Failure to Protect Resident from Verbal Abuse by CNA
Penalty
Summary
A deficiency occurred when a resident with multiple diagnoses, including bipolar disorder, schizoaffective disorder, and moderately impaired cognition, was subjected to verbal abuse by a certified nursing assistant (CNA). The incident was witnessed by a hospice aide, who reported that the CNA entered the resident's room and spoke to her in a loud, aggressive manner, telling her not to turn on her call light repeatedly and threatening to take the call light away. The hospice aide described the CNA as yelling and being verbally loud, which left the resident visibly upset and quiet after the interaction. Despite the report from the hospice aide and corroborating accounts from another CNA and the hospice director, the facility administrator did not initiate a self-reported incident (SRI) or conduct a formal investigation. The administrator did not interview the CNA involved, the resident, or other staff present during the incident. Furthermore, the CNA continued to work with residents after the event, and there was no documentation of any education or corrective action provided to the CNA regarding abuse or customer service. The resident herself reported to surveyors that she had experienced verbal abuse from the CNA on multiple occasions, including being yelled at and called obsessive compulsive. She stated she had reported these incidents to the DON and the ombudsman, but no effective action was taken, and she continued to be cared for by the same CNA. Facility policy required immediate reporting, investigation, and protective measures in response to allegations of abuse, but these procedures were not followed in this case.