BREACH ANALYSIS WORKSHEET (LTC)
A structured tool to help attorneys identify deviations from standards of care, link failures to harm, and organize breach arguments with clarity and precision.
This worksheet guides you through the critical steps of evaluating breach in long‑term care cases. It helps you compare what should have occurred to what actually occurred, identify deviations, and determine whether those deviations contributed to harm.
Use this worksheet during case screening, expert review preparation, and deposition planning to build a clear, evidence‑based breach narrative.
CASE OVERVIEW
Resident Information
• Name
• Age
• Primary diagnoses
• Baseline functional status
• Admission source (hospital, home, ALF, etc.)
Key Dates
• Admission date
• Date of incident
• Date of decline
• Date of hospitalization or death
EXPECTED STANDARD OF CARE
Identify the Applicable Standards:
• Federal regulations (CMS F‑Tags)
• State LTC regulations
• Facility policies
• Nursing standards of practice
• Interdisciplinary expectations
Document What Should Have Happened:
• Expected assessments
• Required monitoring
• Necessary interventions
• Communication requirements
• Documentation expectations
ACTUAL CARE PROVIDED
Document What Actually Happened:
• Assessment findings
• Monitoring frequency
• Interventions performed
• Physician notifications
• Family notifications
• Documentation entries
Identify Gaps or Inconsistencies:
• Missing notes
• Contradictory entries
• Delayed documentation
• Copy‑paste patterns
• Unexplained changes
IDENTIFIED DEVIATIONS (BREACH POINTS)
List Each Deviation Clearly:
• Missed assessments
• Missed or delayed interventions
• Failure to monitor
• Failure to notify physician
• Failure to notify family
• Failure to update care plan
• Inaccurate or incomplete documentation
For Each Deviation, Answer:
• What should have occurred?
• What actually occurred?
• Why is this a breach?
• What evidence supports this?
CAUSATION LINK
Did the deviation contribute to harm?
• Yes / No / Unclear
Describe the Connection:
• How the breach increased risk
• How the breach led to decline
• How earlier intervention could have changed the outcome
Supporting Evidence:
• Medical records
• Expert opinions
• Timeline reconstruction
• Facility policies
• Regulatory standards
TIMELINE RECONSTRUCTION
Build a Clear Sequence of Events:
• Date/time of incident
• Staff observations
• Interventions performed
• Notifications made
• Resident response
• Follow‑up actions
This section pairs well with your LTC Timeline Reconstruction Tool.
