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F0600
D

Failure to Prevent Resident-to-Resident Physical Abuse

East Windsor, Connecticut Survey Completed on 04-24-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A resident with dementia, epilepsy, anxiety disorder, and depressive disorder was involved in a physical altercation with another resident who had a history of behavioral problems, including being inconsiderate to roommates and intentionally disturbing others. The incident occurred when the first resident was waiting at the nurse's medication cart and accidentally touched the second resident, who was attempting to pass by in a wheelchair. The second resident responded by shouting and then physically striking the first resident in the nose. The facility's documentation indicated that both residents had care plans addressing their behavioral issues, with interventions such as monitoring behaviors, documenting observed incidents, and intervening to protect the rights and safety of others. Despite these interventions, the altercation occurred, resulting in the first resident experiencing pain and discomfort, though no visible trauma was noted upon assessment. Staff present at the scene attempted to intervene but were unable to prevent the physical contact, and one staff member was injured while separating the residents. Interviews with the involved resident and staff confirmed the sequence of events, with the resident expressing feelings of embarrassment and fear following the incident. The facility's abuse policy prohibits abuse, neglect, and mistreatment by anyone, including other residents. The report documents that the facility failed to protect the resident from physical abuse by another resident with a known history of altercations.

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