Ky.gov
Effective: 12/5/2024

20.6 Investigations in Alternate Care and Licensed Health Care Facilities

Legal Authority

Introduction

  • ​​​​​The ​​​​​​​​​​​​Department for Community Based Services (DCBS)  conducts investigations of alleged abuse, neglect, and exploitation in licensed healthcare facilities and all levels of alternative care. 
  • The Office of the Inspector General (OIG) licenses all Kentucky facilities that provide health care. Many, but not all, of these licensed healthcare facilities, receive Medicaid/Medicare funds. 
  • Facilities that receive Medicaid/Medicare funds include most: 
    • Nursing facilities; 
    • Hospitals; 
    • Intermediate care facilities; and 
    • Home health agencies. 
  • ​​Licensed healthcare facilities that do not receive Medicaid/Medicare funds include, but are not limited to: 
    • ​Personal care homes; and 
    • Family care homes.


Practice Guidance

  • When an investigation is conducted in a licensed healthcare facility, the SSW is permitted to share preliminary findings and recommendations with the following authorized agencies:
    • Law enforcement;
    • OIG;
    • State long-term care ombudsman;
    • County and commonwealth attorney; and
    • When the facility receives Medicaid/Medicare funding to:
      • The Medicaid Fraud and Abuse Control Division in the Office of the Attorney General; or
    • When the facility does not receive Medicaid/Medicare funding to:
      • ​Office of the Attorney General. 




Procedure

The SSW:
  1. Informs the facility administrator or designee that a protective services investigation is being conducted;
  2. Refers to SOP 20.2 General Interviewing Guidelines for guidance on completing interviews with the alleged victim, alleged perpetrator(s), guardian/conservator, facility staff, or other collaterals;
  3. In addition to the guidelines in SOP 20.2 General Interviewing Guidelines when conducting investigations in alternate care settings, may consult with the following: 
    1. A nurse consultant/inspector (NCI);
    2. The Adult Protective Services Branch;
    3. The Office of Legal Services (OLS); 
    4. Appropriate OIG staff, law enforcement, state long-term care ombudsman, Office of Attorney General, county attorney, and commonwealth attorney,  when conducting joint investigations;
  4. ​May refer to the OIG findings in support of DCBS conclusions;
  5. Obtains records as necessary for the investigation following  SOP 20.2 General Interviewing Guidelines; 
  6. Conducts an exit interview with the facility administrator or designee to discuss the results of the investigation and recommendations; 
  7. Completes and distributes the notices of investigative findings following SOP 20.11 Completion and Distribution of Investigative Findings Notification. 
  8. May send a copy of the completed report to the authorized agency if requested.

​Contingencies and Clarifications ​​​​​​

Resident-to-Resident Allegations​
  • Resident-to-resident allegations are investigated as abuse or exploitation only when it’s determined that the offending resident has the decisional capacity, with understanding and control of their behaviors.
  • ​The SSW must assess the offending resident within the first fifteen (15) calendar days of the investigation and send this information to central intake (CI), to ensure that the new program/sub-program is added as a second incident.
  • ​​The SSW may determine the offending resident’s decisional capacity through observation, records review, and interviews with the victim, facility staff, or other collaterals.
  • Resident-to-resident allegations are investigated as caretaker neglect if it’s believed that facility staff failed to take action to stop or address the abuse or exploitation of the alleged victim. 

Documents

Revisions

​12/5/2024 Additions:

