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F0609
D

Failure to Timely Report Injury of Unknown Origin

South Holland, Illinois Survey Completed on 12-18-2025

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 an injury of unknown origin to the state survey agency within the required two-hour timeframe for one resident. The incident involved a resident who was observed with a swollen and painful left arm, which was later diagnosed at the hospital as a closed supracondylar fracture of the left humerus. Staff interviews and record reviews revealed that the facility became aware of the injury in the morning, but the initial report to the state agency was not faxed until the following afternoon, well beyond the mandated reporting window. The administrator confirmed awareness of the injury and acknowledged that the cause was unknown, but the facility treated the incident as a fall with injury rather than as a potential abuse case, which delayed the reporting process. Multiple staff members, including the Social Services Director and the DON, recounted that there were conflicting accounts regarding how the injury occurred. One resident reported seeing a CNA hurt the injured resident, while another account suggested only hearing a loud noise without witnessing the event. The injured resident was unable to clearly communicate what happened due to fluctuating cognition. The facility's abuse policy requires reporting serious bodily injury with reasonable suspicion of a crime within two hours, but this protocol was not followed. The failure to report the injury promptly was confirmed by the administrator and supported by documentation of the delayed facsimile transmission.

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