Failure to Investigate and Protect Residents After Sexual Abuse Allegations
Penalty
Summary
The facility failed to thoroughly investigate and protect residents following allegations of sexual abuse and harassment involving a resident with severe cognitive impairment and a history of mental health issues. Multiple reports were made by female residents, including one who reported feeling unsafe due to another resident's sexually inappropriate behavior, unwanted advances, and persistent letter writing. Despite these reports, the facility did not provide documentation of a comprehensive investigation, nor did it demonstrate that effective measures were taken to prevent further abuse or address the concerns raised by the residents. Documentation shows that the resident with severe cognitive impairment, along with other female residents, repeatedly expressed discomfort and fear regarding the behavior of another resident, who had a documented history of verbal and behavioral symptoms. The facility's response included minimal actions such as speaking to the alleged perpetrator and providing education, but there was no evidence of a thorough investigation, interviews, or protective interventions. The affected resident continued to receive inappropriate letters even after submitting a grievance, and staff interviews revealed a lack of documentation and uncertainty about the steps taken to ensure resident safety. The facility's own policy requires immediate and thorough investigation of abuse allegations, including interviews, documentation, and protective measures for residents. However, the facility was unable to provide requested investigation records, timelines, or evidence of actions taken to protect residents from further harm. Reports from staff, social services, and law enforcement indicated ongoing issues with harassment and a lack of effective response, further highlighting the facility's failure to meet its investigative and protective obligations.