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F0609
D

Failure to Timely Report Injury of Unknown Origin

Papillion, Nebraska Survey Completed on 04-14-2025

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 submit an investigation report to the state agency within five working days regarding an injury of unknown origin for one resident. The resident in question had short and long-term memory problems, moderately impaired decision-making skills, and required varying levels of assistance with daily activities. The resident was also on anticoagulant medication. On a specified date, staff identified a large bruise on the resident's forehead during a skin evaluation, with the cause of the injury unknown and unobserved by staff. Record review showed that the facility's investigation determined the bruise was of unknown origin, meeting the criteria for an injury of unknown source as outlined in the facility's policy. Despite this, there was no confirmation that the required investigation report was submitted to the state agency within the mandated timeframe. The DON confirmed that such a report should have been sent and that there was no evidence of submission via email or fax.

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