Resident Struck by Staff During Combative Care Episode
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident from physical abuse by staff. A support aide struck a resident on the left shoulder after the resident, who was known to be combative with care, hit the aide during a transfer. The facility’s abuse prevention policy required staff training on prevention of all forms of abuse, recognition of abuse, and supervision of staff on all shifts to identify inappropriate behaviors such as rough handling and physical punishment. Despite this policy, the aide reacted to being hit by the resident and struck back, constituting physical abuse. The resident involved had Alzheimer’s disease with severely impaired cognition, used a wheelchair, and was dependent on staff for all ADLs. The comprehensive care plan documented alteration in mood and behavior due to Alzheimer’s disease, communication deficits, and dementia with psychotic disturbance. It also noted that the resident could be combative and resistive to care, verbally aggressive, and at times refused all care. Interventions in the care plan included providing verbal cues prior to care routines, administering medications as ordered, reporting changes in mood and behavior to the physician, redirecting and providing distractions during agitation, and reapproaching as appropriate. During the incident, the resident was combative with care, hit the support aide during transfer, and the aide responded by hitting the resident on the shoulder. The incident was witnessed and reported by another CNA who was assisting with the transfer. This CNA stated that the resident struck the support aide, and the aide then hit the resident’s left shoulder with their right hand while saying, "don’t hit me," and that the slap was not hard but could be heard. The resident, due to cognitive impairment, could not describe what had happened when assessed afterward. The facility’s investigation, including staff interviews and review of statements, concluded that abuse had occurred when the support aide struck the resident in response to the resident’s combative behavior during care.
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