Failure to Timely Report Alleged Abuse to State Agency
Penalty
Summary
The facility failed to notify the State Agency (Division of Licensing and Certification) in a timely manner regarding an allegation of abuse involving a resident and a registered nurse. On the date of the incident, staff reported to the Director of Nursing (DON) that a resident was agitated and that a registered nurse escalated the situation, resulting in the resident biting the nurse. Additional information was reported to the DON, including that the nurse placed the resident in their room, closed the door, and held it shut for several seconds up to one minute during the resident's escalating behaviors. Text messages from certified nursing assistants to the DON expressed concerns about the nurse's behavior, including the nurse flapping her arms at the resident and encouraging the resident to hit her. Despite these reports and concerns, the facility did not initiate an investigation or notify the State Agency until two days after the incident occurred.