Failure to Provide Required Abuse-Prevention In-Service Before CNA Returned to Direct Care
Penalty
Summary
The deficiency involves the facility’s failure to follow its Abuse, Neglect, Exploitation and Misappropriation Prevention Program policy requiring appropriate in‑service training on resident rights and abuse prevention prior to staff having direct-care responsibilities. A resident admitted with diagnoses including diverticulitis, muscle weakness, dysphagia, depression, and colostomy status had documented cognitive capacity to understand and make decisions and required moderate to maximum assistance with ADLs. On a specified date, progress notes documented that this resident reported an allegation of abuse involving a CNA on the night shift. According to the resident’s report in the progress notes, the CNA allegedly woke the resident aggressively, threw two towels on the resident’s chest and another towel on the colostomy site, and turned and pulled the resident while providing incontinence care. The resident further alleged that the CNA made arm gestures with two closed fists and stated that if the resident spoke up about what happened, the resident would be hit, causing the resident to feel afraid of the CNA. The facility initiated an investigation and suspended the CNA pending the outcome, as reflected in the facility’s 5‑day conclusion of the facility‑reported incident. Record review showed that the CNA returned to work and provided resident care on a later date, as indicated by the time sheet. The Quality Assurance Nurse’s in‑service record for the CNA was dated after the CNA had already returned and provided care. In interviews, the Quality Assurance Nurse confirmed that he did not provide an in‑service to the CNA prior to the CNA resuming resident care, and the Director of Staff Development acknowledged she was responsible for providing one‑on‑one in‑service training before the CNA provided care but had not done so. The Administrator confirmed that the CNA was called back to work after the investigation was concluded and that in‑service training was not completed before the CNA’s shift, contrary to the facility’s policy requiring staff training on preventing, recognizing, and reporting abuse, and on resident dignity and respect, prior to having direct-care responsibilities.
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