Other·March 23, 2023

§ 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. § 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. § 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. F600 §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; An unannounced visit was conducted by California Department of Public Health on 12/6/22 at 10 AM to investigate a facility reported incident regarding an allegation of employee to patient physical abuse. The facility failed to ensure Patient 1 was free from physical abuse (abuse includes physically striking or assaulting a patient) when Certified Nurse Assistant 2 (CNA 2) hit Patient 1 on the head on 11/29/2022. This deficient practice resulted in Patient 1 having a bruise on left cheek, and lacerations on the left cheek and nose. A review of Patient 1's admission record indicated the patient is a 83 year- old- male, admitted at the facility on 9/7/2022 with diagnoses including schizophrenia (a disorder that affects a person's ability to think, feel, and behave clearly), anxiety disorder (fear characterized by behavioral disturbances) and dementia (a group of thinking and social symptoms that interferes with daily functioning). A review of Patient 1's history and physical, dated 9/8/2022, indicated Patient 1 did not have the capacity to understand and make decisions. A review of Patient 1's Minimum Data Set (MDS, a standardized assessment and care planning screening tool), dated 9/14/2022, indicated the patient had severe impaired cognition (ability to understand and make decision), requiring total assistance with dressing and toileting and extensive assistance for eating and personal hygiene). A record review of Patient 1's Situational Background Assessment and Recommendation/ Change of Condition (SBAR/ COC, technique that can be used to facilitate prompt and appropriate communication between the health care provider), dated 11/29/2022 entered at 2:42 PM, indicated the following: 1. Patient 1 had, "bleeding on his nose, bruised left cheek, and a skin tear." 2. CNA 2 stated CNA 2 got upset at Patient 1 and hit the patient on the face. 3. Patient 1 had a skin tear on the nose with measurement of 2 centimeters (cm, unit of measurement) in length, left cheek skin tear that measured 2 cm by 2.5 centimeters and discoloration/ swelling on left cheek. 4. Patient 1 complained of pain "hurts a little bit" on his face. A record review of Patient 1's Progress Notes, dated 11/30/2022 at 6:09 PM, indicated Patient 1 had bluish discoloration on the left side of his face, slightly swollen, with steri-strips (wound closure strips that can be used on small wounds) on the skin tear and unable to open left eye due to swelling." During an interview on 12/6/2022 at 10:15 AM, the Director of Nurses (DON) stated, CNA 2 was arrested (for physical assault of Patient 1) by the police on 11/29/2022. The DON stated, on the day of incident (11/29/2022), the facility separated CNA 2 from Patient 1 immediately and had CNA 2 wait in a separate part of building and that was when CNA 2 tried to run away when the police showed up. The DON stated, Patient 1 had some swelling and bruising (on face and nose).[GY1] During an interview on 12/6/2022 at 10:30 AM, a Licensed Vocation Nurse (LVN1) stated, she was working in the facility on the day that CNA 2 hit Patient 1 on the head. LVN 1 stated, the Housekeeping Staff (HSK) came to her and reported that HSK witnessed CNA 2 hit Patient 1 on the head. During an interview on 12/6/2022 at 10:45 AM, CNA 1 stated, Patient 1 was assigned under her care on 11/29/2023. CNA 1 stated she saw CNA 2 hit Patient 1 on the face. CNA 2 stated Patient 1 was bleeding from a cut on the patient's nose and had bump on the left side of the face. During an interview on 12/6/2022 at 11 AM, HSK stated, on 11/29/2022 while in the Patients 1's room she saw CNA 2 was angry and hit Patient 1 on the face. HSK stated what CNA 2 did to Patient 1 was “wrong.” During an observation of Patient 1 on 12/6/2022 at 11:15 AM, Patient 1 was observed in the dining room, sipping a cup of coffee and was observed with bruising [GY2]on left side of face. A record review of the facility's policy titled, "Reporting Abuse to Facility Management," dated 9/2/2014, indicated, abuse is defined as the willingly infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. The policy also indicated the facility condone patient abuse by anyone including staff members or staff of other agencies serving the patient. The facility failed to ensure Patient 1 was free from physical abuse when CNA 2 hit Patient 1 on the head on 11/29/2022. This deficient practice resulted in Patient 1 having a bruise on left cheek, and lacerations on the left cheek and nose. The above violation had a direct or immediate relationship to the health, safety, or security of Patient 1.