F0744

D

Failure to Provide Appropriate Dementia‑Focused Care and Responses to Behavioral Incidents

Millersburg, Ohio Survey Completed on 01-08-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure staff had the skills and used appropriate approaches to provide person‑centered dementia care to two residents with dementia and behavioral symptoms. For one resident with dementia, depression, anxiety, psychosis, and documented physical and verbal aggression, the care plan specified that staff should offer alternatives when care was refused, allow the resident to make choices, maintain a calm environment, approach slowly and calmly, and stop care if the resident became combative, ensuring safety and returning later. Progress notes documented that this resident was confused, resistive, and combative at times, with increased restlessness, anxiety, and verbal aggression. On the night in question, staff reported the resident initially agreed to a shower but then became combative in the shower room, pulling a staff member’s hair and exhibiting aggressive behaviors.

According to staff statements and the self‑reported incident, a resident assistant and a trainee CNA reported that the resident was combative during the shower and that they were being hit, bitten, and having hair pulled. The RA sought guidance from an RN, who advised using two aides and suggested one aide watch or hold the resident’s hands as a distraction so the resident would not grab, hit, or pull hair. The RA and CNA reported feeling that they were being forced to complete the shower despite the resident’s resistance. The LPN on duty acknowledged knowing that the resident did not want to be showered and that staff had asked her for help multiple times while they were agitated and reporting aggression. The LPN did not immediately enter the shower room, continued other tasks, and only later went in, at which time she found the resident agitated but not aggressive and used a redirection strategy (offering to take the resident back to her “baby”) to complete drying and dressing. Another CNA later provided care without issues. The LPN verified that if a resident became combative or agitated, staff should stop what they were doing, and also verified she did not immediately assess the situation in the shower room to ensure the resident’s safety.

The second component of the deficiency concerns the facility’s failure to ensure staff approached a resident with dementia appropriately after a behavioral incident. This resident had dementia without behavioral disturbance listed among diagnoses but had a care plan for verbal aggression, hallucinations, false accusations, yelling, argumentativeness, insulting comments, and threatening statements, with interventions including removing the resident from overstimulating situations and moving the resident to a quiet, calm environment when behaviors escalated. During an evening smoke break, a staff member’s seven‑year‑old child was outside in the courtyard running around while residents smoked. Multiple statements indicated that the resident became frustrated with the child’s behavior and struck or punched the child in the stomach. The child went inside crying and reported being hit, and a red mark was observed on the child’s abdomen.

After the incident, the LPN who was the child’s mother, and who was not the resident’s nurse and had not witnessed the event, confronted the resident near the nurse’s station. The LPN asked if the resident had hit her child; when the resident confirmed, the LPN told the resident that many children come into the facility and that the resident did not have the right to hit children. The LPN further told the resident that she could be charged with assault, could be taken to jail, and that the resident was “lucky” she was a staff member because someone else might press charges. Other staff and resident statements corroborated that the LPN told the resident she was lucky she was there or in there, that she could be leaving in a police car, and that it was not acceptable to hit other people’s children. The LPN acknowledged she was upset, spoke sternly, and believed she was educating the resident about not hitting children, despite knowing the resident had dementia and that the facility was the resident’s home. The facility assessment and training materials indicated that staff were to receive dementia management, person‑centered care, and communication training, but the events described show that staff responses to these residents’ dementia‑related behaviors did not align with the planned dementia‑care approaches.