Failure to Fully Report Sexual Abuse Allegation to State Authorities
Penalty
Summary
The facility failed to ensure a full description of an allegation of sexual abuse was reported to the state health department for one of three residents reviewed for abuse. The incident involved a male resident observed leaving a female resident's room, after which the female resident was found lying in bed with her sheet pulled down, her brief unlatched on one side and bent down in the front, and her gown pulled up. Staff interviews and written statements indicated that the female resident was yelling, and when staff entered her room, they found her in a compromised state. The male resident was seen leaving her room and stated he had gotten lost. The CNA immediately notified the RN, who observed the same condition of the resident and questioned her about the incident. The resident was unable to verbalize details but pointed to her breast, indicating where she had been touched. The facility's reportable incident documentation only briefly described the allegation, stating that the female resident alleged the male resident touched her breast. However, the full circumstances observed by staff, including the resident's physical state and the sequence of events, were not fully detailed in the report to the state health department. The facility's policy required that all allegations of abuse be reported, but the report submitted lacked a comprehensive description of the incident as observed and documented by staff.