Failure to Timely Report Alleged Staff Roughness to Authorities
Penalty
Summary
The facility failed to report an alleged incident of staff-to-resident roughness to the Department of Inspection and Appeals and Licensing (DIAL) within the required 2-hour timeframe. The incident involved a resident with moderate memory impairment and multiple medical conditions, including heart failure, hypertension, diabetes, and anxiety. The resident required substantial assistance with activities of daily living, such as toileting and transfers. During an evening shift, a CNA was reported to have grabbed the resident's upper arms and pushed them into bed. The resident did not initially report the incident and could not recall the exact date, but later described the staff member as being rough, possibly due to anger directed at another staff member. The facility's internal investigation was prompted by concerns raised during a resident council meeting about staff roughness and inappropriate conversations. Interviews with the resident and another witness revealed that the CNA's behavior was perceived as rough and unprofessional, with additional complaints about the staff member's attitude and failure to provide adequate care, such as not changing the resident's clothes or properly assisting with toileting. The Director of Nursing conducted a reenactment and determined that, while the transfer was technically correct, it may have been performed in a manner considered rough or too quick by the resident. Despite these findings and the facility's policy requiring immediate reporting of all abuse allegations to DIAL within 2 hours, the facility did not notify the authorities within the mandated timeframe. The administrator confirmed this failure to report the incident promptly, which constituted a violation of both facility policy and regulatory requirements.