Adult Programs
Misconduct Complaints

All entities regulated by the Division of Quality Assurance (DQA) must:

• Immediately protect clients from subsequent incidents of misconduct (abuse, neglect, misappropriation and injury of unknown source).

• Investigate all allegations of misconduct

• Document the results of their investigation

• Report allegations/incidents to DQA as appropriate

All Entities except nursing homes:

DQA Memo 04-028, Revised Caregiver Misconduct Reporting Requirements for DQA Entities

• Use the Worksheet or Flow Chart to assist in making the reporting determination.

• Use the F-62447 Incident Report form (below) to report misconduct allegations.

Nursing Homes Only:

OQA memo 05-004, Requirements for Reporting Allegations of Abuse, Neglect, Misappropriation, Injuries of Unknown Source

• Use the F-62617 Alleged Nursing Home Resident Mistreatment, Neglect and Abuse Report for 24-hour notification.

• Use the F-62447 Incident Report form to report misconduct allegations.

All Entities: 

OQA Memo 06--028 Adult at Risk, including Elder Adult at Risk Reporting Requirements for entities regulated by DQA

For allegations involving all staff (noncredentialed and credentialed) or other perpetrators (family member, friend, visitor, resident, etc.) submit the Incident Report to DQA at:

Department of Health Services
Division of Quality Assurance
Office of Caregiver Quality
PO Box 2969
Madison, WI 53701-2969

All incident reports, regardless of perpetrator, must be submitted to the DQA Office of Caregiver Quality.  OCQ will review reports involving noncredentialed staff (nurse aides, caregivers, housekeepers, etc.) for possible investigation and refer reports involving credentialed staff (doctors, RNs, LPNs, social workers, etc.) to the Department of Regulation & Licensing (DRL) for review.  OCQ will also refer reports to other agencies including the Department of Justice, county departments, adult-at-risk agencies, local law enforcement agencies, and others, as appropriate.  One or more of these agencies may also respond to an allegation investigated by DQA.

Forms:

• Incident Report of Caregiver Misconduct and Injuries of Unknown Source (PDF version), F-62447 (PDF, 136 KB)

  • Incident Report of Caregiver Misconduct and Injuries of Unknown Source (Word version), F-62447 (Word, 153 KB)

• Caregiver Misconduct Reporting Requirements Worksheet (PDF, 39 KB)

• Alleged Nursing Home Resident Mistreatment, Neglect and Abuse Report (PDF version), F-62617 (PDF, 18 KB)

  • Alleged Nursing Home Resident Mistreatment, Neglect and Abuse Report (Word version), F-62617 (Word, 52 KB)

• Flowchart (PDF, 20 KB) for Investigating and Reporting Misconduct or Injuries of Unknown Source

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Last Revised: November 06, 2009