Health inspection·October 26, 2023

Regulations Violated: 483.12 (a)(1); 72523(a);72527(a)(10) F600 FCR § 483.12 Freedom from Abuse, Neglect and Exploitation The patient has the right to be free from abuse, neglect, misappropriation of patient 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 patient'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 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. CCR § 72527. Patient 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. On 9/18/23, an unannounced visit was made to the facility to investigate a Facility Reported Incident regarding patient abuse. The facility failed to ensure Patient 4 was free from physical abuse (willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish) according to the facility's policies and procedure (P&P), when Patient 5 punched Patient 4 in his eye. As a result, Patient 4 experienced physical abuse. During a review of Patient 4's Admission Record dated 9/18/23, the Admission Record indicated Patient 4 was admitted to facility on 3/14/11, and readmitted to the facility on 9/14/16 with multiple diagnoses including schizoaffective disorder (a mental health condition including schizophrenia and mood disorder symptoms), chronic obstructive pulmonary disease (COPD, a group of diseases that cause airflow blockage and breathing-related problems), and unspecific convulsions (a sudden, violent, irregular movement of a limb or of the body). During a review of Patient 4's Minimum Data Set (MDS, a standardized assessment and care screening tool) dated 7/14/23, the MDS indicated the patient had no impairment in cognitive skills (ability to make daily decisions). The MDS indicated Resident 4 was independent (no help or staff oversight at any time) from staff for transfers, dressing, and toilet use. During a review of Patient 5's Admission Record dated 9/18/23, the Admission Record indicated Patient 5 was admitted to facility on 10/1/18 with multiple diagnoses including paranoid schizophrenia (a disorder that affects a person's ability to think, feel, and behave clearly), hypertension (high blood pressure), and unspecified asthma (a condition in which a person's airways become inflamed, narrow and swell, and produce extra mucus, which makes it difficult to breathe). During a review of Patient 5's MDS dated 7/14/23, the MDS indicated the patient had no impairment in cognitive skills. The MDS indicated Patient 5 was independent of staff for transfers, dressing, and toilet use. During a review of Patient 6's Admission Record dated 9/18/23, the Admission Record indicated Patient 6 was admitted to facility on 6/24/22 with multiple diagnoses including unspecified schizophrenia and hypermetropia (a vision condition in which nearby objects are blurry). During a review of Patient 6's MDS dated 6/30/23, the MDS indicated the patient had no impairment in cognitive skills. The MDS indicated Patient 6 was independent staff for transfers, dressing, and toilet use. During a concurrent observation and interview, on 9/18/2023 at 12:04 p.m. Patient 4's right eye was red and had a small abrasion on the top of his right eyebrow. Patient 4 stated, Patient 5 punched him in the eye. Patient 4 stated the incident took place in Patient 6's room. Patient 4 stated, Patient 5 was mad that he was in Patient 6's room. During an interview on 9/18/2023 at 1:35 p.m., Patient 6 stated, Patient 5 got mad and punched Patient 4 in his face and body. Patient 6 stated, the incident took place in her room. During a concurrent observation and interview, on 9/18/2023 at 2:27 p.m., Patient 5's right hand was swollen around the knuckles (joints of the fingers). Patient 5 stated his hand was swollen from hitting Patient 4. Patient 5 stated, the incident took place in Patient 6's room. Patient 5 stated, he hit Patient 4 a couple times, because Patient 4 was being disrespectful toward Patient 6. During an interview, on 9/18/2023 at 3:05 p.m., Licensed Vocational Nurse 1 (LVN 1) stated, on 9/17/23, around lunch time, she saw Patient 4 had an abrasion over his eye. LVN 1 stated, she also assessed Patient 5 and noticed the middle knuckle of his right hand was swollen. LVN 1 stated, Patient 5 claimed he punched Patient 4. LVN 1 stated, Patient 5 had anger issues. LVN 1 stated, she had seen Patient 5 at 11:30 a.m., and that there were no, "red flags," to indicate he would do something like that. During an interview on 9/18/2023 at 3:25 p.m., Patient 5 stated, he punched Patient 4 because he got angry. Patient 5 stated, he meant to hit Patient 4 and denied that he was hallucinating or anything like that when he hit Patient 4. During a review of Patient 4's Progress Notes dated 9/18/23, indicated Patient 4 was punched with closed fist on the right eye. Patient 4 sustained an abrasion on the right side of the eye, measuring 0.5 centimeter (cm, unit of measurement) by 0.5 cm. During a review of Patient 4's Change in Condition Evaluation (COC) dated 9/17/23, indicated, on 9/17/23, at approximately 12:45 p.m., Patient 4 was involved in an altercation with another patient and sustained an injury to his right eye. Patient 4's right eye was, "blood shot," and that there was a small amount of blood dripping on the right side of Patient 4's face, bleeding from the eyebrow. During a review of Patient 5's COC dated 9/17/23, indicated, on 9/17/23, Patient 5 was involved in an altercation with another patient and punched the patient on his right eye, causing the patient to sustain an abrasion to the other patient's eyebrow and a blood shot eye. Patient 5's right hand and middle knuckle were slightly swollen. During a review of Patient 4's Body Check dated 9/17/23, indicated Patient 4's right eye was blood shot and there was an abrasion on the eyebrow. Patient 4's injuries were related to an altercation with another patient that took place on 9/17/23 at approximately 12:45 p.m. During a review of the facility's P&P titled, "Abuse Prohibition," dated 2/23/21, indicated, "HealthCare Centers prohibit abuse, mistreatment, neglect, misappropriation of patient property, and exploitation for all patients." The P&P indicated, "The Center will implement an abuse prohibition program through the following: ... Prevention of occurrences". The P&P indicated, "Abuse is defined as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, injury, or mental anguish." The facility failed to ensure Patient 4 was free from physical abuse according to the facility’s Policies and Procedure (P&P), when Patient 5 punched Patient 4 in his eye. As a result, Patient 4 experienced physical abuse. This violation jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of Patient 4.