Failure to Protect Resident from Abuse and Inadequate Staff Training on De-escalation
Penalty
Summary
A cognitively and visually impaired resident with severe dementia, major depressive disorder, and anxiety was subjected to physical and emotional harm during care provided by two CNAs. The resident, who was assessed as high risk for abuse and dependent in activities of daily living, was observed on video footage being physically restrained and slapped by one CNA while the other CNA assisted in changing the resident. The resident was visibly distressed, screaming, and resisting care, yet the CNAs continued with the care without seeking assistance from a nursing supervisor or employing de-escalation techniques. The facility failed to ensure that staff were adequately trained or monitored in behavior de-escalation and dementia care. Interviews with the involved CNAs revealed that they did not recall receiving specific training on managing behaviors associated with dementia or de-escalation techniques. One CNA admitted to not being trained in dementia care and only signing in on an inservice sheet, while the other could not recall any relevant training. Both CNAs minimized the resident's resistance, with one stating that the resident always cried out during care and the other describing the physical contact as a "love tap." The facility's internal incident report did not accurately document the severity of the incident, omitting details such as the resident's audible screams, resistance, threats made by staff, and the slap to the resident's face. The report also failed to reflect the emotional harm experienced by the resident. Staff interviews indicated a lack of understanding of appropriate interventions for residents exhibiting distress or resistance to care, and there was no evidence that the facility provided staff with the necessary training or guidance to prevent abuse or respond appropriately to challenging behaviors.