Failure to Thoroughly Investigate Allegation of Resident Exploitation
Penalty
Summary
The deficiency involves the facility’s failure to thoroughly investigate an allegation of exploitation involving one resident. The facility’s Abuse, Neglect and Exploitation policy requires immediate and comprehensive investigations of alleged abuse, neglect, or exploitation, including identifying and interviewing all involved persons, witnesses, and others who might have knowledge of the allegation, and focusing on determining whether exploitation occurred. The resident involved had diagnoses including anxiety, depression, kidney failure, COPD, and type 2 diabetes, and had a BIMS score of 15/15, indicating intact cognition and that the resident was their own decision maker. The resident reported that an agency LPN stated they did not have gas money to get home from work and accepted eight dollars from the resident, which was later returned. The resident stated they knew the LPN from a prior facility where the LPN had cared for them and believed their relationship made it acceptable to give the LPN money. The ADON was informed by a nurse that the LPN had accepted money from the resident and had instructed the LPN to return it. The ADON then spoke with the resident, who confirmed giving the LPN gas money and that it had been returned, and stated they felt it was acceptable due to their relationship with the LPN. After this interview, the ADON did not conduct any further investigation. The NHA was informed of the incident and determined it was not an allegation of exploitation, in part because the money was returned and the resident did not appear to have adverse psychosocial effects. The NHA confirmed that no additional residents or staff were interviewed to determine if there were similar concerns or if other residents had been affected, and the facility’s investigation contained no further interviews beyond the resident, despite policy requirements for a complete and thorough investigation of alleged exploitation.
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