Unfortunately, there are very serious incidents and accidents that will occur in your community no matter the precautions you take to avoid them. It could be as simple as a resident taking a fall while being involved in your activity programming all the way to an attack on a resident by a staff member or another resident. The Alabama Department of Public Health mandates reporting any incident that affects the health, safety, and wellbeing of a resident- check out the regulation below for how to handle these situations:
420-5-4-.05 Records and Reports
(h) Incident Investigation.
When an incident, as defined below, occurs in an assisted living facility, the facility administrator shall be immediately notified, the facility shall conduct a thorough investigation, and appropriate corrective actions and interventions shall be devised and implemented immediately. A detailed and accurate report shall be completed within 72 hours of the incident. The report shall be given immediately upon completion to the administrator for review.
- Incidents that require investigation are:
(i) An accident or injury of known or unknown origin that was unusual or suspicious in nature such as bruising, pain, or injury that is not consistent with actions necessary in providing day-to-day care to a resident or for which medical treatment was sought.
(ii) A fracture or an injury resulting in medical attention. For the purposes of these rules, medical attention shall be defined as care that rises above the level of first aid, including but not limited to: a physician ordered portable X-ray, a visit to an emergency department, urgent care facility, clinic, or physician office.
(iii) The onset of wandering behavior by any resident who is not fully cognitively intact.
(iv) Elopement by a resident.
(v) Suspected, alleged, confessed, witnessed, or actual abuse of a resident or residents by staff, visitors, or other residents. This includes all types of abuse including mental abuse, physical abuse, sexual abuse, and verbal abuse as defined in these rules.
(vi) Suspected, alleged, confessed, witnessed, or actual neglect of a resident or resident as defined in these rules.
(vii) Suspected, alleged, confessed, witnessed, or actual exploitation of a resident or residents as defined in these rules.
(viii) An outbreak (for purposes of these rules, an outbreak is considered to be two or more affected people within 72 hours or less) of a contagious disease or condition including those listed in Appendix I of Alabama Administrative Code Sec. 420-4-1-.04 (for example foodborne illness, scabies, influenza, or Staphylococcus aureus).
(ix) A fire, earthquake, storm, other act of God, or another occurrence (for example, a natural gas leak or a bomb threat) that causes physical damage to the building in which the facility is located, or that results in the evacuation or partial evacuation of the facility.
(x) Intentional self-inflicted injury, suicide, or suicide attempt by a resident.
(xi) An unplanned occurrence that results in media attention.
(xii) A medication error, overdose, or oversedation.
(xiii) Ingestion by a resident of a toxic substance that requires medical attention.
(xiv) Any indication of malfunction of the sprinkler system, or fire alarm system.
- In addition to other items required by the facility’s policies and procedures, the incident investigation shall contain the following:
(i) Names of all residents involved.
(ii) Names of all staff involved including the person in charge at the time of the incident.
(iii) When the administrator was notified (date and time).
(iv) Circumstances under which the incident occurred.
(v) When the incident occurred (date and time).
(vi) Where the incident occurred (for example, bathroom, bedroom, street, or lawn).
(vii) Immediate actions are taken.
(viii) The extent and description of injury, if any, to the affected resident or residents.
(ix) Immediate treatment rendered.
(x) Symptoms, pain, or injury discussed with the physician, and the date and time the physician was notified.
(xi) Names, telephone numbers, and addresses of witnesses.
(xii) Date and time relatives or sponsor were notified.
(xiii) Out-of-facility treatment.
(xiv) Follow-up care.
(xv) Outcome resolution.
(xvi) The action taken by the facility to prevent the occurrence of similar incidents in the future.
(xvii) The investigative file includes the incident report itself, the incident investigation and all records, documents, statements, images, and information created or reviewed in connection with the investigation.
(xviii) The entire investigative file shall be made available for inspection and copying by representatives of the Department upon request.
(xix) The entire investigative file and documentation of all corrective action taken shall be retained for a period of not less than 3 years after the resident is discharged or dies.
(xx) Interventions devised as a result of the investigation shall be included in a resident record that Assisted Living Facilities is available to the personal care staff.
- In addition, the following incidents shall be reported to the Department’s Online Incident Reporting System within 24 hours of the incident:
(i) A fracture or an injury resulting in death, EMS activation, or the need for medical attention as defined in these rules.
(ii) Elopement by a resident.
(iii) Suspected, alleged, confessed, or witnessed abuse, neglect, or exploitation of a resident or residents by staff, visitors, or other residents. This includes all types of abuse including mental abuse, physical abuse, sexual abuse, and verbal abuse as defined in these rules. The victim’s sponsor or responsible family member shall be notified within 24 hours. All incidents of suspected abuse, neglect, or exploitation shall be reported immediately to the Department of Human Resources or to appropriate law enforcement authorities as required by law. These documents shall be retained with the facility investigative file.
(iv) A fire, earthquake, storm, other act of God, or another occurrence (for example, a natural gas leak or a bomb threat) that causes physical damage to the building in which the facility is located, or that results in the evacuation or partial evacuation of the facility.
(v) Intentional self-inflicted injury, suicide, or suicide attempt by a resident. (vi) An unplanned occurrence that results in media attention.
(vii) Any medication error, overdose, or oversedation. The incident shall be immediately reported to the attending physician, facility medical director, or back-up physician. (viii) Ingestion by a resident of a toxic substance that requires medical attention. (ix) Notifiable diseases and health conditions listed in Appendix I of the Alabama Administrative Code Sec. 420-4-1-.04. shall be reported by the facility to the State Health Officer or the County Health Officer within the time frames specified in 420-4-1-.04. The facility shall maintain documentation of any reports of notifiable diseases or health conditions. This documentation shall be retained for a period of not less than 3 years.
(x) Any indication of malfunction of the sprinkler system, or fire alarm system.
- The report to the Department’s Online Incident Reporting System shall include the following:
(i) Facility name and direct phone number.
(ii) Time and date of the report.
(iii) Reporter’s name.
(iv) Name of resident(s), staff, or visitor(s) involved in the incident.
(v) Names of staff on duty at the time of the incident.
(vi) Date and time of the incident.
(vii) A brief description of the incident.
(viii) Any injury or injuries to the resident(s).
(ix) Action was taken by the facility in response to the incident.
Pro Tip:
- Have a system for who reports incidents and the expected timing of the report to be completed by that individual, as well as a dedicated investigation process for how the incident is investigated and what will be done with the findings.