Service Providers
Special Incident Reporting
A Special Incident Report, or SIR, is a formal report that is filed with the regional center. Service providers/ vendors have the responsibility to report incidents to the regional center that impact a client’s health and/or safety while the client is receiving services or supports, or if the client is a victim of a crime, or dies, regardless of when or where the incident occurred.
The regional center must be notified verbally of an incident within 24 hours of occurrence and written report received within 48 hours of incident. ALL Special Incident Reports (SIRs) must be emailed or faxed to:
SIR EMAIL: SIR@westsiderc.org
SIR FAX NUMBER: (877) 254-6903
Forms
Below are forms service providers/vendors can use to meet reporting requirements. Service providers/ vendors must fill in the document, sign and submit the completed report via email (preferred) or via fax. An electronic signature is accepted for the SIR report via portable document format (PDF).
- Vendor Reporting Instructions SIR 1.17.20
- Report to Westside Regional Center: SIR and Other Observations and Events
- Post-Emergency Restraint Report (PERR)
- Report of Suspected Dependent Adult/ Elder Abuse – SOC 341
- Medication Error Report Diagnostic Tool
- WRC COVID-19 Form For Vendor/Providers Employee/Staff
- WRC COVID-19 Form For Consumer
COVID-19 Reporting
WRC is requesting that vendors or Long-term Care providers complete a form for known or suspected cases of Coronavirus Disease 2019 (COVID-19) among clients and/ or the staff who support them in Residential, Long-Term Care Supported Living or Independent Living. This does not replace the SIR form; it is a supplement form to track the COVID-19.
What You Need To Know About COVID-19:
Coronavirus Disease 2019, also referred to as COVID-19, is a type of virus that has caused a recent outbreak of respiratory illness. The virus is thought to spread mainly from person-to-person:
- Between people who are in close contact with one another (within about 6 feet).
- Through respiratory droplets produced when an infected person coughs or sneezes.
- May also spread through airborne transmission, when tiny droplets remain in the air even after the person with the virus leaves the area.
Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease 2019 (COVID-19) cases. These symptoms may appear 2-14 days after exposure:
- Fever (above 100.4 F)
- Cough
- Shortness of breath
Based upon available information to date, those at high-risk for severe illness from COVID-19 include:
- People aged 65 years and older
- People who live in a nursing home or long-term care facility
- Other high-risk conditions could include:
- People with chronic lung disease or moderate to severe asthma
- People who have heart disease with complications
- People who are immunocompromised including cancer treatment
- People of any age with severe obesity (body mass index [(BM]I)≥40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk
- People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk
Several categories of clients only need to report on COVID-19 form to WRC:
- If symptomatic (fever, cough, shortness of breath) and have been tested for COVID-19.
- Observed symptoms described and were seen in ER and admitted for symptom of COVID-19 and testing done. Either treated inpatient or treated and sent home to self isolate.
- Seen in ER with symptoms and no testing done sent home.
No report is needed if:
- May have come in contact with someone with COVID 19, No symptoms, No testing
- No symptoms and Self-isolating. If symptoms develop then report.
Reporting Requirements & Related Laws
- Mandated Reporter Flowchart for Long-Term Facilities
- Abuse TIP Sheet 3-16-2020 SIR – Changes to Mandated Reporting Law (2013) Outside Agency Reporting Contact information Revised 3-16-2020
- Guidance for Reporting Incidents Related to COVID-19
- Checklist: Medication Administration
- New Expanded Reporting Requirements for Special Incidents – 2017 Letter to Service Providers/ Vendors
- Notice to All APS Mandated Reporters
- Regional Center Responsibilities for Reporting -Welfare and Institutions Code Section 4659.2
- Use of Seclusion and Behavioral Restraints in Facilities – Health and Safety Code 1180 – 1180.6
- Serious Bodily Injury – Welfare and Institutions Code Section 15630.67
- Vendor SIR Reporting Title 17 Regulations
- DDS Risk Management & Mitigation webpage
Risk Management Tools
Regional Center staff, Service Providers and families may find the documents listed below useful in both preventing and reporting Special Incident Reports (SIRs).
