Failure to Timely Report and Respond to Alleged Abuse
Penalty
Summary
The facility failed to follow its Abuse and Neglect Prevention Management policy for one resident when a family member reported that a certified nursing assistant (CNA) roughly handled the resident. The incident was reported by the family member to a registered nurse (RN), who did not notify the Administrator, Director of Nursing (DON), or the California Department of Public Health (CDPH) within the required timeframe. The RN also failed to immediately suspend the CNA involved, allowing the CNA to continue working the remainder of the shift. The DON and Administrator were not informed of the allegation until days later, and the required reporting to CDPH was not completed as outlined in the facility's policy. The resident involved had significant medical conditions, including chronic respiratory failure with hypoxia, hemiplegia, hemiparesis, muscle wasting, difficulty walking, and a history of falls. The resident was cognitively moderately impaired and fully dependent on staff for toileting, transfers, and hygiene. The facility's policy required immediate suspension of the accused staff member and prompt reporting of abuse allegations, but these steps were not followed, resulting in a delay in investigation and potential risk to other residents.