Other·April 10, 2023

§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. Title 22 § 72523. Patient Care Policies and Procedures. (a)Written patient care policies and procedures shall be established and implemented to ensure that patient-related goals and facility objectives are achieved. Title 22 § 72541. Unusual Occurrences. Occurrences such as epidemic outbreaks, poisonings, fires, major accidents, death from unnatural causes or other catastrophes and unusual occurrences which threaten the welfare, safety or health of patients, personnel or visitors shall be reported by the facility within 24 hours either by telephone (and confirmed in writing) or by telegraph to the local health officer and the Department. An incident report shall be retained on file by the facility for one year. The facility shall furnish such other pertinent information related to such occurrences as the local health officer or the Department may require. Every fire or explosion which occurs in or on the premises shall be reported within 24 hours to the local fire authority or in areas not having an organized fire service, to the State Fire Marshal. On 2/18/2023, the State Survey Agency (SSA) made an unannounced visit to the facility to conduct a complaint investigation regarding Resident-to-Resident abuse. The facility failed to follow its policy and procedures regarding reporting an unusual occurrence for Resident 2, who sustained a bruise to the left upper cheek and left under eye. As a result, Resident 2 was placed at risk for further abuse, injuries of unknown origin, and in a delay of an onsite inspection by the SSA to ensure the safety of the Resident 2. A review of Resident 2's Admission Record (Facesheet) indicated Resident 2, a 95 year-old female was admitted to the facility on 4/4/2021 with diagnoses including dysphagia (swallowing difficulties), acute kidney failure (occurs when one's kidneys suddenly become unable to filter waste products from your blood) and muscle weakness (Lack of strength in the muscles-when one's full effort doesn't produce a normal muscle contraction or movement). A review of Resident 2's Minimum Data Set (MDS - a comprehensive assessment used as a care-planning tool), dated 1/9/2023 indicated Resident 2's cognition (ability to think, understand and reason) was severely impaired. The MDS indicated Resident 2 required limited assistance from staff with bed mobility, transfer, locomotion on unit, dressing, toilet use and personal hygiene. It further indicated that Resident 2 required supervision for eating. During an observation and a concurrent interview on 2/18/23 at 1:45 pm, Resident 2 was observed to have a bruise extending from the external upper left cheek to under the left eye all the way to the inner aspect of the eye. Resident 2 was unable to state how the bruise got there. During an interview on 2/18/23 at 2:00 pm, Licensed Vocational Nurse 2 (LVN 2) stated she noticed that Resident 2 had a bruise to her left cheek/under eye which was very noticeable at the beginning of her shift. LVN 2 further stated the charge nurse that was assigned to Resident 2 on the shift prior stated that she had not noticed the bruise until LVN 1 pointed it out. A review of the Change of Condition (COC) dated 2/11/23 at 2/11/23 at 4:13 pm, indicated LVN 2 noted Resident 2 to have left facial area discoloration her left eye during her rounds about 7:10 am. The same COC indicated the clinician was notified at 11:00 am. During an interview with the Director of Nursing (DON), on 3/9/23 at 3:23 pm, the DON confirmed and stated the bruise would be considered an injury of unknown origin. The DON was unable to state the steps required to handle an injury of unknown origin. During an interview with the administrator (ADMN), on 3/9/23 at 3:55 pm, the ADMN confirmed that the bruise was an injury of unknown origin and that it should have been reported to the Department of Public Health (DPH). The ADMN further stated that reporting the injury to DPH would be for resident safety and preventing further injuries. A review of the facility's policy and procedures titled "Injuries of unknown origin-Investigation," revised 11/18/2015, indicated, to protect the health and safety of residents by ensuring that all unexplained injuries are promptly and thoroughly investigated and addressed. An injury of unknown source is defined as an injury that meets both of the following conditions: 1. The source of the injury was not observed by any person, or the source of the injury could not be explained by the resident; and 2. The injury is suspicious because of the extent of the injury; the location of the injury (e.g., the injury is located in an area not generally vulnerable to trauma; the number of injuries observed at one particular point in time; or the incidence of injury over time.) The same policy further indicated unexplained injuries are promptly and thoroughly investigated by the Director of Nursing Services and/or other staff person appointed by the Administrator, to ensure that resident safety is not compromised, and action is taken whenever possible, to avoid future occurrences. The facility failed to follow its policy and procedures regarding reporting an unusual occurrence for one of three sampled residents, (Resident 2) who sustained a bruise to the left upper cheek and left under eye. The above violations had a direct or immediate relationship to the health, safety, or security of Resident 2.