Health inspection·August 31, 2023

Cottonwood Canyon Healthcare Center CA00846283/ OVM611 §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 72315 Nursing Service - Patient Care (b) Nursing Service-Patient Care Each patient shall be treated as an individual with dignity and respect and shall not be subjected to verbal or physical abuse of any kind. 72527. Patients' Rights. (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 and psychosocial harm. The Department conducted an unannounced visit on 06/27/23, to investigate a facility reported incident which occurred on 6/18/23. The facility failed to ensure that Resident 1 was free from physical abuse from Resident 2 who physically assaulted him. This failure resulted in the following: 1. Resident 1 had pain, bleeding, and a laceration above of his right eyebrow, bruising of the face and a small cut on top of his nose. 2. Resident 1 was transferred to a general acute care hospital due to right eye pain and was diagnosed with a nasal fracture (break in bone) with overlying soft tissue swelling (bruising) and periorbital (tissues lining the eye socket) hematoma (area of blood that collects outside the vessels). 3. Resident 1 underwent suturing (to close the wound) of the two-centimeter (cm) lacerations over the right eyebrow and a one cm laceration of the right lower eye lid. 4. Resident 1 received a tetanus vaccine (an injection to prevent infection caused by bacteria called Clostridium tetani. When these bacteria enter the body, they produce a toxin that causes painful muscle contractions) and oral antibiotics (medication to fight against infection). 5. Resident 1 manifested symptoms of anxiety, panic (onset of intense fear or discomfort) disorder and depression. Findings: On 6/27/23 at 1:03 P.M., an unannounced onsite visit at the facility was conducted related to a reported resident to resident altercation. Resident 1 was admitted to the facility on 4/19/22, with diagnoses which included hemiplegia (total or partial paralysis of one side of the body) of his right side, per the facility's Admission Record. A review of Resident 1's History and Physical (H & P) dated 4/20/23, indicated Resident 1 could make his needs known but could not make medical decisions. A review of Resident 1's minimum data set (MDS, an assessment tool), dated 4/19/23, indicated Resident 1 had a Brief Interview for Mental Status (BIMS, ability to recall) score of 15 which meant Resident 1 had intact cognition. Resident 1's functional status on activities of daily living (ADLs, such as eating, bed mobility, transfer, grooming...) indicated he required extensive assistance with a one-person physical assist. On 6/27/23 at 2:36 P.M., an observation and an interview were conducted with Resident 1. Resident 1 was lying in bed, had hard time expressing himself, and had a fading hematoma around his right eye. Resident 1 stated Resident 2 came up to his bed and hit him (Resident 1) in the face. Resident 1 was teary eyed, stated he did not feel safe and wanted to leave the facility. On 6/28/23, a review of Resident 1's change in condition (CIC) dated 6/18/23 at 12 A.M. was conducted. Licensed Nurse (LN) 1 documented, Resident 1 was a victim of resident abuse, and was found by staff with bleeding and laceration above his right eyebrow, bruising of the face, small cut on top of the nose, and complained of pain. On 6/28/23, a review of the hospital emergency department (ED) notes, dated 6/18/23, was conducted. Medical Doctor (MD 1) documented Resident 1 complained of right eye pain after an assault from his roommate (Resident 2). The ED notes indicated Resident 2 hit Resident 1 with a closed fist multiple times on the face. The physical exam completed by MD 1 indicated Resident 1 had a hematoma in his right superior orbit (eye socket), and a small laceration to the lower eye lid and right eye lid. The ED notes indicated the results of Resident 1's cat scan (CT, computerized tomography, a procedure that uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body) showed right periorbital soft tissue swelling and hematoma, right nasal bone fractures with soft tissue swelling. The ED notes indicated Resident 1 underwent suturing of a two-centimeter (cm) laceration above the right eyebrow and a one cm laceration of the right lower eye lid. The ED notes indicated Resident 1 received a tetanus injection. The discharge notes from the ED indicated Resident 1 was to received oral antibiotics two times a day for 10 days. On 6/28/23, a review of Resident 1's nurses progress notes dated 6/19/23 at 1:45 A.M., completed by LN 3 indicated, Resident 1 came back from the hospital on 6/19/23 at 1:30 A.M. Per