Failure to Prevent Resident-to-Resident Abuse
Penalty
Summary
The facility failed to protect residents from physical and verbal abuse by other residents, as evidenced by three separate incidents involving multiple individuals. In the first incident, one resident with hypertension, hemiplegia, and a history of cerebral infarction was slapped in the face by another resident diagnosed with hypertension, anxiety disorder, schizophrenia, and bipolar disorder. The altercation began after a dispute over a TV remote, with the aggressor becoming agitated and physically striking the other resident. Staff and administrative interviews confirmed the physical abuse, and documentation indicated that the incident was substantiated. In a second event, a resident with extrapyramidal and movement disorder and schizophrenia was pushed and scratched by another resident with schizoaffective disorder and chronic pain. The altercation occurred in a common area after a verbal exchange escalated, resulting in one resident being pushed, falling, and sustaining a minor injury. Both residents were found to be cognitively intact, and the incident was confirmed as physical abuse through staff interviews and medical record review. The third incident involved verbal abuse, where a resident verbally threatened another following a disagreement about bathroom use. The aggressor confronted the other resident on the porch, using explicit language and making a direct threat of physical harm. Both parties acknowledged the incident, and the administrator confirmed that verbal abuse had occurred. Facility policies and residents' rights documents were referenced, outlining the definitions and expectations regarding abuse prevention, but the incidents demonstrated a failure to uphold these standards.