Failure to Immediately Report Alleged Verbal Abuse to Administrator
Penalty
Summary
A deficiency occurred when a licensed vocational nurse (LVN) failed to immediately report an allegation of verbal abuse involving a resident and a certified nursing assistant (CNA) to the facility Administrator, as required by policy. The incident involved a male resident with a history of Type 2 Diabetes Mellitus, Chronic Pain Syndrome, and Cognitive Communication Deficit, who was dependent on staff for activities of daily living and had no cognitive impairment. The resident reported that the CNA used profanity towards him, which made him feel upset and uncomfortable. The resident immediately informed the LVN, who then reassigned the CNA but did not notify the Administrator at that time. Interviews revealed that the LVN initially claimed to have reported the incident to the Administrator and Director of Nursing (DON), but later admitted she might not have done so, believing the CNA had already reported it. The DON and Administrator both confirmed that they were not made aware of the incident until the following day, after the resident reported it to the Social Worker. The facility's policy requires all staff to make an immediate verbal report to the Abuse Preventionist or designee when any suspected abuse is identified, regardless of the time of day. The failure to report the allegation immediately delayed the facility's investigation and intervention. The Administrator's contact information was posted throughout the building, and staff were expected to notify her of any abuse allegations without delay. The DON and Administrator both stated that immediate reporting is necessary to ensure resident safety and prevent further harm.