There are few things that can wake up a nursing home administrator faster than a phone call in the middle of the night from their facility reporting an allegation of abuse. Federal regulations require nursing facilities to promptly report any allegation of abuse, within 2 hours.  This week’s blog reviews the critical action steps that must be taken in response to an allegation of abuse.

Action Steps

  1. First and foremost, the resident(s) must be safeguarded. This means that the alleged perpetrator is to be immediately removed from contact with the resident(s). If the alleged perpetrator is a staff member, visitor or vendor, they should be escorted out of the facility. In the case of a resident-on-resident situation, staff should remove the alleged perpetrator from contact with other residents.
  2. The facility must report all alleged violations of abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, immediately, but not later than 2 hours after the allegation is made, if the allegation involves abuse or results in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily harm, to the state survey agency and the adult protective services where state law provides for jurisdiction in long-term care facilities.
  3. An immediate, thorough investigation needs to begin as soon as the allegation is Investigations should include observations, interviews, and record reviews. Typically, management staff will develop an investigation plan and share responsibility for completing the investigation.  For example, following an allegation of physical abuse, Social Services may be delegated to interview all interviewable residents, while nursing completes skin assessments of non-interviewable residents to identify if additional residents may be affected.
  4. In terms of written statements, follow your facility, company or legal recommendations. To ensure that all statements are legible and grammatically correct, the person conducting the interview should prepare a typed/written summary of the interview.  Then review the prepared summary with each witness for accuracy and have the witness sign and date the interview summary and include a statement indicating the interview summary is an accurate representation of what was stated in the interview. Maintain interview summaries in an investigation file.   All involved staff members and/or witnesses need to complete a statement regarding the facts of the alleged incident.
  5. The results of all investigations of alleged incidents must be reported to officials, including the State Survey Agency, within 5 working days of the incident.
  6. If the investigation finds that the allegation is substantiated, or a deficient practice is identified that contributed to the allegation, then the following steps should be taken:
      • An ad hoc QAPI meeting should take place to review the investigation findings, identify measures and/or policy/procedures that would prevent the incident from occurring again and designate staff members responsible for implementing the action plan.
      • The action plan should include monitoring the progress of the adopted policy/procedures to ensure effectiveness and ongoing progress towards the identified goals.
      • Any adaptations to the plan should be discussed in weekly/monthly QAPI meetings.
      • Staff education must be completed on all implemented measures at 100% attendance.
  1. All data pertaining to the allegation and investigation should be maintained in an orderly fashion, such as using a tabbed binder for ease of reviewing the action steps taken in response to the allegation and follow up activity that may be If the allegation leads to a regulatory investigation, all of the needed information should be easily obtained in a timely manner.



Michele Harrison, RN, BSN
Clinical Consultant

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