Elder and Dependent Adult Abuse: Mandated Reporting

This section sets out the standing under which this policy is issued, who owns it, who is bound by it, and how it is kept current. It is not itself a procedure. The obligations begin at Section 1.

Home health staff are often the only people outside the family who see an elder or dependent adult at home. California makes each of them personally responsible for reporting abuse and neglect quickly, and makes failure to report a crime (Cal. Welf. & Inst. Code §15630(h)). This policy tells every staff member what to look for, exactly what to do and by when, and how the Agency supports them and protects the patient.

This policy covers every patient who is 65 or older, and every patient aged 18 to 64 who is a dependent adult, wherever the abuse is thought to have happened (the patient’s home, a family member’s home, a long-term care facility, a hospital, or in the community), and whoever is thought to be responsible, including a family member, a paid caregiver, another provider, or an Agency employee. As the Agency’s own standard, staff follow the same steps for any adult patient they believe is being abused.

For the purposes of this policy, the following terms have the meanings below. The California home health agency regulations (22 CCR Division 5, Chapter 6) and 42 CFR Part 484 both say "patient", and this policy uses the same word for the person receiving home health services.

Every employee who, in their professional capacity or within the scope of their employment, has observed or has knowledge of an incident that reasonably appears to be physical abuse, abandonment, abduction, isolation, financial abuse, or neglect, or is told by an elder or dependent adult that they have experienced any of these, or reasonably suspects that abuse, reports it personally (Cal. Welf. & Inst. Code §15630(b)(1)). The report is made "by telephone or through a confidential internet reporting tool, as authorized by Section 15658, immediately or as soon as practicably possible. If reported by telephone, a written report shall be sent, or an internet report shall be made through the confidential internet reporting tool established in Section 15658, within two working days." Where the abuse occurred in a long-term care facility, the shorter route in §15630(b)(1)(A) applies (Section 7.2).

"The reporting duties under this section are individual, and no supervisor or administrator shall impede or inhibit the reporting duties, and no person making the report shall be subject to any sanction for making the report" (§15630(f)). The Agency’s internal steps in this policy exist only to support the reporter, to protect the patient, and to tell supervisors that a report was made, as §15630(f) allows. Before starting work, every employee signs the statement required by §15659 on Form CA-HH-SG-01-A and receives a copy of §15630.

If the Agency is Medicare-certified, any staff member who identifies, notices, or recognizes mistreatment, neglect, verbal, mental, sexual, or physical abuse, including injuries of unknown source, or misappropriation of patient property, reports these findings immediately to the Agency and other appropriate authorities in accordance with state law (42 CFR §484.50(e)(2)), and the Agency investigates, documents, and acts to prevent further potential violations, including retaliation (§484.50(e)(1)). The Agency applies these federal standards to all patients, as the Agency’s own standard.

None of these proves abuse, and abuse can happen without any of them. Any one of them, with no good explanation, is enough for a reasonable suspicion.

1. If anyone is in immediate danger, leave if you are at risk and call 911. Your safety and the patient’s come first.
2. Give the care the patient needs. Do not confront the person you suspect, and do not promise the patient to keep it secret.
3. Listen. Let the patient tell you in their own words. Ask only open questions such as “How did that happen?” Do not ask leading questions and do not investigate.
4. Note exactly what you saw and what was said, using the patient’s own words, and the date and time. If the patient agrees, you may take photographs of a suspected victim for the report (Cal. Welf. & Inst. Code §15634(a)), using an Agency device, as the Agency’s own standard.
5. Call your nurse supervisor or the on-call nurse at (916) 555-0199 as soon as you safely can, so the Agency can protect the patient. This call supports your report; it does not replace it.

Report to the county Adult Protective Services agency or the local law enforcement agency (Cal. Welf. & Inst. Code §15630(b)(1)(F)): the county Adult Protective Services agency (statewide line 1-833-401-0832, which connects to the county APS for the ZIP code entered, 24 hours a day, 7 days a week) or the local law enforcement agency; call 911 if anyone is in immediate danger. The local Adult Protective Services number for the Agency’s area is (916) 555-0121; county contacts are listed at https://www.cdss.ca.gov/Portals/9/APS/aps-county-contact-list.pdf.

As the Agency’s own standard, staff make the telephone report before the end of the visit or shift in which they formed the suspicion, and send the written report the same day or the next working day. A suspicion that arises at 4 p.m. on a Friday is reported that day, not on Monday.

