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F0689
D

Failure to Report and Document Resident Transfer Accident

West Salem, Wisconsin Survey Completed on 09-16-2025

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

A deficiency occurred when a resident with right-sided hemiplegia, impaired mobility, hypertensive intracerebral hemorrhage, chronic pain, and osteoarthritis was being transferred to the bathroom using an EZ stand. During the transfer, the resident's right arm was bumped against the door frame by CNA staff. The incident was not reported to the charge nurse or documented in the medical record as required by the facility's Resident Incident/Accident Reporting Protocol, which mandates immediate reporting and documentation of all incidents and accidents, regardless of severity. The resident later reported severe pain in the right arm to a registered nurse during a medication pass, prompting the facility to gather witness statements from the involved CNAs. Both CNAs confirmed the incident, noting that the resident's arm was hit during the transfer and that the resident declined an ice pack. The Director of Nursing confirmed that the incident was not reported to the nurse on duty, the charge nurse, or the oncoming shift, in violation of facility policy.

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