Failure to Protect Resident from Verbal and Physical Abuse During Incontinence Care
Penalty
Summary
A deficiency occurred when a certified nursing assistant (CNA) physically and verbally abused a resident during incontinence care. The resident, who had moderate cognitive impairment, anxiety disorder, fibromyalgia, and venous hypertension, was dependent on staff for hygiene and mobility. During the incident, the resident expressed refusal to be changed, became agitated, and attempted to resist care by hitting and cursing at the CNA. Despite the resident's refusal and agitation, the CNA continued to provide care, using increased force to turn and reposition the resident, and verbally yelled at the resident. Another CNA present witnessed the incident and reported that the CNA used profane language and handled the resident roughly, including slamming the resident's legs onto the bed and forcefully turning the resident by the shoulder and hip. The facility's policy prohibits all forms of abuse and requires staff to respect residents' rights to refuse care. The CNA involved admitted to using more force than usual and acknowledged that the resident was combative during care. The CNA also reported the incident to a nurse, expressing concern about the amount of force used. The other CNA present attempted to intervene by asking the CNA to leave the room multiple times, but the CNA completed the care before leaving. The incident was reported to nursing staff, and an assessment was conducted, which did not reveal new injuries but did note some older discolorations on the resident's arms. Documentation and reporting procedures were not fully followed according to facility policy. The electronic medical record did not contain documentation related to the abuse report, and the nurse who assessed the resident did not complete a progress note about the incident or the assessment. Interviews with staff indicated that they were aware of the correct procedures for reporting and documenting abuse allegations, but these procedures were not consistently implemented in this case.