Abusive Handling of Resident During Incontinence Care and Failure to Follow Abuse Protections
Penalty
Summary
The deficiency involves the facility’s failure to protect a cognitively impaired resident from abuse during incontinence care and clothing change. The resident had dementia, Parkinson’s disease, mood disorder, violent behaviors, anxiety, depression, was always incontinent of bowel and bladder, and required maximum assistance with ADLs. The resident’s care plan directed staff to avoid power struggles, explain procedures, maintain a calm, slow approach, stop care and try later if the resident became verbally abusive, not to force tasks, and to allow the resident as much control and decision-making as possible. On the day of the incident, the Maintenance Director/NA began assisting the resident with changing a soiled brief and clothing. The resident refused care from a female CNA, who left the room, and then allowed the Maintenance Director/NA to assist. The DON entered, told the resident he/she needed to get cleaned up, and the resident yelled at the DON to leave. The Maintenance Director/NA obtained the resident’s agreement for the DON to help only with turning in bed. According to the Maintenance Director/NA, the DON pulled on the resident, the resident said it hurt, and the DON told the resident he/she was fine. The resident began pulling and smacking at the DON, who then let go, and the Maintenance Director/NA applied a clean brief. The Maintenance Director/NA noted the resident’s shorts were heavily soiled and obtained the resident’s agreement to change them, but stepped away briefly to check laundry. During this time, the DON began grabbing and pulling on the resident’s shorts. The resident grabbed the shorts with one hand, yelled for the DON to get out and leave him/her alone, and slapped at the DON with the other hand. The Administrator entered the room, and per the Maintenance Director/NA, the DON told the Administrator/CMT/CNA to grab the resident. The Administrator then held the resident’s arm tightly by the hand and elbow while the resident kicked and screamed. The Maintenance Director/NA reported that the resident kicked toward the DON’s face and that the DON responded by saying, “kick me again motherfucker and see what happens.” The Maintenance Director/NA told them to stop, refused to hold the resident’s arms, left the room, and then left the facility. The SSD reported hearing the resident yelling and, from the hallway, heard the DON say, “kick me again motherfucker and see what happens.” The SSD saw the Maintenance Director/NA exit the room stating he/she wanted no part of it. The SSD and BOM both stated they had received abuse training that instructed them to report to the Administrator but did not address what to do if the Administrator was the alleged perpetrator, and they were initially unsure how to proceed. The SSD later learned from the Maintenance Director/NA that the Administrator held the resident down by the arm while the DON cursed at the resident and ripped off the resident’s shorts. The resident later complained of arm pain and refused to allow staff to examine the arm. Observation showed multiple dime-sized, light-yellow discolorations (bruises) on the resident’s forearms and hand, and the resident indicated the bruised area while stating, “they hurt me here.” An x-ray of the right arm and hand showed no fractures. The facility’s abuse policy prohibited verbal, mental, or physical abuse, including holding someone down or grabbing a resident by the arms or legs, and required immediate suspension of any employee alleged to have committed abuse, but the DON and Administrator continued to provide oversight for residents until the following day.
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