Failure to Timely Report Allegation of Verbal Abuse to Authorities
Penalty
Summary
The facility failed to report an allegation of visitor-to-resident verbal abuse within the required two-hour timeframe to the State Survey Agency, the ombudsman, and local law enforcement, as outlined in its own policies. A resident, who was cognitively intact and able to make decisions, reported that a visitor used inappropriate language towards her due to a complaint about a loud television. The incident was reported by the resident to a Social Service Assistant (SSA) the following morning, who then notified the Administrator (ADM) and attempted to address the issue with the visitor. Multiple staff interviews confirmed that the allegation of verbal abuse was recognized and discussed among staff, including the SSA, a Licensed Vocational Nurse (LVN), and a Registered Nurse (RN). Each staff member acknowledged that the use of inappropriate language constituted verbal abuse and that such allegations should be reported immediately to the appropriate authorities. However, there was a breakdown in communication between the SSA and the ADM, resulting in the ADM not being fully informed of the abuse allegation and, therefore, not initiating the required reporting and investigation procedures. The facility's policies clearly state that all allegations of abuse must be reported to the administrator and relevant authorities within two hours if abuse is involved. Despite this, the miscommunication led to a delay in reporting the incident, and the required notifications and investigation were not initiated in a timely manner. This failure resulted in a delay in the investigation and had the potential to place the resident at risk for abuse.