Failure to Timely Report and Investigate Alleged Abuse
Penalty
Summary
The facility failed to immediately investigate and report an allegation of staff-to-resident abuse within 24 hours, and did not submit the investigation to the State Agency (SA) within the required 5 working days. A review of the facility's policy indicated that all abuse allegations must be reported to the SA within 24 hours and a written investigation report submitted within five working days. However, documentation showed that when a resident reported to an LPN that staff had hit them the previous night, the LPN did not report the allegation to the Nursing Home Administrator (NHA) or the SA, nor did they initiate an investigation. The LPN determined the allegation was not credible, believing it to be a dream or misconception, but could not explain how this determination was made. The NHA confirmed that they were unaware of the resident's allegation because it had not been reported by the LPN, and acknowledged that the incident should have been reported and investigated immediately. Additionally, the investigation report was not submitted to the SA until seven working days after the incident, exceeding the required timeframe. The facility census at the time was 39 residents, and the deficiency was identified for one resident who made the abuse allegation.