Other·February 17, 2021

Class "B" Citation 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. 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 and physical abuse, when a Certified Nursing Assistant (CNA 1) was witnessed by a licensed nurse mocking Patient A who had difficulty expressing herself. In addition, the licensed nurse witnessed CNA 1 push Patient A to lay down. Patient A was observed rubbing her right shoulder (the shoulder pushed by CNA 1). This failure had the potential for Patient A to feel humiliated which could cause emotional distress. In addition, the patient complained of pain on her right shoulder after being pushed by the nursing assistant to lay down. On September 30, 2019, at 3:40 p.m., an unannounced visit was conducted at the facility to investigate an allegation of verbal and physical abuse involving Patient A. Patient A's record was reviewed. Patient A was admitted to the facility on August 26, 2019, with diagnoses which included dementia (loss of memory) and muscle weakness. Patient A's BIMS (Brief Interview on Mental Status- an assessment of cognition level) score was 4 (meant severely impaired). A review of the facility document titled," ...SBAR (Situation Background Assessment Recommendation- a communication tool for changes of condition between the nurses and the physician)/ COC (Change of Condition)," dated September 14, 2019, indicated, " ...Allegation of possible rough handling during care and possible inappropriate verbalization to resident by CNA ...pain location: right shoulder ...SBAR charting notes. Allegation of possible rough handling during care and possible inappropriate verbalization to resident by CNA. LVN (Licensed Vocational Nurse) observed CNA using open hand pressed against resident's right shoulder in an effort to lay her down in bed. LVN also states she heard CNA say to (name of Patient A) "Don't move, you are being bad, do not get up." Skin assessment done by RN to right shoulder area...Resident (Patient A) was observed by RN rubbing her right shoulder in a massaging manner..." A review of facility document titled, "Nurses Progress Notes," dated September 15, 2019, indicated,"...At 19:45 (7:45 p.m.), LVN stated she observed CNA handling the resident (Patient A) roughly during care and possible inappropriate verbalization to resident. LVN stated she was standing at her med (medication) cart directly across the hall from resident's room and observed the CNA using open hand pressed against resident's (Patient A) right shoulder in an effort to lay her down in bed. LVN also stated she heard CNA say to (name of Patient A) "Don't move, you are being bad. Do not get up." ...Resident (Patient A) verbalized pain in right shoulder but could not state number on pain scale, she denied pain in the left shoulder..." A review of Patient A’s progress notes dated September 15, 2019, at 4:26 a.m., indicated, "Asked resident (Patient A) what happened before she went to bed she stated" she was pushed and she almost fell"..." A review of Patient A's care plan dated August 26, 2019, indicated the following: a. "Focus: Resident at risk for impaired cognitive function/impaired thought processes. Dementia..."; b. "Goals: Will maintain current level of cognitive function..."; and c. " Interventions: Provide cues, prompting...Promote dignity. Converse with resident and ensure privacy when providing care..." A review of Patient A's care plan dated September 3, 2019, indicated the following: a. "Focus: Resident at risk for Impaired communicated...Expressive problem (difficulty finding the right words) ..."; b. " Goal: Will be able to communicate needs daily and Quality of Life will not be compromised by lack of communication..."; and c. "Interventions: Anticipate and meet the needs of resident...Use alternative communication tools as needed (i.e. communication board, writing pad, signs, gestures, pictures)" On October 3, 2019, at 8:27 a.m., an attempt to interview Patient A was conducted. Patient A was unable to remember the incident involving CNA 1. On October 10, 2019, at 2 p.m., an interview with the Registered Nurse (RN) was conducted. She stated that a Licensed Vocational Nurse (LVN 1) reported witnessing a CNA (CNA 1) push patient on the shoulder. The RN stated the LVN (LVN 1) witnessed CNA 1, "kinda (kind of) yelled" at the patient, " You're being bad," and "Lay here, do not get up." The RN stated the LVN reported that the CNA "mocked" the patient (Patient A), when the patient started speaking her native language, and that CNA 1 pointed her finger at the patient (Patient A) like a child. The RN stated the LVN (LVN 1) thought the CNA's action was uncalled for and disrespectful. In addition, she stated the patient complained of pain on her right shoulder, after the incident on September 14, 2019. On October 16, 2019, at 4:02 p.m., an interview was conducted with LVN 1. LVN 1 stated she was in the hallway across the patient's room when she saw CNA 1 with Patient A. She stated she witnessed the CNA (CNA 1) "kinda (kind of)" mocked her (Patient A) when the patient started speaking her native language, and heard CNA 1 telling the patient, "Na, Na, Na." In addition, LVN 1 stated she saw CNA 1, "kind of pushed her (Patient A)," on her shoulder, to lay down on her (Patient A) bed, and the CNA (CNA 1) stated," Do not move, you're being bad and do not get up." She (LVN 1) stated the patient was rubbing her right shoulder (the shoulder pushed by CNA 1). On November 15, 2019, at 3:30 p.m., CNA 2 was interviewed. CNA 2 stated Patient A can speak English and her language (Tagalog). She stated she would call another nurse to interpret for a patient who could not express her needs due to language barrier. On November 26, 2019, at 3:16 p.m., a phone interview was conducted with the Director of Nursing (DON). She stated it is the duty of the facility staff to use communication board during provision of care for patients whose primary language is not English. The DON stated the facility staff is expected to ensure patient's needs are met. A review of the facility personnel file indicated CNA 1 was terminated on September 18, 2019. A review of the policy and procedure was conducted. The policy and procedure titled, " Reporting Abuse to Facility Management," revised December 2013, indicated,"...Our facility does not condone resident abuse by anyone, including staff members, physicians, consultants, volunteer, staff of other agencies serving the resident, family members, legal guardians, sponsors, other residents, friends, or other individuals...a. Abuse is defined as a willful infliction of injury...intimidation, or punishment with resulting physical harm, pain or mental anguish. b. Verbal abuse is defined as any oral, written, or gestured language that willfully includes disparaging and derogatory terms to residents or their families...Mental abuse is defined as, but is not limited to, humiliation, harassment..." Therefore, the facility failed to ensure Patient A was free from verbal and physical abuse, when a Certified Nursing Assistant (CNA 1) was witnessed by a licensed nurse mocking Patient A who had difficulty expressing herself. In addition, the licensed nurse witnessed CNA 1 push Patient A to lay down. Patient A was observed rubbing her right shoulder (the shoulder pushed by CNA 1) after the incident. This failure had the potential for Patient A to feel humiliated which could cause emotional distress. In addition, the patient complained of pain on her right shoulder after being pushed by the nursing assistant to lay down. This failure had a direct or immediate relation to patient's health, safety, or security.