Failure to Report Drug-Related Incident Involving Residents
Penalty
Summary
The facility failed to ensure that all alleged violations involving abuse, neglect, exploitation, or mistreatment, including injuries of unknown source and misappropriation of resident property, were reported immediately or within the required timeframe to the administrator and appropriate authorities. Specifically, two residents were found in possession of illegal drugs (methamphetamine) and were attempting to smoke them inside the facility. The incident was not reported to the state agency as required by both state policy and the facility's own procedures. One resident, with a history of bipolar disorder, stimulant use, and nicotine dependency, was admitted to the facility and had previously asked other residents if they had connections to obtain methamphetamine. This behavior was reported internally to the DON, ADON, and Administrator. On the day of the incident, the resident left the facility, returned, and was found with another resident in a room with smoke and drug paraphernalia. The DON and Administrator confiscated the drugs and notified the police, but no report was made to the state agency. The second resident, with a history of liver cancer and bipolar disorder, was also involved in the incident and admitted to being offered methamphetamine by the first resident. Interviews with facility staff, including the Administrator and DON, revealed that they did not consider the incident reportable because they believed the drugs were not ingested and no harm occurred. There was no investigation conducted beyond confiscating the drugs and notifying the police. The facility's policy and state guidelines require reporting of such incidents, especially those that pose a threat to resident health and safety, but this was not followed in this case.