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. The resident had multiple complex medical conditions, including traumatic subdural hemorrhage, COPD, asthma, respiratory failure, diabetes, blindness, heart failure, end-stage renal disease on dialysis, major depressive disorder, generalized anxiety disorder, cannabis use, hypertension, hypothyroidism, and traumatic brain injury. A recent MDS assessment documented intact cognition and no behaviors. On an evening in the dining room, the resident requested assistance from staff to return to her room. One CNA stated she would help when finished passing trays, while another CNA was reported to have responded with an expletive directed at or in front of the resident, in the presence of others, causing the resident to feel embarrassed and humiliated and to be tearful throughout the night. Multiple accounts described the same core event: the resident asked to be taken back to her room after dinner, one CNA indicated she was busy, and the other CNA used the word “[expletive]” in connection with the request. The resident reported that the CNA yelled “[expletive] you” at the dinner table and that she did not like this CNA because she was not nice and seemed to hate her. A social services designee documented that the resident said the CNA said “[expletive] you,” threw her arms down, and that another aide eventually pushed the resident back to her room, where the resident cried herself to sleep in her wheelchair. A witness CNA reported that the CNA in question said, “[expletive] I do not wanna do this,” in a manner that the resident heard, and the resident stated she would report the CNA to the DON. The CNA involved acknowledged in a written statement that she used the expletive in front of the resident after the resident requested to be put to bed, stating she was talking to another CNA and did not realize the resident heard her, and that she later went to the resident’s room to apologize. The facility’s abuse policy states that residents have the right to be free from abuse, including emotional or verbal abuse. Despite the resident’s report of crying herself to sleep and feeling embarrassed and humiliated, review of nursing progress notes for the period around the incident showed no documentation of the incident, emotional distress, or provision of emotional support or counseling. The social services designee stated she followed up with the resident the next day but confirmed there was no documentation in the chart of this follow-up for emotional support.
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