Abuse Policy - Interview Questions for the Supervisor

Education Tool - Interview Questions for Reporting Abuse 

Standard 
All allegations or incidents of abuse reported by residents or their families must be thoroughly documented and investigated to ensure the safety and well-being of residents, and compliance with CMS Requirements of Participation and the State Operations Manual (SOM) guidelines for long-term care facilities (LTC). 

Policy 
To provide a structured and consistent approach for supervisors, directors of nursing, and social workers when interviewing residents or families reporting abuse. The goal is to ensure all relevant information is captured accurately to facilitate a thorough investigation. 

Practice Guidelines 

Interview Questions for the Supervisor, Director of Nursing, and Social Worker to Ask the Resident/Family Reporting Abuse: 

1. Statement of Incident: 

• Explain in detail exactly what happened. 

2. Date and Time of Day or Night of Incident: 

3. Who was Involved: 

• Name and/or description of people or person involved. 

4. Were there any Witnesses: 

5. Whom did you Report this Incident to and When: 

6. What was the Response of the Person that you Reported the Incident to: 

7. Is this the First Time this Incident or a Similar Incident has Occurred? If no, Explain: 

Signatures and Verification: 

• Name of Resident/Family Being Interviewed: __________________________________________________ 

• Date and Time: _________________________________________________________________________ 

• Signature of Resident/Family: _____________________________________________________________ 

• (Handwritten statement from resident/family, if possible) 

• Signature of the Person Doing the Interview: _________________________________________________ 

• Title: _________________________________________________________________________________ 

Documentation and Investigation Action: 

• The supervisor, director of nursing, or social worker must document the interview in detail. 

• Use the specified Interview Questions for Reporting Abuse form for documentation. 

• The completed form must be submitted to the Administrator and Director of Nursing Services (DNS) within 24 hours. 

• The Administrator and DNS must review the completed form and initiate an immediate investigation. 

• If the allegation is of a serious nature, it shall be reported by telephone regardless of the time or day. Follow the policy/procedure for Reporting to Government Agencies and Investigation of Abuse Practice Guidelines. 

• The Administrator must notify the Director of Clinical Services and Director of Operations immediately, regardless of the time of day, if the allegation is of a serious nature. 

• The Administrator is responsible for coordinating the investigation and ensuring appropriate action is taken, including conducting interviews and collecting written statements from all staff involved. 

• Documentation in the Nurse's Notes is done timely. 

• The resident is monitored for 72 hours post-incident with Nurse's Notes every shift, including vital signs and documentation of any ill effects. 

References: 

• Centers for Medicare & Medicaid Services (CMS), State Operations Manual (SOM) 

• Requirements of Participation for Nursing Homes, CMS 

• Guidelines for Reporting and Investigating Allegations, CMS