Failure to Treat Resident with Dignity During Dispute Over Alleged Hitting During Care
Penalty
Summary
The facility failed to ensure a resident was treated with dignity and respect when a CNA verbally responded inappropriately after the resident alleged being hit during care. The resident, who had hemiplegia/hemiparesis following a stroke and a BIMS score of 12 indicating moderate cognitive deficit, reported that while receiving perineal care he asked the CNA for a wipe and, when he reached for it, the CNA hit his elbow out of the way. The resident stated it was more than a push and that when he told the CNA, "You hit my elbow," the CNA yelled, "You're a liar." The resident reported that the CNA became mad at him, which upset and angered the resident. Progress notes indicated hospice staff reported the resident’s statement that the CNA hit his elbow while providing care. In a subsequent interview, the CNA acknowledged that during perineal care, when the resident asked, "Why did you hit me?" he became "a little angry" and told the resident, "You're lying," and further stated that he went out of his way for the resident and accused the resident of lying about being hit. The administrator, who serves as the abuse coordinator, stated that staff receive abuse training and that when a resident becomes angry or accusatory, staff are expected to walk away, give the resident space to calm down, and report to the charge nurse, and that the CNA should not have engaged with the resident by calling him a liar. Facility policy on Mood and Behavior Management Techniques directs staff not to argue with residents, to detach from resident agitation, and, if unsuccessful, to walk away and wait before re-approaching, which was not followed in this interaction.
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