Other·September 22, 2023

42 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. (a) The facility must- (1) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion. 22 CCR § 72527 Patient’s 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. Patients shall have the right: (10) To be free from mental and physical abuse. (11) To be treated with consideration, respect and full recognition of dignity and individuality, including privacy in treatment and in care of personal needs. 42 CFR § 483.12(b) The facility must develop and implement written policies and procedures that: (1) Prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property, (2) Establish policies and procedures to investigate any such allegations, and (3) Include training as required at paragraph §483.95. 22 CCR § 72315 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. 22 CCR § 72523 Patient Care Policies and Procedures. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. 22 CCR § 72311. Nursing Service - General (1) Planning of patient care, which shall include at least the following: (A) Identification of care needs based upon an initial written and continuing assessment of the patient's needs with input, as necessary, from health professionals involved in the care of the patient. Initial assessments shall commence at the time of admission of the patient and be completed within seven days after admission. (B) Development of an individual, written patient care plan which indicates the care to be given, the objectives to be accomplished and the professional discipline responsible for each element of care. Objectives shall be measurable and time limited. (C) Reviewing, evaluating, and updating of the patient care plan as necessary by the nursing staff and other professional personnel involved in the care of the patient at least quarterly, and more often if there is a change in the patient's condition. (2) Implementing of each patient's care plan according to the methods indicated. Each patient's care shall be based on this plan. 42 CFR §483.21 Comprehensive Care Plans §483.21(b)(1) The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at §483.10(c)(2) and §483.10(c)(3), that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following — (I) The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required under §483.24, §483.25 or §483.40; and On 7/31/2023, the Department received a facility reported incident (FRI) regarding an allegation of Resident 1 assaulted Resident 2. On 8/11/2023, an unannounced visit was conducted at the facility. The facility failed to: 1. Protect Resident 2 and 3 from physical and emotional abuse. On 7/31/2023 at 3:35 p.m., Resident 1 pushed Resident 2 out of their (Resident 1 and Resident 2) room by aggressively pushing Resident 2 while in the wheelchair and blocking Resident 2 between the bed and the exit door of the room preventing Resident 2 from leaving the room. On 8/2/2023 at 3:23 p.m., Resident 1 hit (using his hand) Resident 3 on her left arm while passing by in the hallway. 2. Implement Resident 1’s care plan to ensure Resident 1 will not have aggressive behavior towards other residents. These failure resulted in Resident 2 feeling uncomfortable and upset with Resident 1. Resident 3 feeling fearful for her safety. a. A review of Resident 2’s Admission Record (Face Sheet), dated 8/4/2023, the Face Sheet indicated Resident 2 was originally admitted to the facility on 07/18/2023 with a diagnoses included paraplegia (inability to voluntarily move the lower part of the body), pressure ulcer of right hip, stage 4 (full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structure), injury at the thoracic spinal cord (affect the upper chest, mid-back and abdominal muscles), and polyneuropathy (many nerves in different parts of the body are involved in a disease or damage). A review of Resident 2’s Minimum Data Set ([MDS] a standardized assessment and care screening tool) dated 6/2/2023, the MDS indicated the cognitive (the ability to think and process information) skills of decisions making was intact, and required extensive assistance with bed mobility, transfers, and personal hygiene. A review of Resident 2’s “History and Physical”, dated 7/20/2023, the H&P indicated Resident 2 had a capacity to understand and make decisions. During a concurrent observation and interview on 8/4/2023 at 11:18 a.m., Resident 2 was laying in his bed, with wheelchair at bedside. Resident 2 stated he was paraplegic and unable to move his lower extremities. Resident 2 stated on 7/31/2023, Resident 1 told him, he (Resident 2) did not belong in the room they (Resident 1 and Resident 2) shared. Resident 2 stated Resident 1 placed his hands on his face and tried to push him out of the room aggressively by pushing his (Resident 2) wheelchair and blocking him between the bed and the door preventing him (Resident 2) from leaving the room. Resident 2 stated he felt