Failure to Ensure CNA Competency in Dementia Care and Behavior Management
Penalty
Summary
Two Certified Nursing Assistants (CNAs) failed to demonstrate appropriate competency in dementia care and behavior management for a resident with severe cognitive impairment, Alzheimer's Disease, major depressive disorder, and anxiety disorder. The resident, who was non-verbal and exhibited care-resistant behaviors, had a care plan that required staff to use de-escalation strategies and ensure the resident felt safe during care. However, during an observed incident, the CNAs did not follow these interventions. A video provided by the resident's family showed one CNA repeatedly telling the resident to put his head down, physically restraining the resident's head and chest, and another CNA removing the resident's clothing in a rough manner. The resident was visibly distressed, screaming, and resisting care, but the CNAs continued without calling for a nursing supervisor. The video also captured one CNA slapping the resident's face after telling him not to scream. Interviews revealed that the CNAs could not recall receiving specific training on dementia care or de-escalation techniques, and one CNA stated she was floated between assignments without dementia-specific training. The facility's internal incident report did not accurately document the resident's distress or the physical actions taken by staff, omitting key details such as the slapping and audible screams. Staff interviews further indicated a lack of understanding of appropriate interventions for care-resistant behaviors.