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F0609
D

Failure to Timely Report Alleged Abuse to State Agency

Green Bay, Wisconsin Survey Completed on 11-18-2025

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 report allegations of abuse to the State Agency (SA) for two residents as required by policy and federal regulations. In the first instance, a resident with multiple diagnoses including dementia, Huntington's disease, and repeated falls experienced a witnessed fall. The Interdisciplinary Team determined that abuse had occurred based on the LPN's progress note. While the initial report was submitted to the SA on the day of the incident, the required 5-day investigation report was not submitted within the mandated timeframe, as the Nursing Home Administrator delayed submission while waiting for an additional staff statement. In the second instance, another resident with intact cognition and a history of congestive heart failure, respiratory failure, and falls reported to staff that a CNA was abusive during care, describing rough handling and feeling unsafe. The facility initiated a grievance form and provided staff education, but did not report the abuse allegation to the SA as required. The Nursing Home Administrator later verified that this allegation should have been reported.

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