All entities regulated by the Division of Quality Assurance (DQA) must:
Immediately protect clients from subsequent incidents of misconduct (abuse, neglect, misappropriation and injury of unknown source).
Investigate all allegations of misconduct
Document the results of their investigation
Report allegations/incidents to DQA as appropriate
For allegations involving all staff (noncredentialed and credentialed) or other perpetrators (family member, friend, visitor, resident, etc.) submit the Incident Report to DQA at:
Department of Health Services
Division of Quality Assurance
Office of Caregiver Quality
PO Box 2969
Madison, WI 53701-2969
All incident reports, regardless of perpetrator, must be submitted to the DQA Office of Caregiver Quality. OCQ will review reports involving noncredentialed staff (nurse aides, caregivers, housekeepers, etc.) for possible investigation and refer reports involving credentialed staff (doctors, RNs, LPNs, social workers, etc.) to the Department of Safety & Professional Services (DSPS) for review. OCQ will also refer reports to other agencies including the Department of Justice, county departments, adult-at-risk agencies, local law enforcement agencies, and others, as appropriate. One or more of these agencies may also respond to an allegation investigated by DQA.
All Entities Except Nursing Homes:
Use the F-62447 Incident Report form to report misconduct allegations.
Nursing Homes Only:
Effective immediately, all nursing homes must immediately report all alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property to the Division of Quality Assurance (DQA) via the online reporting system at http://4.selectsurvey.net/DHS/TakeSurvey.aspx?SurveyID=96MI3ml4.Refer to the misconduct definitions to determine if an alleged incident constitutes a violation. CMS defines "immediately" to be as soon as possible but not to exceed 24 hours after discovery of the incident. To print a copy of the report, click on the browser's print button before clicking the "Done" button.
Use the F-62447 Incident Report form to report misconduct allegations investigations.
Nursing Homes, Hospices and FDDs
DQA Memo 11-021, CMS S&C Memo 11-30 Reporting Reasonable Suspicion of a Crime