|§483.12(c) In response to allegations of abuse, neglect, exploitation, or mistreatment, the facility must:|
§483.12(c)(1) Ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures.
§483.12(c)(4) Report the results of all investigations to the administrator or his or her designated representative and to other officials in accordance with State law, including to the State Survey Agency, within 5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken.
Based on a review of clinical records and the facility's abuse prohibition policy and procedure and staff, resident and family interviews it was determined the facility failed to identify and timely report an injury of unknown origin to the State Survey Agency and report the results of the investigation of the the injury of unknown source to rule out abuse, neglect or mistreatment as the cause of the injury sustained by one resident out of five sampled residents (Resident 1).
A review of the facility policy and procedure entitled "Resident Abuse" last revised by the facility September 1, 2016 indicated that It is inherent in the nature and dignity of each resident at The Company that he/she be afforded basic human rights, including the right to be free from abuse, neglect, mistreatment, and/or misappropriation of property. The management of the facility recognizes these rights and hereby establishes the following statements, policies, and procedures to protect these rights and to establish a disciplinary policy, which results in the fair and timely treatment of occurrences of resident abuse. All reported events (bruises, skin tears, falls, inappropriate or abusive behaviors) will be investigated by the Director of Clinical Services.
A review of Resident 1 was admitted to the facility on October 23, 2020 with diagnoses that included diabetes, anxiety, hypertension. Review of a quarterly Minimum Data Set (MDS assessment -a federally mandated standardized assessment of a resident's abilities and care needs) of Resident 1 dated January 28, 2021, revealed that the resident was cognitively intact.
A review of Resident 1's clinical record revealed documentation dated January 20, 2021, at 5:50 AM, that the resident alerted the nurse at 5:30 AM that her right middle finger was hurting. "Right middle finger is red, warm to the touch, painful upon touch and a yellowy-whitish chalky center is present." The physician ordered Keflex (antibiotic) three times a day for five days and soak in water for 20 minutes three times a day.
There was no documented evidence at the time of the survey ending March 23, 2021, that the facility had conducted an investigation into the origin of Resident 1's injury to her finger.
A review of a physician progress note dated January 21, 2021, revealed that Resident 1 was examined "she is COVID-19 positive, also anemic and she is refusing her iron". There was no evidence that the physician assessed the resident's painful right middle finger during this resident examination or identified a potential cause for the injury.
Resident 1's clinical record revealed documentation dated January 28, 2021, at 3:43 PM which indicated that the physician ordered betadine to the resident's right index finger twice a day for 3 days and Doxycycline (antibiotic) two times a day for 5 days for a diagnosis of cellulitis. There was no indication that an assessment was completed, no further documentation available on this date related to the condition of the resident's finger or the source of the injury.
A review of Resident 1's clinical record revealed documentation dated February 11, 2021, at 3:42 PM that due to the resident's continued complaints of pain of her right index finger, the physician ordered an x-ray of the right hand.
Review of x-ray results dated February 11, 2021, revealed that the resident had a minimally displaced fracture in the base of the third distal phalanx, more likely acute to subacute.
Interview was conducted with Resident 1 on March 23, 2021, at 10:10 AM. Resident 1 stated that her finger was injured while struggling with "that Debbie across the hall" (Resident 2). Resident 1 further stated that Resident 2 came into her room and she "went to pull the tray away from me and I pulled back." According to Resident 1, she yelled loudly at Resident 2 to leave her room.
Interview with the resident's daughter on March 18, 2021, revealed that the resident had reported to her daughter that the injury to her finger was "caused by another patient." The resident relayed to her daughter that another resident (Resident 2) frequently wanders into her room and takes her personal belongings. The resident informed her daughter that Resident 2 had wandered into her room and the residents were involved in a physical struggle during which Resident 1 broke her finger. The resident told her daughter that she had relayed this account to a staff member (last name identified) but that staff member allegedly told the resident not to report the incident since is was "too much paper work."
A review of information submitted by the facility through the time of the survey ending March 23, 2021, revealed that no evidence that the facility had reported anything similar to this allegation to the State Survey Agency.
There was no documented evidence that the facility had identified and acted upon Resident 1's injury of unknown origin or allegation of resident to resident abuse perpetrated by Resident 2 against Resident 1.
Review of Resident 2's clinical record revealed admission to the facility on November 4, 2016 with diagnoses that included dementia with behaviors, major depression, and dysphagia (difficulty swallowing).
Review of an Annual Minimum Data Set (MDS) assessment of Resident 2 dated February 10, 2021, revealed that the resident was severely cognitively impaired.
Review of Resident 2's plan of care initiated October 11, 2018, revealed that the resident is/has potential to be verbally and physically abusive towards staff due to anxiety and mood disorder from known physiological condition with depressive features and updated December 6, 2019 for taking items that don't belong to her. Review of Resident 2's plan of care revealed interventions, which included to keep the resident separated from resident "R.L. Rm 15-1, rm 10A and rm 23B."
Interview with Nursing Home Administrator on March 23, 2021, at approximately 2:30 PM confirmed that the facility did not identify the resident's fractured finger as an injury of unknown origin and timely conduct an investigation to rule out abuse or neglect as the cause of Resident 1's fractured finger and report the results of the investigation to the State Survey Agency.
28 Pa. Code 201.14(a) Responsibility of licensee.
28 Pa. Code 201.18(e)(1) Management.
28 Pa. Code 201.29 (c)(d) Resident Rights
| ||Plan of Correction - To be completed: 04/20/2021|
1. The incident of Res 1 was reported to the State Surveying Agency on 4/8/21.
2. Residents with incidents and accidents in the last 30 days was reviewed by the DON or designee to ensure identification and timely reporting of an injury of unknown origin to the State Survey Agency as well as reporting of the results of the investigation of the injury of unknown source to rule out abuse, or mistreatment as the cause of the injury.
3. DON or designee will complete re-education with nursing staff on the facility's abuse policy with emphasis placed on investigating injuries of unknown origin. Incident and accident investigations will be reviewed by the Interdisciplinary Team (IDT) during the morning clinical meeting.
4. Quality reviews of incidents and accidents will be completed by DON or designee 5x's/week for 12 weeks to ensure identification and timely reporting of an injury of unknown origin to the State Survey Agency as well as reporting of the results of the investigation of the injury of unknown source to rule out abuse, or mistreatment as the cause of the injury. Findings to be reviewed at QAPI committee and updated as indicated. Quality review schedule to be modified based off of findings.