Failure to Thoroughly Investigate Allegation of Sexual Abuse
Penalty
Summary
The facility failed to conduct a thorough investigation into an allegation of sexual abuse involving two residents. According to the documentation, one resident reported to the receptionist that another resident exposed himself and requested inappropriate contact. The facility's investigation included interviews and assessments of both residents and a statement from an activity staff member who witnessed part of the incident. The staff member reported seeing one resident attempting to pull his zipper down but did not observe any exposure of genitals. The investigation documents were not titled or dated, and there was no evidence that the facility assessed or interviewed other residents in the area who may have been affected or had information about the incident. During interviews, the Administrator and DON described their general process for investigating abuse allegations, including interviewing staff, residents, and family, as well as checking the environment and conducting body checks for non-interviewable residents. However, in this case, there was no documentation that these steps were followed for other potentially affected residents. The facility's abuse policy required prompt and thorough investigations, including interviewing witnesses and other residents under the care of the staff member involved, but did not provide specific guidance for situations where a resident was not interviewable and had no family. This lack of thorough investigation did not ensure that other residents were protected from abuse.