* = Required Information
ALLEGED MALTREATMENT REVIEW CHECKLIST
1. INCIDENT OR ACCIDENT REPORT is fully completed and filed.
2. ALLEGED MALTREATMENT REPORT is fully completed and filed.
3. NOTIFICATION TO AN INTERNAL REPORTER ABOUT AN ALLEGED MALTREATMENT REPORT is fully completed, has been mailed to the reporting individual, and a copy has been filed.
4. INTERNAL REVIEW OF ALLEGED MALTREATMENT has been completed and included the following evaluations:
  • whether related policies and procedures were followed,
  • whether the policies and procedures were adequate,
  • whether there is a need for additional staff training,
  • whether the reported event is similar to past events with the vulnerable adults or the services involved,
  • and whether there is a need for corrective action by the license holder to protect the health and safety of vulnerable adults/Minors.
5. A corrective action plan has been developed, documented and implemented to correct current lapses and prevent future lapses in performance by individuals or the license holder
6. The INTERNAL REVIEW OF ALLEGED MALTREATMENT has been documented and made available to the commissioner upon the commissioners request.
7. Initial Disposition has been received, reviewed and filed.
8. Final Disposition has been received, reviewed and filed.
9. Final Disposition response or corrections that were requested or required were completed and submitted.
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