uncomfortable and was upset with Resident 1. A review of Resident 2 “Change of Condition” dated 7/31/2023 at 3:12 p.m., indicated Resident 2 got into an altercation with his roommate (Resident 1) that resulted in physical contact between Resident 1 and Resident 2. A review of Resident 2’s “Progress notes”, dated 8/2/2023 at 2:32 p.m. (late entry), the progress note indicated the Interdisciplinary Team ([IDT] group of different disciplines working together towards a common goal of a resident) met with Resident 2 to review altercation that occurred between Resident 2 and Resident 1. Resident 2 told the Administrator (ADM) that Resident 1 held his wheelchair without Resident 2 consent and proceeded to hit Resident 2’s arm. During a concurrent interview and record review with the Social Service (SS) 1 on 8/4/2023 at 11:52 a.m., Resident 2’s “Social Service Notes”, dated 7/31/2023 was reviewed. The SS notes indicated that on 7/31/2023 Resident 2 will be transferred to a different room due to roommate incompatibility. SS 1 stated Resident 2 told her Resident 1 seemed confused when he (Resident 1) pushed Resident 2’s wheelchair and blocked Resident 2 from leaving the room. Resident 2 stated Resident 1 told him (Resident 2) did not belong in the room that they (Resident 1 and Resident 2) shared. During an interview on 8/4/2023 at 12:15 p.m., with the Director of Nursing (DON), the DON stated he was present when the police came and heard Resident 2 told the police Resident 1 was holding his (Resident 2) wheelchair handles and pulled the wheelchair aggressively from behind preventing Resident 2 from leaving the room. Resident 2 said he tilted Resident 1 hat and Resident 1 let his wheelchair go. During an interview on 8/4/2023 at 1:33 p.m., the ADM stated she was notified by Registered Nurse (RN) 1 on 7/31/2023 at 7 a.m. that Resident 1 pushed Resident 2’s wheelchair aggressively from behind and prevented Resident 2 from leaving the room. The ADM stated the facility failed to have an emergency consultation with the psychologist after Resident 1 pushed Resident 2 aggressively while in wheelchair and Resident 1 should have been on a one-on-one monitoring to prevent Resident 1 from hurting other residents. The ADM stated Resident 1 was not placed on one to one supervision until 8/4/2023. During an interview on 8/4/2023 at 2:30 p.m., the Staff Psychologist (SP) stated that she talked to Resident 1 and Resident 2. SP stated she was told by Resident 2 about the incident on 7/31/2023 with his roommate Resident 1. The SP stated Resident 2 said his roommate Resident 1 was not in his right mind when Resident 1 aggressively pushed Resident 2’s wheelchair. The SP stated Resident 1 was confused and told her that a guy was trying to break into the building, and he (Resident 1) tried to defend the building. b. A review of Resident 3’s Face Sheet, dated 8/4/2023, the face sheet indicated Resident 3 was an 87 year old female, was admitted on 7/17/2023 with a diagnosis of benign neoplasm of meninges (an abnormal but noncancerous collection of cell), major depressive disorder (a mood disorder that causes a persistent felling of sadness and loss of interest), spondylolysis (a stress fracture through the pars interarticularis of the lumber vertebrae) insomnia (a sleep disorder in which you have trouble falling and/or staying asleep), and generalized anxiety (a mental health disorder that produces fear, worry, and a constant feeling of being overwhelmed). A review of Resident 3’s MDS dated 6/21/2023, the MDS indicated Resident 3’s cognitive skills of decisions making was severely impaired and required limited assistance with ADL. A review of Resident 3’s “History and Physical”, undated, the “H&P” indicated Resident 3 had the mental capacity to understand and make decisions. A review of Resident 3 “Change of Condition” dated 8/3/2023, the COC indicated Resident 3 was involved in alleged abused with Resident 1. The COC indicated to keep Resident 3 away from Resident 1. During an interview on 8/4/2023 at 10:43 a.m., with Resident 3, Resident 3 stated (Resident 1) threw a book at her. Resident 3 was unable to state the exact “date and time”. Resident 3 stated she was trying to avoid all residents in the facility so they (the residents) cannot hurt her. A review of Resident 3’s “Interdisciplinary Team Notes” dated 8/4/2023 at 2:05 p.m., the IDT notes indicated Certified Nurse Assistant (CNA) 1 witnessed Resident 1 hit Resident 3 on the left arm as she was passing in the hallway. Resident 3 felt that she was not safe at the facility. During a concurrent interview and record review on 8/4/2023 at 3:06 p.m., with Licensed Vocational Nurse (LVN) 1, Resident 1’s care plan dated 7/8/2023, 7/31/2023 and 8/3/2023 were reviewed. LVN 1 stated Resident 1’s care plan indicated Resident 1 had an altercation with Resident 2, and Resident 3. c. A review of Resident 1’s Admission Record (face