What to report

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.

Resident safety and care

• 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.

Staffing and supervision

• 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.

Employment issues

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.

Diversion and theft

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.