Failure to Report and Investigate Allegation of Sexual Abuse
Penalty
Summary
The facility failed to timely report an allegation of sexual abuse and to initiate an investigation as required by its abuse, neglect, exploitation, and misappropriation prevention program. Resident 1 was admitted with diagnoses including acute respiratory failure, diabetes mellitus, and hypertension, and later left the facility against medical advice on February 17, 2026. During an out-on-pass with a family member on February 15, 2026, Resident 1 allegedly reported that she had been sexually abused by a staff member in the facility. The family member stated that he reported the allegation to the sheriff and police department and then took Resident 1 home after discharging her AMA on February 17, 2026. The DON confirmed that law enforcement came to the facility in response to the resident’s allegation of abuse. However, the DON stated that the facility did not initiate its own investigation or report the allegation to CDPH because Resident 1 had already been discharged when the facility became aware of the alleged abuse. A subsequent review of the facility’s policy and procedure on Abuse, Neglect, Exploitation and Misappropriation Prevention Program showed that the facility was required to identify and investigate all possible incidents of abuse and to investigate and report any allegations within timeframes required by federal requirements. Despite this policy, the facility did not investigate or report the allegation involving Resident 1.
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