Other·June 29, 2022

Rancho Mirage Health and Rehabilitation Center Intake# CA00667604 linked with CA00668421 Citation B 42 CFR 483.12 (a) (1) 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. (a) The facility must- (1) Not use verbal, mental sexual, or physical abuse, corporal punishment, or involuntary seclusion Title 22 72527 (a) (9) Patients' Rights (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. (9) To be free from mental and physical abuse. Title 22 72311(a) (2) Nursing Service - General (a) Nursing service shall include, but not limited to, the following: (2) Implementing of each patient's care plan according to the methods indicated. Each patient's care shall be based on this plan. It was determined that the facility failed to provide an environment which is free from abuse and corporal punishment for Patient 1, when two facility staff witnessed an incident in which the Licensed Vocational Nurse (LVN 1) tapped the patient's forehead and pinched her ears when the patient became combative. This failure resulted in Patient 1 being subjected to physical abuse which could negatively affect the emotional and psychosocial wellbeing of Patient 1. On December 19, 2019, at 12:43 p.m., an unannounced visit to the facility was conducted to investigate an allegation of abuse. On December 19, 2019, at 1:42 p.m., Certified Nursing Assistant {CNA) 1 was interviewed, and stated that on December 14, 2019, at about 10:15 p.m., Patient 1 became combative during the provision of care. She stated that during the commotion, Licensed Vocational Nurse {LVN) 1 came in to the room, went in front of Patient 1, "smacked" her (Patient 1) on the forehead and aggressively wheeled patient out of the bathroom. CNA 1 stated she observed the patient grab LVN l's necklace and breaking it. CNA 1 stated she was positioned behind the patient's wheelchair facing LVN 1 when LVN t pinched the patient's right ear. CNA 1 stated she was shocked with the LVN's action towards the patient (Patient 1). On December 19, 2019, at 1:58 p.m., during an interview, LVN 2 stated if a patient starts getting combative during care, she would stop and redirect the patient. On December 19, 2019, at 2:08 p.m., Registered Nurse (RN) 1 was interviewed. RN 1 was asked how an aggressive patient should be managed. RN 1 stated she would not get too close and would not touch an aggressive patient. RN 1 stated she would calmly talk to the patient. On December 19, 2019, at 2:22 p.m., CNA 2 was interviewed and stated she was assigned to Patient 1 when the incident happened on December 14, 2019. CNA 2 stated the patient got upset and started getting combative, when they (CNAs 1 and 2) were changing her pants. CNA 2 stated LVN 1 came in and asked if they needed help, and saw the patient's arm "flying everywhere." CNA 2 stated she saw LVN 1 "smack" the patient's forehead, and she observed LVN 1 was getting angrier and LVN 1 proceeded to forcefully wheel Patient 1 out of the bathroom. CNA 2 stated LVN 1 then grabbed and pinched the patient's right ear, when the patient yanked LVN l's necklace. CNA 2 heard Patient 1 state "you're hurting me," to LVN 1. CNA 2 stated she observed LVN 1 grab the patient and threw the patient on the bed. She stated the LVN has "passed the line." On December 19, 2019, at 2:43 p.m., CNA 3 was interviewed and stated he would always let the patient know the procedure prior to conducting care. CNA 3 stated if the patient becomes combative and difficult to handle, he would call for another staff to reason out with the patient. On December 19, 2019, at 3:06 p.m., CNA 4 was interviewed. CNA 4 stated stated she would stop provision of care and calm down the patient, if the patient continued being combative. On December 20, 2019, at 3:06 p.m., LVN 1 was interviewed. LVN 1 stated she had worked double shift, and Patient 1 was assigned to her, on December 14, 2019. She stated Patient 1 was combative so she tapped her forehead to get her attention. LVN 1 stated she pushed Patient l's wheelchair out of the bathroom and put patient to bed. LVN 1 denied pinching patient's ear after Patient 1 pulled her necklace. On January 2, 2020, at 3:48 p.m., the family member (FM) of Patient 1 was interviewed. The FM stated she was informed by the facility that a nurse slapped patient on the forehead. The FM stated it was not right for the nurse to slap the patient on the forehead. On January 16, 2020, at 10:20 a.m., the Registered Nurse Supervisor (RNS) was interviewed. The RNS stated on December 15, 2019, at around 4:30 p.m., CNA 2 reported to her, an incident that happened on Saturday {December 14, 2019) involving Patient 1 and LVN 1. The RNS stated CNA 2 reported that LVN 1 entered the patient's room, and observed Patient 1 hitting the two CNAs (CNA 1 and CNA 2).The RNS stated CNA 2 observed LVN 1 tap the patient on the forehead, pick Patient 1 from her wheelchair and threw the patient on the bed. The RNS stated CNA 2 mentioned LVN 1 pulled the patient's ear. On December 19, 2019, Patient l's record was reviewed. Patient 1 was admitted to the facility on March 10, 2016, with diagnoses which included dementia {memory loss). The history and physical dated January 19, 2019, indicated Patient 1 does not have the capacity to understand and make decisions. A review of the documentation titled, "PSYCHIATRIC ASSESSMENT FORM," dated November 6, 2019, indicated, "...CURRENT PSYCHOLOGICAL ISSUES... lmpaired short term memory...Periods of confusion...lmpaired coping skills..." Patient l's progress notes dated December 14, 2019, indicated, "Patient was extremely physically abusive PM (afternoon) shift...Patient was yelling at the CNAs... Patient was witnessed swinging her arms wildly and attempting to hit the CNAs. Charge nurse intervened and patient began hitting again. Charge nurse then attempted to put patient into bed and patient began hitting, kicking, and trying to grab charge nurse's top. She grabbed and broke charge nurse's necklace..." Patient l's care plan revised on January 31, 2019, indicated, "Escalation from her usual behavior pattern and not easily redirected...restlessness, agitation...lnterventions..•approach in a calm and friendly manner...lf gets aggressive, leave resident and return when resident calms..." The policy and procedure titled, "Abuse Prevention Program," dated December 2016, was reviewed. The policy and procedure indicated, "...Our residents have the right to be free from abuse...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 program, the administration will...Protect our residents from abuse by anyone...but not necessarily limited to...facility staff..." The facility failed to provide an environment which is free from abuse and corporal punishment for Patient 1, when two facility staff witnessed LVN 1 tap the patient's forehead and pinch her ears when the patient became combative. This failure resulted in Patient 1 being subjected to physical abuse which could negatively affect the emotional and psychosocial wellbeing of Patient 1. This failure of the facility to provide an environment which is free from abuse and corporal punishment had a direct relationship to the health, safety, or security of patients.