N.H. Admin. Code § He-C 4001.23 - Incident Reports
(a) Program staff directly involved in or
witness to any incident shall complete a legible, written incident report
whenever there is an incident, as defined in
He-C
4001.01(y).
(b) For reportable incidents, as defined in
He-C
4001.01(bc), licensees shall have
responsibility for:
(1) Completing a
preliminary review of an incident to determine if abuse or neglect could have
been a contributing factor to the incident;
(2) Providing the following information to
the department within 48 hours of a reportable incident:
a. The program name;
b. A description of the incident, including
what led to the incident, where it occurred and identification of injuries, if
applicable;
c. The name of the
licensee(s) or personnel involved in, witnessing, or responding to the
reportable incident;
d. The name
of resident(s) involved in or witnessing the reportable incident;
e. The date and the beginning and ending time
of the reportable incident;
f. The
action taken in direct response to the reportable incident, including any
follow-up;
g. If medical
intervention was required, by whom, and the date and time;
h. When the resident's guardian, agent,
surrogate decision-maker, or personal representative, if any, was notified;
i. The signature of the person
reporting the reportable incident;
j. The date and time the resident's licensed
practitioner was notified, if applicable; and
k. The date the licensee performed the
preliminary review required by (1) above; and
(3) For uses of seclusion, restraint, or
other intentional physical contact with a child which is in response to a
resident's aggression, misconduct, or disruptive behavior, in addition to (2)
above, the following:
a. Authorization by the
staff in charge; and
b.
Documentation as required by He-C 4001.23(b)(2) and either
RSA
126-U:7 or
RSA
126-U:10.
(c) Incident reports shall be maintained as
part of the involved resident's records and be made available on the premises
of the program for review by the department.
(d) Program staff shall provide the
resident's parents with information regarding incident reports on the next
business day, which shall include all of the information included on the
incident report.
(e) If the
parent(s) do not have a telephone or cannot be reached, program staff shall
document their efforts to notify the parent(s) and send a written copy of the
incident report to the parent(s).
(f) For uses of seclusion, restraint, or
other intentional physical contact with a child which is response to a child's
aggression, misconduct, or disruptive behavior, program staff shall notify the
resident's parents or guardians in accordance with
RSA
126-U:7 including verbal and written
documentation.
(g) Immediately
following any fire or emergency incident, licensees shall notify the department
by phone, followed by written notification within 72 hours, with the exception
of a false alarm or emergency medical services (EMS) transport for a
non-emergent reason.
(h) The written
notification required by (g) above shall include:
(1) The date and time of the
incident;
(2) A description of the
location and extent of the incident, including any injury or damage;
(3) A description of events preceding and
following the incident;
(4) The
name of any personnel or residents who were evacuated as a result of the
incident, if applicable;
(5) The
name of any personnel or residents who required medical treatment as a result
of the incident, if applicable; and
(6) The name of the individual the licensee
wishes the department to contact if additional information is
required.
(i) As soon as
is practicable but no longer than 24 hours after the use of a medication
restraint, the resident's licensed practitioner shall be notified of the use of
such restraint.
(j) When a resident
has an unexplained absence, after searching the building and grounds without
finding the resident, and it has been determined that the resident is a danger
to themselves or others, the licensee shall immediately notify the local police
department, the department and the resident's guardian, agent, surrogate
decision-maker, or personal representative, if any.
Notes
#2664, eff 3-30-84, EXPIRED: 3-30-90
New. #8581, eff 4-20-06, EXPIRED: 4-20-06
New. #10576, INTERIM, eff 4-26-14, EXPIRES: 10-23-14
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