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F0600
D

Failure to Protect Resident from Abuse and Neglect

Holdenville, Oklahoma Survey Completed on 12-10-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A resident with a history of falls, muscle wasting, atrophy, and moderate cognitive impairment required assistance with personal care and was continent of bowel and bladder. During an incident, the resident was found to have a bruise on their right arm, which was noticed by family members. The resident reported that a CNA was persistent in requiring the use of a bedpan instead of the requested bedside commode, and expressed not wanting that CNA to provide care again. The resident was unaware of how the bruise occurred but stated they were afraid of the CNA involved. Facility records indicate that two CNAs were working on the resident's hall at the time of the incident. The investigation determined that one CNA had forced the resident to use the bedpan against their wishes, failing to provide care as requested by the resident. This action was identified as neglect, as it did not meet the resident's needs and preferences, and resulted in emotional distress and physical harm as evidenced by the bruise.

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