Failure to Protect Resident from Physical Abuse During Incontinent Care
Penalty
Summary
A deficiency occurred when a nursing assistant (NA) provided incontinent care to a cognitively intact resident with a history of major depressive disorder, psychosis, and skin tears, despite the resident's refusal and resistance. The NA entered the resident's room early in the morning, introduced himself, and attempted to change the resident, who became immediately aggressive and refused care. The NA left the room to allow the resident to cool down, then returned and again attempted to provide care. During this interaction, the resident resisted, and the NA held the resident's arms while the resident was fighting, resulting in a skin tear to the resident's left lower forearm. The NA reported the resident's refusal to a nurse but could not recall which nurse instructed him to try again. Resident interviews revealed that the resident did not want to be changed, resisted the NA's attempts, and reported that the NA twisted his hands and caused a skin tear with his fingernails. The resident stated that the NA did not intend to hurt him but should have stopped when he resisted. Nursing documentation and staff statements confirmed the presence of skin tears on the resident's hand and left lower arm following the incident. The resident and a nurse both noted that the NA had a history of being rough with the resident, although the resident did not consider the incident to be intentional abuse. The facility's expectation, as stated by the DON and Administrator, was that all residents must be rounded on and provided with care, including opening briefs and cleaning as needed, regardless of behavioral history. The NA was expected to communicate refusals and resistance to the nurse, but the process for handling such refusals was not clearly documented in this incident. The event resulted in physical harm to the resident in the form of skin tears after care was provided against the resident's will.