Failure to Investigate and Report Alleged Resident Mistreatment
Penalty
Summary
The facility failed to ensure that all alleged violations involving abuse, neglect, exploitation, or mistreatment were reported and investigated according to policy and state law. Specifically, a dietary aide posted a photo of two residents on her personal Snapchat account with a caption, and this was brought to the attention of a facility employee by a friend. The employee did not immediately report the incident, instead waiting until the next day to notify the Nursing Home Administrator (NHA). Upon learning of the incident, the NHA did not interview other residents to determine if the issue was isolated or more widespread, nor was there education provided to staff regarding the importance of timely reporting of such incidents. The facility's policy requires immediate notification of the administrator and a thorough investigation, including interviews with all potentially involved or affected parties. However, the NHA assumed the incident was isolated and did not take steps to assess the broader scope of the concern. The failure to interview other residents and educate staff on timely reporting contributed to the deficiency, as the facility did not fully follow its own procedures for responding to alleged violations involving resident mistreatment.