Physical Abuse of Resident Following Escalation Due to Denied Request
Penalty
Summary
A deficiency occurred when a staff member physically abused a resident by striking them in the face with a closed fist, resulting in an injured eyelid and a broken nose. The incident took place after the resident, who has a history of mental health disorders including major depressive disorder, PTSD, traumatic brain injury, Alzheimer's, and paranoid schizophrenia, became agitated when denied a cigarette outside of scheduled smoking times. The resident's care plan noted a pattern of agitation and aggression when requests were denied, particularly regarding smoking, but did not include documented interventions for managing escalating behaviors. On the day of the incident, the resident requested a cigarette and soda from a nurse, who informed them they would have to wait until the scheduled time. The resident became increasingly agitated, and multiple staff reiterated the denial. The resident then grabbed a CNA by the shirt collar and appeared to push the CNA down the hallway. Another CNA intervened by approaching and striking the resident in the right eye, causing visible injury. The staff did not attempt to de-escalate the situation with alternative options or interventions, despite being aware of the resident's behavioral triggers. Interviews with staff revealed that they had not received formal mental health training prior to working at the facility, and their preparation consisted mainly of reading a training manual. Staff acknowledged the resident's known triggers and aggressive behaviors but did not implement any specific de-escalation techniques or alternative strategies during the incident. The lack of documented behavioral interventions and insufficient staff training contributed to the escalation and subsequent physical abuse of the resident.