Other·October 15, 2024

Title 22 72315 (b) Nursing Service-Patient Care (b) Each patient shall be treated as individual with dignity and respect and shall not be subjected to verbal or physical abuse of any kind. Title 22 72523 (a) Patient Care Policies and Procedures (a)Written patient care policies and procedures shall be established and implemented to ensure that the patient related goals and facility objectives are achieved. Title 22 72527 (a) (10) 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. Patient shall have the right: (10) To be free from mental and physical abuse. CFR §483.12 (a) (1) Freedom from Abuse, Neglect, and Exploitation §483.12 (a) The facility must - §483.12 (a) (1) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion. On September 3 and 4, 2024, unannounced visits were made to the facility to investigate an allegation of physical abuse involving Patient A. It was determined that the facility failed to ensure Patient A was free from physical abuse when a facility staff witnessed Certified Nursing Assistant (CNA) 1 slap Patient A in the face. This failure subjected Patient A to physical abuse. On September 3, 2024, at 10:23 a.m., Patient A was observed lying in bed, awake and alert. Patient A was verbally responsive and was Spanish speaking. During a concurrent interview with Patient A, in the presence of a facility staff as an interpreter, the patient stated a male nurse slapped him in the face in the dining room. Patient A demonstrated how the nurse slapped him in the face with an open hand, and he stated the slap was hard. Patient A could not remember the name of the male nurse. However, Patient A stated a female nurse saw the male nurse slap him in the face. Patient A's record was reviewed. Patient A was admitted to the facility on July 2, 2024, with diagnoses which included dementia (memory loss) and schizophrenia (a mental disorder that affects a person's ability to think, feel, and behave clearly). Patient A's "History and Physical," dated July 3, 2024, indicated Patient A can make his needs known but cannot make medical decisions. The document titled, "Change of Condition," dated August 17, 2024, indicated, "...At approximately 1530 (3:30 p.m.) resident (Patient A) returned from activities to his room. Once there resident made attempts to get up out of wheelchair and was assisted back into a sitting position by CNA. Resident made several attempts to get up and became aggressive, striking out towards CNA. Resident states CNA then slapped him in the face after sitting him back into wheelchair. CNA was removed from the facility immediately...after giving statement...CNA escorted out of facility...Resident assessed for injuries with none noted, no signs of swelling, discoloration, redness, abrasions or open areas. Resident denies pain...Resident verbalized he felt safe and wasn't fearful of a repeated incident..." On September 3, 2024, at 10:35 a.m., the Social Service Designee (SSD) was interviewed. The SSD stated Patient A had a history of hitting staff and if Patient A had that behavior, the staff member should have kept his distance from the patient and not hit the patient back. The SSD stated she followed-up with Patient A after he was slapped by CNA 1, and the patient did not exhibit any emotional or behavioral changes. On September 3, 2024, at 2:23 p.m., CNA 2 was interviewed. CNA 2 stated she was walking in the hallway past Room 27 and saw Patient A sitting in the wheelchair. She stated Patient A was restless and was trying to get out of the wheelchair when she witnessed CNA 1 grab Patient A's arms and forced him (the patient) to sit down. She stated Patient A tried to get out of the wheelchair again and she witnessed CNA 1 put Patient A back in the wheelchair and slapped the patient in the face. She stated she was shocked by what she saw. On September 4, 2024, at 8:36 a.m., during a telephone interview with the LVN, the LVN stated CNA 2 reported that she saw CNA 1 push Patient A back into the wheelchair and slapped him in the face when Patient 1 tried to get out of the wheelchair again. The LVN stated CNA 1 told her Patient A kept getting out of the wheelchair and he was worried Patient A would fall so he pushed him back into the wheelchair. The LVN stated CNA 1 did not mention he slapped Patient A. The LVN stated she checked on Patient A and there was no redness or bruising on Patient A's face and the patient did not appear to be frightened or scared. However, Patient A was mad and upset he was slapped in the face. On September 4, 2024, at 1:03 p.m., during an interview with the Director of Nursing (DON), she stated the staff had an in-service on how to handle difficult and combative patients. The DON stated the staff were aware to keep a distance when the patient's behavior becomes aggressive, and the patient started to strike at them. She also stated the staff were aware to protect themselves and the patient. The DON stated she was not sure what triggered CNA 1 to slap Patient A in the face. A review of the facility document titled, "THE RIGHTS AND PROTECTIONS OF A NURSING HOME RESIDENT," signed, acknowledged and dated by CNA 1 on January 9, 2024, indicated, "...At a minimum, Federal law specifies that nursing homes must protect and promote the following rights of each resident. They have the right to...Be Free from Abuse...Residents have the right to be free from verbal, sexual, physical, and mental abuse..." A review of the facility document titled, "Abuse Prevention Program," revised December 2016, indicated, "...Our residents have the right to be free from 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..." The facility failed to ensure Patient A was free from physical abuse when CNA 1 slapped Patient A in the face, which subjected Patient A to physical abuse. The failure of the facility to protect Patient A from physical abuse had a direct or immediate relationship to the health, safety, or security of the patients.