California Department Of Public Health Statement Acknowledging Requirement Page 2
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2Financial abuse occurs when a person or entity does any of the following: (1) takes, secretes, appropriates, or retains real or
personal property of an elder or dependent adult to a wrongful use or with intent to defraud, or both; or (2) assists in any of
these acts. [W&I § 15610.30(a)]
Abandonment means the desertion or willful forsaking of an elder or dependent adult by anyone having care or custody of that
person under circumstances in which a reasonable person would continue to provide care and custody. [W&I § 15610.65]
Isolation means any of the following: (1) acts intentionally committed for the purpose of preventing, and that do serve to
prevent, an elder or dependent adult from receiving his or her mail or telephone calls; (2) telling a caller or prospective visitor
that an elder or dependent adult is not present or does not wish to talk with the caller, or does not wish to meet with the visitor
where the statement is false, is contrary to the express wishes of the elder or dependent adult, whether he or she is competent
or not, and is made for the purpose of preventing the elder or dependent adult from having contact with family, friends, or
concerned persons (3) false imprisonment (the unlawful violation of the personal liberty of another); or (4) physical restraint for
the purpose of preventing the elder or dependent adult from meeting with visitors. [W&I § 15610.43(a)] These acts shall not
constitute isolation if they are performed in response to a reasonably perceived threat of danger to property or physical safety.
[W&I § 15610.43(c)]
Abduction means the removal from California and the restraint from returning, or the restraint from returning, of any elder or
dependent adult who does not have the capacity to consent to the removal or restraint. [W&I § 15610.06]
WHERE TO CALL IN AND SEND THE WRITTEN ABUSE REPORT
If the abuse is alleged to have occurred in a long-term care facility, including a licensed or unlicensed residential facility serving
adults or elders or an adult day program, you must report to either local law enforcement or the local long-term care
ombudsman. [W&I § 15630(b)(1)(A)] If the abuse is alleged to have occurred anywhere other than a long-term care facility, you
must report to either local law enforcement or county adult protective services. [W&I § 15630(b)(1)(C)]
AS AN EMPLOYEE OR VOLUNTEER OF THIS FACILITY, YOU MUST COMPLY WITH THE DEPENDENT ADULT AND ELDER
ABUSE REQUIREMENTS, AS STATED ABOVE. IF YOU DO NOT COMPLY, YOU MAY BE SUBJECT TO CRIMINAL PENALTY.
I, ________________________________, have read and understand my responsibility to report known or suspected abuse of
dependent adults or elders. I will comply with the reporting requirements.
SIGNATURE
DATE
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