Failure to Prevent Verbal Abuse and Honor Resident Care Preferences
Penalty
Summary
A deficiency occurred when a resident, who was legally blind and had a history of major depressive disorder, was subjected to verbal abuse by a Certified Nursing Assistant (CNA). The resident had previously communicated to both the Licensed Vocational Nurse (LVN) and the Administrator that he did not want this CNA assigned to his care, due to a history of not getting along. Despite these requests, the CNA was assigned to the resident, and an altercation ensued in which the CNA yelled at the resident, used curse words, and called him names. The incident escalated to the point where a Registered Nurse (RN) had to intervene to separate the CNA and the resident. The facility failed to follow its own policies and procedures regarding abuse prevention and resident dignity. The policies required staff to identify, correct, and intervene in situations where abuse was more likely to occur, and to honor residents' preferences regarding their caregivers. Staff interviews confirmed that the resident's preferences were known but not consistently communicated or honored in the assignment process. The CNA and other staff acknowledged that the resident had expressed a desire not to be cared for by this particular CNA, but the assignment was not changed, leading to the incident. The failure to accommodate the resident's preferences and to prevent the assignment of the CNA resulted in the resident experiencing verbal abuse and a negative impact on his psychosocial well-being. The incident was recognized by the Director of Nursing and other staff as a violation of the resident's rights and facility policy, specifically regarding the expectation that residents be treated with dignity and respect at all times.