Health inspection·September 13, 2022

§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. §483.12(a) The facility must— §483.12(a)(1) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion; 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. On 6/1/2022, the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate a facility reported incident about resident-to-resident abuse. The facility failed to ensure Resident 2 was free from physical abuse inflicted by Resident 1. On 5/23/2022 at 8:30 a.m., Resident 1 slapped Resident 2 on the face because he (Resident 1) could not sleep. As a result, Resident 2 had redness on the right side of the face where she was slapped by Resident 1. A review of Resident 1’s Admission Record indicated the facility originally admitted the 69-year-old male resident on 2/15/2022 with a diagnosis of polyneuropathy (a condition in which there is damage to multiple nerves outside of the brain which causes pain, discomfort and mobility difficulties). A review of Resident 1's Health and Physical, dated 2/16/2022, indicated that the resident had the capacity to understand and make decisions. A review of Resident 1's Minimum Data Set (MDS- a standardized assessment and screening tool), dated 5/23/2022, indicated the resident had the ability to understand others and had the ability to be understood by others. A review of Resident 2 s Admission Record indicated the facility originally admitted the 75-year-old female resident on 5/11/2005 and readmitted on 5/23/2017 with a diagnosis of major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest which interferes with daily life). A review of Resident 2's Health and Physical, dated 10/8/2021, indicated the resident had a fluctuating capacity to understand and make decisions. A review of Resident 2's MDS, dated 3/17/2022, indicated the resident usually had the ability to understand others and usually had the ability to be understood by others. A review of Resident 2's physician ' s orders, dated 5/23/2022, indicated an order for Acetaminophen (pain medication) tablet 500 milligram (mg - unit of measurement) give 1,000 mg by mouth every 6 hours as needed for moderate pain management. A record review of Resident 2's Situation Background Assessment Recommendation (SBAR) Communication Form and Progress Note (notes written by nurses), dated 5/23/2022, indicated that on 5/23/2022 at 8:30 a.m., Activity staff (AS) reported that Resident 2 was slapped by Resident 1 on her right side of face. Two nurses assessed Resident 2 after the resident was slapped on her right side of the face by Resident 1. Resident 2 was noted with redness on the right side of the face and was provided the 1,000 mg of Acetaminophen as ordered by the physician. During an interview on 5/31/2022 at 3 p.m., the AS stated that in the morning around 8:30 a.m., he was on his way to the activity's storage room. AS stated during this time, he saw Resident 1 walk out of his room and headed toward the main dining room. AS stated at this time, Resident 2 was sitting in her wheelchair with her back against the wall in-front of the main dining room. AS stated, he saw Resident 1 walk up and stand in front of Resident 2. AS stated, he heard Resident 1 tell Resident 2 to "be quiet", then observed Resident 1 immediately slap Resident 2 on her face. AS stated that Resident 1 deliberately hit Resident 2. AS stated, Resident 1 slapped Resident 2 on the right side of her face with an open palm of his left hand. During an interview on 6/7/2022 at 12:40 p.m., Resident 1 stated that he recalled the incident that happened with him and Resident 2. He stated that he was sleeping in his room which was at the end of the hallway, and she was around 10 to 15 feet away from his room. He stated, he was trying to sleep just after breakfast and woke up because he heard Resident 2. He stated that he went out of his room and walked up to Resident 2. He stated that he asked Resident 2 to be quiet, but she refused. When asked why he slapped Resident 2, he stated, "she pissed me off, so I slapped her, didn't slap her hard, to get her to be quiet, slapped her. And she got quiet after that". When asked if he knew he should not have hit another resident, Resident 1 stated that he knew he should not have but went ahead and hit Resident 2 because she kept talking. During an interview on 5/31/2022 at 12:35p.m., the Licensed Vocational Nurse (LVN 1) stated that on 5/23/2022 in the morning, he was told by AS that Resident 1 went to Resident 2 and slapped her face. LVN 1 stated he went and assessed resident 2 with one other nurse. LVN 1 stated Resident 2 was noted with red mark on her cheek. LVN 1 stated he then went to talk to Resident 1 and the resident told LVN 1 that he slapped Resident 2 because she was talking. LVN 1 stated that Resident 1 had shown instance of angry outbursts previously and would require medication and redirection for this behavior. LVN 1 stated that he recalled there was an incident where Resident 1 had displayed aggressive behavior toward another resident before this incident. LVN 1 stated that the staff that saw Resident 1 walking toward Resident 2 should have intervened prior to the resident getting close to Resident 2. During a concurrent interview and record review on 5/31/2022 at 1:55 p.m., the Director of Nursing (DON), stated that there were no care plans that directly address the aggressive behavior of Resident 1. The DON further stated that they "cannot change his attitude". When the DON was asked if Resident 1 made the choice to deliberately hit Resident 2, the DON stated "yes, we respect his rights." A review of the facility's policy titled, "Abuse Program Policy and Procedure," updated 5/2010, indicated that it is the policy of the facility to maintain an environment free of abuse and neglect, the resident has the right to be free from verbal and physical abuse, and the residents will not be subjected to abuse by anyone including other residents. The policy defined the term physical abuse as including but not limited to hitting, slapping, pinching, and kicking. The facility failed to ensure Resident 2 was free from physical abuse inflicted by Resident 1. On 5/23/2022 at 8:30 a.m., Resident 1 slapped Resident 2 on the face because he (Resident 1) could not sleep. As a result, Resident 2 had redness on the right side of the face where she was slapped by Resident 1. The above violation had direct or immediate relationship to the health, safety, or security of Resident 1.