If the known, suspected, or alleged abuse occurred in a long-term care facility (for example, a skilled nursing facility, a residential care facility for the elderly, or an adult residential facility), the reporter follows Table 3 (Cal. Welf. & Inst. Code §15630(b)(1)(A)). The time limit begins when the reporter observes, obtains knowledge of, or suspects the abuse or neglect (§15630(b)(1)(A)(iii)). The long-term care ombudsman is reached at 1-800-231-4024 (Long-Term Care Ombudsman Hotline, 24 hours a day, 7 days a week).

The telephone or internet report includes, if known: the name of the person making the report; the name and age of the elder or dependent adult; their present location; the names and addresses of family members or any other adult responsible for their care; the nature and extent of their condition; the date of the incident; and any other information, including what led the reporter to suspect abuse, that the receiving agency requests (Cal. Welf. & Inst. Code §15630(e)). The written form also asks for the reporter’s address, telephone number, and occupation; the time and place of the incident; the reporter’s observations; any statement by the victim; and the names of people with knowledge of the incident and of those believed responsible (§15658(b)). Report even if some of this is not known.

If two or more mandated reporters know of or suspect the same abuse and agree, one of them may make a single report, selected by mutual agreement and signed by that member. Any member who knows that the designated member has failed to report must then make the report (Cal. Welf. & Inst. Code §15630(d)).

Criminal conduct not covered by the mandatory report may be reported immediately to the appropriate law enforcement agency (Cal. Welf. & Inst. Code §15630(c)(5)). The Administrator may also refer suspected criminal abuse or neglect, or Medi-Cal fraud, to California Department of Justice, Division of Medi-Cal Fraud and Elder Abuse, Complaint Intake Unit, P.O. Box 944255, Sacramento, CA 94244-2550; (800) 722-0432; online at https://oag.ca.gov/dmfea/reporting. Abuse of types for which reports are not mandated, such as purely emotional abuse, may also be reported (§15630(c)(1)-(4)), and the Agency encourages staff to do so.

A registered nurse is not required to report an incident if all of these conditions exist: the nurse has been told by the elder or dependent adult that they experienced the abuse; the nurse is unaware of any independent evidence that corroborates the statement; the patient has been diagnosed with a mental illness or dementia, or is the subject of a court-ordered conservatorship because of a mental illness or dementia; and, in the exercise of clinical judgment, the nurse reasonably believes that the abuse did not occur (Cal. Welf. & Inst. Code §15630(b)(3)). As the Agency’s own standard, a nurse who relies on this exception first discusses it with the DPCS and documents the reasoning in the clinical record. When in doubt, the nurse reports. The exception does not apply to aides, therapists, or other staff.

1. The reporter tells the nurse supervisor or DPCS that a report was made, the agency called, the date and time, and any report or case number. The reporter does not have to give the content of the report to the employer if they prefer not to; the supervisor records only that a report was made.
2. The DPCS opens a confidential safeguarding file (separate from the health record) and records the report on an incident report (Policy CA-HH-QA-03). The clinical note records the observations, the care given, and that a report was made to the named agency, but not the reporter’s name, as the Agency’s own standard.
3. The DPCS reviews the plan of treatment or plan for personal care services the same day and adds visits, a social work referral, or other safety measures as needed, with the practitioner’s orders where required (Policy CA-HH-CC-01).
4. The Agency cooperates fully with Adult Protective Services, law enforcement, the ombudsman, and the Department. Information relevant to the incident is given to the investigators listed in Cal. Welf. & Inst. Code §15633.5(a).
5. If the patient refuses services or asks the Agency to stop, the patient’s rights are respected, and the DPCS tells Adult Protective Services, which may follow up.
6. The Administrator is told of every report within one business day, as the Agency’s own standard, and reports totals (not names) to the governing body each quarter.

