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SMQT- Fraud & Abuse Graded A+

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SMQT- Fraud & Abuse Graded A+ Abuse Prohibition Review Overview Description The Abuse Prohibition Review assesses whether a facility has both developed and operationalized policies and procedures to protect residents from: - Abuse - Neglect - Involuntary seclusion - Misappropriation of pr...

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  • August 15, 2024
  • 16
  • 2024/2025
  • Exam (elaborations)
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  • SMQT- Fraud & Abuse Graded A+
  • SMQT- Fraud & Abuse Graded A+
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SMQT- Fraud & Abuse Graded A+
Abuse Prohibition Review Overview



Description

The Abuse Prohibition Review assesses whether a facility has both developed and operationalized
policies and procedures to protect residents from:



- Abuse

- Neglect

- Involuntary seclusion

- Misappropriation of property



This includes examining policies and procedures related to:



- Hiring practices

- Employee and volunteer training

- Ongoing supervision

- Reporting and investigating allegations of abuse



---



### General Procedures



The review consists of evaluating the facility’s policies and procedures as outlined in the Guidance to
Surveyors. Key components to be included are:



- Screening of potential hires

- Employee training (for new hires and ongoing training)

- Prevention of abuse policies

,- Identification of incidents or allegations that require investigation

- Investigation protocols for incidents or allegations

- Resident protection during investigations

- Reporting procedures for incidents and facility responses



The general procedure for conducting the Abuse Prohibition Review involves following the Abuse
Prohibition Investigative Protocol.



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### Quiz Question: Objective of the Abuse Prohibition Review



Answer: The primary objective of the Abuse Prohibition Review is to determine if the facility has
developed and operationalized policies and procedures that prohibit:



1. Abuse

2. Neglect

3. Involuntary seclusion

4. Misappropriation of residents' property



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### Investigative Protocol for Abuse Prohibition



The Abuse Prohibition Investigative Protocol is required for every long-term care standard survey and
includes the following steps:



1. Obtain and Review Policies & Procedures

- Collect and review the facility's abuse prohibition policies and procedures.

, - Ensure key components are included: screening, training, prevention, identification, investigation,
protection, and reporting/response.

- Note that these components may not be consolidated into a single document.



2. Interview Responsible Individual(s)

- Interview the individual(s) designated by the facility to coordinate the abuse prohibition policies.

- These individuals should be accountable for evaluating how each component is operationalized.



Interview Questions:

- How do you monitor staff during resident care to prevent neglect?

- How do you decide which injuries of unknown origin require investigation as potential abuse?

- What measures are in place to ensure that residents, families, and staff can voice concerns without
fear of reprisal?



3. Request Written Evidence

- Request documentation on how the facility has responded to alleged violations.

- Select two or three alleged violations from the period since the last standard survey, if available.

- Evaluate whether adequate procedures were implemented for:

- Reporting and investigating incidents

- Resident protection during investigations

- Provision of corrective actions



Note: Reporting requirements at §483.13(c)(2), (c)(4), F225 include notifying the State Survey Agency
of both the alleged violation and results of the subsequent investigation.



4. Interview Residents and Families

- Conduct interviews with residents and their families to gauge their awareness of abuse prohibition
policies and procedures.

- Determine if they know:

- To whom they can report allegations, incidents, or complaints.

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