016.06.05 Ark. Code R. 030
The facility must develop and implement written policies and procedures to ensure that incidents, including:
* alleged or suspected abuse or neglect of residents;
* accidents, including accidents resulting in death;
* unusual deaths or deaths from violence;
* unusual occurrences; and,
* exploitation of residents or any misappropriation of resident property,
are prohibited, reported, investigated and documented as required by these regulations.
A facility is not required under this regulation to report death by natural causes. However, nothing in this regulation negates, waives or alters the reporting requirements of a facility under other regulations or statutes.
Facility policies and procedures regarding reporting, as addressed in these regulations, must be included in orientation training for all new employees, and must be addressed at least annually during in-service training for all facility staff.
The following events shall be reported to the Office of Long Term Care by facsimile transmission to telephone number 501-682-8551 of the completed Incident & Accident Intake Form (Form DMS-7734) no later than 11:00 a.m. on the next business day following discovery by the facility.
RCF INCIDENT REPORTING
In addition to the requirement of a facsimile report by the next business day on Form DMS-7734, the facility shall complete a Form DMS-762 in accordance with Section 310.2.
The following incidents or occurrences shall require the facility to prepare an internal report only and does not require a facsimile report, or form DMS-762 to be made to the Office of Long Term Care. The internal report shall include all content specified in Section 310.3, as applicable. Facilities must maintain these incident record files in a manner that allows verification of compliance with this provision.
Written reports of all incidents and accidents included in section 310.2 shall be completed within five (5) days after discovery. The written incident and accident reports shall be comprised of all information specified in forms DMS-7734 and 762 as applicable.
All written reports will be reviewed, initialed and dated by the facility administrator or designee within five (5) days after discovery. All reports involving accident or injury to residents will also be reviewed, initialed and dated by the Director of Nursing Services or other facility R.N, if any.
Reports of incidents specified in Section 310.2 will be maintained in the facility only and are not required to be submitted to the Office of Long Term Care.
All written incident and accident reports shall be maintained on file in the facility for a period of three (3) years.
The facility's administrator is also required to make any other reports of incidents, accidents, suspected abuse or neglect, actual or suspected criminal conduct, etc. as required by state and federal laws and regulations.
The facility must ensure that all alleged or suspected incidents involving resident abuse, exploitation, neglect or misappropriations of resident property are thoroughly investigated. The facility's investigation must be in conformance with the process and documentation requirements specified on the form designated by the Office of Long Term Care, Form DMS-762, and must prevent further potential incidents while the investigation is in progress.
The results of all investigations must be reported to the facility's administrator, or designated representative, and to other officials in accordance with state law, including the Office of Long Term Care. Reports to the Office of Long Term Care shall be made via facsimile transmission by 11:00 a.m. the next business day following discovery by the facility, on form DMS-7734. The follow-up investigation report, made on form DMS-762, shall be submitted to the Office of Long Term Care within 5 working days of the date of the submission of the DMS-7734 to the Office of Long Term Care. If the alleged violation is verified, appropriate corrective action must be taken.
The DMS-762 may be amended and re-submitted at any time circumstances require.
The facility's written policies and procedures shall include, at a minimum, requirements specified in this section.
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF MEDICAL SERVICES
OFFICE OF LONG TERM CARE
DMS-7734
Incident & Accident Next Day Reporting Form
Purpose/Process
This form is designed to standardize and facilitate the process for the reporting allegations of resident abuse, neglect, misappropriation of property or injuries of an unknown source by individuals providing services to residents in Arkansas long term care facilities for next day reporting pursuant to LTC 310.2.
The purpose of this process is for the facility to compile the information required in the form DMS-7734, so that next day reporting of the incident or accident can be made to the Office of Long Term Care.
Completion/Routing
This form, with the exception of hand written witness statements, MUST BE TYPED !
The following sections are not to be completed by the facility; the Office of Long Term Care completes them:
All remaining spaces must be completed. If the information can not be obtained, please provide an explanation, such as "moved/address unknown", "unlisted phone", etc.
If a requested attachment can not be provided please provide an explanation why it can not be furnished or when it will be forwarded to OLTC.
The original of this form must be faxed to the Office of Long Term Care the next business day following discover by the facility. Any material submitted as copies or attachments must be legible and of such quality to allow recopying.
ARKANSAS DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF MEDICAL SERVICES
OFFICE OF LONG TERM CARE
DMS-762
Facility Investigation Report for Resident Abuse, Neglect Misappropriation of Property, & Exploitation of Residents in Long Term Care Facilities
Purpose/Process
This form is designed to standardize and facilitate the process for the reporting allegations of resident abuse, neglect, or misappropriation of property or exploitation of residents by individuals providing services to residents in Arkansas long term care facilities. This investigative format complies with the current regulations requiring an internal investigation of such incidents and submittal of the written findings to the Office of Long Term Care (OLTC) within five (5) working days.
The purpose of this process is for the facility to compile a substantial body of credible information to enable the Office of Long Term Care to determine if additional information is required by the facility, or if an allegation against an individual(s) can be validated based on the contents of the report.
Completion/Routing
This form, with the exception of hand written witness statements, MUST BE TYPED !
Complete all spaces! If the information can not be obtained, please provide an explanation, such as "moved/address unknown", "unlisted phone", etc. Required information includes the actions taken to prevent continued abuse or neglect during the investigation.
If a requested attachment can not be provided please provide an explanation why it can not be furnished or when it will be forwarded to OLTC.
This form, and all witness and accused party statements, must be originals. Other material submitted as copies must be legible and of such quality to allow re-copying.
The facility's investigation and this form must be completed and submitted to OLTC within five (5) working days from when the incident became known to the facility.
Upon completion, send the form by certified mail to:
Office of Long Term Care, P.O. Box 8059, Slot 404, Little Rock, AR 72203-8059.
Any other routing or disclosure of the contents of this report, except as provided for in LTC 310.3 and 310.4, may violate state and federal law.
Attach the following information to the back of this form. If you do not have one of the specified attachments, please provide an explanation why it can not be obtained or if it will be forwarded in the future.
016.06.05 Ark. Code R. 030