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F0610
D

Failure to Complete Thorough Abuse Investigation

Nebraska City, Nebraska Survey Completed on 09-22-2025

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 conduct a thorough investigation following an allegation of abuse made by a resident. According to the facility's abuse policy, an immediate and comprehensive investigation is required when abuse is suspected or reported, including identifying responsible staff, interviewing all involved parties, and documenting the process. In this case, a resident reported pain under the right breast and stated that someone had hit them, prompting an assessment by a licensed nurse, which found no visible injury. However, the subsequent investigation did not include interviews with staff or other residents, and there was a lack of documentation regarding these critical steps. The resident involved had a history of chronic obstructive pulmonary disease, schizophrenia, and osteoporosis, and was assessed as cognitively intact with a BIMS score of 13/15. The resident also exhibited some behavioral symptoms according to recent assessments. The facility administrator confirmed that the investigation was incomplete, as required interviews and documentation were not performed, resulting in a failure to meet regulatory requirements for responding to alleged violations.

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