Other·May 31, 2022

CFR 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. CFR 483.12 (a) The facility must- CFR 483.12 (a) (1) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion. Title 22 72315 Nursing Service - Patient Care (b) Each patient shall be treated as individual with dignity and shall not be subjected to verbal or physical abuse of any kind. Title 22 72527 Patients’ Rights (a) (10) (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. (10) To be free from mental and physical abuse. It was determined that the facility failed to ensure Patient A was free from verbal abuse, when Registered Nurse (RN 1) was witnessed by a Certified Nursing Assistant (CNA 1) calling Patient A, a "bit** (expletive)." This failure subjected Patient A to verbal abuse. On August 31, 2020, at 11:34 a.m., an unannounced visit was conducted at the facility to investigate an allegation of verbal abuse involving Patient A. On August 31, 2020, at 12:43 p.m., an interview with the Administrator (ADM) was conducted. The ADM stated when he interviewed Patient A, the patient stated that she asked RN 1 for help and RN 1 ignored her. The ADM stated RN 1 called the patient, a “bit** (expletive),” when the patient asked for help again. The ADM stated he investigated the incident, and the allegation of verbal abuse was substantiated. On August 31, 2020, at 3:09 p.m., during an interview, RN 2 stated on her first day back to work on August 18, 2020, she was informed that Patient A wanted to talk to her. She stated the patient reported that RN 1 called her a "bit** (expletive)" and the incident was witnessed by Certified Nursing Assistant (CNA) 1. RN 2 stated she spoke with CNA 1, and the CNA told her she did witness the incident. RN 2 stated she proceeded to report the incident to the ADM. On August 31, 2020, at 3:25 p.m., an interview with CNA 1 was conducted, and stated she could not recall the exact date of the incident. CNA 1 stated she observed Patient A rolling her wheelchair to the nurses' station from her room, and asked RN 1 for help regarding the itching on her arms and was asking questions regarding her laboratory tests. RN 1 ignored Patient A. The CNA stated Patient A then called RN 1 a "bit** (expletive)," to which RN 1 responded, "No, you're a bit** (expletive)." On February 2, 2021, at 2 p.m., a telephone interview was conducted with Patient A. The patient stated she could not recall the exact date of the incident. Patient A stated she rolled her wheelchair to the nurses' station from her room and was talking to CNA 1, when RN 1 "called me a bit** (expletive) or a f***ing bit** (expletive), I can't recall which exactly." She stated she asked RN 1 if she really called her that, and RN 1 said yes. Patient A stated the incident was witnessed by CNA 1. The patient stated she did not want to report it at that time because everybody was afraid of RN 1. However, she reported the incident to RN 2 and the ADM, the next day. On February 16, 2021, a review of Patient A's record was conducted, and indicated Patient A was admitted to the facility on July 19, 2020, with diagnoses including epilepsy (a neurological disorder that causes seizures). The "History and Physical," dated July 20, 2020, indicated Patient A had the capacity to understand and make decisions. The records indicated Patient A was sent out to the general acute care hospital following several successive seizure episodes on August 17, 2020, and returned to the facility on August 18, 2020. The Minimum Data Set (MDS-an assessment tool), dated July 24, 2020, included a Brief Interview for Mental Status (BIMS- a brief screening tool that aids in detecting cognitive status) which indicated Patient A had a score of 15 (a score of 13-15 means intact cognition). A review of the facility's undated policy and procedure titled, "Abuse Prevention Program," indicated, "...Our residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual or physical abuse... As part of the resident abuse prevention, the administration will...Protect our residents from abuse by anyone including, but not necessarily limited to facility staff..." Therefore, the facility failed to ensure Patient A was free from verbal abuse, when Registered Nurse (RN 1) was witnessed by a Certified Nursing Assistant (CNA 1) calling Patient A, a "bit** (expletive)." This failure subjected Patient A to verbal abuse. This violation caused or occurred under circumstances likely to cause significant humiliation, indignity, anxiety, or other emotional trauma to Patient A.