Failure to Immediately Report Witnessed Verbal Abuse
Penalty
Summary
A deficiency occurred when a certified nurse aide (CNA) witnessed an incident of verbal abuse directed at a resident with severe cognitive impairment and failed to report the incident immediately, as required by the facility's Abuse Prevention Program policy. The incident took place during lunch, when one CNA overheard another CNA, who was an agency staff member, make a loud, derogatory comment about the resident in the presence of the resident and three others at the dining table. The resident involved had diagnoses including Down Syndrome, unspecified dementia, and seizures, and was dependent on staff for care. Due to the resident's severe cognitive impairment, he or she was unable to respond to questions about the incident. The CNA who witnessed the event did not report the alleged abuse to the Executive Director until one hour and forty-five minutes after the incident, instead proceeding to provide care to another resident. The delay in reporting was acknowledged by the CNA during an interview, stating that the incident should have been reported immediately. Other staff, including a nurse present at the time, were not informed of the incident by the witnessing CNA. The facility's policy requires all employees to immediately report any violations or alleged violations, and this requirement was not followed in this case.