When the client is: And the suspected abuser is: And the abuse occurs: And the abuse type is: The agency to respond will be: In a LTC facility Resident or Staff (includes contracted staff) Within the facility or Outside the facility Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman In a LTC facility Non-staff (including family/friends, legal and financial professionals, visitors) Within the facility Physical Sexual Neglect Self Neglect Other________ Ombudsman APS Both Lead will be: Ombudsman APS In a LTC facility Non-staff (including family/friends, legal and financial professionals, visitors) Within the facility Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS In a LTC facility Non-staff (including family/friends, legal and financial professionals, visitors) N/A Financial Non-payment of facility bill Ombudsman APS Both Lead will be: Ombudsman APS In a LTC facility Non-staff (including family/friends, legal and financial professionals, visitors) Outside the facility Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS In a Continuing Care Retirement Community (CCRC), resident living in the independent side of the facility Staff (includes contracted staff) Within the CCRC Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS In a CCRC, resident living in the Resident Within the CCRC Physical Sexual Neglect Ombudsman APS Both
independent side of the facility Self Neglect Financial Other________ Lead will be: Ombudsman APS When the client is: And the suspected abuser is: And the abuse occurs: And the abuse type is: The agency to respond will be: In a CCRC, resident living in the independent side of the facility Non-staff (including family/friends, legal and financial professionals, visitors) Within the CCRC Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS In a CCRC, resident living in the independent side of the facility Staff (includes contracted staff) Outside the CCRC Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS In a CCRC, resident living in the independent side of the facility Resident Outside the CCRC Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS In a CCRC, resident living in the independent side of the facility Non-staff (including family/friends, legal and financial professionals, visitors) Outside the CCRC Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS Living in a Community Care Facility (facility should be licensed) Staff (includes contracted staff) or Resident Within the facility or Outside the facility Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS Living in a Community Care Facility (facility should be licensed) Non-staff (including family/friends, legal and financial professionals, visitors) Outside the facility Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS A licensed Adult Day program Resident or Staff (includes contracted staff) Within the facility Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS
When the client is: And the suspected abuser is: And the abuse occurs: And the abuse type is: The agency to respond will be: A licensed Adult Day program (including family/friends, legal and financial professionals, visitors) Within the facility Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS A licensed Adult Day program Resident or Staff (includes contracted staff) Outside the facility (for example, on a field trip) Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS A licensed Adult Day program Non-staff (including family/friends, legal and financial professionals, visitors) Outside the facility (for example, on a trip) Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS In an Acute Care Hospital or Psych Hospital Staff, other patients or non staff (including family/friends, legal and financial professionals, visitors) Within the hospital or within the community (e. g. individual was neglected at home resulting in hospitalization. Must have been an elder or dependent adult at the time of the abuse) Physical Sexual Neglect Self Neglect Financial Other________ APS In an Acute Care Hospital or Psych Hospital An employee of a licensed facility In a long term care facility Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS Facilities exempt from licensure (e.g. Independent Living Facilities, Sober Living Houses that are not providing care and supervision, etc) Staff (includes contracted staff) or Resident Within the facility or Outside the facility Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS When the client is: And the suspected abuser is: And the occurs: And the abuse type is: The agency to respond will be:
Facilities exempt from licensure (e.g. Independent Living Facilities, Sober Living Houses that are not providing care and supervision, etc) Non-staff (including family/friends, legal and financial professionals, visitors) Within the facility Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS Facilities exempt from licensure (e.g. Independent Living Facilities, Sober Living Houses that are not providing care and supervision, etc) Non-staff (including family/friends, legal and financial professionals, visitors) Outside the facility Physical Sexual Neglect Self Neglect Financial Other________ Ombudsman APS Both Lead will be: Ombudsman APS Prisons and jails Neither program has jurisdiction (for prisons, refer to California Dept of Corrections and Rehabilitation; for jail, refer back to local law enforcement) State Hospitals and Developmental Centers Neither program has jurisdiction (report may be made to the designated investigator at the Department of State Hospitals or Developmental Center or local law enforcement) This page intentionally left blank.