Health inspection·January 9, 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; 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. 22 CCR §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. On 11/29/2023, an unannounced visit was made to the facility to conduct the facility reported incident regarding abuse. The facility failed to protect the resident's right to be free from physical abuse (deliberately aggressive or violent behavior with the intention to cause harm) for Resident 1 and Resident 2 when on 10/22/2023, at 3:45 p.m., Resident 1 and Resident 2 punched each other. As a result, Resident 1 and Resident 2 were subjected to physical abuse while under the care of the facility and Resident 1 had facial bruises, a facial cut, and felt anxious and unsafe in the facility. Resident 2 had a skin tear on his forehead and a skin tear on his upper left cheek. A review of Resident 2's Admission Record indicated the facility initially admitted Resident 2 on 3/30/2023 with a readmission date of 8/17/2023. Resident 2's diagnoses included sepsis (the body's extreme response to an infection), schizophrenia (a serious mental illness that affects how a person thinks, feels, and behaves), and major depressive disorder (a common and serious medical illness that negatively affects how you feel, the way you think and how you act). According to a review of the Initial History and Physical, dated 8/18/2023, Resident 2 had the capacity to understand and make decisions. A review of the care plan dated 8/21/2023 indicated Resident 2 had a potential for aggression related to anxiety, with episodes of screaming and yelling. The care plan goal indicated Resident 2 would verbalize understanding of need to control abusive behavior. The care plan interventions indicated to assess resident's coping skills and support system, and when resident becomes agitated to intervene before agitation. A review of Resident 2's Minimum Data Set (MDS - a standardized assessment and care-screening tool) dated 9/29/2023 indicated the resident had delusions (misconceptions or beliefs that are firmly held, contrary to reality). According to a review of the Situation, Background, Assessment, Recommendation communication form (SBAR), dated 10/23/2023 at 11:29 a.m., Resident 2 had a physical and verbal altercation with Resident 1. Resident 1 claimed that Resident 2 unplugged his TV without his permission, started a verbal altercation, then both residents started punching each other. A review of Resident 2's Skin Evaluation, dated 10/23/2023 at 11:31 a.m., indicated a skin tear of 2 cm by 0.1 cm on the left side of the forehead and a skin tear of 2.2 cm by 0.1 cm on the upper left cheek. A review of Resident 2's Order Audit Report, dated 10/23/2023 at 3:04 p.m., indicated open skin on the left upper cheek and to clean the skin with Normal Saline (NS), pat it dry, and apply an antibiotic cream daily for 14 days. A review of the Treatment Administration Record dated 10/24, 10/25, 10/26 and 10/27/2023 indicated Resident 2 received open skin treatments on the upper left cheek and left side of the forehead. A review of Resident 1's Admission Record indicated the facility initially admitted Resident 1 on 1/14/2020 with a readmission date of 9/24/2023. Resident 1's diagnoses included sepsis (the body's extreme response to an infection), major depressive disorder (a common and serious medical illness that negatively affects how you feel, the way you think and how you act), and opioid abuse (compulsive urge to use opioid drugs [class of drugs that derive from the opium poppy plant], even when they are no longer required medically). According to a review of the MDS dated 10/19/2023, Resident 1's cognitive skills (ability to understand and make decisions) were intact and required supervision or touching assistance for transferring, oral and toileting hygiene, and upper body dressing. The MDS indicated Resident 1 was not walking and used a wheelchair as a mobility device. A review of Resident 1’s Skin Evaluation dated 10/23/2023, indicated a skin tear of 0.2 centimeters (cm - unit of measurement) by 1.5 cm on the face. A review of Resident 1's Order Audit Report, dated 10/23/2023 at 6:02 p.m., indicated open skin on the left cheek and to clean the skin with Normal Saline (NS), pat it dry, and apply bacitracin (an antibiotic used to prevent bacterial infection) ointment daily for 14 days. According to a review of Resident 1's Telemedicine Visit (using telecommunications technologies to support the delivery of all kinds of medical, diagnostic and treatment) dated 10/27/2023, Resident 1 was seen for a psychiatric evaluation. The psychiatric evaluation indicated that after the physical altercation with Resident 2, Resident 1 was in physical pain from the incident, verbalized feeling anxious, and was willing to try medication for anxiety. A review of the Physician's Order dated 10/27/2023 at 8:52 p.m., indicated Resident 1 was prescribed Ativan (medication used to treat anxiety) 0.5 milligrams (mg - unit of measurement) taken every six hours as needed for anxiety for 14 days. A review of the Medication Administration Record (MAR) indicated Resident 1 received Ativan 0.5 mg every day from 11/3 through 11/10/2023. During an observation on 11/29/2023 at 12:30 p.m., Resident 1 was in his room, sitting in the wheelchair eating lunch. During a concurrent interview Resident 1 stated his old roommate (Resident 2) was moved to another room because they had an altercation. During an interview on 11/29/2023 at 4:05 p.m., Resident 1 stated that in the middle of the day on 10/22/2023 Resident 2 attacked him. Resident 1 stated that Resident 2 unplugged his TV without asking, he then told Resident 2 to not come near his stuff after which Resident 2 hit him on the cheek, and then they both started punching each other. Resident 1 stated that at the time of the altercation he was sitting in a wheelchair and Resident 2 was standing. Resident 1 stated that as a result of this altercation he received facial bruises, a facial cut, and he was feeling anxious and not safe in this facility. On 11/29/2023 at 4:20 p.m., during an interview, Licensed Vocational Nurse 1 (LVN 1) stated that on 10/22/2023 around 3:45 p.m., he was in another room when he heard screaming from Resident 1's room. LVN 1 stated he went to Resident 1's room and saw that Resident 1 and Resident 2 were fighting with each other. LVN 1 stated that he separated the residents immediately and reported the incident to Director of Nursing 2 (DON 2). During an interview on 11/30/2023 at 4 p.m., the Assistant Director of Nursing (ADON) stated physical abuse happened between Resident 1 and Resident 2, and that it should not have occurred according to the abuse policy and regulations. A review of the facility's policy and procedure titled, "Abuse, Neglect, Exploitation or Misappropriation Prevention," revised April 2023, indicated residents have the right to be free from abuse, this includes physical abuse. The policy indicated the facility abuse prevention program consists of a facility wide commitment and resource allocation to support other residents and identify and investigate all possible incidents of abuse, neglect and mistreatment. The facility failed to protect the resident's right to be free from physical abuse for Resident 1 and Resident 2 when on 10/22/2023, at 3:45 p.m., Resident 1 and Resident 2 punched each other. As a result, Resident 1 and Resident 2 were subjected to physical abuse while under the care of the facility and Resident 1 had facial bruises, a facial cut, and felt anxious and unsafe in the facility. Resident 2 had a skin tear on his forehead and a skin tear on his upper left cheek. The above violation had a direct relationship to the health, safety, and security of Resident 1 and Resident 2.