Failure to Prevent Resident-to-Resident Physical Abuse
Penalty
Summary
The facility failed to protect a resident from abuse when an altercation occurred between two residents in a hallway. According to interviews and record review, one resident approached another, used profanity, and struck the resident across the face with an open hand while the second resident was conversing with a peer. The incident was unprovoked according to a witness, and there were no staff present to observe the event. The resident who was struck reported the incident, and the peer confirmed the account, stating that the aggressor hit the resident in the face hard. The aggressor claimed that the other resident initiated the altercation, but this was not corroborated by the witness or the victim. Both residents involved were documented as cognitively intact based on their most recent BIMS scores. The aggressor had a history of psychotic disorder and other medical conditions, while the victim had chronic obstructive pulmonary disease and other diagnoses. The facility's abuse policy affirms the right of residents to be free from abuse and outlines definitions and prohibitions against such behavior. Despite these policies, the facility did not ensure the prevention of abuse in this instance, as the altercation occurred without staff intervention or supervision.