Failure to Protect Resident from Physical Abuse by CNA
Penalty
Summary
A certified nursing assistant (CNA) physically abused a resident by grabbing and twisting the resident's arm and then placing her hands on the resident's neck and choking her. The incident was witnessed by another CNA and a resident, both of whom confirmed that the CNA grabbed the resident's arm, twisted it, and choked her. The resident, who has a history of trauma related to domestic abuse and physical assault, was left with visible injuries including scratches, bruising, and red marks on her arm and neck. The resident was observed to be upset and tearful following the incident, and her injuries were documented by multiple staff members. The resident involved had significant medical and psychological conditions, including hemiplegia, hemiparesis, vascular dementia, bipolar disorder, and anxiety disorder. She had moderate cognitive impairment but was usually able to make herself understood. Her care plan included trauma-informed interventions and communication support due to expressive aphasia. At the time of the incident, the resident was able to communicate through gestures and yes/no responses, confirming the details of the abuse and identifying witnesses. The incident was corroborated by physical evidence and multiple staff and resident interviews. The facility failed to ensure the resident's right to be free from abuse and neglect, as required by policy and regulation. The CNA's actions constituted willful physical abuse, resulting in physical harm and emotional distress to the resident. The deficiency was further compounded by the fact that not all staff had been trained on behavior management procedures, abuse prevention, and trauma-informed care plans at the time of the incident, which could place other residents at risk of harm.
Removal Plan
- Review completed facility self-reported incident to HHSC for Resident #1
- Interview Resident #2, Resident #3, Resident #4, Resident #5, and Resident #6 to confirm no other residents had been abused and that they enjoyed the facility staff
- Suspend CNA A pending completion of investigation into allegations of abuse
- Terminate CNA A after substantiating the allegation of abuse
- Verify CNA A had a criminal history check before hire
- Report the incident between CNA A and Resident #1 to the local police department
- Conduct safe survey resident interviews to confirm no other residents complained of abuse/neglect or misappropriation and that residents felt safe
- Provide in-service education on abuse and neglect to facility staff
- Provide in-service education on behavior management to facility staff
- Interview staff to confirm understanding of abuse, reporting procedures, behavior management, and de-escalation techniques
- Complete a trauma assessment for Resident #1 by the MDS Coordinator
- Add Resident #1 to psych services and ensure a provider visit