Failure to Monitor and Manage Escalating Behavioral Symptoms Leading to Resident Assault
Penalty
Summary
The facility failed to adequately monitor and address a resident’s escalating behavioral health symptoms, resulting in an aggressive resident-to-resident altercation. The resident had an Annual MDS showing he was unable to complete the cognition interview and had diagnoses including anxiety, depression, and Huntington’s disease, with continual disorganized thinking. His care plan, initiated earlier, identified a potential for physical aggression such as hitting, kicking, punching, and choking staff and other residents related to an impulse control disorder, and included an intervention to analyze and document times of day, places, circumstances, triggers, and de-escalation strategies. An Aggressive Behavior Assessment documented a history or recent episodes of aggressive or agitated behavior and substantial non-compliance with medications, treatment, or care. On the night and early morning in question, nursing staff observed the resident pacing up and down the hallway, repeatedly opening and shutting his door, and playing his TV at maximum volume, which was disrupting other residents. He became upset when staff asked to close his door and refused to allow it to be closed, with increased behaviors noted afterward. Communication about his behavior was sent to the Assistant DON, and management voiced understanding. Later that morning, the resident exited his room, walked toward the nurses’ station with his hands behind his back, and, without prior verbal request, punched another resident sitting in a wheelchair near the nurses’ station in the face with a closed fist, knocking him backward out of the wheelchair and then kicking him. Staff separated the residents as the aggressive resident continued to curse, threaten, and lunge at staff, attempting to hit the on-duty nurse. The DON stated the resident had strong behaviors, became agitated, walked up and down the hallway, and did not show many signs before a negative behavior, indicating the facility did not ensure his whole emotional and mental well-being was closely monitored during his escalating behavior.
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