Failure to Timely Report Alleged Abuse to Authorities
Penalty
Summary
The facility failed to implement its policies and procedures regarding the timely reporting of an abuse allegation for one of three sampled residents. Specifically, a resident with hemiplegia, hemiparesis, and osteoarthritis reported to the Director of Staff Development (DSD) that a Certified Nursing Assistant (CNA) had pushed on his leg, hit him with a pillow, and spoken to him in a rude and disrespectful manner during care. The DSD acknowledged that these actions constituted abuse and that, according to facility policy, such allegations must be reported to the California Department of Public Health (CDPH) and other agencies within two hours. However, the report was not made within the required timeframe, resulting in a delay in the investigation by CDPH. Interviews and record reviews confirmed that the resident was able to make decisions for activities of daily living and required moderate assistance for personal care. Another resident corroborated that the CNA had spoken rudely to the affected resident. The facility's policy clearly stated that abuse allegations must be reported immediately, defined as within two hours, and that employees involved would be placed on leave pending investigation. Despite these policies, the required timely reporting did not occur in this instance.