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F0609
D

Failure to Report Injury of Unknown Origin to State Authorities

Broken Arrow, Oklahoma Survey Completed on 05-07-2025

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 report an injury of unknown origin to the Oklahoma State Department of Health as required by policy. A resident with kidney failure and dementia, who was totally dependent on staff for care and had intact cognition, was found to have a left shoulder subluxation after their family reported shoulder pain to nursing staff. The injury was unwitnessed, and the resident was unable to explain how it occurred. Nursing notes documented the assessment, x-ray, and subsequent transfer to the emergency room for evaluation. Despite the facility's policy requiring immediate reporting of injuries of unknown source to the State Survey Agency, the incident was not reported. The Director of Nursing confirmed that an internal investigation was conducted, but the required external notification was not made. The deficiency was identified during a review of records and staff interviews, which confirmed the lack of timely reporting to the appropriate authorities.

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