Failure to Immediately Report Alleged Abuse to Authorities
Penalty
Summary
The facility failed to implement its policy requiring the immediate reporting of abuse allegations when a resident accused a Certified Nursing Assistant (CNA) of sexual abuse. On 4/13/25, the resident informed staff of the alleged abuse, and both CNAs present reported the incident to a Licensed Nurse (LN). The LN removed the resident from the CNA's assignment but did not report the allegation to the Director of Nursing (DON) or the Administrator as required by facility policy. The incident was not reported to the California Department of Public Health until 4/15/25, which was outside the mandated reporting timeframe. Interviews confirmed that the CNAs followed internal reporting procedures by notifying the LN immediately after the resident's accusation. However, the LN failed to escalate the report to higher management or the appropriate authorities in a timely manner. The facility's policy, revised in August 2022, mandates that all employees report known or suspected abuse immediately, and that a report must be sent to the licensing agency within two hours of forming the suspicion. This lapse resulted in a delay in notifying the authorities and potentially delayed the investigation and protective actions for the resident.