Verbal and Physical Mistreatment of a Cognitively Impaired Resident by CNA
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident from verbal mistreatment by staff. The resident involved had severe cognitive impairment due to Alzheimer’s disease, cancer, and a history of physical and verbal behaviors directed toward others. According to the MDS, the resident required staff assistance for transfers, used a wheelchair, and had sustained a prior fall with injury. The care plan directed staff to redirect behaviors, step away and re-approach if the resident was resistive, and to verbally reward positive behavior. On the day of the incident, two CNAs were in the resident’s room providing care before lunch. The resident became combative and jabbed one CNA in the eye while being rolled for incontinence care. Multiple staff accounts, including those of the ADON, DON, charge RN, and the eyewitness CNA, consistently described that after being struck in the eye, the CNA who was hit became upset. The eyewitness CNA reported that the CNA who was struck backed away briefly, then grabbed the resident by the shoulders, shook him, and told him to “shut the f**k up,” repeating this loudly twice. She also reported that he said words to the effect of, “If you weren’t a resident, I would beat the s**t out of you.” The Administrator’s account of the eyewitness report included that the CNA also said, “If you weren’t a resident I would f**ing kill you.” The roommate, who had moderate cognitive impairment, reported hearing the staff member call the resident a “f**er” after the resident poked the staff in the eye, and stated that the staff did not hit or hurt the resident. The charge RN documented that she was notified by a CNA that another CNA yelled at the resident, grabbed him by the shoulders, and made threatening statements. When the RN entered the room shortly after, the resident was smiling, denied pain or discomfort, and a full body assessment revealed no visible injury. The facility’s investigation concluded that verbal abuse was verified based on the eyewitness CNA’s account and corroboration from the roommate, and that physical abuse in the form of aggressively grabbing the resident’s shoulders was reported by the eyewitness CNA, though denied by the accused CNA. The facility’s abuse policy in effect stated that all residents have the right to be free from abuse, including verbal and physical abuse, and that residents must not be subjected to abuse by anyone.
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