Practical guide · Incident follow-up
Group home incident reports: what to record and when.
Published 2026-10-28 · Updated 2026-10-28
An incident report is the written record of an event that harmed, or could have harmed, a person you support. It protects the person, the staff member and the agency, and it is often the first record an investigator or reviewer reads. Each state sets its own categories, forms and deadlines, and federal Medicaid rules now set a minimum definition of critical incidents. The example uses invented people.
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Key points
The short version.
- Make the person safe first, then report and write.
- Know your state's categories, deadlines and notifications.
- Federal minimum critical incident categories apply from July 9, 2027.
- Write facts, the person's words and every notification time.
- Track corrective actions to completion and review trends monthly.
- Keep the incident report separate from notes and the MAR.
01 · Incident follow-up
What counts as an incident.
Most states split events into critical or serious incidents, which must be reported to the state or another agency, and other incidents your agency records and reviews internally. Your state's list decides which is which.
Common categories include injuries and falls, medication errors, abuse, neglect or exploitation allegations, behavioral events, use of restraint or other restrictive interventions, missing persons, emergency room visits and hospitalizations, police involvement, property damage and death.
02 · Incident follow-up
The federal definition of a critical incident.
The 2024 Medicaid Access Rule (42 CFR 441.302(a)(6)) requires states running HCBS waivers to define critical incidents to include, at a minimum, the events below, and to require providers to report critical incidents that occur during services, or result from a failure to deliver services in the person's plan, within state timeframes.
States must comply beginning July 9, 2027, and must have an electronic incident system meeting the rule beginning July 9, 2029. States are also expected to start investigations, complete them and see corrective actions finished for at least 90% of critical incidents within their own deadlines, so expect your state to ask providers for complete, timely reports.
- Verbal, physical, sexual, psychological or emotional abuse.
- Neglect.
- Exploitation, including financial exploitation.
- Misuse or unauthorized use of restrictive interventions or seclusion.
- A medication error resulting in a call to poison control, an emergency department or urgent care visit, a hospitalization or death.
- An unexplained or unanticipated death, including a death caused by abuse or neglect.
03 · Incident follow-up
Do these first, then write.
The report comes after the person is safe. Follow your agency's emergency procedure and the reporting law in your state.
- Make the person and others safe, and get medical care; call 911 if needed.
- Tell your supervisor or the on-call manager right away.
- If abuse, neglect or exploitation is suspected, report it to the agency your state law requires; do not wait for a supervisor to decide.
- Preserve evidence and do not question the person or others beyond what you need for safety.
- Write the report before your shift ends, while details are fresh.
04 · Incident follow-up
What to write in the report.
Write what you saw, heard and did, in the order it happened. Someone who was not there should be able to picture the event and the response.
- The person's name, and the date, time and exact location.
- What happened, in observable terms, including the person's own words.
- What happened just before, if you know it.
- Injuries you observed, without diagnosing them.
- What you and others did, and when.
- Who you notified, how and at what time.
- Witnesses, by name or role as your policy allows.
- Your name, signature, and the date and time you wrote the report.
05 · Incident follow-up
An example incident report.
"On 03/14 at about 6:40 a.m., I heard a thud from the bathroom next to K.'s room. I knocked and K. said, 'I fell.' I found K. sitting on the floor next to the tub, holding his left wrist. The bath mat was folded under his left foot. He said, 'My wrist hurts.' I saw no bleeding; his left wrist looked swollen compared with his right. I helped him stay seated and called the on-call nurse at 6:45 a.m., who told me to apply ice and arrange transport to urgent care. I called the house supervisor at 6:50 a.m. Staff member B. stayed with the other residents. K. left for urgent care with me at 7:10 a.m. The supervisor said she would notify K.'s guardian and case manager. Written by [name], DSP, 03/14 at 9:30 a.m."
Notice what it leaves out: no guesses about why K. fell, no blame and no diagnosis. Causes are for the follow-up review.
06 · Incident follow-up
Deadlines and notifications.
States set reporting deadlines, and serious incidents often require notification within hours rather than days. Know your state's timelines, and who must be told, such as the state, the person's guardian and case manager and law enforcement, before you need them. Put them in your incident policy and on the staff quick reference.
Record each notification, the time and the person told. A late or undocumented notification is one of the most common findings in an incident review.
07 · Incident follow-up
Follow-up, investigation and trends.
A supervisor should review every report: is it complete, was it reported on time, and what needs to change? Assign each corrective action to an owner with a due date, update the person's plan or risk measures if needed, and record when each action is done.
Look across reports every month for patterns: the same person, time of day, staff member, location or type of event. Trends are often where real prevention happens.
- Review for completeness and timeliness.
- Assign corrective actions with owners and due dates.
- Update plans and risk measures when needed.
- Review patterns monthly.
08 · Incident follow-up
Incident reports, progress notes and the MAR.
An incident report does not replace other records. Record the shift in the progress note as your policy directs, record medication errors on the MAR the way your procedure requires, and keep the incident report as its own record.
LunahUP keeps incident facts, the responsible reviewer and unfinished follow-up actions with owners and due dates in view. Your staff decide what is reportable and submit state reports the way your program requires.
Questions people ask
Short answers.
What is a critical incident in a group home?
A serious event your state requires providers to report, such as abuse, neglect, exploitation, misuse of restraint or seclusion, certain medication errors and unexplained deaths. Federal rules set this minimum list; states can add more.
Who should write the incident report?
Usually the staff member who saw or discovered the incident, before the end of their shift. Others who were involved may add their own statements, as your policy allows.
How soon must a group home incident be reported?
Your state sets the deadline. Serious incidents often must be reported within hours. Abuse, neglect and exploitation must be reported under your state's reporting law, which may require immediate reporting.
Is a medication error an incident?
Agencies usually treat any medication error as an incident. Under federal rules, an error that leads to a poison control call, emergency or urgent care visit, hospitalization or death is a critical incident.
Should the incident also go in the progress note?
Follow your agency's policy. Many agencies note briefly in the progress note that an incident occurred and keep the full details in the incident report.
Sources
Check the official source.
Requirements change and differ by state. Confirm current rules with your state agencies and payers.
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