Failure to Protect a Resident From Physical Abuse During Toileting Care
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident’s right to be free from physical abuse by staff when a CNA physically pushed the resident’s face during toileting care. The resident had been admitted in 2021 and had diagnoses including Alzheimer’s disease, major depressive disorder, anxiety, and delusional disorder. A quarterly MDS showed severe cognitive impairment, delusions, rejection of care, wandering, and a need for substantial to maximum assistance with toileting, personal hygiene, and transfers, with partial to moderate assistance for bed mobility and transfers, and independence with walking. The resident’s care plan noted that the resident was occasionally physically and verbally aggressive with staff during care and that undesirable behavior would be monitored and managed. On the day of the incident, the resident was being toileted by two nurse aides due to the resident’s known aggressive behaviors. According to interviews, the resident was spitting, hitting, and trying to bite staff, but staff were able to get the resident onto the toilet. One aide (NA B) reported that while their back was turned gathering equipment, they heard laughing and then saw the other CNA (CNA A) with hands on either side of the resident’s face, apologizing and stating it was just a reaction. NA B stated that staff should not hit a resident under any circumstance, as this would be considered abuse. Staff were unable to interview the resident about the incident due to cognitive deficits, and a skin assessment revealed no new skin concerns. In interviews, CNA A admitted that while kneeling in front of the resident to assist with pants, the resident spit on them, and they reacted by pushing the resident’s face away and telling the resident not to do that. CNA A described this as an instant reaction without thought and acknowledged that they inappropriately touched the resident’s face. In a separate interview, HR recounted that CNA A reported having reacted on instinct by smacking a hand over the resident’s mouth and telling the resident to stop. Multiple staff members, including CNAs, CMTs, housekeeping, an LPN, an RN, the DON, and the Administrator, consistently stated that it is never acceptable to hit, push, or otherwise strike a resident and that such actions are considered abuse. The facility’s abuse prevention policy states that the facility will not tolerate physical abuse by employees or others.
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