Job aids

ALW incidents and quality assurance: the steps to remember

The short step lists from each lesson of ALW incident reporting and quality assurance for care coordinators, on one page. Print it for the station or the break room. Each list points back to its lesson, where the sources are linked.

Open the course Print a poster with a QR code

Decision guide

A home reports an event: where does it go?

Is there any sign or report of abuse or neglect of the participant?

Yes
Report it yourself, immediately, to APS and DHCS, and to CCL if she lives in an RCFE or ARF. DHCS ranks suspected abuse or neglect as level 3. The home makes its own reports too.
No
Is it a rights violation, communicable disease, privacy breach, licensing sanction, unexpected death in the home, outbreak, fire or major accident?
- Yes
  Level 3, high priority. Check that the home sent it to the CCA and DHCS within 24 hours. Forward it to DHCS at once, and follow it to resolution.
- No
  Was there unauthorized restraint or seclusion, a medication error, police involvement, criminal victimization or financial exploitation?
  - Yes
    The waiver says these go to the CCA and DHCS. Forward the report at once. If you cannot tell how serious it is, ask the DHCS ALW unit rather than wait.
  - No
    Was there an injury, an emergency visit with a hospital stay, suicidal talk or an attempt, AED or CPR, or a major change in condition?
    Yes
    Level 2, moderate priority. The home reports to the CCA and DHCS within 24 hours if serious, 72 hours if less. Forward it at once, and check whether the ISP needs changes.
    No
    Is it a fall or behavior episode without injury, her own ER visit, a stay away over 24 hours, hospice, or an expected death elsewhere?
    Yes
    Level 1: not sent to ALW. Record it in her file, and watch for a pattern at monthly visits. An absence over 24 hours goes to the CCA for billing only.
    No
    It does not match the lists here. Record the facts, and ask your agency's lead or the DHCS ALW unit how to treat it. Do not set the level alone.

Meet any immediate danger first: call 911 or use the site's emergency process. This guide sorts your next step for the ALW route only. It does not replace the home's licensing reports or anyone's mandated-reporting duty, and DHCS decides how a report is ranked when it is unclear.

Step through it one question at a time: alwbeta.com/training/courses/alw-incidents-and-qa#decision-guide

Lesson 1

What the waiver counts as an incident

A home calls about something that happened to a participant overnight. Your first decision is whether the waiver counts it as an incident for the CCA and DHCS. This lesson sets out the events the ALW waiver and the DHCS checklist list, and the look-alikes that stay in the file.

Death from any cause, wherever it happened
Serious injury, as the physician determines; AED use
Abuse, unexplained absence and other threats to welfare
Restraint, seclusion, medication error, police matter, financial exploitation
Outbreak, poisoning, major accident, fire; licensing sanctions
Absence over 24 hours: CCA only, for billing

Lesson: alwbeta.com/training/courses/alw-incidents-and-qa#lesson-inc-what-counts

Lesson 2

Who reports, to whom, and how fast

Once an event counts, the next questions are who sends it, where, and by when. A late report or a wrong route leaves DHCS without the facts it needs. This lesson covers the times the waiver states, the CCA's own step, the DHCS priority levels and the route for signs of abuse.

Home to CCA and DHCS: 24 hours if serious, 72 if less
CCA to DHCS: at once, through the dedicated box
Level 1: not sent to ALW; still recorded
Level 2: injury, hospital stay, self-harm, AED or CPR
Level 3: abuse, neglect, rights, disease, sanctions, unexpected death
Signs of abuse or neglect: APS, DHCS and licensing, immediately

Lesson: alwbeta.com/training/courses/alw-incidents-and-qa#lesson-inc-who-and-when

Lesson 3

Follow-up and documentation

Sending the report starts the work. The waiver makes the CCA the first line of quality assurance: you act for the participant, follow the incident to its end and keep DHCS informed. This lesson covers what a report holds, what DHCS does with it, and what you check and record.

Check the report: resident, date, details, physician, findings, treatment, disposition
Forward to DHCS at once; ask the home for missing parts
Call the home and check on the participant
Follow the incident to resolution; keep DHCS told of its status
Visit problems: report to DHCS that day; adjust the ISP if needed

Lesson: alwbeta.com/training/courses/alw-incidents-and-qa#lesson-inc-follow-up

Lesson 4

The participant's safety plan

After an incident, the question becomes what keeps it from happening again. In ALW that plan lives in the ISP, and the participant helps shape it. This lesson covers how risks are found and planned for, the emergency plan, the limits on restraint and seclusion, and what participants learn about abuse.

Ask everyone about risks: participant, representative, provider, CCA
Plan each risk with her; record her concerns
Emergency plan in the ISP fits her mobility
No physical restraint, no seclusion; report any unauthorized use
Prescribed chemical restraint: purpose and use in the ISP; monitor it
Teach abuse, neglect, exploitation and whom to contact

Lesson: alwbeta.com/training/courses/alw-incidents-and-qa#lesson-inc-safety-plan

Lesson 5

The quality-assurance measures the waiver lists

Every report you send and every note you write feeds the waiver's quality system. DHCS uses them to spot trends, coach providers and act when problems persist. This lesson covers what your agency must keep, what DHCS measures and reviews, and how a pattern of incidents becomes a corrective action plan.

Log every complaint and incident report
Close a SIR only at resolution; keep DHCS told
Document risk monitoring and abuse information in the file
Trend: TA in 30 days, follow-up in 30, then a CAP of 60 to 90 days
CCAs watch the providers; DHCS watches everyone

Lesson: alwbeta.com/training/courses/alw-incidents-and-qa#lesson-inc-quality-assurance