Failure to Protect Residents Following Staff-to-Resident Abuse Allegation
Penalty
Summary
The facility failed to protect residents from further abuse by staff following an allegation of staff-to-resident abuse. Specifically, a resident reported to CNAs that a male CNA was rough while cleaning the perineal area during a shower, resulting in a 2 cm by 1 cm open area with bleeding on the scrotum. The incident was documented in nursing notes, and the resident's family and the administrator were notified. Multiple staff interviews confirmed that the resident reported the male CNA was rough, and that the injury was observed and reported to nursing staff. The CNA in question was identified as the only male CNA working on the resident's hallway during the relevant shift, and assignment records confirmed his presence on the unit with the resident and other residents. Despite the resident's report and staff observations, the administrator did not consider the incident to be an abuse allegation and did not report it to the state health department. The alleged perpetrator was not suspended pending investigation, contrary to the facility's own abuse prohibition and reporting policy, which requires immediate suspension of any employee alleged to have committed abuse. The CNA continued to work on the unit with other residents after the allegation was made, and no immediate protective measures were implemented.