F0609

D

Failure to Timely Report Resident-to-Resident Abuse Allegation to State Agency

Pikeville, Kentucky Survey Completed on 01-08-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to timely report an allegation of resident-to-resident physical abuse to the state survey agency (SA) within the required two-hour timeframe. The facility’s abuse policy addressed reporting and response, including reporting to state agencies as required, but did not specify timeframes for reporting abuse allegations. Resident #100, who had a history of thoracic vertebrae compression fractures, unspecified dementia, anxiety, and repeated falls, and had a BIMS score of 9 indicating moderate cognitive impairment, was involved in the incident. Resident #99, who had diagnoses including major depressive disorder, adjustment disorder, low back pain, peripheral vascular disease, and a right below-knee amputation, and who used a wheelchair and had a BIMS score of 13 indicating intact cognition, was identified as the resident who punched Resident #100 on the arm as they passed in the hallway.

Record review showed that the incident occurred at approximately 2:00 AM on 07/01/2025. LPN #4 reported that she notified the Administrator and the DON of the allegation at approximately 2:30 AM, in accordance with the expectation that staff immediately report allegations to the Abuse Coordinator (the Administrator) and that abuse allegations be reported to the SA within two hours. The Administrator confirmed awareness of the two-hour reporting requirement and stated that the incident occurred around 2:00–3:00 AM, but acknowledged that she did not report the allegation to the SA until 11:30 AM, as evidenced by the automatic reply email from the SA time-stamped 11:30 AM on 07/01/2025. This resulted in the allegation being reported approximately nine hours after the incident, rather than within the required two-hour timeframe.