Other·July 21, 2021

F 600 §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) (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)(10) (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 2 free from abuse when Resident 1, who required monitoring for physical aggression and was observed to have escalating behaviors, attacked Resident 2, and ten minutes later attacked Resident 2 again, which caused an eight-centimeter (cm, a length of measurement; eight cm equals 3.15 inches) laceration (open wound) on Resident 2's forearm. Resident 2 required transfer to the acute care hospital emergency room to have the laceration closed with stitches. Resident 2 expressed feeling afraid Resident 1 would come back and kill her. A review of Resident 2's Face Sheet indicated Resident 2 was admitted to the facility in 2015 with dementia without behavioral disturbances and difficulty walking. The Face Sheet indicated Resident 2 had a non-English preferred language and was her own responsible party. During an interview on 1/21/20 at 12:55 p.m., with Resident 2 and an interpreter, seated in a chair in the hallway outside her room, the interpreter translated Resident 2 stated she did not want to talk. Review of a letter from Resident 2's family member dated 2/13/20, indicated, "since the incident, she [Resident 2] is continuing telling us she is scared. She says the person may come back to kill her." A review of Resident 1's History and Physical dated 9/29/14, indicated Resident 1 was admitted in 2014 with included diagnoses of Parkinson's disease (A disease of progressive deterioration of the brain and muscular systems.), amputation (surgical removal) of the right arm below the elbow joint, depression, and non-specific psychological disorders. A review of Resident 1's Face Sheet indicated Resident 1 had dementia (a brain disorder that affects the ability to remember, think clearly, communicate, and perform daily activities and that may cause changes in mood and personality) with behavioral disturbance, and was his own responsible party. A review of Resident 1's care plan with the listed problem, "Behavioral Symptoms," dated 12/21/19, indicated Resident 1 manifested the problem by hitting and grabbing others. The care plan approaches for the long term goal of "less occurrence with interventions" included: encourage resident to verbalize feelings and offer understanding and empathy; identify situation that might have caused behavioral problem and assist resident in resolving identified issues; monitor for behavior not easily altered and refer to MD [physician]; remove from triggering environment to a calm and quite [sp] place with supervision; inform responsible party for untoward changes in behavior; observe for pain or discomfort that might trigger negative behavior; medicate with prn [as needed] anti-anxiety as needed." During an observation and interview in Resident 1's room on 1/21/20, at 10:43 a.m., with Resident 1, Resident 1 sat in a wheelchair with a staff member seated in the room providing one on one supervision. Resident 1 had no right arm below the elbow joint. Resident 1 stated he had been upset because Resident 2 had been making noise. Resident 1 stated he did not tell anyone he wanted her to be quiet, he just went to her room and pulled her by the arm, off the bed onto her buttocks. During an interview on 1/23/20, at 9:35 a.m., with LVN 1, LVN 1 stated she remembered on New Year's night shift (12 a.m. to 7 a.m.) she had found Resident 1 and Resident 2 on the floor together. She stated Resident 1 said he had pulled Resident 2 out of the bed and into the hallway. LVN 1 stated she escorted him to his room and tried to provide one on one supervision but Resident 1 kept walking around, so she brought him with her to the nurse station. LVN 1 stated she noticed Resident 1 had disappeared; she found him in Resident 2's room with a CNA trying to protect Resident 2 from Resident 1 by blocking him with her body. During an interview on 1/23/20 at 10:35 a.m., with Registered Nurse 1 (RN 1), RN 1 stated she remembered the incident between Resident 1 and Resident 2. Around 3 a.m. she heard Resident 1 talking, so she went to check on him and saw Resident 1 and Resident 2 on the floor in the hallway, with Resident 1 holding Resident 2's forearm. RN 1 stated she separated them, asked Resident 1 to step back, and asked what happened. RN 1 stated Resident 1 said he had dragged Resident 2 out of the bed. RN 1 stated Resident 1 had said he had pulled her out of bed because he was "sick." RN 1 stated she checked Resident 2's right arm and noticed a discolored area. RN 1 stated Resident 2 was not ambulatory, so RN 1 and two CNAs assisted her back into her bed; Resident 1 was taken to the nurse station with another nurse. During an interview on 1/23/20 at 8:55 a.m., with Certified Nursing Assistant 1 (CNA 1), CNA 1 stated on 1/1/20, she and another co-worker saw Resident 1 walk into the hallway by Resident 2's room. CNA 1 stated she tried to block Resident 1 from entering Resident 2's room, but Resident 1 pushed his way into the room. CNA 1 stated she shouted for help but Resident 1 quickly grabbed Resident 2's arm and held it very tightly before other staff arrived to help. CNA 1 stated after Resident 1's hand was released from Resident 2, there was a cut on Resident 2's forearm. A review of Resident 1's nurse progress notes by Licensed Vocational Nurse 1 (LVN 1) dated 1/1/20, at 4:12 a.m., reflected the following: "At 3:00 am ...we found out both Resident 1 ... and Resident 2 ...lying on the floor on the hallway in front of Resident 2's room ...Resident 2 was crying...Resident 1 was lying calmly and getting up to sit down ...Resident 1 stated 'I grabbed her out of the bed' and he said 'because I am sick'. We separated them, found that Ms. Lam's right forearm with light reddish disc. (discoloration) ...I heard one CNA calling for help at 3:10 am ...I and other 2 CNAs ...ran from station 1 to the room ...trying for help them. We saw that one CNA was protecting Resident 2 with her body from pulling down by Resident 2 from the bed. At that time Resident 2 was being assisted by 2 CNAs-CNA 1 and ...for ADLS (activities of daily living) when Resident 1 managed to get into Resident 2's room ...CNAs tried to stop him, from entering the room, however he pushed them to the sides. Resident 2 was on the half way of the bed ...I removed Resident 1's fingers one by one from Resident 2's right forearm. Resident 1 was very strong even with one hand. Found that Resident 2's right forearm got skin tear ..." A review of Resident 2's acute care hospital record, "Trauma and Critical Care Surgery Consultation," date of service 1/1/20 at 4:32 a.m., indicated Resident 1 was assaulted by another resident at her skilled nursing facility which resulted in a laceration of the right upper extremity. A review of Resident 2's acute care hospital record, "Laceration Repair Note," showed Resident 2 had an eight centimeter wound of the right upper forearm which was cleaned, irrigated, and closed with sutures (surgical thread used to stitch wound edges together). The facility policy titled, "Abuse Prevention Program," dated 5/28/19, indicated "Our residents have the right to be free from abuse ....As part of the resident abuse prevention, the administration will: Protect our residents from abuse by anyone including, but not necessarily limited to facility staff, other residents ..." The facility policy titled, " Resident-to-Resident Abuse," dated 2/2017, indicated, "Facility staff will monitor residents for aggressive/inappropriate behavior towards other residents...." Therefore, the facility failed to keep Resident 2 free from abuse when Resident 1, who required monitoring for physical aggression and was observed to have escalating behaviors, attacked Resident 2, and ten minutes later attacked Resident 2 again, which caused an eight-centimeter (cm, a length of measurement; eight cm equals 3.15 inches) laceration (open wound) on Resident 2's forearm. Resident 2 required transfer to the acute care hospital emergency room to have the laceration closed with stitches. Resident 2 expressed feeling afraid Resident 1 would come back and kill her.