Health inspection·March 29, 2023

Section 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. (a) The facility must - (1) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion. The following citation is written as a result of an unannounced visit conducted at the facility on 10/19/21 at 9:03 a.m. to investigate facility reported incident CA0075681. The Department determined the facility failed to ensure Resident 1 was free from abuse, when Resident 1 was restrained while Certified Nursing Assistants (CNAs) provided care and sustained discoloration on bilateral forearms. Resident 1 was admitted to the facility on 1/2/20 and diagnoses included chronic obstructive pulmonary disease (COPD-chronic inflammatory lung disease that makes it hard to breath) and psychosis (mental disorder characterized by disconnection from reality). Review of Resident l's Quarterly MDS (Minimum Data Set-an assessment tool), dated 9/3/21 described Resident A as able to make herself understood and as having the ability to understand others. The MDS described Resident 1 as having a BIMS (a brief screening that aids in detecting cognitive impairment) score 13 which indicated she was cognitively intact and as having no delirium or behavioral symptoms. Review of Resident l's SBAR (incident reporting tool) -Alleged Abuse Report of Incident," dated 10/12/21 indicated Resident 1 called 911 and stated "she was abused by staff member, resident states t6hat (sic) she was held down by certain CNA ... " The SBAR indicated Resident 1 was interviewed by a nurse and the Social Service Director (SSD). Resident 1 stated, "she was held down by CNA and it hurt her arm." The document also indicated under Social Services Note: "Resident [1] expressed fear and anxiety regarding CNA providing continued care." Review of Resident 1 's, "Skin Inspection Assessment-V3," dated 12/12/21 indicated "Full head to toe done, only issues noted were discoloration on bilateral forearms." Review of a facility form, "Interview/Investigative Record," dated 10/11/21, indicated CNA 1 went back into Resident l's room to help change her due to Resident 1 "is supposed to be 2 people assist." "CNA [CNA 1] asked for permission to help change resident, resident stated no, CNA [CNA l] proceeded to help B/C (because) she felt the other CNA needed help. Patient [Resident 1] scratched CNA, held residents' hands down, pt (patient) kicked her & called her a bitch, she proceeded to spit. CNA 1 then threw a towel on her face to protect self until care was complete." Review of a facility form "Interview/Investigative Record," dated 10/12/21 indicated CNA 2 was interviewed. CNA 2 stated Resident 1, "Didn't want to be change; linen soiled transfer bed to w/c (wheelchair) to clean bed; PT (patient) kept pulling off brief. Spit on [CNA 1]; kick [CNA l]; cussed at [LN l]. Held arm/hand shut to keep resident "safe." She did not see towel on mouth or hands held down. Asked [CNA l] how she protected herself from spit, [CNA l] said she put towel." CNA 2 was asked if she reported to supervisor she replied, "No." Review of CNA l's "Disciplinary Action Notice," dated 10/18/21 indicated CNA 1 failed "to provide resident care consistent with respect for patient's right to refuse." The notice also indicated CNA 1 failed "to provide care consistent with facility policy and procedure with respect to residents right to refuse as evidenced by restraining patient to provide care, patient refusing care." "Summary of disciplinary action to be taken ... allegation of abuse has been substantiated." "Consequence of failure to abide by policy: termination." Review of CNA 2's, "Disciplinary Action Notice," dated 10/18/21 indicated CNA 2 failed "to provide resident care consistent with respect for patients right to refuse." The notice indicated, "Allegation of abuse has been substantiated." "Consequence of failure to abide by policy: termination." Review of the facility's policy, "Abuse Prevention, Intervention, Investigation & Crime Reporting Policy," revised November 2016 indicated, "The resident has the right to be free from abuse ... 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 medial symptoms. The facility is responsible for assuring resident safety by prohibiting verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion; and ensuring that residents are free from physical or chemical restrains imposed for purpose of discipline or convenience and that are not required to treat the resident's medical symptoms." In violation of the above cited standards, the facility failed to ensure the resident was 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, including but not limited to: The Department determined the facility failed to ensure Resident 1 was free from abuse, when Resident 1 was restrained while Certified Nursing Assistants (CNAs) provided care and sustained discoloration on bilateral forearms. This violation caused or occurred under circumstances likely to cause significant humiliation, indignity, anxiety, or other emotional trauma to a patient.