Failure to Track and Monitor Choking Incident in QA Process
Penalty
No penalty information released
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 track and monitor a choking incident involving one resident, as required by its policy on safety and supervision. According to the nursing note, staff responded to a resident who was choking, and paramedics later pronounced the resident deceased. Despite this serious event, there was no documentation in the quality assurance notes regarding monitoring or tracking of the incident. The corporate nurse confirmed that the incident was neither reviewed nor documented by the quality assurance group, contrary to facility policy that mandates QA review of safety and incident reports.