Failure to Protect a Resident From Verbal Abuse During Shower Care
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident from verbal abuse by a CNA during a shower episode. A resident with hemiplegia, hemiparesis following a cerebral infarction, a right above-knee amputation, intermittent explosive disorder, PTSD, and adjustment disorder was care planned as dependent on staff for transfers and bathing, used an electric wheelchair, and required care in pairs due to extensive attention-seeking behaviors and making false statements and accusations. On the day of the incident, the resident was in the shower room receiving care from two CNAs for transfer and showering, consistent with his need for two-person assistance. After the shower was completed, one CNA left to obtain a male staff member to assist with the transfer, and the other CNA (CNA 6) was positioned outside the shower room door to provide oversight and privacy. While the resident remained in the shower room, he became upset and began banging and yelling. Multiple staff witness statements and interviews indicated that a verbal altercation then occurred between the resident and CNA 6. Nurse witnesses reported hearing loud voices and both the resident and CNA 6 yelling and cursing at each other from the shower room, but did not see any physical altercation. One nurse supervisor reported that when she approached, she heard yelling and cursing from both the resident and CNA 6, and that CNA 6 ran out of the shower room stating the resident had hit her. When the supervisor and charge nurse spoke privately with the resident, he admitted he had been cursing at the CNA and stated she was cursing back at him, and that she lunged at him in a threatening manner "like a boxer," though he denied that anyone was hit. Additional staff accounts described the resident directing racially charged and profane insults toward CNA 6, including references to her "fat black African" appearance, and spraying her with the shower head. One CNA stated she did not hear CNA 6 engage verbally with the resident at that time, while another RN reported hearing both the resident and CNA 6 "cussing each other out" in the shower room and later again at the nurse’s station. In his own interview, the resident stated that CNA 6 came into the shower room and started yelling at him, cursing and calling him names, and that he yelled back and told her to get out. He reported that when he later passed the nurse’s station, CNA 6 again began to yell at him and he yelled back until another CNA intervened. The facility’s abuse and neglect protocol defined abuse as including verbal abuse that causes physical harm, pain, or mental anguish, and the internal investigation concluded that CNA 6 had engaged in verbal abuse of the resident during this incident.
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