Failure to Protect Resident From Verbal Abuse by CNA
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident from verbal abuse by a CNA in the dementia unit dining room. During a random observation, surveyors heard the CNA loudly say to one resident, "If you give me four seconds I will come and get you!" Shortly afterward, in the presence of an LPN and the assistant to the nurse practitioner, the same CNA loudly told another resident who was repeatedly requesting to lie down and asking for help, "If you are going to lay down, then stay down. I can't help you every four seconds. I am not going to give you ice cream, and I am not going to give you cookies. You are going to eat your food!" These statements were made in a raised voice in the dining room setting. In interviews, the CNA stated she did not consider her behavior to be abusive and indicated she had to "talk over" the resident because the resident did not hear her. She reported that the resident would eat many cookies and primarily wanted cookies and ice cream, and she described her own behavior as needing to get loud and that ignoring the resident would be abuse. The LPN present indicated he did not know if what the CNA said was abuse and reported he did not hear exactly what was said, but he acknowledged that yelling at residents was not effective and that he taught staff to use a different vocal approach with residents with dementia. Another CNA reported witnessing the same CNA using raised tones with residents and telling a resident, "That's enough," and stated that she had not reported this because other staff handled the resident in a similar way. The resident subjected to the verbal statements had diagnoses including severe vascular dementia with mood disturbance, psychotic disorder with delusions due to a physiological condition, depression, anxiety, delusional disorders, and hallucinations, with a recent MDS indicating severe cognitive impairment. Her care plan documented increased repetitive behaviors, including repeatedly exiting and re-entering her room, frequently requesting cookies, food, water, and to go to bed, and making repetitive verbal requests such as "I want a drink of water" and "I want to lay down." Interventions in the care plan included reminiscing, one-on-one interactions, offering movies/TV, and calming music to help her self-soothe. Despite this, staff interviews and observations showed that the CNA used raised tones and limiting language toward the resident in the dining room, contrary to the facility’s abuse prohibition policy, which defines verbal abuse as the use of oral or gestured language that includes disparaging or derogatory terms within a resident’s hearing, regardless of their ability to comprehend.
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