Delayed Reporting of Alleged Abuse by Staff
Penalty
Summary
The facility failed to ensure that an allegation of physical abuse was reported immediately, as required by both facility policy and state law. Two nurse aide trainees witnessed a certified nurse aide slap a resident across the face and verbally abuse the resident during care. Instead of reporting the incident immediately to a supervisor or nurse, the trainees discussed the event between themselves and delayed reporting it for two days. The incident was eventually reported to a certified nurse aide, who then escalated it to the unit manager, and subsequently to the administrator. The resident involved had diagnoses including diabetes, obesity, and a mood disorder, and was dependent on staff for toileting and required supervision for bed mobility. The resident was alert, oriented, and had no documented behaviors. At the time of the incident, the resident did not report any mistreatment or abuse to the social worker and denied being abused when interviewed, although the nurse aide trainees described the resident as being shocked or unfazed by the slap. There were no physical injuries observed or reported. Interviews with staff revealed that the nurse aide trainees were unsure of the reporting process and were fearful of losing their jobs, which contributed to the delay. The facility's policies clearly state that any suspicion of abuse must be reported immediately, not to exceed two hours after discovery, to the administrator and the state agency. The delay in reporting resulted in the administrator and the New York State Department of Health being notified outside of the required timeframe.