Failure to Thoroughly Investigate Alleged Abuse Incidents
Penalty
Summary
The facility failed to provide evidence that all alleged violations of abuse were thoroughly investigated for two residents. In the first instance, a resident reported that a Certified Nursing Assistant (CNA) made an obscene gesture and expressed feeling unsafe with that CNA present. The facility's own Misconduct Incident Report documented the allegation, but the Nursing Home Administrator confirmed that the investigation was incomplete, as other staff who worked with the CNA were not interviewed and staff were not educated regarding abuse and mistreatment as required by the facility's Abuse Prevention Program. In the second instance, another resident alleged that the same CNA was rough during care, resulting in bruises, and made derogatory comments about the resident's weight. The facility's grievance form documented these concerns, but again, the Nursing Home Administrator acknowledged that the investigation was not fully conducted. Specifically, other residents and staff were not interviewed, and further education on abuse and mistreatment was not provided to staff, contrary to the facility's policy for investigating such allegations.