Failure to Investigate and Suspend Staff After Abuse Allegation
Penalty
Summary
The facility failed to implement its policy and procedure regarding the investigation of an abuse allegation for one resident. A resident reported that a Physical Therapy Assistant (PTA) had roughly squeezed her while assisting her into a wheelchair, resulting in a skin tear on her right arm. The resident, who was cognitively intact according to her most recent assessment, informed the Director of Rehabilitation (DOR) and requested a different PTA. The Occupational Therapist (OT) and Physical Therapist (PT) were also made aware of the allegation, and the OT reported it to the DOR. The DOR was believed to have reported the incident to the Director of Nursing (DON). Despite the facility's policy requiring all abuse allegations to be thoroughly investigated and for the accused employee to be suspended pending investigation, the DON did not conduct an investigation or report the allegation because she did not observe a bruise on the resident. The PTA was not suspended and continued to have resident contact. The resident's medical record did not contain documentation of the abuse allegation. The facility's policy, revised in September 2022, specifies that any employee accused of abuse is to be placed on leave with no resident contact until the investigation is complete, and that a follow-up investigation report is to be provided within five business days.