Failure to Protect a Cognitively Impaired Resident From Physical Abuse by Staff
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident from physical abuse by a staff member. The resident was an elderly male with major depressive disorder, dementia, hypertension, and anxiety disorder, care planned for impaired cognitive function, fall risk, and aggressive behaviors such as throwing objects and attempting to hit staff. His BIMS score of 3 indicated severe cognitive deficit. On the day of the incident, a nursing assistant (NA B) was providing care and preparing to lock the resident’s wheelchair to get him ready to be changed when the resident struck NA B in the face. According to NA B’s written statement, she then hit the resident back in the head “out of reflexes,” in direct violation of the facility’s abuse prevention policy, which states residents have the right to be free from abuse and that the facility must protect residents from abuse by anyone, including staff. Following the incident, staff interviews and documentation confirmed that NA B admitted to hitting the resident in response to being hit. CNA D reported that NA B came out of the room talking about what had happened and appeared to be in shock, and CNA C reported hearing NA B yell, “Don’t do that!” before being told by NA B that the resident had hit her and she hit him back. The administrator stated that NA B disclosed the incident after being removed from resident care, and the HR representative reported that NA B explained her behavior by referencing how she was taught to respond when hit. A progress note documented that an LVN assessed the resident and noted light discoloration to the forehead, possible edema to the jaw area, and slight discoloration to the left upper ribs, with x‑rays ordered of the skull, jaw, and ribs for precautionary evaluation. The facility’s self-report indicated that the resident stated he was “roughed up” and that NA B admitted to hitting him in the head.
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