Failure to Timely Report Allegation of Staff-Resident Sexual Relationship
Penalty
Summary
The facility failed to complete required reporting to the State Survey and Certification Agency in a timely manner regarding an allegation of an inappropriate sexual relationship between a staff member and a resident. According to the facility's Abuse Prevention Policy, all alleged violations involving abuse, neglect, exploitation, or mistreatment must be reported immediately, but no later than 2 hours if the allegation involves abuse or results in serious bodily injury, or within 24 hours if not. Additionally, the results of all investigations must be reported to the State Survey Agency within 5 working days. However, a review of the facility's reporting records and incident logs revealed no documentation of this allegation being reported as required. The incident involved a resident with multiple medical diagnoses, including fractures, bipolar disorder, insomnia, and muscle weakness, who was found to be cognitively intact based on a BIMS score of 15 out of 15. The allegation surfaced as a rumor among staff regarding a possible sexual relationship between the resident and a CNA. The administrator acknowledged hearing the rumor but did not report it to the State Survey and Certification Agency, citing that it was only a rumor and not a formal complaint or report from a resident. No incident report was created, and the only documentation related to the investigation was found in the CNA's personnel file. Interviews with facility staff confirmed that the allegation was not reported to the State Survey and Certification Agency. The Director of Clinical Operations stated that an internal investigation was conducted and concluded there was nothing to report, characterizing the situation as staff gossip. The MDS nurse also reported hearing the rumor but did not report it, believing it to be unsubstantiated gossip. As a result, the facility did not fulfill its obligation to report the allegation of abuse in accordance with federal and state requirements.