Resident Physically Abused by NA During Combative Care Episode
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident’s right to be free from physical abuse. Facility policy on resident abuse, neglect, and exploitation, revised July 2023, defines physical abuse as including hitting, slapping, punching, biting, and kicking, and states that the facility will protect the health, welfare, and rights of each resident by prohibiting and preventing abuse. Despite this policy, a nurse aide (Employee 1) physically struck a resident during the provision of care. The resident involved had diagnoses including intracranial injury (TBI) and Parkinson’s disease. During evening care, the resident became combative while two nurse aides, Employee 1 and Employee 2, were providing incontinence care and transferring the resident to bed. According to clinical documentation and staff statements, the resident hit Employee 1 in the face, either directly with his hand or by striking a wet washcloth that then hit Employee 1. Employee 2 reported that immediately after being hit, Employee 1 responded by smacking the resident in the face with an open hand and verbally stating, “You think you’re just going to keep hitting me!” The resident was assessed following the incident and was noted to have redness to the right cheek, with no bruising or skin tears, no reported pain, stable vital signs, and no change from baseline mental status. Resident interview was not possible due to the resident’s diagnosis. In interviews with facility leadership, Employee 1 admitted that she slapped the resident, characterizing it as a reaction to being hit, although she later attempted to modify her account to say she pushed the resident’s arm away. The facility’s investigation concluded that Employee 1 was physically abusive when she chose to hit the resident in return for the resident’s actions, and that the resident’s behavior did not warrant this response, which was considered resident abuse.
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