Ask Proactive – We recently had a resident fall that resulted in a fracture, and we anticipate this may trigger a complaint survey. Our team is concerned and wants to make sure we’re prepared. What should we be doing right now?

Q:

We recently had a resident fall that resulted in a fracture, and we anticipate this may trigger a complaint survey. Our team is concerned and wants to make sure we’re prepared. What should we be doing right now?

 

A:

You’re right to anticipate survey activity—falls with fracture are one of the most common triggers for complaint investigations. The key to success is to shift from a reactive stance to intentional preparation.

 

Consider taking these steps:

1. Reconstruct the Full Timeline (Start to Finish)

Surveyors will focus heavily on sequence of events. You should be able to clearly outline:

1. Resident’s condition and fall risk prior to the event
2. What happened during the fall (as best as can be determined)
3. Immediate response and assessment
4. Notifications (physician, family, EMS if applicable)
5. Treatment and follow-up

If your team cannot clearly tell this story, that’s your first red flag.

 

2. Validate Your Fall Risk Process

Expect surveyors to ask:

1. Was this resident appropriately assessed for fall risk?
2. Were interventions care planned?
3. Were those interventions actually implemented?

Review:

1. Fall risk assessments (were they timely and accurate?)
2. Care plan interventions (specific vs generic)
3. CNA documentation (were interventions carried out consistently?)

 

3. Scrutinize Post-Fall Response

This is where many facilities get cited.

Ensure you can demonstrate:

1. Immediate and thorough post-fall assessment
2. Neurological monitoring (if indicated)
3. Documentation of pain, function, and changes in condition
4. Timely escalation when fracture suspected

Delays or vague documentation here are a major risk.

 

4. Review Investigation & Root Cause Analysis

Surveyors are not just looking at what happened—they want to see how you responded.

Your investigation should clearly show:

1. Contributing factors (environmental, clinical, behavioral)
2. Whether interventions were appropriate prior to fall
3. What changes were made after the fall

Your root cause analysis should actually lead to meaningful changes, not just “re-educate staff.”

 

5. Ensure Documentation Tells the Same Story Everywhere

Inconsistencies will hurt you quickly.

Cross-check:

1. Nursing notes
2. Incident report
3. Therapy notes (if involved)
4. Care plan updates
5. Physician documentation

Everything should align in terms of timing, condition, and response.

 

6. Prepare Your Staff (Confidence Over Perfection)

Staff will likely be interviewed.

Coach them to:

1. Speak honestly and based on what they know
2. Avoid guessing or filling in gaps
3. Be able to describe interventions they use for that resident
4. Stay calm and professional

A confident CNA who can explain what they do to prevent falls is incredibly powerful during survey.

 

7. Be Ready to Show “System Strength,” Not Just Case Management

Surveyors will ask themselves: Was this preventable—or was this an unavoidable outcome despite appropriate care?

Be prepared to demonstrate:

1. A consistent fall prevention program
2. Ongoing monitoring of high-risk residents
3. QAPI involvement if trends are identified
4. Staff education and competency

 

A fall with fracture does not automatically equal a deficiency. What matters most is your ability to show:
✔ The resident was appropriately assessed
✔ Interventions were in place and implemented
✔ The response was timely and thorough
✔ The facility learned from the event and adjusted accordingly

If you can clearly tell that story, you significantly strengthen your survey position.

 

 

Next steps:

• Did you know that Proactive offers same day crisis support through the Proactive Solutions Center. Learn more about accessing same day Virtual Consultations for expert support for questions, program guidance, incident management or help during a survey.
• Register to join us April 14, 2026 for Fall Prevention: Data Driven Interventions as part of the monthly Survey & Clinical Risk Management series

 

 

 

Written By:

 

 

Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, CPC, CLNC

VP of Quality & Compliance

Proactive LTC Consulting

 

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