Failure to Provide Psychosocial Follow-Up After Abuse Allegation
Penalty
Summary
The facility failed to provide medically-related social services to a resident following an allegation of resident-to-resident physical abuse. After the incident, there was no documentation of psychosocial follow-up for the resident, who was the alleged victim. The resident had severe cognitive impairment, as indicated by a BIMS score of 6 out of 15, and preferred to communicate in Mandarin, requiring an interpreter for effective communication with healthcare staff. Despite this, the only depression screening conducted since admission was performed with input from staff who did not communicate with the resident in his preferred language, and no interpreter or family assistance was used. Interviews with facility staff confirmed that the expected process for abuse allegations includes a 72-hour psychosocial follow-up focused on the alleged victim, but this was not completed or documented for the resident in question. The social services assistant and administrators acknowledged the lack of psychosocial follow-up, and the electronic health record review corroborated the absence of such documentation. The failure to provide appropriate psychosocial support hindered the resident's ability to attain or maintain his highest practicable psychosocial well-being.