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F0609
D

Failure to Timely Report Alleged Abuse to State Authorities

Duncanville, Texas Survey Completed on 05-01-2025

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 immediately report an allegation of abuse involving two residents, as required by Texas law and facility policy. Specifically, a resident with hemiplegia and a history of stroke, who was cognitively intact, reported being physically abused by another resident. The incident, witnessed by the DON, involved one resident grabbing another by the jacket around her shoulder. The DON reported the incident to the Administrator, who serves as the Abuse Coordinator, within an hour. However, the Administrator did not report the allegation to the state agency within the required two-hour timeframe. Instead, the initial report was delayed, and there was confusion regarding the date of the incident and the method of reporting, with the Administrator unable to provide documentation of a timely report. Record review showed that the facility's notification to the state agency was not sent until two days after the incident, and the provider investigation report was also delayed. Interviews with staff revealed a lack of clarity regarding the reporting timeframe, with the DON believing the requirement was 24 hours rather than two. The facility's policy clearly states that allegations of abuse must be reported within two hours, but this protocol was not followed in this case, resulting in a deficiency for failure to timely report suspected abuse.

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