Failure to Timely Report Resident-to-Resident Verbal and Mental Abuse
Penalty
Summary
The facility failed to timely report allegations of verbal and/or mental abuse to the Abuse Coordinator on three separate occasions involving resident-to-resident altercations. In the first incident, one cognitively intact resident verbally abused another, including yelling, screaming profanities, and attempting to strike the other resident. The staff member who witnessed the event did not report it, stating she was unaware that verbal or mental abuse required reporting. The incident was only reported after the affected resident informed a nurse the following day. In the second incident, a cognitively intact resident yelled and used derogatory language toward a severely cognitively impaired roommate over a dispute about noise. The altercation was documented in a nurse's progress note, but the agency LPN who witnessed the event did not notify supervisory staff or the Abuse Coordinator. The affected resident reported feeling hurt by the name-calling, and the incident was not reported or investigated until much later. The third incident involved two cognitively intact residents who engaged in a screaming match during a group activity, resulting in one resident being verbally abused and becoming upset to the point of crying. The staff member present did not report the incident, expressing a lack of awareness that such behavior constituted reportable abuse. In all three cases, the facility's policy requiring immediate reporting of potential abuse to supervisors and the administrator was not followed, and the incidents were not promptly investigated.