Failure to Thoroughly Investigate Facial Injury Associated With Abuse Allegation
Penalty
Summary
The deficiency involves the facility’s failure to thoroughly investigate a potential injury of unknown origin related to an allegation of abuse for one resident. The resident had dementia with behavioral disturbances, restlessness, agitation, and bipolar disorder, and was severely cognitively impaired with a BIMS score of 3/15. According to the facility-reported incident, the resident became combative and physically and verbally aggressive during care with a CNA at approximately 10:00 PM, during which the resident sustained a skin tear to the right fourth finger and a contusion to the right cheek. The next morning, the resident told the DON that the CNA had grabbed her hand and hit her face, and when the RN assessed the resident after the incident, the resident stated that the CNA had punched her. The RN documented bruising and mild swelling under the right eye at the bony area and noted that the CNA stated she could have hit the resident’s face while the resident was swinging. The facility’s investigation file contained statements from the CNA describing the resident grabbing her arm and swinging, and the CNA pulling back, causing the skin tear from the CNA’s watch, but the CNA denied remembering any contact with the resident’s face. Another nurse documented observing a swollen and discolored right eye and that the CNA did not know how the facial bruising occurred or whether the resident’s own hand hit her face. An undated abatement document stated the resident became combative, sustained a skin tear, and hit herself, causing swelling to the eye, while also noting that the resident had reported being punched in the face. There was no documentation in the investigation file or EMR ruling out or mentioning any pre-existing facial bruising before the incident or exploring possible causes for the cheek contusion. Although all staff on the unit were interviewed, they were not specifically asked about the cheek contusion, and the Administrator and DON later acknowledged they could not determine the exact cause of the facial injury and that the reenactment focused on the skin tear rather than the cheek contusion, contrary to facility policy requiring a determination of the probable source for injuries of unknown origin.
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