California Department Of Public Health Statement Acknowledging Requirement
Download a blank fillable California Department Of Public Health Statement Acknowledging Requirement in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete California Department Of Public Health Statement Acknowledging Requirement with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
STATEMENT ACKNOWLEDGING REQUIREMENT TO REPORT
SUSPECTED ABUSE OF DEPENDENT ADULTS AND ELDERS
NOTE: RETAIN IN EMPLOYEE/ VOLUNTEER FILE
NAME
POSITION
FACILITY
California law REQUIRES certain persons to report known or suspected abuse of dependent adults or elders. As an employee
or volunteer at a licensed facility, you are one of those persons - a “mandated reporter.”
PERSONS WHO ARE REQUIRED TO REPORT ABUSE
Mandated reporters include care custodians and any person who has assumed full or intermittent responsibility for care or
custody of an elder or dependent adult, whether or not paid for that responsibility. [Welfare & Institutions Code (“W&I”) section
15630(a)] Care custodians include administrators or employees of any CDSS licensed facility, including support and
maintenance staff, or persons providing care or services for elders or dependent adults. [W&I §§ 15610.17(e)&(j)]
PERSONS WHO ARE THE SUBJECT OF THE REPORT
Elder means any California resident, 65 years or older. [W&I § 15610.27]
Dependent adult means any California resident, aged 18 through 64, who has physical or mental limitations that restrict
his/her ability to carry out normal activities or to protect his/her rights including, but not limited, to persons who have physical or
developmental disabilities or whose physical or mental abilities have diminished because of age. [W&I § 15610.23]
WHEN REPORTING ABUSE IS REQUIRED
Any mandated reporter, who in his or her professional capacity, or within the scope of his or her employment, has observed or
has knowledge of an incident that reasonably appears to be abuse or neglect, or is told by an elder or dependent adult that he
or she has experienced behavior constituting abuse or neglect, or reasonably suspects that abuse, shall report the known or
suspected instance of abuse. This must be done BY TELEPHONE IMMEDIATELY or as soon as practically possible, and BY
WRITTEN REPORT WITHIN TWO (2) WORKING DAYS. [W&I § 15630(b)]
PENALTY FOR FAILURE TO REPORT ABUSE
Failure to report abuse of an elder or dependent adult is a MISDEMEANOR CRIME, punishable by jail time, fine or both.
[W&I § 15630(h)]
CONFIDENTIALITY OF REPORTER AND OF ABUSE REPORTS
The duties of mandated reporters are individual and no supervisor or administrator shall impede or inhibit the reporting duties,
and no person making the report shall be subject to any sanction for making the report. However, internal procedures to
facilitate reporting, ensure confidentiality, and apprise supervisors and administrators of reports may be established, provided
they are not inconsistent with the reporting law. [W&I § 15630(f)]
The reporting person, the report, and the information on the report, shall be kept confidential and may be disclosed ONLY as
provided by law. Any violation of confidentiality is a MISDEMEANOR CRIME. [W&I § 15633(a)]
ABUSE THAT MUST BE REPORTED
Abuse of an elder or dependent adult that must be reported includes: 1) physical abuse; 2) neglect; 3) financial abuse;
4) abandonment; 5) isolation; and 6) abduction. [W&I § 15630(b)]
DEFINITIONS OF ABUSE
Physical abuse means any of the following: (1) assault (an unlawful attempt, coupled with a present ability, to commit a
violent injury on another person); or assault with a deadly weapon; (2) battery (willful and unlawful use of force or violence
upon another person); (3) unreasonable physical constraint, or prolonged or continual deprivation of food or water; (4)
sexual assault (as defined in the Penal Code); or (5) use of a physical or chemical restraint or psychotropic medication
for (a) punishment, or (b) a period beyond that for which the medication was ordered, or (c) any purpose not authorized by the
physician and surgeon. [W&I § 15610.63]
Neglect means the negligent failure of any person having the care or custody of an elder or dependent adult to exercise that
degree of care that a reasonable person in a like position would exercise. [W&I § 15610.57(a)] Neglect Includes, but is not
limited to, the following: (a) failure to assist in personal hygiene, or in the provision of food, clothing, or shelter; (b) failure to
provide medical care for physical and mental health needs (unless the sole reason is voluntarily relying on treatment by
spiritual means through prayer alone in lieu of medical treatment); (c) failure to protect from health and safety hazards; or (d)
failure to prevent malnutrition or dehydration. [W&I § 15610.57(b)]
SOC 341A (3/03)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Security Information For Participants - California Department Of Public Health - Public Health Microbiologist I Open Examination Continuous Testing
Legal
Application For Certified Copy Of Birth Certificate - California Department Of Public Health
Business
Affidavit Of Homeless Status Fee Waiver Application Form - California Department Of Public Health
Legal
Related Categories
Parent category: Legal