Example Incident/Accident Report Form:
AFC Incident/Accident Report BCHS-4607
LICENSING RULES FOR AFC HOMES
R 400. Incident notification, incident records.
Rule 693.
(1) If a resident has a representative identified in writing on the resident’s care
agreement, a licensee shall report to the resident's representative within 48
hours after any of the following:
(a) Unexpected or unnatural death of a resident.
(b) Unexpected and preventable inpatient hospital admission.
(c) Physical hostility or self-inflicted harm or harm to others resulting in
injury that requires outside medical attention or law enforcement
involvement.
(d) Natural disaster or fire that results in evacuation of residents or
discontinuation of services greater than 24 hours.
(e) Elopement from the home if the resident’s whereabouts is unknown.
(2) If an elopement occurs, staff shall conduct an immediate search to locate
the resident. If the resident is not located within 30 minutes after the
elopement occurred, staff shall contact law enforcement.
(3) An incident must be recorded on a department-approved form and kept
in the home for a period of not less than 2 years.
(4) The department may review incident reports during a renewal inspection
or special investigation. This does not prohibit the department from
requesting an incident report if determined necessary by the department. If
the department does request an incident report, the licensee shall provide
the report in electronic form within 24 hours after the request. The
department shall maintain and protect these documents in accordance with
state and federal laws, including privacy laws.
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AUTHORITY: P.A. 218 of 1979.
COMPLETION: Is Required
CONSEQUENCE: Violation of Adult Foster Care Administrative Rule
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LARA is an equal opportunity employer/program. |