- Checklist: Aspiration/ Aspiration Pneumonia
- Checklist: Impaction & Severe Constipation
- Checklist: Insulin Dependent Diabetes
- Checklist: Epilepsy
- Checklist: Gastronomy Tube (G-Tube) Feeding
- Checklist: Osteoporosis
- Checklist: Staphylococcus “Staph” Infection
- Checklist: Weight Management
- Clinical Professionals – Medical Risks Factors and Prevention of Falls and Fractures
- Incident Response Card
- Incident Response Checklist
- Preventative Action Checklist
- Preventing Falls
- Preventing Falls and Fractures – Information for Supporters and Providers
- Risk Assessment Evaluation & Planning
- Risk Assessment Evaluation & Planning Worksheet
- Risk Assessment Inventory: Falls
- Risk Assessment Inventory: Major Depression
- Risk Assessment Inventory: Osteoporosis
- Risk Assessment Inventory: Physical & Nutritional Management
- Risk Assessment Inventory: Skin Breakdown
- Risk Assessment Inventory: Substance Abuse
- Risk Management Training Manual
- Specific Clinical Risk Factors: Aspiration Pneumonia
- Specific Clinical Risk Factors: GI Problems in People with Developmental Disabilities
Mandated Reporting Links
Adult Protective Services (APS) – State mandated Title XX service program which mandates the prompt investigation of all situations involving elders (age 65 or older) and dependent adults (physically or mentally impaired 18-64 year old) who are reported to be endangered by physical, sexual or financial abuse, abandonment, isolation, abduction, neglect or self-neglect or hazardous living conditions. Online reporting is accessible here.
Department of Child and Family Services (DCFS) – Mandated reporters may now complete Child Abuse Reporting online.. It is necessary to make a phone report first and receive a reference number that will allow you to log in to the Mandated Reporters site to complete the written report.
Long Term Care Ombudsman – An Ombudsman is an individual who is trained and State-certified to objectively investigate and resolve complaints made by individuals against abuses. The Long Term Care OMBUDSMAN Program is a free and confidential service that maintains and improves the quality of life for resident in long-term care facilities.
Semi-Annual Risk Management SIRs
Mortality and Non-Mortality Special Incident Reports Combined
This semi-annual report summarizes mortality and non-mortality special incident rates for individuals with developmental disabilities served by regional centers.
Mortality Special Incident Reports
This semi-annual report summarizes mortality special incident rates for individuals with developmental disabilities served by regional centers.
Non-Mortality Special Incident Reports
This semi-annual report summarizes non-mortality special incident rates for individuals with developmental disabilities served by regional centers.
Resource Links
California Poison Control System (CPCS) is the statewide provider of immediate, free and expert treatment advice and assistance over the telephone in case of exposure to poisonous, hazardous or toxic substances. Call us toll-free – 1-800-222-1222, 24 hours a day, 7 days a week, 365 days a year.
Department of Developmental Services for COVID-19 Information and Resources page provides links to general information about COVID-19, approved changes to increase flexibility for providers, resources and more.
Department of Developmental Services (DDS) SafetyNet is a website with health and safety information for individuals with developmental disabilities and for the people who support them. On this site you will find: articles, slideshows, and videos; tools to use in your everyday life; links to online resources; and more!
Official California Legislative Information – This site is maintained by the Legislative Counsel of California and contains up-to-date information on law, legislative sessions, and bill information.
Preventative Health Campaign – Flu and pneumonia are common causes of serious illness and even death, and these diseases are largely preventable. The best way to prevent flu and pneumonia is to get vaccinated. The California Department of Developmental Services is launching a campaign to get everyone with a developmental disability vaccinated for flu, and everyone vaccinated for pneumonia if they are 65 years old or older, as well as those from 19 to 64 years old who have a chronic health condition. DDS has created materials for this campaign. These materials include informational brochures on the flu vaccine and the pneumonia vaccine, and a poster, in English, Chinese, Spanish, Tagalog, and Vietnamese. Campaign materials, related videos, and articles are also available on the DDS SafetyNet Website.