Other·November 4, 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; The facility failed to ensure one of two sampled residents (Resident 1) remained free from psychological/mental abuse. * Certified Nursing Assistant (CNA) 1 confronted and asked Resident 1 to lie or say nothing when questioned about a separate incident involving CNA 2 who was CNA 1's family member. This failure resulted in Resident 1 feeling scared, intimidated, tearful, uncomfortable, dismissed, upset, and feeling bad for needing help. Findings: Review of the Report of Suspected Dependent Adult/Elder Abuse (SOC 341) dated 8/12/21, showed the facility reported an allegation of psychological/mental abuse to Resident 1. The report showed CNA 1 asked Resident 1 to lie or say nothing when questioned about a separate incident involving CNA 1's family member who was also an employee of the facility (CNA 2). Review of the facility's Policy and Procedure (P&P) titled Abuse Prohibition Policy and Procedure dated 2/23/21, showed mental abuse includes, but is not limited to humiliation, harassment, and threats of punishment or deprivation. Mental abuse may occur through either verbal or nonverbal conduct which causes or has the potential to cause the patient to experience humiliation, intimidation, fear, shame, agitation, or degradation. Medical record review for Resident 1 was initiated on 8/31/21. Resident 1 was readmitted to the facility on 8/12/20. Review of the Minimum Data Set (MDS, a standardized assessment tool) dated 8/18/21, showed Resident 1 had no cognitive impairment. Resident 1 required assistance of two persons with transfers. On 8/31/21 at 1523 hours, a concurrent interview and observation of Resident 1 was conducted. When asked to describe the events which took place on the day in question, Resident 1 stated she was sitting in her wheelchair by the hallway next to her room when CNA 1 approached her. Resident 1 stated CNA 1 repeatedly asked her if she had reported anything. Resident 1 stated she answered no, but CNA 1 continued asking if she had reported something and they were going to speak to their employee union. Resident 1 stated CNA 1 told her if anyone asked questions, Resident 1 should just play stupid, and that should be easy for Resident 1. Resident 1 was observed to be teary eyed while recalling the incident. Resident 1 stated this made her feel like she did something bad and made her feel as if she was in a cage. Resident 1 stated she was scared. Resident 1 was observed rocking back and forth in her wheelchair and rubbing the top of her head repeatedly with both hands. Review of the Clinical Summary dated 8/15/21, showed Resident 1 was seen by the psychologist. The documentation showed Resident 1 highlighted two "unfortunate experiences" with two of her CNAs. On 7/30/21, Resident 1 stated she overheard her assigned CNA asking CNA 2 for assistance with wheelchair transfer. Resident 1 stated she heard CNA 2 saying "why do you need help if you have already been trained?" Resident 1 stated she told CNA 2 if she did not want to help so they could find another person to assist. Resident 1 stated CNA 2 yelled at her saying she did not know what she was talking about. The documentation showed Resident 1 felt uncomfortable, like she was treated "like a child and scolded," dismissed, and upset. The documentation showed Resident 1 became teary eyed while recounting the incident. The documentation further showed Resident 1 stated several days after the incident with CNA 2, CNA 1 who was CNA 2's family member confronted her about the incident with CNA 2. Resident 1 stated CNA 1 asked her multiple questions about the incident which made her feel intimidated. The documentation showed Resident 1 recalled during the interaction with CNA 1, CNA 1 told her to "play dumb - it should be easy for you - and not say anything" when she was questioned about her interactions with CNA 2. At this point of the encounter with the psychologist, Resident 1 began to cry stating she did not want to cause trouble but also felt she was not treated respectfully. Resident 1 stated the interactions with CNAs 1 and 2 made her cry and felt bad for needing help. On 9/23/21 at 1412 hours, a telephone interview was conducted with CNA 3. CNA 3 stated she was familiar with Resident 1. When asked if CNA 3 observed any changes to Resident 1's mood, affect, or socialization; CNA 3 stated yes. CNA 3 stated Resident 1 had become quieter, sad, and not talked to CNA 3 like she used to. On 9/28/21 at 1051 hours, a telephone interview and concurrent facility document review was conducted with the Director of Staff Development (DSD). When asked what took place on 8/11/21, the DSD stated CNA 1 confronted Resident 1 and asked if she had sent the DSD a text message about any concerns. Resident 1 told CNA 1 no. CNA 1 then told Resident 1 that she should not say anything to anyone who asked her questions. When asked to describe the resident's mood and affect, the DSD stated Resident 1 was very emotional. The DSD stated Resident 1 was almost out of breath when speaking of the incident, Resident 1 needed emotional support to continue speaking and was described to be crying during the interview. On 9/28/21 at 1534 hours, a telephone interview was conducted with the Administrator. The Administrator verified the above findings. When asked what the outcome of the facility's abuse investigation was, the Administrator stated CNA 1 had been separated from employment at the facility. The Administrator stated CNA 1 was out of line asking Resident 1 to lie. The Administrator stated CNA 1 did not take the feelings of Resident 1 into consideration or consider how the discussion would make Resident 1 feel. The Administrator further described this treatment by CNA 1 as inappropriate. This violation, jointly, separately, or in any combination had a direct or immediate relationship to the health, safety or security of patients or residents.