Report - Results of Investigation of Abuse, Neglect, Misappropriation of Property, Injury of Unknown Origin or Mistreatment

Report – Results of Investigation of Abuse, Neglect, Misappropriation of Property, Injury of Unknown Origin or Mistreatment 

Standard 
All allegations or incidents of abuse, neglect, misappropriation of property, injury of unknown origin, or mistreatment occurring on the facility’s premises must be reported, documented, and thoroughly 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 ensure prompt and thorough investigation of any allegations or incidents, identify contributing factors, and implement measures to prevent recurrence, maintaining a safe environment for residents. 

Practice Guidelines 

Report – Results of Investigation 

Name of Facility: __________________________________________________________________ 

Name(s) of Resident(s) Involved: _____________________________________________________ 

An allegation/incident of ☐ Abuse ☐ Neglect ☐ Misappropriation of Property ☐ Injury of Unknown Origin ☐ Mistreatment was reported to DPH on _______________________________. 

The allegation/incident was investigated. The facility ☐ was unable ☐ was able to substantiate the allegation/incident. 

Brief Description of What the Facility Did to Investigate: 

The conclusion above is based on: 

Signature of Person Making this Report: ________________________________________________ 

Title: __________________________________________________ 

Print Name and Title: __________________________________________________ 

Date: ______________________________________________ 

Documentation and Investigation Action: 

• The charge nurse and/or department director/supervisor must document the allegation/incident and conduct an immediate investigation. 

• Use the specified Report – Results of Investigation form for documentation. 

• Witnesses, if any, must be documented on the report along with their contact information. 

• The Administrator and Director of Nursing Services (DNS) must be informed of all allegations/incidents and review completed reports. 

• If the allegation/incident 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/incident is of a serious nature. 

• The Administrator will ensure that staff directly involved will be suspended pending a complete investigation, depending on the circumstances of the incident. 

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

• Completed Report – Results of Investigation forms must be submitted within 24 hours to the Administrator and DNS. 

• 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