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F0609
D

Failure to Timely Report Investigation Results for Injury of Unknown Source

Novato, California Survey Completed on 05-01-2025

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 the results of an investigation into an injury of unknown source for one resident within five working days, as required. The resident, who had a history of contractures in both hands, was found with bruising, purple skin discoloration, swelling, and limited mobility in the right arm. The resident was unable to explain the cause of the injury and was observed to be grimacing and crying. The resident was subsequently sent to the emergency room, where a closed displaced spiral fracture of the right humerus was diagnosed. Interviews with facility staff, including the Director of Staff Development, Infection Preventionist, and Assistant Director of Nursing, confirmed that the results of the investigation into the injury should have been submitted to the Department within five working days. However, the facility was unable to provide evidence that this report was made within the required timeframe. Review of the facility's policy also indicated that such reporting is required within five working days of the incident.

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