Resident Slapped by CNA During Care Following Behavioral Incident
Penalty
Summary
A deficiency occurred when a certified nurse aide was witnessed slapping a resident on the head during care. The resident involved had diagnoses including dementia with severe agitation, polyosteoarthritis, and a history of falls, and was assessed as rarely or never able to understand or communicate. The care plan for this resident included interventions for behavioral challenges, such as establishing trust, monitoring mood and behavior, and using diversions and support during care. During an episode of care, the resident bit the aide's arm, and the aide responded by slapping the resident's head in an attempt to get free. Multiple staff interviews and statements confirmed that the aide reacted physically to being bitten, with one aide witnessing and hearing the slap, and the involved aide admitting to the action, stating it was a reaction to pain. The incident was reported by staff to nursing supervisors and the DON, and the event was documented as having been witnessed. The family of the resident was informed and expressed dissatisfaction with the occurrence, emphasizing that such actions should not happen regardless of intent. Facility policies reviewed during the investigation clearly prohibit any form of physical abuse or mistreatment, including slapping or hitting residents. Despite the lack of intent to harm, the act of slapping the resident was recognized by staff and supervisors as inappropriate and a form of physical abuse. The incident was reported to the Department of Health as an allegation of abuse, and the facility's investigation verified that physical contact occurred in response to the resident's behavior.