Other·April 15, 2025

Modoc Medical Center DP SNF F 609 Reporting of Alleged Violations CFR(s): 483.12(b)(5)(i)(A)(B)(c)(1)(4) Based on interview and record review, the facility failed to report an injury of unknown origin for one of one Patient (Patient 1) sampled for abuse. Patient 1 was found to have significantly large suspicious bruising on both of her breasts from an unknown cause. The facility had not reported this to the California Department of Public Health (CDPH), Ombudsman (Patient advocate agency), or to their local Law Enforcement agency, or sent in a 5 day follow up report with the conclusion of their investigation within 5 days to CDPH, in accordance with their Abuse Policy. This failure resulted in the inability for CDPH, Ombudsman and Law Enforcement to gather additional information surrounding Patient 1's injuries and conduct their own investigation, which could negatively impact Patient 1's physical, emotional and psychosocial well-being and quality of life. Findings: A review of facility's policy provided by Director of Nursing (DON) titled, "Elder Abuse" dated January 2012, indicated abuse as the, "willful infliction of injury ...resulting in physical harm,pain, or mental anguish." Facility policy further indicated it would "identify events such as suspicious bruises on patients ...that may constitute abuse and determine the direction of the investigation." Facility policy indicated the facility would investigate alleged incidents and complete an SOC 341 form (a form used to report suspected elder abuse to the Ombudsman and CDPH), notify the Ombudsman, local Law Enforcement and call the Department of Health Services Licensing and Certification (CDPH), no later than two hours after the allegation is made. Then complete a written investigation report in writing to the Ombudsman, State Survey Certification Agency, and any other agency according to law. During a record review of Patient 1's admission record, Patient 1 was admitted to the facility on 5/28/19 with diagnoses that included failure to thrive (decline in overall health, including weight loss, decreased appetite, and reduced physical function stemming from various underlying medical or psychosocial issues), and dementia (loss of memory, language, and other thinking abilities that are severe enough to interfere with daily life). A record review of Patient 1's, "Wound, Skin Tear or Bruise Investigation Report" dated 8/20/24, completed by Registered Nurse (RN) A indicated, "Multiple bruises with different stages found [on Resident 1's breasts] during shower. Possible self-picking?" RN A documented that, "nursing interventions were to monitor untilresolved." A record review of Patient 1's, "Nursing Narrative Note Final Report" dated 8/20/24 5:03 pm, written by RN A, indicated a Certified Nursing Assistant (CNA), "reported that resident has multiple bruises on her breast and her right hand. Assessed resident [Resident 1's] body. Multiple bruises with different stages, yellowish and dark purple color. Physician Assistant assessed the bruises. DON and nurse supervisor notified. Nursing intervention: Monitor until healed ...and continue to investigate the incident." A record review of Patient 1's, "Long Term Care Progress Note Final Report" dated 8/20/24 4:41 pm, Medical Doctor (MD) A documented, "Extensive bruising to bilateral breast and right forearm. Noticed today by nursing while the patient received a bath." During a concurrent review facility's Abuse Policy and interview with the DON on 3/26/25 at 1:48 pm, DON stated, "we couldn't verify what happened." DON confirmed the facility had not completed an SOC-341 or reported Patient 1's suspicious bruises to CDPH, Ombudsman and local Law Enforcement, or reported the results of their investigation to CDPH within 5 days, in accordance with their Abuse Policy and State and Federal regulations. Therefore, this had a direct affect on the health, safety and welfare of Patient 1.