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F0609
D

Failure to Report Allegation of Neglect to State Agency

Bemidji, Minnesota Survey Completed on 07-17-2025

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 allegation of neglect to the state agency for a resident who was admitted with diagnoses including atrial fibrillation, adult failure to thrive, and hypertension. The resident required assistance with repositioning, toileting, and wheelchair mobility. According to progress notes, the resident's family expressed concerns about poor care, specifically that the resident was not eating or drinking adequately and was refusing medications. The family insisted the resident be sent to the emergency department, and upon arrival at the hospital, the resident was found to be dehydrated and vomiting. The family explicitly described the care as neglect to facility staff. Despite these allegations and the facility's own policy requiring reporting of neglect allegations within specified timeframes, interviews with staff revealed that the allegation was not reported to the state agency. The social services designee and licensed social worker both acknowledged the family's claims but stated the facility did not believe neglect had occurred and therefore did not report the incident. The administrator confirmed that the allegation was not reported, as she was not aware of the concerns until after the family had already removed the resident from the facility.

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