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F0609
E

Failure to Report Injuries of Unknown Origin and Investigation Results

Santa Clara, New Mexico Survey Completed on 07-10-2025

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 all injuries of unknown origin and the results of related investigations to the State Survey Agency for one of three residents reviewed for falls. Specifically, a resident experienced multiple injuries of unknown origin, including a bruise on the chin, a large scratch from shoulder to hip, abrasions, and multiple skin tears on different dates. The resident was unable to state how the injuries occurred. Incident reports were completed for each event, but there was no documentation indicating that these reports or the follow-up investigation results were submitted to the state agency as required. During interviews, the facility's investigator stated that investigation reports and follow-up reports were completed and submitted via fax, but was unable to provide copies or fax confirmations due to computer issues. The state agency confirmed that it did not receive initial or follow-up reports for some of the injuries and only received an initial report for one incident, with no follow-up. There was no evidence in the facility's records to show that the required notifications and investigation results were sent to the state agency within the mandated timeframe.

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