Health inspection·August 22, 2024

F600 §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; § 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. On 7/9/24 at 8:00 AM the Department of Public Health conducted an unannounced visit at the facility, for the health recertification survey. The facility failed to protect Patient 1 from verbal abuse from Patient 2. As a result, Patient 1 was at risk from suffering negative psychosocial outcome such as fear, anxiety, or loss of self-esteem. A review of Patient 1s Admission Record indicated the patient was readmitted to the facility on 10/4/2023 with diagnoses that included acute respiratory failure (a sudden condition in which not enough oxygen passes from the lungs into the blood), end stage renal disease (ESRD - a stage where the kidneys can no longer support the body's needs for waste removal and fluid balance), hemiplegia (paralysis of one side of the body), and dysphagia (difficulty swallowing). A review of Patient 1's H&P, dated 10/5/2023, indicated the patient could make needs known but could not make medical decisions. A review of Patient 1's MDS, dated 6/18/2024, indicated the patient is assessed with severely impaired cognitive skills for daily decision making. Patient 1required supervision/touching assistance while eating and was dependent (staff does all effort needed to complete activity) for bathing, dressing, oral, personal and toileting hygiene. A review of Patient 1's comprehensive care plan, initiated 7/8/2024, indicated the patient received verbal aggression from roommate and increased risk for emotional distress. A review of Patient 2's Admission Record indicated the patient was admitted to the facility on 2/27/2024 with diagnoses that included violent behavior, dementia (a condition characterized by progressive or persistent loss of intellectual functioning), paranoid (behavior where a person feels distrustful and suspicious of other people and acts accordingly) schizophrenia (a severe mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions), impulse disorder (a behavioral condition that make it difficult to control actions or reactions) and psychotic disorder (a severe mental disorder) with hallucinations (an experience involving the apparent perception of something not present). A review of Patient 2's MDS, dated 6/5/2024, indicated Patient 2had intact cognitive skills (ability to think, remember and reason) for daily decision making. The MDS indicated the patient is independent with eating, set up or clean up assistance with oral hygiene and supervision or touching assistance (staff provide verbal cues and/or touching assistance during activity) with toileting and bathing. A review of Patient 2's comprehensive care plan, initiated 7/8/2024, indicated Patient 51 noted with episode of verbal aggression towards roommate (Patient 260). A review of Patient 2’s "Change in Condition Evaluation," dated 7/8/2024, indicated [unnamed] staff reported that Patient 2 went to Patient 1 and stated "Motherf***er, I will come to you and choked you, until you die." A review of Patient 2's Social Services Progress Note, dated 7/9/2024, indicated Patient 2 noted with an episode of verbal aggression on 7/8/2024 with Patient 1. During an interview on 7/09/24 at 9:10 AM with the Director of Nursing (DON), the DON stated there was an incident of verbal aggression between Patients 2 and 1. During an interview on 7/10/2024 at 10:22 AM with Certified Nursing Assistant 10 (CNA 10), CNA 10 stated on Monday (7/8/2024), while in Room A, she witnessed Patient 50 walk past the bed of Patient 1, turn to Patient 1 and stated "Motherf***er, I will choke you until you die." CNA 10 stated she then stood between Patient 2 and Patient 1, while telling Patient 1 to stop and Patient 2 responded "move, I am going to kill him." A review of the facility's Policy & Procedure (P&P), titled "Abuse Prevention and Prohibition Program," 8/1/2023, indicated each patient has the right to be free from abuse [verbal] and the facility is committed to protecting patients from abuse by anyone, including but not limited to other patients. The facility failed to protect Patient 1from verbal abuse from patient 2. As a result, Patient 1 was at risk from suffering negative psychosocial outcome such as fear, anxiety, or loss of self-esteem. This violation(s) caused or occurred under circumstances likely to cause significant humiliation, indignity, anxiety, or other emotional trauma to Patient 1.