Failure to Prevent Resident-to-Resident Abuse Resulting in Physical Harm
Penalty
Summary
The facility failed to protect three residents from abuse, resulting in significant physical harm. One resident with a history of schizoaffective and bipolar disorder, who was experiencing delusions and agitated behavior, entered another resident's room and punched them in the mouth. This incident caused the victim to lose a dental implant and a natural tooth, resulting in bleeding and distress. Multiple staff interviews and medical records confirmed the physical altercation and the extent of the dental injuries, which required further dental evaluation and treatment. In a separate incident, two roommates were involved in a physical altercation over a television remote. One resident attempted to retrieve the remote from the other, leading to a physical struggle in which one was kicked in the face and responded by punching the other in the head multiple times. Both residents sustained injuries: one had a laceration to the upper lip, and the other complained of a headache after being kicked in the head. Staff interviews and hospital records corroborated the sequence of events and the resulting injuries. The facility's own policies affirm the right of residents to be free from abuse, including physical harm inflicted by others. Despite these policies, the incidents described involved residents inflicting physical harm on each other, with staff only becoming aware after the events had occurred. The facility's monitoring and supervision were insufficient to prevent these abusive incidents, as evidenced by the residents' ability to engage in physical altercations resulting in injury.