Appendix A: Requirements and Best Practices for Reportable Incidents

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1 Appendix A: Requirements and Best Practices for Reportable Incidents Reporting Incidents The table below shows what events must and must not be reported to achieve compliance with 55 Pa.Code (c). Remember that there is no penalty for over-reporting; if a home questions whether an incident report is required, it is best to report the incident. 55 Pa.Code (1) The death of a resident. Any death that occurs while the home is the resident s place of residence. This includes: - Deaths at the home - Deaths while the resident is at a community setting (e.g., while walking in the neighborhood, attending a day program, etc.) - Deaths while the resident is temporarily staying elsewhere (e.g., visiting family) - Deaths at a hospital or medical facility when the resident is expected to return to the home Deaths that occur at a hospital or medical facility when the resident is not expected to return to the home, unless the resident was hospitalized as a result of an injury sustained while under the home s care. A copy of the death certificate is required only under the following circumstances: - The death was unexpected or unusual (e.g., not a result of advanced age or terminal illness) - The cause of death is not immediately known - At the request of the Department (2) A physical act by a resident to commit suicide. Any attempt, successful or otherwise, to commit suicide. Suicidal ideation or threats to commit suicide. Any sign of potential self-harming behavior should trigger a response by the home to seek behavioral health care (see (a)). (3) A serious bodily injury or trauma requiring treatment at a hospital or medical facility. This does not include minor injuries such as sprains or minor cuts. - Fractures - Dislocations - Internal injuries - Head injuries - Lacerations requiring treatment beyond bandaging - Burns - Frostbite - Eye injuries - Heat Exhaustion or Sunstroke - Unresponsiveness - Any change in health status where the cause is unknown but warrants hospital treatment - Any injury that requires treatment at or admission to a hospital or medical facility - Scheduled outpatient or inpatient medical treatment or hospitalization that is not due to an injury or trauma. - Hospital treatment for a medical condition such as heart disease, COPD, stroke, kidney failure, etc. - An injury or trauma that occurs away from the home while the resident is under the care of a non-pch caregiver, such as while attending a day program or on a visit with family. - Hospital visits for diagnostics if no treatment is provided. If a resident is transported to a hospital or medical facility as a precautionary measure (e.g., after a fall where no injuries have been identified), and is returned to the home without treatment within 24 hours of the event that triggered the hospital visit, an incident report does not need to be submitted.

2 (4) A violation of a resident's rights in Any violation of a resident s rights, or any perceived violation of a resident s rights (e.g., a resident complains that her rights have been violated, but the home cannot immediately prove whether this is the case). Misuse of a resident s funds by the home s staff persons or the legal entity does not require reporting as a violation of (x); misuse of funds must be reported as described at (6), below. (5) An unexplained absence of a resident for 24 hours or more, or when the support plan so provides, a period of less than 24 hours, or an absence of a resident from a secured dementia care unit. Self-explanatory. An incident where a resident of a secured dementia care unit wanders outside without leaving the property of the home and is immediately guided back inside by staff. It is important the homes accurately assess and plan for residents supervision needs. The unexpected absence of a resident with extensive supervision needs for less than 24 hours must be reported, even if the resident doesn t live in a secured dementia care unit. (6) Misuse of a resident's funds by the home s staff persons or legal entity. (7) An outbreak of a serious communicable disease as defined in 28 Pa.Code 27.2 (relating to specific identified reportable diseases, infections and conditions). See Appendix C for a list of communicable diseases. Known or reasonable suspicion of misuse of funds by any person employed by the home or by the legal entity. Any event where two or more persons present in the home have been diagnosed with any of the communicable diseases listed at Appendix C. - Suspected misuse of funds by any person employed by the home or by the legal entity - Misuse of funds by a volunteer, family member, or a private caregiver. - An event where one person present in the home has been diagnosed with any of the communicable diseases listed at Appendix C. - Any event where two or more persons present in the home have been diagnosed with a disease not listed at Appendix C. It is recommended but not required that suspected misuse of funds by any person employed by the home or by the legal entity, or misuse of funds by a volunteer, family member, or a private caregiver be reported. If the police are investigating misuse of funds by anyone, the incident must be reported as described at (11), below. (8) Food poisoning of residents. Any event where one or more residents have been diagnosed as suffering from food poisoning, or where there is reasonable suspicion to believe that food poisoning occurred. Suspected food poisoning.

