Failure to Protect Residents From Verbal and Physical Abuse by CNA
Penalty
Summary
The deficiency involves the facility’s failure to protect multiple residents from verbal and physical abuse and to ensure they were treated with dignity and respect. One cognitively intact resident with hemiplegia, heart failure, a history of sacral pressure ulcer, and frequent urinary incontinence reported that a CNA entered her room during the night, yelled in the hallway, and demanded that she put her head down in bed because the CNA was not going to hurt her own back assisting with turning. The resident, who required substantial to maximal assistance with bed mobility and toileting, became scared of this staff member and was afraid to use the call light after becoming incontinent of urine. As a result, she remained in a urine-soaked brief until the next shift arrived several hours later. She did not immediately report the incident due to fear of retaliation and later told the social worker she was scared of the CNA and felt she had not been treated with dignity and respect. Another cognitively intact resident with hypertension, diabetes, anxiety, depression, insomnia, and benign prostatic hyperplasia reported that the same CNA entered his room during the early morning hours without knocking, spoke to him in a bossy manner, told him he was wet, and threw a pad toward him while telling him to get up and change his soiled pad. This resident stated he felt he was treated like he was nothing, not treated with dignity and respect, and that he was scared of the CNA. He also reported that the CNA was yelling and raising her voice in the common area near his room. Facility documentation of resident interviews corroborated that he described the CNA as bossy and that he was fearful of her. A third resident with cognitive impairment, Parkinson’s disease, frequent urinary incontinence, and a documented mood severity score indicating minimal depression was found to have multiple bruises and expressed significant anxiety and tearfulness. Progress notes documented bruising to both medial thighs and the right lateral thigh, complaints of discomfort to both lower legs, and chest discomfort. EMS records indicated staff and family reported the bruising and discomfort were possibly due to abuse by a staff member and that there had been a fall the previous night that was not reported, with no other trauma identified to account for the bruises. Hospital emergency department records documented pinpoint bruising to both lower extremities, small areas of bruising to the inner thighs, and old bruising to the right knee, with an impression including adult physical abuse confirmed, multiple contusions, and assault by nursing home staff. Family and hospital documentation also recorded that the resident reported staff at the facility had told her that her husband did not want to talk to her and was with another woman, that staff were mean to her, and that she described being put on the floor by many people in what she called a surprise attack, with pain all over her body. The facility’s internal QA investigation summarized that multiple residents on the same hall described the CNA as not kind, rough during care, and impatient, and concluded, based on ER information, that the situation was consistent with abuse.
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