Failure to Timely Report Verbal Abuse Allegation to State Agency
Penalty
Summary
The deficiency involves the facility’s failure to timely report an allegation of verbal abuse to the State Agency (SA) within the required two-hour timeframe, as required by federal regulation and the facility’s own Abuse Policy and Procedure. The policy dated 1/24/22 states that any alleged incident reported must be investigated and reported to the state within two hours of knowledge of the alleged incident. On 2/14/26 at approximately 8:40 AM, the resident representative (RR) for Resident #1 reported an allegation of verbal abuse, supported by an audio recording, to facility nursing staff. The RR requested to speak with administration and provided access to the recording to two RNs. Record review and interviews show that the allegation was promptly communicated internally but not reported externally within the required timeframe. RN #2, the RN Supervisor on Unit A, notified the DON by telephone at approximately 8:50 AM on 2/14/26. The DON then notified the Administrator at approximately 9:01 AM the same morning. Despite this, the allegation of abuse was not initially reported to the SA until 2/16/26 at 11:30 AM, well beyond the two-hour reporting requirement. The facility’s own investigation documentation dated 2/19/26 confirms these times and the delay in reporting. Interviews with the DON, Administrator, RR, and RN #2 corroborate the sequence of events and the delay. The DON acknowledged being notified of the allegation on 2/14/26 at approximately 8:50 AM and stated she reported the allegation to the SA on 2/16/26 at 11:30 AM. The Administrator confirmed he was notified by the DON on 2/14/26 at about 9:00 AM and that the allegation was not reported to the SA until 2/16/26. The RR confirmed she reported the verbal abuse allegation and shared the recording with nursing staff on the morning of 2/14/26. The Administrator confirmed that the facility failed to report the allegation of abuse within the required timeframe according to state and federal requirements, resulting in a deficiency at 42 CFR 483.12(c)(1)(4) for failure to timely report alleged violations.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.