Failure to Timely Report Allegation of Abuse and Injury of Unknown Origin
Penalty
Summary
The facility failed to report an allegation of abuse involving an injury of unknown origin within the required two-hour timeframe to the New Jersey Department of Health (NJDOH). The incident involved a resident who was discovered to have an abrasion on their left knee. Initially, the resident stated they had caused the injury themselves, but later told their Medical Power of Attorney that they had been dropped by caregivers during a transfer. This new allegation was communicated to the facility's Social Worker and Director of Nursing, and the Care Plan was updated to reflect the resident's claim. Despite being made aware of the allegation on 10/26/25, the facility did not submit the Facility Reportable Event (FRE) to the NJDOH until 10/29/25. Interviews and documentation review confirmed that the facility staff, including the DON and LNHA, were aware of the resident's allegation prior to the report being filed. The facility's own policy required immediate notification to the NJDOH for unexplained injuries or suspected abuse, but this protocol was not followed. The surveyor's review of emails, the occurrence journal, and the care plan update all indicated that the facility had sufficient information to trigger a timely report, but failed to do so within the mandated period.