): Have procedures to:
o Provide residents, families and staff information on how and to whom they may report concerns, incidents and grievances without the fear of retribution; and provide feedback regarding the concerns that have been expressed. (See 483.10(f) for further information regarding grievances.)
o Identify, correct and intervene in situations in which abuse, neglect and/or misappropriation of resident property is more likely to occur. This includes an analysis of:
- Features of the physical environment that may make abuse and/or neglect more likely to occur, such as secluded areas of the facility;
- The deployment of staff on each shift in sufficient numbers to meet the needs of the residents, and assure that the staff assigned have knowledge of the individual residents' care needs;
- The supervision of staff to identify inappropriate behaviors, such as using derogatory language, rough handling, ignoring residents while giving care, directing residents who need toileting assistance to urinate or defecate in their beds; and
- The assessment, care planning, and monitoring of residents with needs and behaviors which might lead to conflict or neglect, such as residents with a history of aggressive behaviors, residents who have behaviors such as entering other residents' rooms, residents with self-injurious behaviors, residents with communication disorders, those that require heavy nursing care and/or are totally dependent on staff.
IV. Identification (483.13(c)(2)): Have procedures to:
o Identify events, such as suspicious bruising of residents, occurrences, patterns, and trends that may constitute abuse; and to determine the direction of the investigation.
V. Investigation (483.13(c)(3)): Have procedures to:
o Investigate different types of incidents; and
o Identify the staff member responsible for the initial reporting, investigation of alleged violations and reporting of results to the proper authorities. (See 483.13 (c)(2), (3), and (4).)
VI. Protection (483.13(c)(3): Have procedures to:
o Protect residents from harm during an investigation.
VII. Reporting/Response (483.13(c)(1)(iii), 483.13(c)(2) and 483.13(c)(4)): Have procedures to:
o Report all alleged violations and all substantiated incidents to the state agency and to all other agencies as required, and take all necessary corrective actions depending on the results of the investigation;
o Report to the State nurse aide registry or licensing authorities any knowledge it has of any actions by a court of law which would indicate an employee is unfit for service; and
o Analyze the occurrences to determine what changes are needed, if any, to policies and procedures to prevent further occurrences.
EVERY facility is REQUIRED by the regulations to have a procedure and policy for handling abuse, neglect, and misappropriation allegations and the investigation process. This should be available to all employees and not a secret known only to the DON and administratior. All licensed staff are MANDATED reporters and have the legal obligation to FIRST protect the person who is the alleged victim, and then investigate, and report.
This is a serious issue that is looked at carefully by the regulatory agencies- not just the "State" but the Ombudsman, Department of Social Services, Adult Protective Services, and the Office of the Attorney General and Inspector General, as well as CMS. All facility reported incidents are reviewed carefully by the state agency and CMS. At every survey the Administrator is asked if the facility has had any allegations of abuse, misappropriation, or neglect since the last survey and then the documents/reports are reviewed. In my state we examine ALL the documentation of the investigation - not just the written letter of the outcome. We are required to validate the investigation process and that the facility is ensuring that every allegation is thoroughly investigated and reported.
- 0Jun 11, '11 by txdonWe do have policies and procedures for reporting incidents. The problem is the DON is controlling the process. When an allegation of abuse is reported by a staff member, the incident is reported to the DON for investigation. THe problem is a lot of them are lost, dismissed, or never follow up on. How does the regulatory agencies know if they never get reported? Also, when an "investigation" is conducted if other residents don't substantiate the allegation made by the resident then it is unsubstantiated. Also, my administrator told me falls resulting in fractures do not require reporting. He said that was done away with 15 years ago. How would I find out what is deemed reportable. Recently state resurveyed us and detected several residents who had falls so they asked the DON for all the falls for the last 3 months. She did not provide all the falls because she "misplaced" the incident reports and she signed and back dated incidents several of them. The DON is supposed to submit all incidents to our corporate office through a database reporting system. The problem is not all are being reported. It's a mess. Any suggestions
- 3Jun 12, '11 by CapeCodMermaidIf you have a corporate compliance hot line, call it the next time you go to work. If what you're saying is true, things are not right at the facility. Of course a fall with a fracture must be reported as must any other 'significant injury'.
I've had staff members complain about each other and then tell me I never investigated anything because they never 'heard' that I had. Most investigations are confidential. If someone accused you of abuse, would you want the whole building to know.
You are leveling some very serious charges against both your DON and administrator. You really should call someone at corporate and let them investigate. For all you know, they have already been told and are already investigating.
- 0Jun 12, '11 by txdonOur agency does have a compliance hotline. I will voice my concerns to them. I have never used the compliance hotline but the last person in management who did was terminated for "other" reasons. The DON found out who the person was based on inside knowledge of the evidents that occurred. It was evident who the person was based on the information provided. Our facility has 5 G tags and 1 IJ. I agree that things are very wrong with this facility and not sure how to proceed. I realize what I'm saying is serious, that's why I need advice on what to do. I understand that investigations are confidential however when the DON is given an allegation of abuse concern and it's automatically dismissed before the investigation something is not right. When an allegation of abuse is given to the DON the response often is: Really? I find that hard to believe, yeah right?, If that really happened I think I would have been the first to know about it, high fiving CNA's when things are unsubstantiated, the list goes on and on.
I did not mean to infer my administrator was covering up incidents. My administrator truly believes that falls resulting in fractures are not reportable if the origin is known and doesn't involve neglect or abuse - such as resident was ambulating, lost balance and fell. The administrator said as long as it wasn't abuse or neglect of any kind then the incident is not considered a reportable to state. Do states vary when it comes to reportables. All reported occurances are tracked on our states CMS website. Only 1 out the 15 allegiations that I'm aware of is listed as of 6/12/11. The CMS website is updated daily.Last edit by txdon on Jun 12, '11 : Reason: need to add additional information
- 0Jun 14, '11 by adnil65I agree with many of the advise & suggestions in the various posts. In our facility the person who investigates abuse are the social workers. Everyone is encouraged to report & follow-up on abuse charges, we take it VERY seriously!
As far as the facilty getting tagged; as painful as it is, maybe thats not such a bad thing. At least the allegation would be investigated. Sorry.
- 0Jun 14, '11 by debRN0417What's to stop an employee (you) from reporting something themself? You can call the state. It certainly will get you a survey though, but if you give names and dates then the state will be able to investigate and the first thing that will be asked is where the facility investigation is...then you will know if she is truly reporting or not and if the allegations are true or not. It is a rather harsh thing to do, but abuse and neglect of individuals that are depending on us to care for them and protect them is a serious matter. You can report confidentially but you have to give specifics.