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F0609
D

Failure to Timely Report Suspected Physical Abuse

Lake View Terrace, California Survey Completed on 07-21-2025

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 incident of suspected physical abuse involving a resident with multiple diagnoses, including COPD, schizoaffective disorder bipolar type, and diabetes mellitus. The resident, who had intact cognitive functioning and required staff assistance for daily activities, reported to a registered nurse that a staff member had pushed him into the restroom, causing pain, while he was resisting by holding onto the door frame. The incident was also disclosed to a certified nurse assistant, who acknowledged understanding that such actions could constitute physical abuse but did not report the incident to her supervisor as required. Interviews with staff confirmed that the incident was not reported immediately, and the facility's policy mandates that all employees are required to report suspected abuse, neglect, or exploitation immediately to the administrator and appropriate authorities. The administrator and registered nurse both recognized that the failure to report the incident on the same day as the complaint could result in ongoing harm to the resident. The facility's policy on abuse reporting and investigation was not followed in this case, as the initial report of abuse was not promptly communicated to supervisory staff or external authorities.

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