Resident-on-resident physical abuse at nurse’s station
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident’s right to be free from abuse when one resident struck another resident near the left ear with a closed hand. According to interviews and record review, the incident occurred in the early morning hours when one resident, who was upset about being unable to reach a taxi service, was at the nurse’s station banging a cup on the glass and requesting ice. Another resident approached the area to return snacks to the snack room and stood behind the agitated resident. When the agitated resident turned and asked if the other resident was enjoying the “show,” the second resident replied that they did not care about the “pathetic ass show,” which preceded the physical contact. The striking resident, who had diagnoses including depression, bipolar disorder, and schizophrenia, then attempted to punch the other resident. CNA A was positioned between the two residents, and the striking resident had to reach around the CNA, resulting in a closed-hand hit to the left side of the other resident’s face near the ear rather than a full punch. Staff accounts, including those of CNA A and RN A, consistently described the sequence of events as beginning with the striking resident’s agitation over the taxi call, followed by the verbal exchange at the nurse’s station, and culminating in the physical contact. The facility’s abuse and neglect policy states that the facility is committed to protecting residents from abuse by anyone, including other residents, and that residents who allegedly mistreat another resident will be removed from contact with the resident during the course of an investigation. The resident who was struck had intact cognitive skills, no documented behaviors, and required supervision or touch assistance with eating and transfers, with diagnoses including anxiety, depression, psychotic disorder, and schizophrenia. After the incident, this resident reported having no pain, no red marks or injuries, and no aftereffects, and stated feeling safe in the facility, though feeling better after a room change. The facility’s policy also indicates that the environment and resident characteristics should be assessed to identify situations in which abuse is more likely to occur and that residents with behaviors that might lead to conflict should be identified, but the report documents that both residents’ most recent MDS assessments showed cognitive skills intact and no behaviors prior to the incident. Despite the presence of staff at the nurse’s station and CNA A’s attempt to intervene, the physical contact occurred, constituting the failure to protect the resident from abuse by another resident.
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