Failure to Investigate Unexplained Bruising as Possible Abuse
Penalty
Summary
The facility failed to investigate an injury of unknown origin as possible abuse for one resident with dementia and a right above-elbow amputation. The resident’s face sheet showed cognitive impairment, and progress notes documented bruising to the corner of the left eye, described as dark purple and approximately 3 cm by 0.5 cm, and additional bruising to the left upper arm measuring 10 cm by 5 cm, light purple/blue in color. The resident was alert and oriented to one sphere, confused, had impaired memory, and was unable to explain how either bruise occurred. No one witnessed how the bruising happened. The LPN who discovered the bruising stated she treated it as an injury of unknown origin and possible abuse, notified the DON, and completed a risk management/incident form that documented the unexplained bruising and the resident’s poor ability to report the cause. The DON acknowledged that a risk management form was completed but stated the bruising was considered explainable and therefore not treated as abuse, asserting it was plausible the resident sustained the bruise while swinging or forcefully pulling on a door handle, grab bar, or wheelchair component, despite there being no witnesses to such behavior and no behavior documented that corresponded with this explanation. The risk management/incident report signed by the DON characterized the bruising as plausibly self-inflicted based on behavioral observations, even though the resident was a poor historian, could not recall the cause, and there were no witnesses or prior safety alerts for that area. Social services staff reported the resident would hold the door handle and sometimes flail his arms when staff tried to remove his hands but had never seen the resident hit himself. The administrator later stated that unexplained bruising to the corner of a resident’s eye with no explanation and no witnesses should trigger an injury of unknown origin abuse investigation, and confirmed that no such abuse investigation was conducted, despite the facility’s abuse policy requiring investigation and reporting of suspicious injuries of unknown origin, including a black eye in a resident unable to communicate when no source is witnessed.
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