Failure to Investigate Resident-to-Resident Abuse Allegation
Penalty
Summary
The facility failed to investigate an allegation of resident-to-resident abuse involving two residents. According to the facility's Abuse Prevention Policy and Procedure, any alleged mistreatment, neglect, or abuse must be documented and investigated, including gathering information about the incident, interviewing all pertinent parties, and maintaining records. However, a review of the records showed that after an altercation where one resident struck another in the face following an accusation of theft, there was no documented investigation into the incident as required by policy. Both residents involved had recent admissions and relevant diagnoses, with one being cognitively intact and the other moderately cognitively impaired. Interviews with both residents confirmed the physical altercation, and staff intervention was noted. Despite these facts, the DON stated that no investigation was conducted because abuse was not suspected, which was inconsistent with the facility's policy and procedures for handling such allegations.