Failure to Prevent and Report Verbal Abuse Among Residents
Penalty
Summary
The facility failed to prevent and properly report verbal abuse for two residents who were subjected to repeated racial and discriminatory remarks by other residents. One resident, admitted with respiratory failure and cognitively intact, experienced multiple incidents where another resident made derogatory comments about their language and ethnicity in the presence of staff, family, and other residents. Despite these repeated outbursts, staff responses were limited to apologizing to the affected resident and advising them to avoid the perpetrator or ignore the comments, rather than intervening or addressing the abusive behavior. No documentation of an internal investigation or facility-reported incident was provided for these events, and staff did not report the incidents to the appropriate authorities as required by facility policy. Another resident, with dementia and anxiety, reported being subjected to a racial slur by a former roommate following an argument. This incident led the resident to avoid communal areas due to discomfort and fear of further interaction. Again, the facility did not provide any documentation of an investigation or facility-reported incident related to this verbal abuse. Interviews with facility leadership confirmed awareness of the incidents but revealed no evidence of timely reporting or investigation, as required by the facility's abuse policy.