Failure to Remove Accused Staff and Investigate Abuse Allegations
Penalty
Summary
The facility failed to ensure that staff members accused of abuse were immediately removed from resident access and that all abuse allegations were properly investigated. In one instance, a resident with significant physical impairments and cognitive intactness reported a verbal altercation with a certified nursing assistant (CNA). The CNA was not immediately removed from the premises and remained in areas accessible to residents, including the nurse's station, after being told to leave. Statements from staff and the CNA confirm that she was present in the facility and in proximity to residents after the allegation was made, contrary to facility policy requiring immediate suspension and removal of accused staff pending investigation. Additionally, the facility did not investigate all reported abuse allegations. Another resident with a history of traumatic brain injury and behavioral issues made repeated allegations that a nurse made inappropriate comments about his body. The resident's family also reported these concerns. Despite these reports, there was no documentation of any investigation into the allegations, and the administrator confirmed that no investigation was conducted. The administrator attributed this failure to the absence and inaction of the previous Director of Nursing (DON), who did not initiate or document any inquiry into the matter. The facility's own abuse policy requires immediate protection of residents and prompt, thorough investigation of all abuse allegations. However, in both cases, the facility did not follow its policy: the alleged perpetrator was not immediately removed from resident areas, and one resident's abuse allegation was not investigated at all. These failures were confirmed through interviews, record reviews, and the absence of required documentation.