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F0610
D

Failure to Investigate Resident Elopement

New Salem, North Dakota Survey Completed on 04-14-2025

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 thoroughly investigate an elopement incident involving a resident who was found by a community member in a nearby town gym and returned to the facility. The facility was unable to determine the exact time the resident left the building, with conflicting dates noted between the facility report and the medical record. Nursing documentation indicated the resident was confused and a code alert was applied for safety, but there was over an hour gap in staff charting during the time of the incident. The facility did not identify the causative factors of the elopement, limiting their ability to implement appropriate interventions.

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