Health inspection·November 22, 2024

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- (a)(1) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion. 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. CCR § 72527. 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. Patients shall have the right: (10) To be free from mental and physical abuse. 22 CCR § 72523 (a) 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 10/7/2024, the California Department of Public Health (CDPH) received a facility reported incident (FRI) regarding an allegation of abuse. On 10/9/2024 at 1:15 p.m., CDPH conducted an unannounced onsite visit at the Skilled Nursing Facility (SNF) to investigate the FRI. The facility failed to ensure: 1. Certified Nursing Assistant (CNA 1) did not verbally abuse (using words to name call, bully, demean, frighten, intimidate, or control another person) Resident 1. 2. CNA 1 followed the facility's policy and procedure (P/P) titled, "Abuse, Neglect, and Exploitation", that indicated the facility was to prevent and prohibit abuse including verbal abuse; the use of oral, written or gestured communication or sounds that willfully includes disparaging (expressing the opinion that something is of little worth) and derogatory (showing a critical or disrespectful attitude) terms to residents, or within hearing distance regardless of their age, ability to comprehend, or disability. This deficient practice resulted in Resident 1 to feel offended and cry hysterically (to cry in an uncontrolled state of anger, excitement, or panic) in reaction to CNA 1 to enter Resident 1's room. Findings: A review of Resident 1's Admission Record indicated Resident 1, a 59-year-old female, was admitted to the facility on 5/14/2024 with diagnoses of primary lateral sclerosis (a progressive neuromuscular [nerves and muscles] condition that causes worsening muscle weakness and/or stiffness), generalized anxiety disorder (a mental health condition that causes people to experience excessive and persistent worry about everyday things), and encounter for palliative care (specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness). A review of Resident 1's Minimum Data Set ([MDS] - a federally mandated resident assessment tool) dated 8/21/2024, indicated Resident 1 was moderately cognitively (a person's ability to think, learn, remember, use judgement, and make decisions) impaired. The MDS indicated Resident 1 was dependent (helper does all the effort) for all activities of daily living (ADLs- routine tasks/activities such as bathing, dressing and toileting a person performs daily to care for themselves). A review of Resident 1's untitled Care Plan dated 8/21/2024, indicated Resident 1 communicated by trying to verbalize with low sounds, spelling out words as able, and some pointing and gesturing. The Care Plan goals for Resident 1 included be able to express self, utilize a communication board (a tool that helps people with limited language skills express themselves), and verbalize as able. The Care Plan's interventions included approaching Resident 1 calmly, listening carefully, asking yes or no questions, being patient, using the communication board, asking open ended questions, and waiting for Resident 1's response. A review of Resident 1's Change of Condition Evaluation dated 10/7/2024, indicated the Director of Staff Development (DSD) received a report from Licensed Vocational Nurse (LVN 1) informing her that Resident 1 was "emotionally distraught". The LVN 1's assessment indicated LVN 1 observed Resident 1 and discovered that Resident 1 was upset because she saw CNA 1 walked into her room. The evaluation indicated LVN 1 conducted a more comprehensive review and discovered Resident 1 stated CNA 1 told her she smelled and the statement that she smelled upset Resident 1. A review of Resident 1's Psychotherapy (the treatment of mental conditions by verbal communication and interaction) Diagnostic (methods to identify diseases, injuries, or disabilities) Interview note dated 10/8/2024, indicated Resident 1 had multiple health concerns that affect her ability to deal with stress and anxiety. A review of Resident 1's Physician's Progress Notes dated 10/9/2024, indicated Resident 1 was a hospice patient (end of life care). During an interview on 10/9/2024 at 2 p.m., Resident 1 was able to answer questions by saying each letter to spell words out. Resident 1 spelled out 'CNA 1 was rough', Resident 1 spelled out 'CNA 1 told me you smell', Resident 1 spelled out, 'CNA 1 was controlling', and 'CNA 1 was not patient'. Resident 1 shook her head yes to the question "do staff need to be patient and explain what they are going to do?" Resident 1 shook her head "yes" when asked if she was crying when CNA 1 entered her room on 10/7/2024 and when asked "why?" she spelled out that CNA 1 was "bad." During an interview on 10/10/2024 at 1:21 p.m., LVN 1 stated she was with Resident 1, in Resident 1's room on 10/7/2024 when CNA 1 walked into the room to answer the call light for Resident 1's roommate. LVN 1 stated that as soon as Resident 1 saw CNA 1 walked into the room she began crying hysterically so LVN 1 asked CNA 1 to exit the room. LVN 1 stated she then began interviewing Resident 1. LVN 1 stated that Resident 1 informed her (LVN 1) that CNA 1 said something hurtful to her which was "you smell". LVN 1 stated that Resident 1 informed her (LVN 1) that was not the first time CNA 1 said something hurtful to her (Resident 1). LVN 1 stated that once she informed Resident 1 that the facility would change the assignment and they would get her another CNA, she "mellowed out a bit" and seemed like her normal self. LVN 1 stated it was very surprising to see Resident 1 crying like that and it was uncharacteristic for her. LVN 1 stated she felt something was wrong by judging Resident 1's reaction to CNA 1, and that prompted her to inform the DSD about what was going on. LVN 1 stated it was not respectful to tell a resident they smell, and it could hurt their feelings. LVN 1 stated the facility was the resident's home and they should feel comfortable in their home. During an interview on 10/11/2024 at 11:43 a.m., Registered Nurse (RN 1) stated verbal abuse was anything that was said by mouth that could hurt a resident mentally and emotionally and that if you told a resident "You smelled" it was considered verbal abuse if that was the resident's perception of the statement, especially if the resident cried. RN 1 stated staff had to approach Resident 1 more delicately and be more patient with her due to her difficulty expressing herself. During a review of the facility's policy and procedure (P/P) titled "Abuse, Neglect, and Exploitation", dated 10/2022, the P/P indicated the facility was to prevent and prohibit abuse. The P/P indicated verbal abuse was the use of oral, written, or gestured communication or sounds that willfully includes disparaging (expressing the opinion that something is of little worth) and derogatory (showing a critical or disrespectful attitude) terms to residents, or within hearing distance regardless of their age, ability to comprehend, or disability. 1. CNA 1 did not verbally abuse Resident 1. 2. CNA 1 followed the facility's P/P titled, "Abuse, Neglect, and Exploitation", that indicated the facility was to prevent and prohibit abuse including verbal abuse; the use of oral, written or gestured communication or sounds that willfully includes disparaging and derogatory terms to residents, or within hearing distance regardless of their age, ability to comprehend, or disability. This deficient practice resulted in Resident 1 to feel offended and cry hysterically in reaction to CNA 1 to enter Resident 1's room. These violations presented a direct or immediate relationship to the health, safety, security, or welfare of the residents.