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F0609
D

Failure to Timely Report Injury of Unknown Origin

Park Ridge, Illinois Survey Completed on 06-21-2025

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 implement its abuse prevention policy by not reporting an injury of unknown origin in a timely manner. On 6/18/25, a resident was assessed by the Restorative Nurse and the Director of Nursing, with the surveyor present, and was observed to have discoloration on both sides of the breasts. Staff interviews confirmed that any injury of unknown origin should be reported immediately to the Administrator for investigation and to the state agency, but this was not done. The Director of Nursing acknowledged that the incident was not reported to the Illinois Department of Public Health (IDPH) as required, and the Administrator admitted that the initial report was not sent in a timely manner, despite staff being aware of the reporting protocol. The resident involved had multiple diagnoses, including cerebral infarction, coronavirus, anemia, type 2 diabetes mellitus, hyperlipidemia, heart failure, and hypertension. A progress note indicated that bruising was observed on 6/13/25, but the incident was not reported to IDPH until 6/18/25. The facility's abuse prevention policy, revised in November 2023, requires prompt reporting of all injuries of unknown source to appropriate authorities, including the state licensing agency, the resident's representative, attending physician, and medical director. The failure to follow this policy resulted in a deficiency for not reporting the injury of unknown origin as required.

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