Failure to Report Alleged Verbal Abuse to State Agency
Penalty
Summary
The facility failed to report an allegation of verbal abuse by staff to the State Agency as required by its Abuse, Neglect, Exploitation Policy. The policy, dated 1/23/26, states that the facility will report all alleged violations to the Administrator, state agency, adult protective services, and other required agencies within specified timeframes, including immediately but not later than two hours after an allegation involving abuse. On 2/11/26, a resident (R2) reported to the ADON (V3) in the dining room that two CNAs (V6 and V7) had used foul language toward her and called her a c**t. V3 stated she immediately reported the allegation to the DON (V2), who instructed her to report it to corporate staff (V4 and V12), which she did. At the time of the survey on 3/20/26, a review of the facility’s reports to the State Agency showed no documentation that this verbal abuse allegation had been reported. Corporate staff (V4, President of Operations, and V12, Regional Director) confirmed they were covering for the Administrator during the week of the allegation. V12 stated that V2 informed her that R2 claimed two CNAs had called her a c**t and were being mean to her. V4 and V12 then interviewed R2 in an office; V12 reported that R2 changed her story and said no one called her names, but that she did not like the care she was receiving. Based on this, V12 did not believe it qualified as an abuse allegation, and no report was sent to the State Agency. In contrast, during the survey interview on 3/20/26, R2 stated she had told V3 that two CNAs had called her a c**t a few nights prior and that, when questioned later by two older women identified as V4 and V12, she again reported that the CNAs had called her a c**t, though she did not repeat their names because she had already given them to V3. Despite these allegations and the facility’s written policy, the incident was not reported to the State Agency.
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