Failure to Implement ANEMMI Policy for Grievances and Verbal Abuse Allegation
Penalty
Summary
The deficiency involves the facility’s failure to effectively implement its Abuse, Neglect, Exploitation, Misappropriation, Mistreatment, and Injury of Unknown Origin (ANEMMI) policy and procedure in response to complaints and an allegation of verbal abuse involving two residents. One resident, who was cognitively intact with a BIMS score of 15 and had multiple medical conditions including necrotizing fasciitis, type 2 diabetes, chronic combined systolic and diastolic heart failure, difficulty in walking, muscle weakness, and colostomy status, filed two grievances on the same day. His care plan documented a colostomy related to a large buttock wound with interventions for ostomy care daily and PRN, and extensive assistance with ADLs and bed mobility. Despite these documented needs, the resident reported that when his colostomy bag broke open, leaving feces on his stomach, his call light went unanswered for approximately three hours during the 3 p.m. to 11 p.m. shift, and that staff repeatedly told him they would get to it but did not promptly provide care. The same resident stated that the colostomy appliance was coming away from the skin with feces on it and that he had to wait for a nurse, who he believed was occupied with three admissions that night. He reported that the colostomy bag broke around 9 p.m. and was not addressed until about 11 p.m., and that the colostomy was supposed to be changed as needed. He indicated that he filed a grievance about the delayed response and that “that is as far as it went,” stating that no one came and talked to him about that grievance. He also filed another grievance related to his POA attempting to call the nursing desk multiple times and being hung up on; he reported that the nursing home administrator did speak with him and his POA about the phone complaint, but there is no indication in the report that the facility treated the colostomy-related grievance as a potential neglect concern or investigated it under the ANEMMI policy. A second resident reported an allegation of verbal abuse by a CNA during incontinence care. During this episode, the staff member was heard to say three times, “I do not give a damn,” and, when the resident requested a replacement gown, the staff member was heard to say “no.” The resident confirmed she was not provided a replacement gown during the care. The facility’s SNF Risk Management Tracking Tool documented an entry for this resident as an allegation of verbal abuse on the date of the incident. The facility’s ANEMMI policy defined abuse to include deprivation of goods or services necessary to maintain physical, mental, and psychosocial well-being, and neglect as failure to provide goods and services necessary to avoid physical harm, pain, mental anguish, or emotional distress, and required immediate reporting and thorough investigation of all allegations. The survey findings indicated that the allegation of verbal abuse was verified, yet there was no update to this resident’s care plan, and the overall findings concluded that the facility failed to effectively implement its ANEMMI policy and procedure for both residents.
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