Other·June 28, 2021

Mission Skilled Nursing and Sub Acute Ctr F607 §483.12(b)(1)-(3) DEVELOP/IMPLEMENT ABUSE/NEGLECT POLICIES §483.12(b) The facility must develop and implement written policies and procedures that: §483.12(b)(1) Prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property, §483.12(b)(2) Establish policies and procedures to investigate any such allegations, and §483.12(b)(3) Include training as required at paragraph §483.95, The facility failed to implement their written abuse (the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish) policy for one of 24 sampled residents (Resident 14) when certified nursing assistant A (CNA A) continued to provide direct care for activities of daily living (ADLs, such as bed mobility, transfer, toileting, dressing, bathing, personal hygiene, locomotion on unit, and locomotion off unit), had interactions with Resident 14 during weights monitoring and assistance with social dining after an abuse incident investigation when Resident 14 alleged CNA A committed verbal abuse. These failures resulted in Resident 14's emotional distress and social isolation. Review of Resident 14's undated face sheet indicated she was admitted on 3/9/19, with diagnoses of diabetes (increase in blood sugar), hemiplegia (paralysis of one side of the body), muscle weakness, and hypertension (increase blood pressure). Review of Resident 14's minimum data set (MDS, an assessment tool) dated 3/23/21, indicated she had a brief interview for mental status (BIMS, cognitive status) score of 15 (a score of 15 means cognitively intact), required staff assistance for bed mobility, transfer, dressing eating, toilet, bathing, locomotion on unit, locomotion off unit, and personal hygiene. Review of Resident 14's situation, background, assessment, recommendation (SBAR, a way for health care professionals to communicate effectively with one another, and allows for important information to be transferred accurately) dated 12/3/20, indicated Resident 14 had an allegation of verbal abuse against CNA A, which occurred approximately 11/19/2020 at 11:00 a.m., when CNA A called her "gordita" (Spanish word for fat person per the resident), and Resident 14 identified this incident as a stressor due to her inability to sleep. The goal was to make sure the resident would be safe and free from harm. Review of Resident 14's undated abuse incident investigation related to verbal abuse, Resident 14 was not able to provide the exact date but mentioned the incidence occurred around 11/27/2020. Resident 14 did not want CNA A to come back to her room and she did not want to interact with CNA A. CNA A and her supervisor were made aware that she cannot provide any direct care to Resident 14 or her roommate. Facility staff ensured Resident 14's preferences continued and were accommodated. During an observation and interview with Resident 14 on 6/7/21 at 9:20 a.m., Resident 14 was lying in bed and tearful. Resident 14 stated CNA A told her she was "so big" and the incident happened in 2020. Resident 14 stated CNA A should not come to her room and CNA A was assigned to provide direct care to her. Resident 14 stated CNA A comes to her room and she did not want to see her. Resident 14 stated she felt terrified and scared when she saw CNA A in her room and Resident 14 cried. Resident 14 stated she just wants to stay in her room. Review of the CNA's assignment sheet indicated on 6/4/21 and 6/5/21, CNA A was assigned to provide direct care to Resident 14. During an interview with CNA A on 6/11/21 at 7:57 a.m., CNA A stated she was assigned to work all stations as both a CNA and RNA (Restorative Nursing Aide). CNA A confirmed she was assigned to provide direct care to Resident 14 on 6/4/21, 6/5/21, and sometimes she was assigned to weigh Resident 14. CNA A also stated she served Resident 14's food on 6/6/21 in the social dining area. CNA A also added Resident 14 requested to go back to her room after being served her food. During an interview with the social service assistant (SSA) on 6/11/21 at 10:25 a.m., she stated Resident 14 was alert, oriented, cooperative, and could make decisions. The SSA confirmed she was aware of the verbal abuse incident reported on 12/3/20 regarding Resident 14 and CNA A. The SSA stated CNA A should not be assigned to Resident 14 and should have no interactions with Resident 14 to prevent emotional distress to the resident. SSA also stated the nursing staff should have monitored and checked CNA A was no longer assigned to Resident 14. The SSA stated Resident 14 could have emotional distress and psychological distress when CNA A was assigned to her. During an interview with the director of staff development (DSD) on 6/11/21 at 1:40 p.m., she confirmed CNA A was assigned to weigh Resident 14 and sometimes assigned in social dining to assist Resident 14. The DSD stated Resident 14's preference related to not wanting CNA A to provide direct care to her should have been monitored, and discussed during the interdisciplinary meeting (IDT, improve communication technique). The DSD also stated Resident 14 was in the social dining area on 6/6/21 with CNA A, and Resident 14 wanted to return to the room because she did not want to interact with CNA A. During an interview with registered nurse C (RN C) on 6/11/21 at 2:17 p.m., she stated she was the assigned charge nurse for 6/4/21, and assigned CNA A to provide direct care to Resident 14. During an interview with the director of nursing (DON) on 6/11/21at 3:34 p.m., the DON stated CNA A should not have been assigned and interacted with Resident 14 on 6/4/21 and 6/5/21. The DON stated Resident 14's preference related to not wanting CNA A to provide direct care to her should have been monitored and implemented to prevent future abuse. DON confirmed there was no facility staff who monitored and checked CNA A's schedule. Review of the facility's 2016 policy, "Abuse Prevention, Interventions, Investigation & Crime reporting policy", indicated the facility is responsible for assuring resident safety by prohibiting verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion. The facility failed to implement their written abuse (the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish) policy for one of 24 sampled residents (Resident 14) when certified nursing assistant A (CNA A) continued to provide direct care for activities of daily living (ADL's, such as bed mobility, transfer, toileting, dressing, bathing, personal hygiene, locomotion on unit, and locomotion off unit), had interactions with Resident 14 during weights monitoring and assistance with social dining after an abuse incident investigation which Resident 14 alleged CNA A committed verbal abuse. These failures resulted in Resident 14's emotional distress and social isolation. This failure had a direct relationship to the health, safety, or security of residents.