Failure to Investigate and Timely Report Alleged Verbal Abuse
Penalty
Summary
The facility failed to ensure that an allegation of verbal abuse involving a resident was thoroughly investigated. The incident involved a resident with multiple diagnoses, including diabetes and morbid obesity, who was cognitively intact at the time. According to the grievance log, the resident reported being publicly shamed by the dietitian in the presence of others, with comments made about her dietary choices and weight loss. The documentation of the grievance did not include information on protective measures for the resident, interviews with staff or the resident, or the facility's investigative conclusions at the time of the incident. Additionally, the incident was not reported to the State Survey Agency's Long-Term Care Reporting Portal until approximately six months after it occurred. The delay in reporting and lack of thorough documentation and investigation at the time of the grievance constituted a failure to respond appropriately to an alleged violation of abuse. The deficiency was identified through record review, grievance log review, and staff interviews.