Health inspection·July 2, 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. § 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. § 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. The California Department of Public Health (CDPH) received an entity reported incident on 5/17/2024 regarding a verbal disagreement between a Certified Nursing Assistant (CNA) and a resident (Resident 1). On 5/23/2024, the CDPH conducted an unannounced investigation at the facility. The facility failed to: 1. Protect Resident 1 from verbal abuse from Restorative Nursing Assistant (RNA 1). As a result, Resident 1, and RNA 1 were involved in a verbal altercation which caused Resident 1 to feel attacked and experience anxiety. Resident 1 was a 54 year-old male admitted to the facility on 6/21/2021 with diagnoses including bipolar disorder (a mental illness that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks) and diabetes mellitus (a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine). A review of Resident 1’s Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 3/18/2024, indicated that Resident 1’s cognitive skills (mental action or process of acquiring knowledge and understanding) for daily decision making was intact. The MDS indicated Resident 1’s vison was moderately impaired. The MDs indicated Resident 1 needed set up or clean up assistance with eating and oral hygiene, and during transfers from lying to sitting, from sitting to standing and during transfers. The MDS indicated Resident 1 required supervision with his activities of daily living. The MDS indicated Resident 1 required supervision to walk at least 150 feet in a corridor. The MDS indicated Resident 1 had a diagnosis of legal blindness. A review of Resident 1’s History and Physical (H&P), dated 9/14/2023, indicated Resident 1 had the capacity to understand and make decisions. The H&P indicated Resident 1 had a diagnosis of depression (feelings of sadness and/or a loss of interest in activities a person once enjoyed). During an interview on 5/24/2024 at 10:37 a.m. with Resident 1, in Resident 1’s room, Resident 1 stated he had a verbal altercation with RNA 1. Resident 1 stated he got upset because RNA 1 threw his nourishment (nutritional supplement) towards his feet when he was lying on his bed. Resident 1 stated he went outside of his room to follow the RNA 1 and told her she was a “b--tch” and not to throw his food at him like if he was a dog. Resident 1 stated he notified Registered Nurse (RN 1) about the verbal abuse and was told RN 1 would talk to RNA 1. Resident 1 stated he overheard RN 1 talk to the RNA 1 about the incident, and RNA 1 lied which made the resident mad. Resident 1 stated he felt mad and used profanity towards RNA 1. Resident 1 stated, RNA 1 replied by using profanity towards Resident 1. Resident 1 stated RNA 1 called him the “n-word.” Resident 1 stated he could not believe that he was disrespected in his own home. Resident 1 stated he felt anxious and upset during the verbal abuse. During an interview on 5/23/2024 at 11:55 a.m. with RN 1, RN 1 stated Resident 1 told her RNA 1 threw his nourishment toward his feet. RN 1 stated during her conversation with the RNA 1, Resident 1 was close by and heard their conversation. RN 1 stated, Resident 1 came close to them and used profanity towards RNA 1. RN 1 stated the RNA 1 responded to Resident 1 using profanity. RN 1 stated she never observed that type of behavior from staff before and that was unacceptable. RN 1 stated staff should not ever verbally abuse residents. During an interview on 5/23/1014 at 12:25 p.m. with the Social Services (SS) Supervisor, the SS Supervisor stated she heard a commotion coming from outside in the hallway. The SS Supervisor stated she saw Resident 1 walking in the hallway looking upset. The SS Supervisor stated she heard RNA 1 and Resident 1 arguing with each other but could not make out what words were exchanged. During an interview on 5/5/2024 at 2:22 p.m. with the SS Assistant, the SS Assistant stated she heard a verbal interaction between Resident 1 and RNA 1. The SS Assistant stated she heard Resident 1 use profanity words towards RNA 1 and RNA 1 repeat the bad words back to Resident 1. The SS Assistant stated Resident 1 told her he was upset because RNA 1 threw his food at him. During an interview on 5/23/2024 at 2: 40 p.m. with the Infection Preventionist (IP) Nurse, in the conference room, the IP Nurse stated she heard screaming coming from outside in the hallway, she came out of the conference room and saw RNA 1 and Resident 1 screaming at each other and exchanging profanity words. The IP Nurse stated she did not know what words RNA 1 called Resident 1. The IP Nurse stated she never witnessed staff behave like that toward a resident before. The IP Nurse stated staff were in-serviced on how to deal with situations like that and staff have been told to walk away. The IP Nurse stated RNA 1 should have known not to argue with a resident. The IP Nurse stated RNA 1 was wrong for arguing with a resident especially when using bad words. During an interview on 5/23/2024 at 3:08 p.m. with the Health Information Manager (HIM), the HIM stated she was in the conference room and heard screams coming from the hallway. The HIM stated she heard Resident 1 and RNA 1 exchanging “foul words”. The HIM stated Resident 1 and RNA 1 were going back in forth using profanity towards each other and the IP Nurse came to separate them and walked Resident 1 back to his room. The HIM stated she did not understand why RNA 1 used that language toward Resident 1 instead of saying nothing and walking away. During an interview on 5/5/2024 at 3:39 p.m. with the Director of Nursing (DON), the DON stated RNA 1 informed her that Resident 1 called her foul words. The DON stated RNA 1 told her she got upset and cursed back at Resident 1. The DON stated RNA 1 should not have argued with Resident 1 and used profanity. The DON stated RNA 1 was supposed to walk away from the situation and notify her charge nurse or supervisor. The DON stated RNA 1’s behavior was unacceptable, and this was Resident 1’s home and all residents needed to be respected. A review of facility’s Policy and Procedure (P&P) titled “Abuse Prevention Program”, dated 1/2028, indicated residents had the right to be free from abuse, including verbal abuse. The P&P indicated as part of the resident abuse prevention, the administration would protect their residents from abuse by anyone including but not limited to facility staff, other residents, consultants, volunteers, family members, friends, and visitors. The facility failed to: 1. Protect Resident 1 from verbal abuse from RNA 1. As a result, Resident 1 and RNA 1 were involved in a verbal altercation which caused Resident 1 to feel attacked and experience anxiety. This violation caused or occurred under circumstances likely to cause significant humiliation, indignity, anxiety, or other emotional trauma to Resident 1.