Other·April 28, 2023

§ 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. §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- Freedom from Abuse, Neglect, and Exploitation §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; On 2/23/2023, at 9:15AM, an unannounced visit was made to the facility to investigate a facility reported incident regarding an incident of alleged patient abuse. The facility failed to ensure Patient 1 was free from verbal abuse when an alleged verbal altercation occurred between Patient 1 and Cook 1. As a result, Patient 1 experienced discomfort, rudeness, and tried to avoid conflict with Cook 1 from verbal abuse which placed Patient 1 at risk for disruption of psychosocial well-being. A review of the Admission Record indicated the facility admitted Patient 1, a 43-year-old male on 9/7/2022 with diagnoses including pulmonary embolism, fatty liver, and right femur fracture. A review of Patient 1's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 11/30/2022, indicated the patient was independent with cognitive skills (ability to think, understand and reason) for daily decision making. Patient 1 required supervision (oversight, encouragement or cueing) with bed mobility, transfer, walking, locomotion, eating and toilet use. A record review of Social Service Progress Notes, dated 2/10/2023 at 3:04 PM, indicated Patient 1 stated he was outside, at the parking lot, talking to Patient 2 when Cook 1 approached them and told Patient 1 that he was a snitch (informant who reports a crime or a tattletale) and to stop calling Cook 1 names. The IDT note indicated Patient 1 stated, "Cook 1 kept on calling me a bitch and wanted to attack me. Cook 1 told me, he will be back for me." A review of a facility form titled, "Patient Grievance/ Complaint Investigation Report," dated 2/10/2023, indicated IDT met with Patient 1 after an incident with Cook 1 at the parking lot. Patient 1 stated, Cook 1 told him that he was a "Snitch" and walked up to him to "fight." A follow up note, dated 2/15/2023, indicated Cook 1 will be terminated (end of an employee’s work with a company) as a part of correction after the altercation between Cook 1 and Patient 1. During an interview on 2/23/2023 at 9:37 AM, Dietary Supervisor (DSS) stated Cook 1 reported that Patient 1 had said, "People who work here, could only make shit food." DSS stated, "Cook 1 started yelling and telling Patient 1 to shut up. I didn't pay attention to particular cursing words Cook 1 said to Patient 1." During an interview on 2/23/2023 at 10:15 AM, Director of Staff Development (DSD) stated while supervising another patient outside the facility on 2/10/23, he saw Cook 1 yell at Patient 1. DSD stated, "Cook 1 was aggressive and agitated for some reason." DSD stated Patient 1 and Patient 2 were talking about something else when Cook 1 passed by and assumed thought the patients were talking about him. DSD stated, "Cook 1 was so mad and went to Patient 1's face, like he was about to fight somebody on the streets." During an interview on 2/23/2023 at 11:46 AM, the Administrator (Adm 1) stated she conducted the investigation of the alleged incident that happened on 2/10/2023 between Patient 1 and Cook 1. Adm 1 stated Cook 1 was terminated on the grounds of violation of policy and procedure which indicated employees are to treat all patients with kindness, respect, and dignity and honor the exercise of patient's rights and the facility establishes a safe environment that supports patient to the extent as possible. The facility identifies, corrects, and intervenes in situations in which abuse, neglect, exploitation, misappropriation of patient property, and/or mistreatment is likely to occur. Adm 1 stated Cook 1 cursed and was aggressive with Patient 1 and the behavior was not acceptable. Adm stated she was not aware of complaints received from kitchen staff with regards to Cook 1's "mean" attitude, as reported by the DSS on the same day of the altercation between Cook 1 and Patient 1. During an interview on 2/23/2023 at 3:41 PM, Patient 1 stated, "The situation was not good between me and Cook 1 because back in November 2022, I ordered food and Cook 1 would tell me that this is not a hotel or you can't be ordering this and that, and that's how I was treated." Patient 1 stated, "About 2 weeks before the incident that happened outside, I was complaining about him. I just thought Cook 1 was being rude towards me. When I asked for juice, water, bread or anything, Cook 1 said, we don't have it, what do you want? You are always asking for stuff, and this is that and all that or he'll say, "No. I don't have it." Patient 1 stated, "I always send the nurses to go to the kitchen because I'm trying to avoid conflict with him." During an interview on 2/23/2023 at 3:47 PM, Patient 1 stated, Cook 1 overheard him and Patient 2 talking about some clowns when Cook 1 started responding to him saying, "Oh man, are you familiar with the word snitching? You snitched on me and you are always snitching to the administrative people." Patient 1 stated he told Cook 1 that was what they were supposed to do if they have a complaint so Administration can be aware of the situation. Patient 1 stated Cook 1 was cursing while talking to him. During an interview on 2/24/2023 at 2:40 PM, Director of Nursing (DON) stated, Patient 1 was verbally abused by Cook 1. During an interview on 3/2/2023 at 3:57 PM, Cook 1 stated Patient 1 was outside with Patient 2 when Patient 1 started using profanity (swearing, which were considered to be inappropriate and offensive). Cook 1 stated, "Patient 1 looked at me and said you are nothing but a bitch, so to me that word means a lot. I was raised in the street and it means fighting words." Cook 1 stated, "I went in front of Patient 1's face and called him a bitch. I slurred out some cursing words towards him." A review of Patient 1's undated Care Plan (CP) indicated Patient 1 was at risk for disruption of psychosocial well-being related to verbal altercation with employee, cursed and yelled at by an employee. A review of the facility's policy and procedure titled, "Patient Rights," revised January 1, 2012, indicated employees are to treat all patients with kindness, respect, and dignity and honor the exercise of patient's rights. A review of the facility's policy and procedure titled, "Abuse - Prevention, Screening, & Training Program " revised July 2018, indicated the facility establishes a safe environment that supports patient to the extent as possible. The facility identifies, corrects, and intervenes in situations in which abuse, neglect, exploitation, misappropriation of patient property, and/or mistreatment is likely to occur. The facility failed to ensure Patient 1 was free from verbal abuse when an alleged verbal altercation occurred between Patient 1 and Cook 1. As a result, Patient 1 experienced discomfort, rudeness, and tried to avoid conflict with Cook 1 from verbal abuse which placed Patient 1 at risk for disruption of psychosocial well-being. This violation caused or occurred under circumstances likely to cause significant humiliation, indignity, anxiety, or other emotional trauma to patients