Failure to Monitor Psychosocial Wellbeing After Abuse Allegation
Penalty
Summary
The facility failed to monitor and document the psychosocial wellbeing of a resident following an allegation of sexual abuse by a staff member. The resident, who had a history of post-traumatic stress syndrome due to previous physical and emotional abuse, was admitted with moderate cognitive impairment and was dependent on staff for many activities of daily living. Physician orders required staff to monitor the resident for psychosocial wellbeing, including observing and charting progress notes for behavior, refusal of care, social isolation, and pain management, and to notify the provider of any concerns, with monitoring to occur every shift for five days. However, a review of progress notes showed no documentation of such monitoring related to the abuse allegation, and staff confirmed that this monitoring was not performed.