Failure to Report Suspected Abuse to Local Law Enforcement
Penalty
Summary
The facility failed to report an incident of suspected staff-to-resident abuse to local law enforcement within the required timeframe. During a shower, a Certified Nurse Assistant (CNA) reflexively smacked a resident's upper right leg with an open hand after the resident kicked towards the CNA. Although the incident was reported to the State Agency within the required two-hour window, it was not reported to local law enforcement. The facility's policy mandates that all alleged violations involving abuse must be reported immediately, but not later than two hours after the allegation is made, to both the State Agency and local law enforcement if the events involve abuse or result in serious bodily injury. The resident involved was severely impaired in decision-making regarding daily living tasks. Following the incident, the resident was assessed and found to have no injuries or changes in condition. The CNA involved was removed from the unit and later terminated. The Director of Nursing and the Administrator did not report the incident to local law enforcement, believing it was not a crime due to the lack of injury and the reflexive nature of the CNA's action. The Attorney General's office later communicated with the facility, but the local police were not contacted as required by the facility's policy.
Plan Of Correction
Plan of Correction: Approved March 19, 2025 1) The Director of Nursing spoke with the NYS Attorney General’s Office and reviewed investigative findings and submitted requested information. Policy and Procedure on reporting to local authorities updated. 2) The Administrator spoke with the Lieutenant of the New Castle Police Department to review and confirm requirements of notification for any suspected abuse incidents. All resident occurrences were reviewed and confirmed that appropriate action was taken in all cases involving abuse. 3) To reduce risk of reoccurrence, the administrator or designee will immediately report any suspected cases of abuse to the appropriate State agency and law enforcement. Inservice training on abuse reporting requirements will be conducted for all staff at a minimum of no less than quarterly. 4) The Director of Nursing will monitor ongoing compliance by reviewing and signing off on all resident occurrences to ensure compliance with reporting requirements. Compliance rates for reporting of abuse and notification to local law enforcement will be monitored and will be reported in writing, by the Director of Nursing at least quarterly, to the Administrator and Quality Committee, their findings and corrective actions for a period of not less than 18 months, with ensuing frequency as determined by the Quality Committee. 5) Initiated 1/21/2025 by the Director of Nursing.