F0609

D

Failure to Timely Report Injury of Unknown Source with Serious Bodily Injury

Laplace, Louisiana Survey Completed on 01-15-2026

Penalty

No penalty information released

Summary

The facility failed to timely report an injury of unknown source with serious bodily injury to the State Survey Agency as required by its Abuse, Neglect, and Misappropriation of Funds Program policy. The policy stated that if abuse was determined, could not be ruled out with reasonable certainty, or if the source of an injury was unknown and could not be determined, the Administrator would report the incident through the State Incident Management System. An incident report submitted through the State Incident Management System showed that an injury of unknown origin with bruising to the left shoulder was reported for Resident #1 on 12/16/2025 at 4:15 PM, and that the resident had reported this issue the week prior. Nursing documentation showed that on 12/09/2025 at 9:42 AM, the resident complained of pain to the left shoulder.

Resident #1’s quarterly MDS with an Assessment Reference Date of 12/09/2025 documented that the resident was not interviewable or was confused (BIMS score of 99), had upper and lower extremity impairments, and was dependent on staff for transfers and ADLs. A nurse practitioner was notified on 12/11/2025 that the resident complained of left shoulder pain and ordered an x-ray. The radiology report dated 12/11/2025 revealed an age-indeterminate fracture of the proximal left humerus with mild displacement, and a physician progress note dated 12/16/2025 described an acute displaced angulated fracture through the surgical neck of the humerus with medial displacement of the shaft. The Administrator and the DON each stated they determined the injury was not of unknown origin based on the resident’s osteoporosis diagnosis and did not suspect abuse; therefore, they did not report the incident to the State Survey Agency within the required two-hour timeframe.