Failure to Report Alleged Verbal Abuse to State Agency
Penalty
Summary
A deficiency occurred when the facility failed to ensure that an allegation of verbal abuse was reported to the state agency as required. A cognitively intact resident with multiple medical diagnoses, including coronary artery disease, heart failure, diabetes, and a history of cerebrovascular accident, reported that a CNA called him an "ass" during an interaction regarding another resident's disruptive behavior. The resident stated he reported the incident to the DON, who attempted to minimize the situation, allegedly due to a personal relationship with the CNA. The resident expressed dissatisfaction with the response and indicated that no one had asked him for a formal statement regarding the incident. Interviews with the CNA confirmed the use of the inappropriate term, and the CNA acknowledged it was disrespectful. The DON admitted to addressing the situation informally by speaking with both parties but did not report the incident to the administrator or the state agency. The administrator was unaware of the incident until the surveyor's inquiry. Review of facility policy confirmed that all such allegations should be immediately reported to the administrator and appropriate agencies, which did not occur in this case.
Plan Of Correction
including management team, regarding reporting of all allegations of abuse. Education will be completed by 6/6/25. New hired staff will be educated on abuse policy during orientation. Step 4 NHA/designee will monitor compliance of reporting to state agency allegation of Abuse, Neglect, Misappropriation weekly X4 then monthly x2. The results of the audits will be submitted to the QA committee for further review and recommendations.