SIR Vendor LTC reporting form revised 8.13.19_FINALMedication Error Diagnostic Tool with SIRA 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
Vendor may fill in the document, print, sign and email or fax to WRC SIR Email or Fax .
*UPDATE: As of January 1, 2017 vendor responsibilities when reporting Special Incidents involving the use of restraints have CHANGED. WRC revised our Special Incident Reporting Form to include reference to these changes in a fillable PDF document. We have also made the Post Emergency Restraint Response form a PDF fillable document. Please discard all other versions of WRC SIR Form and use this revised document.
Below are forms service providers can use to meet the mandate.
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.
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 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.
Restrains and Seclusion – This is the Senate Bill regarding use of restraints and seclusion in final version in H&S Code section 1180.3. (a)This section shall apply to psychiatric units of general acute care hospitals, acute psychiatric hospitals, psychiatric health facilities, crisis stabilization units, community treatment facilities, group homes, skilled nursing facilities, intermediate care facilities, community care facilities, and mental health rehabilitation centers. It is considered a “Best Practice” for all consumers.
An Age for Justice: Confronting Elder Abuse in America
Elder Abuse: Learn the Signs and Break the Silence
Signs of Elder Abuse by National Adult Protective Services Association
Social Security Administration with APS Financial Abuse
Recognizing & Responding to Elder Abuse in Residential Care Setting 1 Care Facility
Your Legal Duty Part 1 of 2
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