Failure to Timely Report Allegation of Abuse to DON and State Agency
Penalty
Summary
The deficiency involves the facility’s failure to immediately report an allegation of abuse involving a resident with contractures of the left elbow, wrist, and hand. The resident, who had documented capacity to understand and make decisions, told a family member that during the night a CNA slammed her left arm on the bed while attempting to wake her for a brief change. The resident reported feeling unsafe and wanting to leave the facility following the incident. There was no documented evidence in the electronic medical record that this allegation was reported to the DON, the administrator, or the State Agency within two hours of the allegation being made, as required. On the morning of the same date, the RNS became aware of an incident when the resident reported that the CNA had been rough with her during perineal care. The RNS acknowledged that this was considered an allegation of abuse that should have been reported immediately to the DON and to the State Agency, in accordance with facility expectations and policy. The RNS stated she did not report the incident to the DON or the State Agency. The DON confirmed that staff were expected to report any allegations of abuse to the DON and administrator within two hours and that such allegations should be reported to the State Agency. The facility’s Abuse, Neglect, and Exploitation policy required reporting all alleged violations to the administrator, state agency, and other required agencies immediately, but not later than two hours after the allegation is made.
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