Failure to Report Resident Abuse Allegations to Required Authorities
Penalty
Summary
The facility failed to follow its abuse reporting policy by not reporting two residents' allegations of rough handling and verbal abuse to the State Survey Agency (SSA) and other required authorities. The facility's written policy on Abuse, Neglect, Exploitation or Misappropriation-Reporting and Investigating states that all reports of resident abuse, neglect, exploitation, or misappropriation must be reported to local, state, and federal agencies as required, and that suspicions must be reported immediately to the administrator and appropriate external agencies. The policy defines "immediately" as within two hours for allegations involving abuse or resulting in serious bodily injury, and within 24 hours for allegations that do not involve abuse or result in serious bodily injury. Record review showed that these reporting requirements were not followed for two residents. One resident, with a Quarterly MDS BIMS score of 13 indicating little to no cognitive impairment, filed a grievance stating that a CNA was very rough while changing her brief and pushed on her shoulder while trying to turn her. Another resident, also with a BIMS score of 13, filed a grievance stating that the same CNA handled the resident very roughly and was rude, which the Social Worker documented as verbal abuse. The Social Worker reported that she took both complaints, and the Administrator confirmed she had interviewed both residents regarding the allegations. The Administrator further confirmed that she did not report these abuse allegations to the SSA, Ombudsman, police, or the residents' medical doctor, and record review confirmed that the allegations were not reported within the required time frame.
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