1. Any allegation or suspicion that an Agency employee, contractor, or volunteer abused, neglected, or took property from a patient is reported to the outside agency exactly as in Section 7, and to the Administrator at once.
2. The person is removed from all patient contact, with pay pending the outcome unless the Administrator decides otherwise, while the Agency investigates, and the Agency takes action to prevent further potential violations, including retaliation, while the complaint is investigated (42 CFR §484.50(e)(1)(iii); applied to all patients as the Agency’s own standard).
3. The Administrator, or a person the Administrator names who is not involved, investigates, cooperating with and not interfering in any outside investigation. The investigation and its outcome are documented (42 CFR §484.50(e)(1)(ii)).
4. Where the person is a certified home health aide or certified nurse assistant, the Administrator also reports the matter to California Department of Public Health, Investigation Branch/Investigation Section, PO Box 997416, MS 3303, Sacramento, CA 95899-7416; message center (916) 492-8232; fax (916) 552-8788; cnamisconduct@cdph.ca.gov. Where the person holds a professional license, the Administrator decides with legal advice whether a report to the licensing board is required or appropriate, as the Agency’s own standard.
5. Disciplinary action follows the personnel policies (Policy CA-HH-HR-01). Any employee who retaliates against a person for making a report is disciplined up to dismissal.

• Reports of suspected abuse, and the information in them, are confidential and may be disclosed only as Cal. Welf. & Inst. Code §15633 allows. The identity of the reporter is confidential and disclosed only among the agencies listed in §15633.5(b), or to the district attorney in a criminal prosecution, when the reporter waives confidentiality, or by court order (§15633.5(c)).
• Staff never tell the family, the suspected abuser, or other staff who made a report.
• A care custodian or health practitioner who reports a known or suspected instance of abuse is not civilly or criminally liable for any report required or authorized by the law, including for taking and sending photographs of a suspected victim with the report (§15634(a)).
• The Agency never sanctions, disciplines, or retaliates against a staff member for making a report (§15630(f)).
• Making a report is a disclosure permitted by law under the Agency’s privacy policies (45 CFR §164.512(c); Policy CA-HH-PRV-01). It is logged in the disclosure log by the privacy official, without the reporter’s name.

Failure to report, or impeding or inhibiting a report of, physical abuse, abandonment, abduction, isolation, financial abuse, or neglect of an elder or dependent adult is a misdemeanor, with greater penalties where the abuse results in death or great bodily injury, and concealing a failure to report is a continuing offense (Cal. Welf. & Inst. Code §15630(h)). Under the Agency’s own rules, failure to report, or any attempt by a supervisor to discourage, delay, or take over a report, is serious misconduct.

Accountability under this policy is allocated as follows.

Signed Forms CA-HH-SG-01-A are kept in each personnel file for the length of employment and three years after it ends (Cal. Welf. & Inst. Code §15659(a) requires the employer to keep them; the period is the Agency’s own standard, matching personnel records). Safeguarding files (incident report, date and time of report, agency and case number, copy of the written report if the reporter provides one, actions taken) are kept confidentially by the DPCS for at least seven years, as the Agency’s own standard. The DPCS reviews every safeguarding file each quarter to check that reports were made on time and the patient’s care was adjusted, and the results feed the quality program (Policy CA-HH-QA-02).

Every employee is trained at orientation, before any patient contact, on this policy, Table 1, the reporting routes and time limits, how to complete the Report of Suspected Dependent Adult/Elder Abuse, form SOC 341 (California Department of Social Services), and confidentiality, and signs Form CA-HH-SG-01-A. Training is repeated each year, as the Agency’s own standard, with case examples (bruises explained by a fall that does not fit, a son who controls the patient’s money, a patient in a residential care facility for the elderly). Supervisors are trained not to discourage or take over reports.

This policy implements the following authorities.

• Cal. Welf. & Inst. Code §15630, Mandated Reporters of Elder and Dependent Adult Abuse
• Cal. Welf. & Inst. Code §§15610.05-15610.63, Definitions (abandonment, abduction, abuse, care custodian, dependent adult, elder, financial abuse, isolation, long-term care facility, neglect, physical abuse)
• Cal. Welf. & Inst. Code §§15633, 15633.5, Confidentiality of Reports and Reporters
• Cal. Welf. & Inst. Code §15634, Immunity of Reporters
• Cal. Welf. & Inst. Code §15658, Written Report Form and Confidential Internet Reporting Tool
• Cal. Welf. & Inst. Code §15659, Signed Statement Before Employment
• 22 CCR §74743(b)(4), Patient Rights
• 42 CFR §484.50(e), Investigation of Complaints and Reporting of Abuse (if Medicare-certified)
• 45 CFR §164.512(c), Disclosures About Victims of Abuse, Neglect, or Domestic Violence

The following documents are read together with this policy.

This policy is adopted by the governing body of Sample Agency, LLC. The effective date, the person who approved it, and the date of approval are shown in the header block and recorded in the signature lines below.

Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a rule cited in Section 16 is amended, the amendment is recorded in this table and a new version of this policy is issued.