the LN's note, Resident 1 complained of 7/10 (level of severity, 10 being the most painful) pain on his right eye and was given pain meds. Per the LN's note, Resident 1 had two stitches above his right eyebrow with dark purplish bruising around his eyes with swelling. Per the LN's note, Resident 1 was reported to have a right sided nasal fracture, and right orbital swelling. Per the LN's note, Resident 1 was referred to an eye care specialist and an Ear, Nose, and Throat (ENT) doctor. On 6/28/23, a review of Resident 1's physician progress noted dated 6/19/23 at 3:30 P.M., indicated, the physician gave a new order for antianxiety medication to Resident 1. On 6/28/23, a review of Resident 1's nurses progress notes dated 6/20/23 at 12:56 P.M., completed by the Director of Nursing (DON) indicated, Resident 1 did not feel safe at the facility and requested to transfer. On 6/28/23, a review of Resident 1's nurses progress notes dated 6/20/23 at 2:31 P.M., completed by LN 4 indicated, Resident 1 refused breakfast and lunch, felt depressed, and did not feel safe at the facility. On 6/28/23, a review of Resident 1's social services (SS) notes dated 6/20/23 at 4:20 P.M., completed by SS indicated, Resident 1 was in pain, was depressed, and verbalized to SS that he did not want to live at the facility. On 6/28/23, a review of Resident 1's nurses progress notes dated 6/21/23 at 8:51 A.M., completed by LN 5 indicated, Resident 1 refused to eat unless was sent out of the facility. On 6/28/23, a review of Resident 1's CIC dated 6/21/23 at 9:01 A.M., indicated, "...Behavioral Status Evaluation: Depression (e.g., crying, hopelessness, not eating, multiple somatic complaints) ...Neurological Status Evaluation: Nursing observations, evaluation, and recommendations are: since he came back from ED [sic] reported not eating, claiming continues to do till placement done out of here..." On 6/28/23, a review of Resident 1's social services notes dated 6/21/23 at 1:56 P.M., completed by SS indicated, Resident 1 verbalized to SS that he (Resident 1) was depressed and angry that he could not defend himself. On 6/28/23, a review of Resident 1's social services notes dated 6/22/23 at 4:01 P.M., completed by SS indicated, Resident 1 verbalized to SS that he wanted a discharge plan. Per SS notes, Resident 1 was noted with "Post- Traumatic Stress Disorder (PTSD, a mental and behavioral disorder that can develop because of exposure to a traumatic event) due to physical abuse - flashback, fear, severe anxiety, and/ or mistrust, loss of interest in activities (meals), guilt, and/ or loneliness..." On 6/28/23, a review of Resident 1's mental health physician progress notes dated 6/22/23 at 9 P.M., indicated Resident 1 demonstrated symptoms of severe anxiety and moderate intensity of depression. Per the physician progress notes, Resident 1 symptoms of anxiety observed included "Persistent and exaggerated negative beliefs of expectations about self and others which cause significant anxiety, intrusive thoughts, frequently shifting concerns, uncomfortable with uncertainty, anticipatory anxiety such as fearing continued negative events and worry is experienced as difficult to control and distressing. The pt. manifests the diagnostic features of panic disorder...Pt was recently attacked by a resident at the facility and reported he does not feel safe since the attack and wants to be moved to another facility...Regarding symptoms of anxiety: Patient presents as nervous. Symptoms of depression include feeling alone in the world even when others are around. Regarding depressive symptoms: Patient presents as troubled with cares..." Resident 2 was admitted to the facility on 1/17/23, with diagnoses which included Huntington's disease (genetic disease that attacks the brain, causing unsteady and uncontrollable movements, cognition [perception, awareness, thinking, judgement] and mental health), per the facility's Admission Record. A review of Resident 2's minimum data set (MDS, an assessment tool), dated 4/26/23, indicated Resident 2 had a BIMS score of 6 which meant Resident 2 had a severely impaired cognition. Resident 2's functional status on transfer indicated the activity occurred once or twice with one-person physical assist. On 6/27/23 at 2:10 P.M., an observation and an interview were conducted with Resident 2. Resident 2 was lying in bed, watching television. During the interview, Resident 2 was asked about the altercation with Resident 1. During the interview, Resident 2 got agitated, yelled, made a fist, and swung his fisted hands up in the air. Resident 2 stated Resident 1 called him names and the staff did not do anything about