When an incident occurs, the service provide must notify RCOC of the incident by fax or telephone within 24 hours and submit a written report within 48 hours.
The fax number of reporting is (714) 796-0600. The telephone number for reporting is (714) 796-5335.
All incident reports should be submitted to these numbers only.
When notifying RCOC, include as much information as possible about the incident.
Review the following 13-step process below to be sure that your report is as complete as possible.
- Print or type incident reports. Reporters (the person calling or writing the report) should always include their name and phone number when making an incident report. Reports should always include a date written and the date/time/location of the incident. If the location of the incident is a specific vendor site, that should be noted.
- Be sure that the consumer is accurately identified with name, date of birth, UCI number, sex, and diagnosis.
- Be sure that the vendor name, address and phone number are included on the report.
- Include the names and phone numbers of witnesses to the incident.
- For hospitalization or emergency room visits, include when the consumer was seen/admitted, the name of the physician who treated the consumer, what treatment was given, when the consumer was discharged, and what orders were given upon discharge.
- For all incident reports, include follow-up activities such as appointments with the consumer’s primary physician, neurologist, psychiatrist, etc., Planning Team meetings, changes to the Individual Service Plans/behavior plans, and whether the consumer will need to be served by another vendor.
- For 5150s (involuntary psychiatric confinement), be prepared with information regarding the consumer’s part history of behaviors and psychiatric admissions, what behaviors led to the 5150, when the consumer is expected to be discharged from the hospital, and whether the consumer will need to be served by another vendor.
- If the consumer is a victim of a crime, abuse, or rights violation, include a description of the alleged perpetrator. This includes a general physical description, name, and relationship to consumer. If the alleged perpetrator is a staff person, the incident report should include information on the status of the vendor’s investigation. A final report of the investigation outcome should be submitted to RCOC upon completion of the investigation.
- If the police were involved in the incident, include the name(s), badge number(s), police department, and phone number(s) of the responding police officers.
- Include what action will be taken to prevent similar incidents from occurring in the future.
- Include what other individuals/agencies were notified of the incident (parents, conservator, guardian, licensing agency, protective services agency, etc.). For agency contacts, include the name of the contact person and their phone number.
- If the incident is expected to generate media interest, note this in the report.
- When reporting deaths, it is especially important to report the following information:
- What were the events leading up to the death?
- When was the consumer last in stable health?
- What did the consumer do the day before he or she died?
- Was the consumer’s activity and appetite normal? If tube fed, were feedings being tolerated normally?
- When was the last time the consumer was seen by a physician?
- When was the last time the consumer was seen by a nurse?
- When was the consumer last seen by a staff member before his or her death?
- Was any type of intervention or resuscitation attempted? If so, what was done?
- What is the presumed cause of death?