ISDH IJ/SSQC Update

There were three events in the month of July that led to 7 IJ citations being issued all of which were also SSQC.

The first event, citing F225 and 226, involved the lack of investigation and reporting of allegations of sexual abuse by a staff member of a resident.   In this particular case, a resident who apparently had a history of making false accusations reported that a female staff member was having sex with a male resident in the resident’s room (the resident making the accusation was the roommate).  The Administrator did not take the accusation as credible due to the resident’s history and the details of the accusation.  However, the ISDH took exception with the lack of investigation and reporting to the ISDH of this allegation. 

The second event involved the failure to order and monitory lab values for 2 residents receiving Warfarin.  The failure resulted in citation of F329 and was cited as past noncompliance as the facility caught its error and corrected it prior to survey.  The error was due to miscommunication during a conversion of physician orders to a new computer system.

The third event involved the failure of the facility and the facility’s management to address and report verbal abuse by the Administrator to residents and staff.  Citations were issued for F223, F225, F225, and F490, all related to the alleged verbal abuse by the Administrator.  Behavior of the Administrator was described as demeaning, humiliating, and threatening to residents and staff.  Staff reported to ISDH that they had called the corporate hotline several times concerning the Administrator.  F490 was issued due to the management’s alleged failure to ensure the facility was administered to attain or maintain the highest practicable mental and psychosocial well-being of each resident based upon the behavior of the Administrator.

To review the 2567s for the July IJs/SSQCs and for a summary of all IJs/SSQCs in 2014, click here.