Failure to Protect Resident from Physical Abuse by Roommate
Penalty
Summary
The facility failed to ensure that a resident remained free from abuse, as required by policy, for one of four residents reviewed for abuse. The incident involved a resident who alleged that his roommate struck him in the mouth after a verbal exchange regarding slamming the door. The affected resident was found to have redness on the lower lip, which was documented in both the incident report and nursing progress notes. Staff statements confirmed that the resident reported being struck, although there were no witnesses to the event, and the resident denied experiencing pain or discomfort. The medical records indicate that the resident who reported the abuse was cognitively intact, with a BIMS score of 15, and had multiple diagnoses, including specified disorders of the brain and seizures. The roommate involved in the alleged incident had a history of chronic medical conditions and was no longer in the facility at the time of the investigation. The facility's abuse prevention policy prohibits and aims to prevent all forms of abuse, including physical abuse, but the incident was not substantiated due to lack of witnesses. Nevertheless, the documentation shows that the facility did not ensure the resident's right to remain free from abuse, as required.