Incident Reporting Department Name Development/Communications CHAPTER: SUBJECT: Incident Reporting APPROVAL: EFFECTIVE DATE: 2/17/2005; Updated 7/5/2005 Updated 10/20/05 POLICY NUMBER: DC-002 REPLACES (policy # and date): CFOP 215-6, dated November 1, 1998 I. PURPOSE: To establish Children s Network of Southwest Florida procedures for identifying and reporting information related to client risk prevention incidents. II. REVIEW HISTORY: Revision to policy effective 2/17/2005. III. IV. CONTACT: Quality Management Director for reportable incidents; CEO, COO, or Director of Community Development/Communications for critical incidents. PERSONS AFFECTED: Children s Network staff and contracted providers. V. POLICY: A. It is the responsibility of all Children's Network of Southwest Florida personnel and case management organization staff to promptly report all incidents in accordance with the requirements of these procedures. B. This reporting system does not replace existing abuse, neglect and/or exploitation reporting requirements. Allegations of abuse, neglect or exploitation must still be reported to the Florida Abuse Hotline and appropriate district Florida Local Advocacy Committees as required by law. C. This operating procedure does not replace the investigation and review requirement provided for in Department of Children and Families CFOP 175-17, Child Death Review Procedures. VI. RATIONALE: This policy provides a way to assure management of Children's Network Southwest Florida is aware of critical and reportable incidents in a timely manner. It also clarifies which events must be reported. Page 1 of 9 P & P Incident Report DC-002
VII. VIII. CROSS REFERENCES: Department of Children and Families Operating Procedures 215-6, Incident Reporting and Client Risk Prevention, November 1, 1996. Florida Statutes Chapter 110. DEFINITIONS: 1. Abuse/Neglect/Exploitation (Institutional). Abuse inflicted on a client residing in a licensed institutional setting. 2. Altercation/fight. A physical confrontation occurring between a client, a client and employee, or two or more clients at the time services are being a. rendered, or when a client is in the physical custody of the Children's b. Network of Southwest Florida which results in one or more clients or c. employees receiving medical treatment by a licensed health care professional. 3. Client Death. A person whose life terminates due to or allegedly due to an accident, act of abuse, neglect, or other incident occurring while in the presence of an employee, in a Children s Network of Southwest Florida operated or contracted facility or services center, while under the supervision of the Children's Network of Southwest Florida or in the custody of the Department when a death review is required pursuant to Department of Children and Families operating procedure 175-17, Child Death Review Procedures. 4. Client Injury or Illness. A medical condition or injury of a client under supervision of the Children s Network of Southwest Florida or in the custody of the Department which requires medical treatment by a licensed health care professional. A report is required if an injury is sustained or allegedly sustained due to an accident, act of abuse or other incident occurring while in the presence of an employee at the Children s Network of Southwest Florida or at a contracted facility. 5. Criminal Activity. Criminal conduct perpetrated by an employee while on state property or while the employee is representing the Children s Network of Southwest Florida, which results in an arrest. 6. Disease Epidemic. A contagious disease that spreads rapidly. 7. Elopement. The unauthorized absence beyond eight hours or other time frames, as defined by a specific program or operating procedure, of a child who is in the custody of the department and under the supervision of the Children s Network of Southwest Florida. 8. Licensed health care professional. For the purposes of this operating procedure, a person who is licensed to practice medicine pursuant to Chapter 458, F.S. or Page 2 of 9
licensed as a nurse practitioner pursuant to Chapter 464, F.S. 9. Missing child. A person who is under the age of 18 years, whose location has not been determined; and who has been or will be reported as missing to a law enforcement agency. 10. Reportable Critical Incident. All client-related incidents that result in serious harm or injury to staff or other clients, or a critical incident such as an employee (or provider) felony arrest. A critical incident is the most severe type of incident that impacts the Children's Network of Southwest Florida to the greatest extent. (see Matrix below) Critical Incident Categories Death of Client Abuse/Neglect of client in provider care Serious Injury to client by staff. Serious Injury to staff by client Serious Injury self-inflicted by client Felony Arrest employee/provider Sexual Assault/Harassment to client Vehicle serious violations staff Comments Report all Includes all allegations Requiring physician s care Requiring physician s care Requiring physician s care All not tracked by inspector general s office Report all i.e., DUI, loss of license 11. Sexual Battery. An allegation of sexual battery by a client on a client, employee on a client, or client on an employee as evidenced by medical evidence or law enforcement involvement. 12. Suicide Attempt. An act which clearly reflects the physical attempt by a client to cause his or her own death while in the physical custody of the Children s Network of Southwest Florida or its contracted or certified provider, which results in bodily injury requiring medical treatment by a licensed health care professional 13. Theft/Vandalism/Damage. The act of stealing by a client, willful or malicious defacement or destruction of public or private property by a client and impairment of property by a client. IX. PROCEDURES: A. Reportable incidents 1. Immediately upon becoming aware of an incident as described in the definitions, every employee of the Children's Network of Southwest Florida or contract provider is responsible for reporting such an event, first, by notifying Page 3 of 9
