Health inspection·August 24, 2021

§483.12 Freedom from Abuse, Neglect, and Exploitation The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart. This includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident's medical symptoms. §483.12(a) The facility must- §483.12(a)(1) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion; 22 CCR § 72315 (b) Each patient shall be treated as individual with dignity and respect and shall not be subjected to verbal or physical abuse of any kind. 22 CCR § 72527 (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. The facility shall establish and implement written policies and procedures which include these rights and shall make a copy of these policies available to the patient and to any representative of the patient. The policies shall be accessible to the public upon request. Patients shall have the right: (10) To be free from mental and physical abuse. The facility failed to follow the aforementioned regulation by failing to keep Resident 43 free from abuse when Hospitality Aide (HA) 5 punched Resident 43 in the face during an altercation. This failure resulted in Resident 43 sustaining a laceration (a tear, cut or opening in the skin caused by an injury) under the nose and above upper lip that had profuse bleeding and required hospitalization for suturing. Resident 43 returned from the hospital with two sutures below the nose and above the upper lip, and mild swelling on the area. HA 5's physically assault towards Resident 43 had the potential to cause Resident 43 to lose balance and fall on the concrete floor that could likely cause serious head injury and possibly death. The Administrator (ADM), Director of Nursing (DON) and Regional Director of Clinical Operations were notified by the survey team of the Immediate Jeopardy (IJ, a situation in which a provider's noncompliance with one or more requirements of participation have caused or is likely to cause serious injury, harm, impairment, or death to a patient/resident.) on 7/1/21 at 2:48 p.m. The facility failed to ensure Resident 43 was free from physical abuse. During an on-site survey on 7/2/21, and through observation, interviews and record reviews, the facility showed they initiated a plan of correction through immediate training of employees regarding abuse prevention. The IJ was abated on 7/2/21 at 11:21 a.m. Findings: Review of Resident 43's Face Sheet indicated Resident 43 was admitted to the facility on 7/29/18 with diagnoses that included anxiety disorder (a mental health disorder characterized by feelings of worry, anxiety, or fear, strong enough to interfere with one's daily activities), and mood disorder (intense feelings of sadness or elation not consistent with one's circumstances and interferes with daily functions). Review of Resident 43's Minimum Data Set (MDS, an assessment tool used to direct resident care) dated 5/6/21 indicated Resident 43 had a Brief Interview for Mental Status (BIMS, an assessment of one's orientation to time and capacity to remember) score of 8. The BIMS score range is from 0-15, with zero as the most impaired. Review of Resident 43's Behavioral Symptoms care plan last reviewed/revised 5/7/21 indicated Resident 43 had behaviors that included rejection of care, was physically and verbally abusive to others including staff. The care plan indicated a long-term goal for Resident 43's behavior to be diverted into a productive and meaningful activity. Approaches identified to achieve this goal included providing support to Resident 43 by allowing Resident 43 to express self without confrontation, encouraging Resident 43 to verbalize feelings and offer understanding and empathy, and removing Resident 43 from triggering environment to a calm and quiet place with supervision. During an interview with Administrator (ADM) on 6/29/21 at 9:38 a.m., ADM stated, on 6/28/21 at 6:45 a.m., a facility staff had summoned ADM about an incident at the back door. ADM stated, Hospitality Aide (HA) 5, who was assigned to watch the back door, was involved in an altercation with Resident 43. ADM stated, immediately after the incident and during interview with HA 5, HA 5 said Resident 43 called HA 5 names, pushed, and hit HA 5 to the point that HA 5 got emotional. ADM stated HA 5 reacted by hitting Resident 43. ADM stated Licensed Vocational Nurse (LVN) 5 witnessed the incident. During an interview and concurrent review of Resident 43's Progress Notes with LVN 5 on 7/1/21 at 9:11 a.m., LVN 5 stated, on 6/28/21 at 6:45 a.m., Resident 43 had just woken up and was in the hallway walking towards the back door. HA 5 was sitting on a chair at the back door. LVN 5 stated, Resident 43 said something incoherent and HA 5 could be heard talking back to Resident 43. LVN 5 stated, she told HA 5 to "stop and leave Resident 43 alone" but HA 5 did not listen. HA 5 then took his jacket off, stood up from the chair and walked towards Resident 43. Resident 43 punched HA 5 on the upper body and HA 5 punched Resident 43, hitting his face under the nose and above the upper lip. LVN 5 stated there was significant amount of bleeding on Resident 43's face that needed pressure and ice pack. LVN 5 stated the incident happened fast and did not expect HA 5 to react the way he did. LVN 5 stated, when a resident becomes aggressive, staff had to allow them to express how they feel while making sure of their safety. LVN 5 stated a staff should not react in a way that would escalate a resident's behavior. Resident 43's Progress Notes dated 6/28/21 indicated Resident 43 "sustained a cut under his nose and was profusely bleeding ... [Attending Physician] was notified and received order to transfer resident to the hospital for evaluation and [treatment]." The notes indicated Resident 43 was transferred to the hospital at 7:15 a.m. Review of Resident 43's Patient Visit Information dated 6/28/21 indicated Resident 43 was seen and treated at the Emergency Department for a laceration "injury due to physical assault" and absorbable sutures were placed. During an interview and concurrent observation with Resident 43 on 6/29/21 at 10:30 a.m., Resident 43 had a cut under the nose above the upper lip with mild swelling. Resident 43 stated somebody hit him in the face with something and when asked if his face hurt, he responded "oh yeah." During an interview and concurrent review of HA 5's files with Director of Staff Development (DSD) 1 on 6/30/21 at 11:38 a.m., DSD 1 stated, upon HA 5's hire date on 5/2/18, facility provided HA 5 training on how to deal/manage residents with difficult behaviors, which was part of the dementia (a chronic progressive disease marked by memory loss, personality changes and impaired reasoning) training. DSD 1 stated a test was administered to evaluate HA 5's understanding of the topic. Review of the training document titled "Dementia Care: Managing Challenging Behaviors indicated 10 examination questions that required responses from HA 5. DSD 1 stated HA 5 answered nine out of ten questions incorrectly. DSD 1 stated, because HA 5 failed the test, HA 5 needed to be re-trained by having HA 5 watch the video for the second time, discussing why the responses provided were incorrect, and having HA 5 re-take the test. DSD 1 stated there was no documentation that any of these steps were done and there was no documentation that another test was administered to HA 5. DSD 1 stated HA 5's abuse training in 2019 indicated a set of test questions to evaluate whether HA 5 understood abuse prevention protocol. DSD 1 stated HA 5 did not answer the test questions. During a follow-up interview with DSD 1 on 6/30/21 at 2:18 p.m., DSD 1 stated HA 5's files did not show any documentation that abuse training was provided in 2020 and 2021. Review of the facility's policy and procedure titled, "Abuse & Neglect Prohibition," last revised May 2013, indicated "Each resident has the right to be free from mistreatment, neglect, abuse, involuntary seclusion and misappropriation of property." The facility's policy indicated, physical abuse includes hitting, slapping, pinching, and kicking. The policy also indicated, under "Procedure: Training," each employee will be trained regarding these policies, and such training is provided, "During orientation, annually, and more often as determined by the facility." Therefore, the facility failed to keep Resident 43 free from abuse when Hospitality Aide (HA) 5 punched Resident 43 in the face during an altercation, resulting in Resident 43 sustaining a laceration under the nose and above upper lip that had profuse bleeding and required hospitalization for suturing. The above violation has a direct relationship to the health, safety, or security of patients.