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F0609
D

Failure to Timely Report Alleged Abuse Incident

Prescott, Arizona Survey Completed on 04-28-2025

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 ensure that an allegation of abuse involving a staff member and a resident was reported in accordance with professional standards and facility policy. The incident involved a resident with multiple medical diagnoses, including toxic encephalopathy and cirrhosis, who alleged that a male staff member hit her during the night. Documentation shows that the resident made these allegations to staff, requested her husband be called, and subsequently left the facility with her husband. Staff interviews revealed that the allegation was not reported to management or the state agency within the required timeframe. Multiple staff members, including CNAs and an LPN, were aware of the resident's allegations but did not immediately report the incident to supervisors or management as required by facility policy and federal regulations. The LPN acknowledged that the allegation was not reported to the Assistant Director of Nursing (ADON) until several hours after the initial report from the resident, citing workload and a belief that the resident was confused. The ADON and DON both stated that they were unaware of the allegation until the following morning, and the Executive Director confirmed that management was not notified by the night shift staff. Facility policy and federal regulations require that all allegations of abuse be reported immediately, or within two hours if the allegation involves abuse or results in serious bodily injury. The failure to report the allegation in a timely manner was confirmed through clinical record review, staff interviews, and policy review, resulting in a deficiency for not adhering to required reporting standards.

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