Health inspection·July 12, 2023

F600 §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; Review of the facility's P&P titled Abuse-Prevention Program revised 9/2017 showed the facility does not condone any form of resident abuse and develops facility P&Ps, training programs, and systems to promote an environment free from abuse and mistreatment. Review of the SOC-341(Report of Suspected Dependent Adult/Elder Abuse) dated 5/23/23, showed Resident 1 reported Resident 2 had pushed him causing him to fall. 1. Medical record review of Resident 2 was initiated on 5/26/23. Resident 2 was admitted to the facility on 3/13/23. Review of Resident 2's MDS dated 3/19/23, showed Resident 2 was cognitively intact. Review of Resident 2's Progress Notes dated 5/23/23 at 1633 hours, showed Resident 2 had pushed Resident 1 causing him to fall to the ground while they were waiting in line to smoke. Resident 2 stated Resident 1 attempted to cut the line in front of him while he was in line to smoke. Resident 2 then pushed Resident 1 and Resident 1 fell to the ground 2. Closed medical record review for Resident 1 was initiated on 5/26/23. Resident 1 was admitted to the facility on 5/12/23 and was transferred to an acute care hospital on 5/22/23. Review of Resident 1's History and Physical Examination dated 5/31/23, showed Resident 1 had the capacity to understand and make decisions. Review of Resident 1's MDS dated 5/16/23, showed Resident 1 was cognitively intact and used a walker and a wheelchair as mobility devices. Resident 1 needed supervision and one-person physical assistance when walking in the room and in corridor and when moving to and from off-unit locations. The document also showed Resident 1 was not steady but able to stabilize without human assistance for walking, moving from the sitting to standing position, and turning around and facing opposite direction while walking. Review of Resident 1's IDT Progress Notes-Behavior Management dated 5/23/23 at 1626 hours, showed Resident 1 was involved in a resident-to-resident altercation with Resident 2 and was assessed to have a pain level of nine out of 10 on a pain scale of 0 to 10 (with 0 = no pain, 4-5 = moderate pain, and 10 = excruciating pain). Resident 1 was also assessed to have difficulty with range of motion on the right lower extremity. The document showed Resident 2 had pushed Resident 1 causing Resident 1 to fall to the ground. Review of Resident 1's eInteract Change in Condition Evaluation dated 5/21/23 at 1828 hours, showed Resident 1 complained of the right inner thigh pain. Resident 1 rated his pain to be seven out of 10 on a pain scale of 0 to 10 (with 0 = no pain, 4-5 = moderate pain, and 10 = excruciating pain). The document showed Resident 1's medical provider was notified on 5/21/23 at 1800 hours; however, the nursing staff was waiting for a response from the medical provider. Review of Resident 1's Medication Administration Record for May 2023 showed Resident 1 was administered 650 mg of acetaminophen on 5/21/23 at 1700 hours, for a pain level of seven. Review of Resident 1's Progress Notes dated 5/22/23 at 1109 hours, showed Resident 1 was complaining of right hip pain, could not get out of bed, and refused the physical therapy. The document also showed Resident 1 reported he was pushed by another resident. Further review of Resident 1's Progress Notes dated 5/22/23 at 1209 hours, showed Resident 1 was sent out to Acute Care Hospital 1's emergency department. Review of Resident 1's medical record from Acute Care Hospital 1 showed Resident 1 was admitted to Acute Care Hospital 1 on 5/22/23, for the right thigh and hip pain for two days after he reported he was pushed by another resident while standing, falling on his right side. The right thigh pain was sharp and worse with weightbearing. The document also showed Resident 1 had tenderness on the medial right thigh with limited range of motion of the right hip due to pain. Review of Resident 1's Acute Care Hospital 1's right hip x-ray result dated 5/22/23, showed Resident 1 had a right subcapital femoral neck (the neck of the thigh bone) fracture (a break of the bone). The document also showed Resident 1 had soft tissue swelling in the area. Further review of Resident 1's Acute Care Hospital 1's medical record showed Resident 1 had undergone a right total hip arthroplasty (a major surgical procedure to replace a damaged joint with an artificial joint). On 5/25/23 at1439 hours, an interview was conducted with Resident 2. Resident 2 stated Resident 1 accused him of trying to remove Resident 1 from his place in the smoking line when Resident 1 put his fists in front of Resident 2's face and attempted to pull Resident 2 from his place in line. Resident 2 then pushed Resident 1 who fell to the ground. Resident 2 stated facility staff responded by asking about the altercation. On 6/1/23 at 1105 hours, an interview was conducted with the DON. The DON stated a facility staff (LVN 1) witnessed the altercation between Residents 1 and 2. On 6/1/23 at 1155 hours, an interview and concurrent medical record review was conducted with LVN 1. LVN 1 stated she witnessed the altercation between Residents 1 and 2. LVN 1 recounted the altercation occurred on 5/20/23 at approximately 2000 hours. LVN 1 stated she observed Resident 1 attempting to shove or punch Resident 2 and Resident 2 responded by swinging his left arm at Resident 1 causing him to lose his balance and fall to the ground. LVN 1 asked Resident 2 why he swung his arm at Resident 1 knocking him to the floor. Resident 2 replied that Resident 1 tried to push him. This violation had a direct or immediate relationship to the health, safety or security of the client.