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F0557
D

Failure to Ensure Respectful and Dignified Treatment During Care

Fitchburg, Massachusetts Survey Completed on 09-17-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A deficiency occurred when a certified nurse aide (CNA) failed to treat a severely cognitively impaired resident with respect and dignity during the provision of care. The resident, who had Lewy Body Dementia and PTSD, was admitted with severe cognitive impairment and a history of behavioral symptoms and rejection of care. During an episode of incontinence care, the CNA was overheard by multiple staff members yelling profanities and derogatory language at the resident in a loud and raised tone of voice while in the bathroom. Witnesses, including a nurse and another CNA, reported hearing the CNA use explicit language such as 'fucking dumb ass' and 'you fucking stand up' directed at the resident. The nurse responded by attempting to intervene, instructing the CNA to stop and exit the bathroom, but the CNA initially refused, citing the resident's unsafe position. Additional staff were summoned to assist, and the CNA eventually left the bathroom after repeated requests. The incident was reported to supervisory staff, including the shift supervisor and the DON, who confirmed through interviews and written statements that the CNA admitted to using inappropriate language and acknowledged her conduct was not respectful. The facility's policies on abuse investigation, reporting, and resident rights require all residents to be treated with respect and dignity. The CNA's actions, as directly observed and reported by staff, constituted a failure to uphold these standards, resulting in the resident being subjected to disrespectful and undignified treatment during care.

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