Failure to Maintain Resident Dignity During Post-Fall Assessment
Penalty
Summary
A deficiency occurred when a registered nurse (RN) failed to treat a resident with dignity and respect during a post-fall assessment. The incident involved a female resident with a diagnosis of depression and an intact cognitive status, as indicated by a BIMS score of 13. After an unwitnessed fall in her room, the RN addressed the resident in a stern tone, asking, 'What is wrong with you?' and 'Do you want to break something?' while the resident was still on the floor. This interaction was captured on surveillance video and confirmed through observation and interviews. The resident's comprehensive care plan did not contain information related to dignity or respectful treatment. Interviews with facility leadership, including the ADON, ADM, and DON, confirmed that the resident was not treated with dignity, respect, consideration, or courtesy during the incident. The facility's admission packet also states that residents have the right to be treated with dignity, courtesy, consideration, and respect.