CNA Threw Metal Fork at Resident During Verbal Altercation
Penalty
Summary
The deficiency involves a failure to protect a resident from physical abuse when a CNA deliberately threw a metal fork at the resident during a verbal altercation. The facility’s own Abuse and Neglect Policy defines abuse as the willful infliction of injury, intimidation, or punishment with resulting physical harm, pain, mental anguish, or emotional distress, and specifically includes corporal punishment and hitting or flicking with an object. On the day of the incident, the CNA was passing lunch trays on the 300 hall near the courtyard door and observed several residents outside smoking during an unscheduled or unsupervised time. The CNA confronted the group about being outside without supervision, and a verbal exchange began between the CNA and the resident. According to the facility’s investigation and multiple interviews, the CNA and the resident engaged in back‑and‑forth yelling and cursing. The CNA reported that the resident began screaming and cussing and walked toward the CNA with a cane, which the CNA perceived as threatening. The CNA stated that as the resident approached, the CNA threw a metal fork taken from a meal tray toward the resident in an attempt to stop the resident’s forward movement. The resident reported that the CNA became angry during the argument, went behind the counter, grabbed a fork, and threw it, striking the resident’s arm near the elbow. The resident stated that he or she blocked the fork with an arm and expressed surprise that staff would throw an object. A nurse (RN E) and a CMT both described hearing or seeing a verbal exchange in the hallway, with the resident and CNA yelling at each other, and confirmed that the CNA threw a fork at the resident while the resident was in the hallway moving toward the nurses’ station. The resident involved had no cognitive impairment documented on a recent MDS and no recorded history of physical, verbal, or other behavioral symptoms directed toward others. Diagnoses included anemia, seizures, and hypertension. Staff interviews were inconsistent regarding the resident’s typical behavior; some staff described the resident as calm and not aggressive, while others stated the resident could be aggressive, intimidating, or have a temper when not getting his or her way. However, the MDS indicated no behavioral symptoms were present. The facility’s investigation documented that the fork made contact with the resident’s arm, though no discoloration or injury was noted and no medical treatment was required. Multiple staff, including CNAs, an LPN, RN E, and the ADON, characterized throwing a fork or any object at a resident as abuse, and the Administrator acknowledged that throwing and yelling at a resident constituted abuse under the facility’s policy.
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