Root Cause Analysis (RCA) Form
Built into CareHub for DD-waiver providers, pre-formatted, signed, and audit-ready out of the box.
What is the RCA?
A Root Cause Analysis (RCA) form documents the systematic investigation of a serious incident, what happened, why it happened, what contributed to it, and what corrective and preventive actions will be taken. Most state DD-waiver programs require RCAs for serious or recurring incidents (Level II/III in NC, MUI categories in OH, CHRIS-reportable events in VA). The RCA is the artifact that demonstrates to a state surveyor that a provider doesn't just react to incidents, they actually learn from them and reduce the chance of recurrence. A well-completed RCA traces the incident from immediate trigger through contributing factors through systemic root cause, then specifies a corrective action plan with timelines, owners, and follow-up review dates. CareHub's RCA workflow is built for that chain.
When it's required
Triggered when an incident reaches a severity threshold defined by state regulation, typically Level II/III, MUI categories, or CHRIS-reportable events. Most state programs require RCA completion within a specified timeframe after the incident.
Who completes it
Typically a program manager, QIDP, or designated incident-investigation lead. The RCA is reviewed by the agency administrator and becomes part of the individual's permanent record.
Agency applicability
- DBHDS (Virginia)
- DODD (Ohio)
- DDA (Maryland)
- BHHF (West Virginia)
- DHHS (North Carolina)
- ODP (Pennsylvania)
- DBHDD (Georgia)
- HHSC (Texas)
- DDS (California)
Required fields
What goes on the RCA.
Incident summary
What happened, date, time, individuals involved, location, immediate actions taken.
Direct cause
The immediate trigger of the incident.
Contributing factors
Environmental, staffing, training, or systemic factors that contributed.
Root cause(s)
The underlying organizational or systemic cause that, if addressed, would prevent recurrence.
Corrective actions
Specific actions to be taken with owners, deadlines, and verification steps.
Preventive actions
Systemic changes to reduce the likelihood of similar incidents in the future.
Follow-up review
Date for verifying corrective actions were implemented and effective.
Signatures
Investigator, program manager, and (in some states) administrator signatures.
How CareHub handles the RCA
Built into the workflow, not bolted on.
RCA template aligned to your state's regulatory framework (DBHDS CHRIS, DODD MUI, NC Level II/III, etc.)
Linked directly to the source incident report, no re-entering details
Corrective-action tracking with deadline alerts and owner assignment
Supervisor-signature workflow with magic-link e-signing
Audit-prep export combines incident + RCA + corrective actions in one PDF
Trend reporting across RCAs to surface systemic patterns over time
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Frequently Asked Questions
Common questions about the RCA.
Does CareHub provide RCA templates for every state?
Yes. CareHub's RCA form is built to satisfy the state-specific requirements of every state we serve, DBHDS (Virginia), DODD (Ohio), DDA (Maryland), BHHF (West Virginia), DHHS (North Carolina), ODP (Pennsylvania), DBHDD (Georgia), HHSC (Texas), and DDS (California).
Can the RCA be linked to the original incident report?
Yes. CareHub auto-links the RCA to the source incident, prefilling individual, date, location, and incident-type fields so the investigator focuses on the analysis rather than re-entering details.
How does CareHub track corrective actions from the RCA?
Each corrective action gets an owner, a deadline, and a follow-up review date. Owners receive alerts as deadlines approach; supervisors see open corrective actions on the compliance dashboard.
Can administrators sign the RCA electronically?
Yes. CareHub supports multi-signature workflows with magic-link e-signing. Administrators sign from any device without needing to log in.
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