Failure to Timely Report and Submit Findings for Abuse and Theft Allegations
Penalty
Summary
The facility failed to report two separate allegations of abuse involving a resident to the State Survey Agency within the required two-hour timeframe. In one instance, an alleged incident of verbal abuse between a staff member and a resident was not reported promptly. In another case, an allegation of staff-to-resident abuse was also not reported within the mandated period. Staff interviews revealed delays in internal communication, with staff waiting for responses from administrative personnel before reporting incidents, and some staff not immediately notifying administrative staff upon learning of the allegations. The facility's policy requires immediate reporting, but this was not followed in these cases. Additionally, the facility did not submit investigation findings to the State Survey Agency for three residents involved in separate incidents. One incident involved a missing wedding ring, and another involved an allegation of resident-to-resident abuse. The findings for these incidents were either not submitted or were submitted significantly late, with one report delayed by 13 business days. Staff interviews indicated that frequent changes in administration and issues with reporting and investigating incidents contributed to these failures. Facility policies reviewed require timely reporting and submission of findings, but these procedures were not adhered to in the cited cases.