Delayed Reporting of Alleged Abuse Incident
Penalty
Summary
The facility failed to ensure timely reporting to the State Agency of an incident involving alleged abuse between two residents. One resident, with a history of hypertension and chronic obstructive pulmonary disease, was involved in an incident with another resident who has epilepsy and schizoaffective disorder. During the incident, one resident lost balance and placed a hand on the other's neck and shoulder area, while the other resident responded by placing a hand on the first resident's abdomen to prevent a fall. The incident resulted in the first resident experiencing pain but declining further medical evaluation. Staff statements indicated that the resident continued to allege physical abuse after the event. Although the facility conducted a thorough investigation and documented the incident, the Administrator in Training was not made aware of the situation until the following day, and the initial report to the State Agency was not filed until several days after the incident. This delay exceeded the facility's policy requirement to report all alleged violations within 24 hours, regardless of whether the event involved abuse or resulted in serious bodily injury. The delay in reporting had the potential to hinder timely review by the State Agency of the facility's investigative process.