What nursing home staff can report

What to report

Facility staff can report resident safety and care problems, staffing and supervision failures, employment issues, and diversion and theft. That covers falls, medication errors, restraints, unpaid overtime, and retaliation against someone who raised a concern.

Anything on the safety review is fair game, and so is anything that is not on it. Below is the shape of what this channel was designed to carry.

What resident care problems should nursing home staff report?

• Falls, and the conditions that produce them — lighting, flooring, clutter, call-light response times.
• Pressure injuries, unexplained bruising, cuts or wounds that are not being documented or treated.
• Medication errors, missed doses, unlocked carts or cabinets, expired stock, records that do not match what was given.
• Sedatives or antipsychotics used to manage behavior rather than to treat a diagnosis.
• Physical restraints, including bed rails and chairs a resident cannot leave.
• Residents left in soiled clothing or bedding, missed meals, missing hydration.
• Infection control that is not happening — hand hygiene, PPE, isolation when it is called for.

Can I report understaffing in a nursing home?

• Ratios that make the assignment impossible rather than merely hard.
• Staff working outside their training or license.
• New staff left unsupervised.
• Complaints about understaffing that have gone up the chain and stopped there.

Can I report unpaid overtime and other employment problems?

These are on the safety review as well, in the employment and labor risk section, because a facility that mishandles its staff generally mishandles its residents.

• Unpaid overtime, missed breaks, timekeeping that does not reflect hours worked.
• Misclassification of employees as independent contractors.
• Injuries not being recorded, PPE not being provided, unsafe lifting expectations.
• Discrimination or harassment, and complaints about either that went nowhere.
• Retaliation against someone who raised a concern.

Should I report missing controlled substances?

Controlled substances going missing is both a resident-safety problem and a federal exposure for ownership. It is one of the things ownership most wants to hear about early. Drug diversion and DOJ exposure.

Frequently asked questions

Is it reportable when a resident is sedated to control behavior?

Yes. Sedatives or antipsychotics used to manage a resident’s behavior, rather than to treat a diagnosis, belong in a report. So do physical restraints, including bed rails and chairs a resident cannot leave. Write down what you saw and the date, and describe the resident by room number and unit instead of full name where you can.

Do I have to stick to the items on the safety review?

No. Anything on the CareGuard safety review is fair game, and so is anything that is not on it. The lists on this page show the shape of what the channel was built to carry: resident care, staffing and supervision, employment issues, and diversion and theft. If something at work puts residents or staff at risk, it can be reported.

Can I report retaliation for raising a concern?

Yes. Retaliation against someone who raised a concern is one of the employment issues this channel carries, along with unpaid overtime, missed breaks, misclassification as a contractor, unrecorded injuries, and harassment complaints that went nowhere. These sit on the safety review in the employment and labor risk section, because a facility that mishandles its staff generally mishandles its residents.

Can I report infection control problems?

Yes. Infection control that is not happening is a resident safety problem: missed hand hygiene, PPE that is not used, or isolation that is skipped when it is called for. The same goes for residents left in soiled clothing or bedding, missed meals and missing hydration. Report what you saw, when you saw it, and on which unit.