Introduction

  • The ​​​​​​​​​​​​Department for Community Based Services (DCBS)  conducts investigations of alleged abuse, neglect, and exploitation in licensed healthcare facilities and all levels of alternative care. 
  • The Office of the Inspector General (OIG) licenses all Kentucky facilities that provide health care. Many, but not all, of these licensed healthcare facilities, receive Medicaid/Medicare funds. 
  • Facilities that receive Medicaid/Medicare Funds include most: 
    • Nursing facilities; 
    • Hospitals; 
    • Intermediate care facilities; and 
    • Home health agencies. 
  • ​​Licensed healthcare facilities that do not receive Medicaid/Medicare funds include, but are not limited to: 
    • ​Personal care homes; and 
    • Family care homes.
Practice Guidance
  • When an investigation is conducted in a licensed healthcare facility, the SSW is permitted to share preliminary findings and recommendations with the following authorized agencies:
    • Law enforcement;
    • OIG;
    • State long-term care ombudsman;
    • County and Commonwealth attorney; and
    • When the facility receives Medicaid/Medicare funding to:
      • The Medicaid Fraud and Abuse Control Division in the Office of the Attorney General; or
    • When the facility does not receive Medicaid/Medicare to:
      • ​Office of the Attorney General. ​
  1. Informs the facility administrator or designee that a protective services investigation is being conducted;
  2. Refers to SOP 20.2 General Interviewing Guidelines for guidance on completing interviews with the alleged victim, alleged perpetrator(s), guardian/conservator, facility staff, or other collaterals;
  3. In addition to the guidelines in SOP 20.2 General Interviewing Guidelines when conducting investigations in alternate care settings, may consult with the following: 
    1. A nurse consultant/inspector (NCI);
    2. The Adult Protective Services Branch;
    3. The Office of Legal Services (OLS); 
    4. Appropriate OIG staff, law enforcement, state long-term care ombudsman, Office of Attorney General, county attorney, and Commonwealth attorney,  when conducting joint investigations;
  4. ​May refer to the OIG findings in support of DCBS conclusions;
  5. Obtains records as necessary for the investigation following SOP 20.2 General Interviewing Guidelines​; 
  6. Conducts an exit interview Verbally shares these findings and recommendations with the facility administrator or designee to discuss the results of the investigation and recommendations;  when the investigation is completed and approved by the FSOS or designee; ​
Resident-to-Resident Allegations​
  • Resident-to-resident allegations are investigated as abuse or exploitation only when it’s determined that the offending resident has the decisional capacity, with understanding and control of their behaviors;
  • ​The SSW must assess the offending resident within the first fifteen (15) calendar days of the investigation and send this information to central intake (CI), to ensure that the new program/sub-program is added as a second incident;​
  • ​​The SSW may determine the offending resident’s decisional capacity through observation, records review, and interviews with the victim, facility staff, or other collaterals;​
  • Resident-to-resident allegations are investigated as caretaker neglect if it’s believed that facility staff failed to take action to stop or address the abuse or exploitation of the alleged victim. 


12/5/2024 Delete:

Practice Guidance

  • ​​DCBS is the lead investigative agency when the alleged victim meets the statutory requirements pursuant to KRS 209.020(4), including reports involving state operated facilities. 
  • ​​​​Allegations of resident to resident abuse are reported as adult abuse or exploitation only when the SSW determines through record review, interview and observation of the residents that the offending resident had the capacity to understand and control his behaviors.​
Procedure
  1. Conducts investigations of alleged abuse, neglect and exploitation in all levels of alternate care; 
  2. Is permitted to consult with service region or central office staff in any prevention or protection case; 

  1. May consult with a nurse consultant/inspector (NCI) or a nurse service administrator when allegations of neglect involve complex medical or nursing issues; 


​8.  Shares the findings with the appropriate authorized agencies using the Notification of Protective Services Investigative Findings Reporting Form; 
9.  Notifies the alleged perpetrator of the finding using the DPP-247 APS Unsubstantiated Investigation Notification Letter or the DPP-248 Adult Protective Services Substantiated Investigation Notification Letter;
10.  Sends notice of the finding, via the DPP-248 APS Substantiated Investigation Notification to the perpetrator: 
    1. By certified mail; 
​11.  Sends a copy of the DPP-248 APS Substantiated Investigation Notification to:
​Office of the Ombudsman
  1. Performance Enhancement Branch
    Quality Assurance Section
    275 East Main Street, 1E-B
    Frankfort, KY 40621

    Or via e-mail APS.Appeals@ky.gov ​


The SSW:
  1. Determines if neglect did occur; 
  2. Assesses the adult who committed the act if it is determined that neglect did not occur, but abuse or exploitation did;
  3. Assesses the resident’s capacity to understand and control his/her behaviors;
  4. Documents the findings as found and substantiated, if the adult who committed the act is found to be in control of his/her behaviors.