F0609

D

Failure to Report Injury of Unknown Origin to State Agency

Geneva, Ohio Survey Completed on 01-20-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to report an injury of unknown origin to the State Survey Agency as required by its own policy and regulations. A resident with multiple complex medical conditions, including local skin infection, congestive heart failure, pulmonary fibrosis, dysphagia, hypoxemia, hypertensive heart disease with heart failure, gout, anemia, osteoporosis, major depressive disorder, generalized anxiety disorder, hypothyroidism, chronic pain syndrome, chronic kidney disease, acute respiratory failure with hypoxia, myocardial infarction, osteoarthritis of the knee, cognitive communication deficit, COPD, repeated falls, and legal blindness, was admitted on 01/07/22. The resident’s MDS assessment showed a BIMS score of 00, indicating severe cognitive impairment, and documented that the resident was dependent on staff for all ADLs and mobility.

On 06/05/25, the resident complained of right knee pain, and an x-ray was ordered and performed on 06/06/25. The x-ray results showed a broken osteophyte at the superior margin of the patella, likely chronic, and moderate osteoarthritis of the right knee joint. During an interview on 01/08/25, the DON stated that staff were unaware of how the resident’s knee injury occurred and confirmed that an investigation was conducted. However, no self-reported incident related to this injury of unknown origin was submitted to the State Survey Agency, despite the facility’s written policy requiring immediate reporting of suspected abuse, neglect, exploitation, misappropriation, or injury of unknown source to the administrator and appropriate officials within specified time frames. This failure to report was identified as an incidental finding during a complaint investigation.