Failure to Prevent Resident Abuse and Neglect
Penalty
Summary
The facility failed to protect residents from abuse and neglect, as evidenced by two separate incidents involving two cognitively intact residents. In the first incident, a resident with anxiety and depression reported that a nurse aide intentionally struck their foot with a linen cart and then verbally abused and threatened them. The nurse aide was overheard yelling at the resident, making threatening statements, and using profane language. This behavior was witnessed by a registered nurse, who confirmed the verbal abuse and threats directed at the resident. In the second incident, another resident with depression, muscle weakness, and a need for assistance with personal care reported being afraid to use the call bell for help during a night shift due to intimidating comments made by their assigned nurse aide. The resident stated they were not changed throughout the shift and remained in a soiled brief until the following morning. The resident's bed was found soaked and required cleaning due to a strong urine odor. Documentation and interviews revealed that the nurse aide made disparaging remarks to the resident and other residents under their care, contributing to an environment of intimidation and neglect. Both incidents were substantiated through staff witness statements, resident interviews, and facility documentation. The facility's failure to prevent and address these actions resulted in residents being subjected to verbal abuse, threats, and neglect, contrary to facility policy and regulatory requirements for resident rights and safety.