Health inspection·December 17, 2024

§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. § 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. § 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. 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 11/18/2024 the California Department of Public Health (CDPH) received a facility reported incident (FRI) alleging that on 11/17/2024 Certified Nursing Assistant (CNA 1) yelled and threw the urinal and bottle of water at Resident 1. On 11/21/2024, CDPH conducted an unannounced visit to the facility to investigate FRIs allegations. Upon investigation, CDPH determined the facility did not protect Resident 1 from verbal and physical abuse by CNA 1. The facility failed to: 1. Ensure CNA 1 did not yell at Resident 1 and did not throw the urinal and a bottle of water at Resident 1. 2. Ensure CNA 1 waited for Resident 1 to finish using the bathroom and did not enter the bathroom when Resident 1 asked CNA 1 to wait before entering. As a result, Resident 1 felt emotional and disrespected, and was placed at risk for psychological distress (a state of emotional suffering that can include symptoms of anxiety [a mental health condition that involves persistent and excessive feelings of fear or anxiety that can interfere with daily life], and depression [mental health condition that can impact a person's thoughts, feelings, behavior, and sense of well-being]). A review of Resident 1's Admission Record indicated Resident 1, a 71-year-old male, was admitted to the facility on 10/3/2024 with diagnoses including muscle weakness, anxiety (feeling of fear, or uneasiness), major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest, and schizophrenia (a mental illness that is characterized by disturbances in thought). A review of Resident 1's Minimum Data Set (MDS- a resident assessment tool), dated 10/10/24, indicated Resident 1 had intact cognitive (ability to make decisions, understand, and learn) skills for daily decision making. The MDS indicated Resident 1 required supervision with oral hygiene, toileting, shower, personal hygiene, bed mobility, transfer, locomotion on unit and off unit, dressing, eating, toilet, and personal hygiene. A review of Resident 1's History and Physical (H&P) dated 10/3/2024 indicated Resident 25 had the capacity to understand and make decisions. A review of Resident 1's Care Plan titled, "Resident 1 is at risk for a psychosocial well-being problem related to episode of disagreement with CNA 1" dated 11/17/24, indicated the care plan interventions included to encourage Resident 1 to verbalize feelings and concerns, listen to resident concerns and follow up with appropriate intervention to the problem, monitor resident's whereabouts and assessed for any emotional distress. A review of Resident 1's Care Plan titled, "Resident with psychosocial disturbance /trauma related to disagreement with a nurse dated 11/17/24, the Care Plan l indicated a goal for Resident 1 was not to have any negative emotional effect because of the incident with CNA 1 for 90 days. The Care Plan interventions included to encourage Resident 1 to verbalize feelings and concerns, listen to resident concerns and follow up with appropriate interventions to the problem. A review of Nurses Progress Note dated 11/17/24 , and timed at 1:00 p.m., indicated on 11/17/2024 around 7:30 a.m., Resident 1 reported that he had a disagreement with CNA 1, when CNA 1 wanted to empty the urinal while Resident 1 was still in the bathroom. The Nurses Progress note indicated CNA 1 responded with an attitude (someone replied to a question or comment in a way that conveyed a negative or disrespectful feeling). Resident 1 stated CNA 1 threw a drinking cup towards him while he was inside the bathroom. A review of Situation, Background, Assessment, Recommendation (SBAR-is a verbal or written communication tool that helps provide essential, concise information), dated 11/17/24, indicated Resident 1 stated "He had a disagreement with CNA 1, when CNA 1 wanted to empty the urinal while Resident 1 was in the bathroom. The SBAR indicated CNA 1 responded with attitude. The SBAR indicated CNA 1 threw a drinking cup towards him inside the bathroom and was very disrespectful. The SBAR indicated the incident affected Resident 1 emotionally. A review of Interdisciplinary team (IDT- a collaborative meeting where various healthcare professionals work together to plan and coordinate resident care) note dated 11/18/24 indicated members of IDT met with Resident 1 to discuss the incident that occurred on 11/17/24 regarding CNA 1 who had an altercation with the resident. Resident 1 stated "the nurse threw a urinal at me and did not give me privacy while I was using the bathroom." A review of Resident 1's Physician Progress Note dated 11/19/24, indicated Resident 1 was receiving Olanzapine (medication used to