3 (9) A physical or sexual assault by or against a resident. (10) Fire or structural damage to the home. - Any act of physical violence by a staff person against a resident, regardless of degree - Any act of physical violence by one resident against another resident where the victim sustains an injury of any degree. - Any sex act between a staff person and a resident - Any nonconsensual sex act between residents - Any sex act between residents where one or both of the residents is cognitively impaired such that consent cannot be established Structural damage from any source (e.g., natural disasters, vehicle accidents, or water damage from a sprinkler system) - Any act of physical violence by one resident against another resident where the victim does not sustain an injury. - Consensual sex between residents with no cognitive impairment. Self-explanatory. Acts of violence between residents where no injury requiring medical treatment occurs does not need to be reported, but the behavior must be addressed in the residents Resident-Assessment and Support Plans. (11) An incident requiring the services of an emergency management agency, fire department or law enforcement agency, except for false alarms. (12) A complaint of resident abuse, suspected resident abuse or referral of a complaint of resident abuse to a local authority. - Any incident where police are present in the home except for response to a 302 involuntary commitment proceeding - Any incident where emergency management personnel respond to an actual or pending crisis event (e.g., natural gas leak, oncoming blizzard, or flood) - Any incident where fire department personnel respond to an alarm or emergency call Actual or suspected cases of any of the following by anyone: - The infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish. - The willful deprivation by the personal care home or its staff persons of goods or services which are necessary to maintain physical or mental health. - Sexual harassment, rape or abuse, as defined in 23 Pa.C.S. Chapter 61 (relating to protection from abuse). - Exploitation by an act or a course of - Calls to an ambulance/ems services for scheduled or emergency transportation - Police response to an EMS call for emergency transportation - A police response to a 302 involuntary commitment proceeding The need to summon an ambulance or EMS provider may result from an incident that must be reported, such as a serious bodily injury. In such cases, the incident required to be reported is the inciting event, not the presence of first responders.

4 conduct, including misrepresentation or failure to obtain informed consent which results in monetary, personal or other benefit, gain or profit for the perpetrator, or monetary or personal loss to the resident. - Neglect of the resident, which results in physical harm, pain or mental anguish. - Abandonment or desertion by the personal care home or its staff persons. (13) A prescription medication error as defined in (relating to medication errors). Any of the following, if the home administers medication to a resident to is unable to or who chooses not to administer his own medications: - Failure to administer a medication. - Administration of the wrong medication. - Administration of the wrong amount of medication. - Failure to administer a medication at the prescribed time. - Administration to the wrong resident. - Administration through the wrong route. A prescription medication error by a resident who is self-administering medications. (14) An emergency in which the procedures under (relating to emergency preparedness) are implemented. Any event that requires the home to activate the emergency preparedness plan required by (b). Any incident where emergency management personnel respond to an actual or pending crisis event (e.g., natural gas leak, oncoming blizzard, or flood). Incidents where emergency management personnel respond to an actual or pending crisis event must be reported as described at (11), above. (15) An unscheduled closure of the home or relocation of the residents. (16) Bankruptcy filed by the legal entity. Self-explanatory. Self-explanatory. This includes temporary relocations, which would likely require reporting per (11) and (14). Self-explanatory. Self-explanatory.

5 (17) A criminal conviction against the legal entity, administrator or staff that are subsequent to the reporting on the criminal history checks under (relating to criminal history checks). (18) A termination notice from a utility company. This includes a termination notice or an actual service termination. Self-explanatory. Self-explanatory. Self-explanatory. Self-explanatory. (19) A violation of applicable health and safety laws listed in (relating to applicable health and safety laws). Any violation of any of the laws listed at Appendix B.