it. On 6/27/23 at 3:09 P.M., an interview was conducted with Certified Nursing Assistant (CNA) 1. CNA 1 stated on 6/18/23, Resident 1 was agitated, and was yelling. CNA 1 stated before the time of the physical altercation occurred, she (CNA 1) answered Resident 1 and 2's call light. CNA 1 stated she checked on Resident 1 while Resident 2 yelled at them (CNA 1 and Resident 1). CNA 1 stated while she was asking questions to understand what happened, Resident 2 swung opened the privacy curtain between him and Resident 1. CNA 1 stated "I thought it (curtain) got ripped off." CNA 1 stated Resident 2 kept on yelling, bent to his knees, and grabbed Resident 1's bed. CNA 1 stated "From the few words I got, (name of Resident 2) was threatening to hit (name of Resident 1). CNA 1 stated Resident 1 was "Very scared", and Resident 2 was "Aggressive." CNA 1 stated she asked Resident 2 to get off Resident 1's bed, for him to sit down, and it took her several times to say it before Resident 2 complied. CNA 1 stated once Resident 2 laid back to his bed, she (CNA 1) stepped out from the residents' room to inform the licensed nurse (LN) 1. CNA 1 stated LN 1 directed her to inform LN 2. CNA 1 stated a few minutes after stepping out, the assigned CNA (2) came back and checked Residents 1 and 2 and found Resident 1 was injured and bleeding from his right eyebrow. CNA 1 stated "I realized the issue and did a mistake by leaving them alone in the room." CNA 1 stated she panicked and should have not left the two residents. On 6/28/23, a review of Resident 2's nurses' progress notes dated 5/28/23 at 10:43 A.M., completed by LN 6, indicated Resident 2 had an increased agitation, refusing care and became physical with a staff. Per the nurses' notes, Resident 2 was sent to the hospital. On 6/28/23, a review of Resident 2's hospital records dated 5/28/23, completed by MD 2, indicated Resident was aggressive and was combative with the staff at the skilled nursing facility (SNF). Per MD notes, Resident 2 was extremely agitated and combative at the emergency department (ED) and required chemical restraints by the ED physician. On 6/28/23, a review of Resident 2's nurses' progress notes dated 6/3/23 at 1:26 P.M., completed by LN 6, indicated Resident 2 came back from the hospital. Per the nurses' notes, "Resident has history of aggressive and combative behavior and noncompliance with medication requiring chemical restraints and a sitter. His Seroquel (antipsychotic medication) was increased and will be referred for psyche consult while in the facility. Will be monitored for adherence to medications and changes in mood or behavior..." On 6/28/23, a review of Resident 2's H & P dated 6/6/23, indicated Resident 2 could make needs known but could not make medical decisions. A physician's progress notes dated 6/6/23, indicated Resident 2 had increased agitation, his behaviors were not controlled in the facility and was sent to hospital. Per MD notes, the plan was to monitor Resident 2 and he seemed okay as far as agitation was concerned. On 6/28/23 at 3:57 P.M., a telephone interview was conducted with LN 2. LN 2 stated the physical altercation could have been prevented if CNA 1 stayed with the residents and did not leave the residents' room. On 6/28/23 at 3:59 P.M., a telephone interview was conducted with the DON. The DON stated CNA 1 should have called for help and should not have left the residents' room to prevent the physical altercation. On 6/28/23, a review of the facility's policy titled, Abuse Prevention Program, revised December 2016, indicated, "Our residents have the right to be free from abuse...This includes but is not limited to...physical abuse...1. Protect our residents from abuse by anyone including, but not necessarily limited to...other residents..." On 6/28/23, a review of the facility's policy titled, Resident to Resident Altercation, revised December 2016, indicated, "...1. Facility staff will monitor residents for aggressive/inappropriate behavior towards other residents, family members, visitors, or to the staff..." The facility failed to ensure that Resident 1 was free from abuse by Resident 2. This failure compromised Resident 1's physical and mental well-being and potentially caused undue stress to a resident with a diagnosis of anxiety (a mental health disorder characterized by worry or fear that interferes with daily functioning). In addition, staff left both Resident 1 and Resident 2 alone in the same room, while attempting to get assistance from other staff. As a result, Resident 2 physically assaulted Resident 1. These violations, jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of patients or residents.