Failure to Protect Resident from Physical Abuse During Care
Penalty
Summary
A deficiency occurred when a certified nurse aide (CNA) physically tapped a resident's hand during a shower after the resident became combative. The resident, who had diagnoses including anxiety disorder, cognitive communication deficit, and insomnia, was known to be non-compliant and combative with care such as transfers and showers. During the incident, the CNA self-reported that they tapped the resident's hand in response to the resident's combative behavior. Another CNA was present and witnessed the event, describing the tap as not aggressive, but noted that the resident's behavior escalated afterward. A skin assessment later revealed a bruise on the resident's right hand and additional bruises on the upper arm, consistent with the physical contact described. The facility's policy prohibits all forms of abuse, including physical abuse such as hitting or slapping, and requires staff to follow procedures for managing combative behavior. However, the involved staff did not adhere to these policies. The CNA involved admitted to the action, and the witnessing CNA did not report the incident until after the primary CNA self-reported. The LPN on duty was informed of the incident and observed a reddened area on the resident's hand, but the CNAs were not immediately removed from duty. The LPN also reported that the witnessing CNA initially denied the incident until learning it had already been reported. Further, the RN supervisor was informed of the situation but did not take appropriate action according to facility policy, as the involved staff were sent back to work after the initial report. The DON and administrator were not notified until the following day. The investigation concluded that the CNA's action constituted physical abuse, and the staff involved failed to follow established procedures for reporting and managing abuse and combative behavior.