Failure to Thoroughly Investigate Abuse Allegation Involving Non-Communicative Resident
Penalty
Summary
The facility failed to conduct a thorough investigation into an allegation of abuse involving a resident with severe cognitive impairment and multiple disabilities. An incident was reported in which a resident claimed to have witnessed inappropriate sexual contact between a staff member and another resident who was non-communicative and dependent in all activities of daily living. The facility's investigation was limited to a head-to-toe assessment of the alleged victim, a brief interview in which the resident was unable to respond, and a review of staffing and camera footage. No interviews were conducted with other staff or residents, and there was no documentation of the incident in the resident's record. Additionally, the facility did not perform a psychosocial follow-up assessment or notify the family or responsible party of the abuse allegation or investigation. The resident's medical record lacked any mention of the reported incident, and the facility's own policy required more comprehensive investigative procedures, including interviews with all relevant parties and documentation of all incidents. The administrator confirmed that no further assessments or notifications were made regarding the alleged abuse.