Physical Abuse of Resident by CNA During Behavioral Incident
Penalty
Summary
A deficiency occurred when a certified nurse aide (CNA) physically abused a resident during an altercation. The incident began when the resident, who had a history of impulse disorder, paranoid schizophrenia, and obsessive-compulsive personality disorder, became upset about not having a cigarette. The resident, described as severely cognitively impaired and with a history of physical aggression, was running toward a door when the CNA attempted to intervene by grabbing the resident from behind. The resident responded by striking the CNA in the face and pulling the CNA's hair. In response, the CNA struck the resident in the face with a closed fist, causing both to fall to the floor, with the CNA on top of the resident and continuing to swing at the resident with a closed fist. Multiple staff members, including another CNA and an LPN, witnessed the CNA on top of the resident, with the resident sustaining visible injuries such as a laceration and bleeding from the nose, a scratch under the left eye, and later confirmed acute avulsion fracture of the distal nasal bone. The altercation required intervention from several staff members to separate the CNA from the resident. Witnesses reported that the CNA continued to strike the resident even after both were on the floor, and staff described the incident as abuse, noting that the CNA's actions were excessive and not in line with de-escalation or non-physical intervention techniques outlined in facility policy. The facility's own policies emphasized the use of non-physical interventions and de-escalation as first-line responses to behavioral crises, and specifically prohibited the use of force or physical punishment. Despite these policies, the CNA engaged in physical violence against the resident, resulting in significant injury. The incident was reported to law enforcement as an assault, and medical evaluation confirmed the extent of the resident's injuries. Multiple interviews with staff and another resident corroborated that the CNA's actions constituted physical abuse.