Here 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.