his/her immediate supervisor of the incident orally or by telephone and, then, by completing the Incident Report form (Exhibit 1). In the event the direct supervisor is unavailable, the employee is to continue up the chain of command until the employee is able to reach a supervisor or manager and provide that individual with an oral report of the reportable incident in advance of the preparation of the written incident report. 2. If the incident occurs outside of working hours, the Children's Network of Southwest Florida Quality Management Department, the department s district administrator and the client s child welfare case manager (if applicable) should be notified as soon as possible by phone or fax the next working day unless the incident is a critical incident. 3. In addition, all incident reports should be reviewed and transmitted directly to the Children s Network of Southwest Florida s Quality Management Department, the department district administrator and the client s child welfare case manager (if applicable) by the employee s immediate supervisor, if available. If the supervisor is not available, the employee should transmit the form to the Children s Network of Southwest Florida s Quality Management Department, the department district administrator and the client s child welfare case manager (if applicable) by facsimile transmission device or hand deliver, if practical. 4. A copy of the incident report shall be maintained in the employee s work unit by the unit supervisor. Unrelated children will need to be listed on a separate incident report, (i.e.: if two or more clients are involved in an incident and they are not related, a separate incident report will be done for each child involved). In order to preserve confidentiality, use initials for clients other than the one who is the subject of the report. 5. Upon receipt and review of the incident report by the Children's Network of Southwest Florida designee, the responsible contract manager, or person responsible for licensing of a facility, the facility will make the determination for the need for follow-up. A suspense date established to assess: a. Staff compliance with program policy and procedure. b. Appropriate handling of the situation and action taken to protect the staff/client. c. Steps taken to maintain control of the situation and to limit further liability of the Children s Network of Southwest Florida and its contract providers. Page 4 of 9
d. The arrangement for appropriate medical care and following up on recommendations made by the medical care provider. e. Notification of law enforcement if deemed necessary. B. Critical incidents 1. Upon receiving oral or telephonic notification of any critical incident, the supervisor/manager should, in an abundance of caution, promptly notify the Children s Network CEO/COO and Director of Resource Development/Communications so that appropriate steps can be initiated to mitigate the situation in advance of a more detailed review of the facts. If the incident occurs after business hours, the CEO should be called immediately. As soon as the written incident report is available, it should be faxed to the Children s Network of Southwest Florida Quality Management Department. The supervisory review of the incident report is intended to ensure completeness of information and coordination of appropriate corrective action and follow-up to protect the client from further risk or injury and to manage activities to control the situation. C. Missing children. 1. An incident report must be completed and sent within 8 hours to the District Administrator and the Children s Network of Southwest Florida s Quality Management Department for children who have been reported as missing. If there are exigent circumstances the incident report on the child must be faxed immediately. Refer to Policy QM-006 for complete instructions on missing children reporting. 2. The Child Welfare Case Manager must notify Child Welfare legal Services with in 24 hours of the child s disappearance and no later than 48 hours. D. Requests for copies of incident reports 1. Any request by the public or media for a copy of an incident report should be directed to the Director of Resource Development/Communications at the Children s Network of Southwest Florida in order to assure all legal requirements are met. 2. The Director of Resource Development/Communications will collaborate with the Communications Officer at the Department of Children and Families to coordinate pertinent information that would be released under public records law. Information will, at a minimum, answer the following questions: who; what; when; and where. Page 5 of 9
3. Contract managers and licensing personnel should review and consider incident reports for the 12 months prior to renewal when re-licensing a home or facility or renewing a contract. 4. Subsequent requests for corrective action plans, status reports or additional information may be initiated on an individual basis as determined by the situation. Exhibits 1. Incident Reporting Form Page 6 of 9
THIS DOCUMENT IS SUBJECT TO CONFIDENTIALITY REQUIREMENTS AND SHOULD BE HANDLED ACCORDINGLY. Follow-Up Only IR # Date: County: Contract Provider: Name of Facility/Site: Address of Facility/Site: Telephone #: SUNCOM #: Date & Time of Incident: Law Enforcement Notified: Yes No Abuse Registry Notified Yes No 1-800-962-2873 CATEGORIES Theft/Vandalism/Damage Client Injury/Illness Altercation/Fights Death Disease Epidemic Criminal Activity (Employee) Elopement/Runaway Sexual Assault (Other) Suicide Attempt Abuse/Neglect/Exploitation (Institutional) Client to Client Sexual Battery BRIEF DESCRIPTION OF INCIDENT Use Additional Page if Necessary Other Event IDENTIFYING INFORMATION Persons Involved: First Name Last Name Child/Adult Date of Birth Relationship to Agency Page 7 of 9 P & P Incident Report DC-002
Reporting Employee: Date: Cc: Immediate Supervisor Date: Cc: Children s Network of SW Florida Date: Cc: District Administration (239) 338-1215 Date: What measures have been taken to protect the client and to gain control or manage the situation? Page 8 of 9
Instructions for Completing the Incident Report Form: 1. FAX completed form to DCF District Administration at: (239) 338-1215, and fax to Children s Network, Attention: Mandy Warick at (239) 425-6344 2. Follow-up only check when this report is additional information about a situation previously reported. Each incident report will be numbered for informational purposes. 3. Date date report is being made 4. County county where incident occurred. 5. Contract Provider -- provider who is providing services to the client. 6. Categories refer to incident reporting matrix procedures for definitions of these categories (Check One) 7. Brief Description type this information (preferred) or print clearly. Use full names and only report facts. Identifying information will be redacted if there is a public records request. 8. Identifying Information First and Last Names; A for Adult or C for Child. Place DOB or age if DOB is unknown. Indicate if the incident involves a client, staff or other. 9. The reporting employee is to ensure that the incident report is CC, unless this responsibility has been designated. Page 9 of 9