treat the symptoms of schizophrenia) 5.0 milligram([mg] unit of measurement), for schizophrenia as manifested by anger, Fluoxetine (medication used to treat depression) 20 mg for depression, and Trazodone (medication used to treat depression) 50 mg for depression. The Physician's Progress Note indicated Resident 1 had frequent recurrence of anxiety, extreme sensitivity to stressors, and episodes of nightmares. The Physician's Progress note indicated Resident 1 reported increased anxiety and worry. During observation and concurrent interview with Resident 1 on 11/21/24 at 1:39 p.m., Resident 1 was observed coming out from the bathroom and refused to talk about the incident on 11/17/2024 between him and CNA 1. Resident 1 stated "he does not want to talk about it again because he complained to staff and called the police." Resident 1 stated everyone in the facility was aware of what happened on 11/17/2024. Resident 1 stated CNA 1 always like to come to the bathroom whenever he was using the bathroom. Resident 1 stated CNA 1 threw the urinal and bottle of water at him. Resident 1 stated CNA 1 was very disrespectful, invading his privacy while he was using the bathroom, even when he asked CNA 1 to wait so that he can finish using the bathroom. Resident 1 stated CNA 1 refused to wait. During a telephone interview on 11/21/24 at 1:50 p.m., CNA 1 stated she was not feeling well when she came in to work on 11/17/2024 at 11 p.m. but asked by the charge nurse to stay until 6 a.m. CNA 1 stated, she started changing the residents and emptying urinals, and wanted to go empty the urinals in Resident 1's bathroom while Resident 1 was in the bathroom. CNA 1 stated she knocked on the bathroom door and nobody responded so she went in. CNA 1 stated she told Resident 1 she was here to pick up the urinals from the bathroom, and Resident 1 asked her to wait until he finished using the bathroom. CNA 1 stated that she could not wait as she only had 10 minutes before her shift ends to go home. CNA 1 stated Resident 1 came out of the bathroom and threw water toward her. CNA 1 stated Resident 1 asked her to clean the spilled water in his room and she responded, "I am not a housekeeper." CNA 1 stated Resident 1 threw urinals in the hallway. During an interview on 11/21/2024 at 2:58 p.m., the Social Service Designee (SSD) stated CNA 1 was wrong in throwing water and urinal towards Resident 1. SSD stated CNA 1 should not have thrown water at Resident 1. SSD stated CNA 1 should have reported the incident to the charge nurse. During an interview on 12/3/2024 at 10:56 a.m. Licensed Vocational Nurse (LVN 1) stated he was at the nursing station when Resident 1 came to the nursing station looking for the supervisor. LVN 1 stated Resident 1 told him that CNA 1 threw the urinal and water at him while he was in the bathroom. LVN 1 stated CNA 1 enter the bathroom without knocking on the door to collect the urinals. LVN 1 stated Resident 1 asked CNA 1 to wait until he was done using the bathroom, but CNA 1 responded she does not have time to wait until Resident 1 finished using the bathroom. LVN 1 stated CNA 1 started collecting the urinals in the bathroom even after Resident 1 told CNA 1 he still needs to use the urinal. LVN 1 stated, Resident 1 got upset and threw water and the urinal at CNA 1. LVN 1 stated CNA 1 threw urinals and water bottle back at Resident 1. LVN 1 stated when she asked CNA 1 if Resident 1's allegation was true, CNA 1 responded that Resident 1 was rude to her, and she did not have the time to wait for Resident 1 to finish using the bathroom. LVN 1 stated CNA 1 had previous altercation with Resident 1 and did not like to be assigned to care for Resident 1. A review of facility's policy and procedure (P&P) titled "Abuse Prevention, and Reporting dated 6/12/2024, indicated "The purpose of abuse prevention as to address the health, safety, welfare, dignity, and respect of residents by prevention abuse, neglect, misappropriation of resident property, exploitation, and mistreatment including freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat medial symptoms." The P&P indicate "Verbal Abuse as any use of oral, written, gestured communication, or sounds that willfully includes disparaging and derogatory terms directed to residents within their hearing distance, regardless of age, ability to comprehend, or disability." The facility failed to: 1. Ensure CNA 1 did not yell at Resident 1 and did not throw the urinal and bottle of water at Resident 1. 2. Ensure CNA 1 waited for Resident 1 to finish using the bathroom and did not enter the bathroom when Resident 1 pleaded for CNA 1 to wait before entering. As a result, Resident 1 felt emotional and disrespected, and was placed at risk for psychological distress. These violations had a direct or immediate relationship to the health, safety, or security of patients and residents.