F0609

D

Failure to Timely Report Injuries of Unknown Origin to State Authorities

Arverne, New York Survey Completed on 01-12-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure that all alleged violations involving abuse, neglect, mistreatment, and injuries of unknown origin were reported to the State Survey Agency immediately, and no later than two hours after discovery, as required by facility policy and state reporting mandates. The facility’s written policy, revised 05/06/2025, required that all alleged violations involving serious injuries of unknown source be reported and investigated immediately, with findings reported to the New York State Department of Health (NYSDOH) within two hours, as well as to law enforcement and other required agencies. Surveyors found that this policy was not followed for two residents whose injuries met criteria for injuries of unknown origin.

For one resident with cellulitis, sepsis, and dementia, an Annual MDS documented moderately impaired cognitive skills and a need for supervision or assistance with activities of daily living. On 04/12/2024 at approximately 7:00 AM, this resident was observed in a wheelchair in the hallway with facial discoloration, redness to the right forehead and cheek, and ecchymosis and redness around both eyes, with mild swelling to the forehead and eyelids. The resident was unable to explain what happened due to cognitive impairment and a language barrier, and employee statements did not identify any witness to the injury. The Accident/Incident Report identified the event as an injury of unknown source, staff became aware at 7:00 AM, and the Administrator was notified at 9:00 AM. However, the incident was not submitted to NYSDOH until 1:57 PM, exceeding the two-hour reporting requirement. During interview, the Assistant DON confirmed the incident was reported but did not provide an explanation for the late submission.

For another resident with non-Alzheimer’s dementia, Parkinson’s disease, and cerebrovascular disease, an Annual MDS documented short- and long-term memory problems and severely impaired cognitive skills for decision-making. On 11/21/2025 at 6:00 AM, this resident was found sitting in a wheelchair in another resident’s room with blood dripping from the left side of the face and a 2 cm laceration to the left eyebrow; the location of occurrence was unknown, and the resident could not state what occurred due to severely impaired cognition. The resident was sent to the hospital for evaluation and later returned with Steri-Strips and swelling to the left eyebrow. The facility’s incident report documented no conclusion as to what occurred, and there was no documented evidence that this injury of unknown origin was reported to NYSDOH. In interviews, the DON stated the incident was initially documented as a fall and acknowledged that, upon review, it could be considered an injury of unknown origin, and the Assistant DON stated the incident should have been reported as an injury of unknown origin because there was no clear evidence of a fall and did not recall any discussion about reporting it.