sheet), dated 8/4/2023 indicated Resident 1 was a 78 year old male, was admitted to the facility on 5/27/2023, with a diagnoses that included dementia (the loss of cognitive functioning – thinking, remembering, and reasoning - to such an extent that it interferes with a person’s daily life and activities), behavioral disturbance (any persistent and repetitive pattern of behavior that violates societal norms or rules, seriously impairs a person’s functioning, or creates distress in others), psychotic disturbance (a collection of symptoms that affect the mind, where there has been some loss of contact with reality), mood disturbance (feelings of distress, sadness or symptoms of depression, anxiety), and anxiety (a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome). A review of the Resident 1’s MDS dated 6/2/2023, the MDS indicated Resident 1’s cognitive skills of decision making was moderately impaired and required extensive assistance with activities of daily living (ADL). A review of Resident 1’s care plan for aggressive behavior dated 7/8/2023, the care plan indicated Resident 1 had an aggressive behavior towards another resident on 7/7/2023. The care plan indicated that Resident 1 will not manifest aggressive behavior towards others by the next review date. Interventions were to encourage Resident 1 to verbalize feelings and concerns, engage Resident 1 in activities of interest, psychology consult (focus on providing psychotherapy [talk therapy] to help patients) and follow up, psychiatric consult (intended to establish a deeper understanding by both the physician and the patient as to what the patient's condition is and the type of treatment plan that is required to meet the agreed upon mental health goals as set forth by the information gathered during the doctor and patient) and follow up, and wellness check by the Director of Nursing (DON). A review of Resident 1’s “Change of Condition” dated 7/31/2023 indicated Resident 1 had an altercation with his roommate (Resident 2). A review of Resident 1’s “Care Plan” dated 7/31/2023, indicated Resident 1 had the potential to manifest aggressive behavior towards others as evidenced by incident with roommate (Resident 2) on 7/31/2023. The care plan indicated the goal for Resident 1 was not to manifest aggressive behavior towards other by next review date. The care plan indicated the plan for interventions were to encouraged Resident 1 to verbalize feelings and concerns, engage resident in activities of interest, psychology consult and follow up, psychiatric consult and follow up, wellness check by SSD and wellness check by the DON. A review of Resident 1’s “Care Plan” dated 8/3/2023, indicated Resident has the potential for aggressive behavior as manifested by recent altercation with female resident (Resident 3), Resident 1’s goal was resident will not manifest aggressive behavior towards other residents. The care plan interventions were to engage Resident 1 in activities of interest, encourage resident to verbalize feelings and concerns, psychiatric consult, psychology consult, assist Resident 1 to common and supervised areas, and always monitor Resident 1’s where abouts. During an interview on 8/4/2023 at 4:15 p.m., CNA 1 stated she saw Resident 1 hit Resident 3 in the left arm when Resident 1 was passing Resident 3 in the hallway. During an interview on 8/22/2023 at 10:35 a.m., the DON stated the facility should have provided one to one monitoring to Resident 1 after Resident 1 hit Resident 2 on 7/31/2023 to prevent Resident 1 from harming other residents. The DON stated the facility should have had Resident 1 on a one-on-one supervision. The DON stated there was an in-service to make sure the facility put Resident 1 in a supervised area. A review of the facility’s policy and procedure (P&P) titled, “Abuse Prevention Program”, dated 12/2016, indicated facility will protect residents from abuse by anyone including, but not necessarily limited to: facility staff, other residents. The P&P indicated the facility will implement measures to develop and implement policies and procedures to aid preventing abuse, neglect, or mistreatment of the residents. A review of the facility’s Policy and Procedure (P&P) titled “Resident Rights” dated 12/2021, the P&P indicated Federal and State laws guarantee certain basic rights to all residents of the facility. These rights include the right to … be free from abuse, neglect, misappropriation of property, and exploitation. A review of the facility’s P&P titled “Goals, Objectives and Care Plans”, dated 4/2009, the P&P indicated: 1. The care plan goals and objectives are defined as the desired outcome for a specific resident problem. 2. When goals and are not achieved, the residents clinical record will be documented as to why the results were not achieved and what new goals and objectives have been established. Care plans will be modified accordingly. 3. Care