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F0609
D

Delayed Reporting of Injury of Unknown Origin

Menomonee Falls, Wisconsin Survey Completed on 08-19-2025

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 injury of unknown origin (IUO) within the required timeframe to the State Survey Agency for a resident who was moderately cognitively impaired and had diagnoses including spastic hemiplegia and quadriplegia. The resident complained of right ankle pain and was sent to the hospital, where a closed fracture of the right ankle was diagnosed. The x-ray report indicated the age of the fracture was undetermined. Upon return from the hospital, the resident was given an order for oxycodone for pain management. Documentation shows that the incident was reported to the Director of Nursing (DON) in a timely manner by the LPN, and the Administrator was also informed. However, the facility did not submit the Misconduct Incident Report to the State Survey Agency until five days after the injury was first identified. The delay occurred because the Interim Administrator was unsure if the event was reportable and wanted to gather additional information before submitting the report.

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