V. Administrative Review, Findings, Recommendations, and Implementation

Transcription

1 V. Administrative Review, Findings, Recommendations, and Implementation 1. Was the incident reported in a timely manner? If No, please explain here. (AND enter your corrective action plan in Implementation section below.) 2. What actions were taken immediately to protect the health and safety of the individual? List actions here. If none were taken, please explain here. (AND enter your corrective action plan in implementation section below.) 2a. Was victim assistance offered when appropriate? Yes No NA (Circle One) If yes, what assistance was offered? If no, please explain here. (AND enter your corrective action plan in Implementation section below.) 3. If the incident involved a target, was the alleged target(s) removed from potential contact with all individuals receiving services until the incident investigation is completed? Yes No NA (Circle One) If yes, enter date and time personnel action occurred: If no, explain here. (AND enter your corrective action plan in Implementation section below.) Page 1 of 6

2 4. Were there injuries to the individual? Enter date and time injury discovered: 4a. If yes, was prompt medical attention provided? Yes No NA (Circle One) *If no, a neglect incident may have to be filed and corrective action in response to the delay in treatment needs to be present in the report. If no, please explain. (And enter your corrective action plain in Implementation section below.) 4b. Is follow up medical treatment recommended? If yes, date and time of scheduled follow up appointment(s): 5. Did the investigation start in a timely manner? If no, please explain. (AND enter your corrective action plan in Implementation section below.) 6. Was the family notified of the incident within 24 hours? If no, please explain. (AND enter your corrective action plan in Implementation section below.) Page 2 of 6

3 6a. When appropriate were notification requirements relating to the Adult Protective Services Act, Older Adult Protective Services Act and Child Protective Services Law met? If no, please explain. (AND enter your corrective action plan in Implementation section below.) 7. Did the evidence collected and presented in the report by the investigator support their analysis? Please explain why you believe the evidence collected and presented did or did not support the investigator s analysis. 8. Did the evidence support a determination that abuse or neglect occurred? If yes, explain. (AND enter your corrective action plan in Implementation section below.) Page 3 of 6

4 9. Were there violations of agency or facility policy involved in this incident? If yes, explain. (AND enter your corrective action plan in Implementation section below.) 10. Review Status: To Be Continued Closed (Circle One) If to be continued, due date: 11. Administrative Findings: Confirmed Not confirmed Inconclusive (Circle One) Please explain the basis/reasons for your Administrative Finding (confirmed, not confirmed, inconclusive). Page 4 of 6

5 Implementation 12. Were there any issues or concerns identified in the investigation that would lead to changes in individual(s) care, modifications to the individual support plan personnel, or other administrative and systemic practices? If no, explain. If yes, use the template below to create an action plan. Include information on what activities are to be completed, who is responsible for completing them, a target date for completion, and the date the action is completed (if known at time of completion of report). Action Functional Area (e.g. Fiscal, Program Services, Personnel, etc.) Person(s)and Position(s) Responsible Target Date Status Page 5 of 6

6 Reviewer Name and Title Signature Page 6 of 6