Failure to Protect Resident From Physical Abuse by CNA
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident from physical abuse by staff. The resident was admitted with diagnoses including muscle weakness, bipolar disorder, and a right rib fracture sequela, and had a BIMS score of 5 indicating severe cognitive impairment. Nursing notes documented a change in condition monitoring for swelling to the left radial wrist and skin discoloration on the left inner thigh, and an x-ray later showed mild degenerative joint disease of the left wrist. During personal care, a CNA who was not assigned to the resident assisted with a brief change. According to the facility-reported incident, the resident became agitated and scratched the CNA’s face, after which the CNA slapped the resident on the right side of the face. An eInteract SBAR summary documented that the assigned CNA witnessed the other CNA slap the resident on the right side of the face with a “medium slap” while attempting to provide care. In an interview, the witnessing CNA stated that the assisting CNA insisted on holding the resident’s wrist despite being told it was uncomfortable for the resident, that the resident freed a hand and hit the CNA’s face, and that the CNA then hit the resident back in the face and left the room. The resident then sat up in bed and pointed to the wrist. The CNA who committed the abuse had been hired several months earlier, had undergone background screening, and had last received abuse training at orientation. The facility’s abuse prevention and management policy defined physical abuse as including hitting and slapping and required screening and training of staff on abuse prevention and understanding resident behaviors that may increase the risk of abuse.
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