Failure to Identify and Respond to Verbal and Emotional Abuse
Penalty
Summary
The facility failed to ensure that staff were fully trained to correctly identify and respond to mental, emotional, and verbal abuse. A certified nursing assistant (CNA) yelled at a resident, made disparaging comments about the resident's ability to perform bed mobility, and humiliated the resident regarding her weight and size. The incident occurred late at night when the resident was alone and in a vulnerable state. The resident reported feeling unsafe, worthless, and emotionally distressed, and was observed crying during the interview. The resident's husband confirmed the negative impact of the incident on his wife. Other staff, including a housekeeper, were aware of the CNA's rude behavior but did not report it. The charge nurse (CN) on duty at the time was not adequately trained to collect pertinent information to make an accurate determination of abuse. When the incident was reported, the CN only received vague information and did not clarify the details or escalate the situation for further guidance. As a result, the CNA involved was allowed to finish her shift and continue providing care to residents after the incident. The director of staff development (DSD) and other leadership staff later acknowledged that the incident constituted verbal and mental abuse, and that the CN should have gathered more information and reported the incident appropriately. A review of facility policies and staff interviews revealed that while abuse prevention training was provided, it did not sufficiently cover the distinction between rudeness and abuse or equip staff in charge with the skills to thoroughly investigate and report abuse allegations. The CNA involved had a documented history of negative behavior, including previous written warnings. The failure to properly identify, report, and respond to the abuse incident resulted in the potential for other residents to experience similar mistreatment.