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F0610
D

Failure to Investigate Alleged Verbal and Mental Abuse

Chicago, Illinois Survey Completed on 05-21-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to conduct a thorough investigation into an allegation of verbal and mental abuse after a resident reported being bullied by two other residents. The resident, who was cognitively intact as indicated by a BIMS score of 15, stated that two peers repeatedly called him derogatory names and that this harassment had persisted for over a year. The resident reported the bullying to hospital staff during a recent hospitalization, which prompted a call from the hospital social worker to the facility. The facility administrator was notified of the allegation by an LPN, but the administrator only interviewed the resident's roommate, who was not named by the resident as a perpetrator, and did not interview the resident or the two residents accused of bullying. No documentation of a comprehensive investigation was provided, aside from a single witness statement from the roommate. The administrator confirmed that no further interviews or written records were made regarding the incident, and was unaware that the allegation involved residents other than the roommate. The facility's abuse policy requires prompt and aggressive investigation of all abuse allegations, including interviews with the person reporting the incident, the resident, and anyone likely to have direct knowledge, as well as documentation of all incidents. These procedures were not followed in this case.

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