Abuse Allegations - page 3

by txdon

12,749 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


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    About the company hotline....be careful.

    I worked for a company that would forward the complaint call to the Administrator of the facility, who would then play it for the DON. They knew exactly who was calling.

    I worked for a company that sent out surveys every year to rate your facility. They were supposedly anonymous. Copies of the surveys were sent to the Admin/DON to handle the complaints. Guess who could tell who wrote what?

    I don't want to sound like I'm paranoid. I learned a lot at that job that made me realize a lot of things. The problem is, if you get blackballed for something like this, you won't work in that area again.

    Pick your battles. That's all I'm saying.
    barbarake21 likes this.
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    Quote from txdon
    We 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
    Do you have a corporate compliance officer or an anoymous reporting line for the company?These are very serious allegations, all staff are mandated reporters, call in your suspicions as per state/federal law, and notify your DNS /administrator in writing. Are you part of the management team? Do you help investigate these abuses? DON's are required to maintain incident logs and reports, these are easily accessed for state surveyors. We report everything now in this state.
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    Had a friend that staff came to with a concern. My friend (not a nurse) was unsure what to do so she called her supervisor and the supervisor told her to direct them to the hotline. My friend did not disclose the concern, just that it was an allegation of falsification of records and neglect. My friend advised staff to call hotline. Staff calls hotline. My friend and the staff got fired...my friend was fired for "insubordination", administrator was told about the hotline call and said she (my friend) should have told her (the administrator) first...the administrator was the one who the complaint was about!!!!!!! I do not trust hotlines. They are "by the company, for the company". The "supervisor" was corporate so I'm sure she told that a call would be coming on the hotline....so much for confidentality being anonomyous!
    barbarake21 and pixie120 like this.
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    Yeah....we have a compliance line and one of the corporate nurses told me it goes to her. So much for an unbiased view of things. Although, in her case, she usually is pretty fair minded.
    pixie120 likes this.
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    Quote from txdon
    Our 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.
    I know this post is old but can I jump in here with a comment? In this state, the specific wordings and items that must be reported are in a purple book and the number of the state hotline clearly posted all over the building. You can make anoymous reports, you dont' have to say you are an employee. That having been said, you are also a mandated reporter, so if YOU suspect abuse, YOU must call it to the hotline. (AND usually you have 24 hours to dothis, so do an initial investigation, then proceed, so you have more data).Protocals are generally guidance that IF you feel there is a reportable offense (and now, a crime, new in this state, we have to report all suspected crimes) you call the DON and Administrator, voice concerns, or fill out incident report, and then call in your complaint. As a DON I agree, I would be furious if you DIDN'T tell me, nothing worse than the state calling back for "more information on this allegation" and I have no incident report and haven't a clue that the "abuse" occurred. None of this should be a "secret" your facility should be doing regular inservices on abuse and neglect and the state laws are easily viewed on Nursing Home complaince laws, on whatever state you reside.
    The other concern is your DNS may NOT be able to substantiate. I have done many an investigation and the patient simply cannot tell me WHO the person was and it could have been one of 5 CNA's that did this to her/him, and without collaborating evidence (ie bruises, roommate or family concerns, or peripheral investigations of surrounding patients regarding care in general) I cannot proceed. I call it into the state, but then call it back in unable to substantiate. Resident too confused to interview, and shows no signs of abuse, fall,neglect etc.

    I do think the line staff sometimes "gossip" it into a bigger issue, (I have had that happen where it was this, and then, I interview the person(s) and they say, "Oh, no... I didn't see that, I was told that in report by that nurse" Interview that nurse "NO, I didn't see it, but the friend of the roommate told me..." and then the whole investigation fizzles cuz there was no true witness and no one has the same story. Plus by the time I am made aware, sometimes it is 5 days later, or it happened over the weekend, but no nurses notifying, charted, told family or MD, and there is no bruise, no fall, or the resident discharges home....or it's a whole other patient all together". I can only teach the staff to report everything via incident report so it's a clear record that can be investigated.
    We always have to remember that the abuse/neglect has to be systematically substantiated, in order to proceed with termination and reporting on to that person's license. I would certainly ASK the DNS to tell me how or why she wasn't able to substantiate whichever particulars you are concerned about. If one of my staff asked me, I would gladly show them the process and the incident report. Also, another really big concern, staff will verbally tell me and the world about stuff, but I have to chase them down to get a witness statement, or incident report.
    CapeCodMermaid likes this.
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    Per CMS guidelines, a copy of the last survey must be posted in a open area in the facility so that it may be viewed by residents, visitors, families and staff. Look at you last survey and see what the reporting agency is for your state. Texas is the Department of Aging and Disability Services (DADS). Also the 800 number for reporting incidents must be posted so that anyone (resident, visitors, staff, families, etc) can see it and read the number. Also, you can go to nursing home compare online and that should have a responsible reporting agency for your state as well.
    I hope this helps.
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    We report all allegations of abuse confirmed or not, even the ridiculous. I do investigate each case, and make sure the resident is interviewed. What I don't do is talk about an ongoing or concluded investigation with employees not directly involved in the event. Many employees show up in my office looking to find out what is going on, and my response is always the same, thanks for your concern, but I can't discuss it with you.
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    Let me just ask, not to offend you, but are you sure about that? Do you have access to the investigations to know for 100% guarantee they are not completed? Do you have access to your corporate database? Or is it an assumption that she is not doing her job?
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    My first instinct is that the DON is playing with her license and may involve those above her as well. I would RUN RUN to another job.. She is falsifying nformation and doing other ILLEGAL things! Does the Administrator know this? are you a DON or ADON in her building?
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    I haven't seen a website where our reportables are public, just the ERS system which is a secure website. I was under the impression that if you have an IJ, the surveyors can't leave your facility until the IJ is cleared. Also, your administrator hangs his or her license on the wall as being responsible for everything that occurs in your building. It's a scary thought that he/ she is unfamiliar with reporting requirements, or is complacent with what your DON is not doing. Whistleblowing is an option for you, but even with whistleblower laws, it may cost you your job. You are obligated to make sure your residents are safe in their environment, so don't wait too long to act!


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