Failure to Maintain Resident Dignity Due to CNA’s Profane and Sexually Inappropriate Comments
Penalty
Summary
The deficiency involves failure to maintain resident respect and dignity when a CNA acted in an unprofessional and verbally inappropriate manner toward a resident during a smoking break. One resident involved had dementia and other psychiatric and neurologic diagnoses, with a BIMS score of 09 indicating impaired cognition but adequate hearing, clear speech, and ability to understand others. His care plan noted he could refuse care and repetitively ask questions, requiring assistance and cueing with ADLs. Another resident involved, his roommate, had mood, anxiety, PTSD, and depression diagnoses, with a BIMS score of 15 indicating intact cognition, adequate hearing, clear speech, and understanding, and no behaviors noted. On the date of the incident, the cognitively impaired resident reported that during a smoke break the CNA told him he had a very small penis and that her husband’s was bigger, and that she was swearing at him. He stated his roommate was next to him during the smoke break and overheard the comments, and that no other staff were present. The cognitively intact roommate later confirmed that the CNA made inappropriate comments to the first resident about the size of his penis and used profanities toward him during the smoking break, again stating that no other staff were present. Multiple staff accounts described a loud commotion and profanities used by the CNA in or near the smoking area in the presence of residents. Several LPNs reported hearing a commotion from the smoking area while they were in the conference room eating, then observing the CNA in the doorway handing out cigarettes and screaming or using profanities, though they were unsure exactly to whom the profanities were directed and did not hear specific threats. One LPN stated there were residents in the smoking area, described as the usual smokers, and another LPN stated there were no residents having behaviors or noted to be agitated at that time. A CNA reported seeing the CNA and two residents arguing at the smoking door and noted that the CNA had previously been observed treating residents without respect and dignity. The CNA’s personnel file documented a prior final written warning for arguing with the appearance of aggressive behavior and use of inappropriate, abusive, or foul language toward or in the presence of a resident, employee, or visitor, and a subsequent disciplinary action for similar behavior on the date of the incident. The employee handbook classified such conduct—arguing, aggressive behavior, or use of inappropriate, abusive, or foul language toward or in the presence of a resident, employee, or visitor—as a serious work rule violation, while residents and staff interviews and documentation established that the CNA’s conduct occurred in the presence of residents and included profanities and sexually inappropriate comments toward a resident.
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