Other·October 17, 2022

Health & Safety Code 1418.91 (a) A long-term health care facility shall report all incidents of alleged abuse or suspected abuse of a resident of the facility to the Department immediately, or within 24 hours. (b) A failure to comply with the requirements of this section shall be a class "B" violation. On 8/22/22, an unannounced visit was conducted at the facility to investigate a complaint regarding an alleged incident of abuse towards one long-term care patient (Patient 1). Patient 1 was admitted to the facility on 2/8/22, with diagnoses included heart failure, asthma, and major depressive disorder (persistent sadness). On 8/19/22, Patient 1 reported to the Administrator, Restorative Nurse Assistant (RNA) had yelled at him and flipped him off with her middle finger (often used to expressed displeasure, rage, excitement, or protest). The Administrator failed to report this allegation of abuse. The facility failed to ensure staff implemented their policy of reporting abuse, or suspected abuse, in a timely manner, and adhere to the Health & Safety Code 1418.91 (a) (b). Based on observation, interview, and record review, the facility failed to follow its abuse policy and procedure (P&P) for one of three sampled patients (Patient 1), when the facility failed to report an allegation of abuse. During a concurrent observation and interview on 8/22/22, at 2:18 PM, Patient 1 was sitting on his bed. Patient 1 stated on 8/19/22, he had taken another patient in the kitchen to get coffee when he was told by Restorative Nurse Assistant (RNA) he was not allowed to go pass a red tape and had given Patient 1 the middle finger (often used to express displeasure, rage, excitement, or protest). Patient 1 stated, "I see [RNA] she said no you can't come here and flipped middle finger at me." Patient 1 stated he verbally reported the incident to the Administrator the same day. During an interview on 8/22/22 at 2:20 PM, with Certified Nursing Assistant (CNA), CNA stated Patient 1 was alert and oriented. CNA stated Patient 1 was told by RNA he was not allowed to pass the red line and RNA had given Patient 1 the middle finger. CNA stated Patient 1 had been refusing to eat and "heard him crying" since the incident happened on 8/19/22. During a review of Patient 1's "Admission Record (AR)" the AR indicated Patient 1 was originally admitted on 2/8/22, with diagnoses included heart failure, asthma, and major depressive disorder (persistent sadness). The Minimum Data Set (MDS- a comprehensive assessment tool) dated 5/15/22, indicated a BIMS (Brief Interview for Mental Status) score of 15 (13-15 cognitively intact). During a review of the facility's "Resident Grievance/Complaint Investigation Report," dated 8/19/22, the report indicated, "Resident [Patient 1] wanted to speak with Admin [sic] regarding employee (RNA) in kitchen stating she "flipped him off" and was yelling at him." During an interview on 8/22/22, at 3:14 PM, with Administrator, Administrator stated on 8/19/22, Patient 1 verbally reported RNA gave him the middle finger "I assumed he meant she flip him off." Administrator stated she had investigated and concluded the investigation the same day and decided there was no need to report the allegation to the state agency, law enforcement, and Ombudsman (patient advocate). Administrator stated she did not report the allegation of abuse made by Patient 1 on 8/19/22, to the proper authorities. During an interview on 8/23/22, at 8:32 AM, with Director of Staff Development (DSD), DSD stated there were different types of abuse including "verbal." DSD stated verbal abuse included belittling, using derogatory language, and/or flipping a finger. DSD stated according to the facility Abuse P&P, the alleged accusation made by Patient 1 "should been reported" to the proper authorities. During a review of the facility's P&P titled, "Reporting Abuse," dated 2017, the P&P indicated, "Verbal abuse" means the use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to residents or to their families, or within their hearing distance, regardless or their age, ability to comprehend, or disability. . . " During a review of the facility's P&P titles, "Abuse Prevention and Prohibition Program," dated 2020, the P&P indicated, ". . .i. In order to facilitate reporting, ensure confidentiality, and promote order at the Facility, the Administrator, or his/her designee, of the Facility shall be the individual who reports known or suspected instances of abuse of resident at the Facility to the proper authorities. D. The Facility will report allegations of abuse, neglect, exploitation, mistreatment, injuries of unknown source, misappropriation of resident property, or other incidents that qualify as a crime. 1. Immediately, but no later than 2 hours-if the alleged violation involves abuse or results in a serious bodily injury to the state survey agency, law enforcement, and the Ombudsman. ii. No later than 24 hours-if the alleged violation (e.g., misappropriation of property, neglect) does not involve abuse and does not result in a serious bodily injury to the state survey agency, law enforcement, and the Ombudsman." In violation of the above cited, the facility failed to ensure staff reported an abuse allegation timely. This failure resulted in a delay of the investigation. This violation had a direct or immediate relationship to the health, safety, or security of patients or residents and constitutes a class "B" citation.