Failure to Thoroughly Investigate Bruising of Unknown Origin
Penalty
Summary
The facility failed to thoroughly investigate the possibility of abuse for a resident who was found with multiple bruises of unknown origin. The resident, who had severe cognitive impairment and was on blood thinning medication, was discovered by a CNA to have several bruises on her arms, calves, and behind her knees during a shower. The incident was reported to the RN, who assessed the resident, notified the DON, the resident's power of attorney, and the physician, and obtained statements from staff and interviewed other residents. However, the investigation did not include skin checks for non-interviewable residents to rule out abuse, nor did it explore all possible causes for the bruising, such as the use of compression stockings or recent behavioral incidents. The facility's investigation focused primarily on the resident's elevated INR and the possibility of bruising from sitting on hard surfaces, despite the presence of a cushion on the dining chair and no assessment of other potential sources like the toilet or shower chair. Additionally, a progress note indicated the resident had hit staff during toileting, but this was not investigated as a possible cause for the arm bruising. The DON concluded the investigation after attributing the bruising to the high INR, without further exploration of other plausible causes or a comprehensive assessment of the situation.