Clarification of Nursing Home Reporting Requirements for Alleged Violations of Mistreatment, Neglect, and Abuse, Including Injuries of Unknown Source, and Misappropriation of Resident Property

PDF Version of BQA 05-004 (PDF, 96 KB)

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DATE: March 23, 2005 DSL-BQA-05-004
Supersedes BQA 04-028 only for Nursing Homes

TO: Nursing Homes NH 02

FROM: Jan Eakins, Chief, Provider Regulation and Quality Improvement Section

Via: Cris Ros-Dukler, Director, Bureau of Quality Assurance

Effective Immediately: Center for Medicare and Medicaid Services (CMS) Survey and Certification (S&C) Memo 05-09 at www.cms.hhs.gov/medicaid/survey-cert/sc0509.pdf (PDF, 94 KB) provides directions and mandatory nursing home requirements regarding alleged violations of mistreatment, neglect, and abuse, including injuries of unknown source, or misappropriation of resident property. BQA memo 05-004 supersedes BQA memo 04-028 for Nursing Homes and can be found in its entirety via http://dhfs.wisconsin.gov/rl_DSL/Publications/BQAnodMems.htm. Please note that memo 04-028 remains in effect for the other providers listed on that memo.

To comply with this S & C Memo:

• Nursing homes 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 BQA. Immediately means as soon as possible, but not to exceed 24 hours after discovery of the incident.

• Designated facility staff must complete the attached form titled "Alleged Nursing Home Resident Mistreatment, Neglect And Abuse Report " (DDE-2617) (PDF, 18 KB) for all allegations, and e-mail it to Caregiver_Intake@dhfs.state.wi.us or fax to 608-243-2020 within 24 hours of discovery of the incident. This form is available on the website at http://dhfs.wisconsin.gov/forms/index.htm.
  [Word version of DDE-2617 (Word, 52 KB) added 4/05]

• Upon completion of the internal investigation, the facility must mail the following:
  • Completed "Caregiver Misconduct Incident Report" (DDE-2447) (PDF, 140 KB),
  • A copy of the "Alleged Nursing Home Resident Mistreatment, Neglect And Abuse Report " (DDE-2617) (PDF, 18 KB),
  • The incident report and any available documentation, and
  • The results of the investigation within 5 working days to:

Department of Health & Family Services
Division of Quality Assurance
Office of Caregiver Quality
P. O. Box 2969
Madison, WI 53701-2969

These requirements are based on federal rules and are different from guidance previously provided in BQA memo 04-028, which was based on Wisconsin’s Caregiver Law. If you have any questions, please contact your Regional Field Operations Director.

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