§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;
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Observations:
Based on review of facility policies, clinical records, and investigation documents, as well as staff interviews, it was determined that the facility failed to ensure that residents were free from abuse for one of seven residents reviewed (Resident 4).
Findings include:
The facility's policy for abuse, dated January 31, 2024, indicated that residents had the right to be free from abuse, neglect, misappropriation of resident property, corporal punishment, and involuntary seclusion. Abuse was defined as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Willful meant the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm.
A quarterly Minimum Data Set (MDS) assessment (a mandated assessment of a resident's abilities and care needs) for Resident 1, dated January 23, 2024, indicated that the resident was usually understood and could usually understand others, was cognitively intact, had no behaviors, and had diagnoses that included anxiety (feeling of fear, dread, and uneasiness). A care plan, dated October 16, 2023, revealed that Resident 1 had behaviors and staff were to intervene as necessary to protect the rights and safety of others.
A quarterly MDS assessment for Resident 4, dated February 24, 2024, revealed that the resident was understood, understands, exhibited physical and verbal behavioral symptoms directed towards others which occurred one to three days during the review period, and had a diagnosis which included multiple sclerosis (MS - a chronic disease of the central nervous system) and cerebral vascular accident (CVA - commonly referred to as a stroke).
A nursing note, dated February 12, 2024, at 4:08 p.m. revealed that Resident 1 was involved in an altercation with another resident. Resident 1 stated, "I was sitting here at the table talking to another resident when Resident 4 started wheeling into the dining room, and I said 'here comes Resident 4'. Then Resident 4 kept bumping into my chair, and I told him to stop, but he kept doing it, so I hit him." The resident demonstrated the motion, and claimed it was an open-handed hit.
A nursing note for Resident 4, dated February 12, 2024, revealed that the resident had a small scleral abrasion (an area damaged by scraping or wearing away) of the right eye with surrounding subconjunctival hemorrhage (a broken blood vessel in the eye). A new order was received for erythromycin ointment (a topical antibiotic) three times per day for seven days.
The facility report, dated February 12, 2024, indicated that an event occurred on February 12, 2024, at approximately 1:30 p.m. when Resident 4 wheeled himself backwards into the dining room and Resident 1 became upset because Resident 4 bumped his wheelchair into Resident 1. Resident 1 turned his wheelchair to the side and slapped Resident 4 on the right side of his face, causing Resident 4 to have a blood shot eye. Resident 4 was assessed by the certified registered nurse practioner (CRNP - a registered nurse (RN) who has advanced education and clinical training in a health care specialty area) and an order was received for an eye ointment for the redness noted in his eye.
A statement from Resident 1 regarding the incident on February 12, 2024, undated, revealed that he was sitting at the table talking to another resident when Resident 4 started wheeling into the dining room. Resident 4 kept bumping into his chair and he told him to stop, but Resident 4 kept doing it and he hit him. Resident 1 claimed it was an open-handed hit.
A statement from Resident 4 regarding the incident on February 12, 2024, undated, revealed that he came around the corner of the dining room and Resident 1 stated, "Here comes that damn Resident 4." Resident 4 said that he did not do anything so he did not know why Resident 1 was running his mouth. Resident 4 did accidentally bump into Resident 1's chair and then Resident 1 hit Resident 4 with a fist.
A statement from Resident 7, undated, revealed that Resident 4 bumped into Resident 1's chair and then Resident 1 swung at him, which started as a fist but he could not quite reach him, so Resident 1's hand opened as it made contact.
Interview with the Nursing Home Administrator on March 26, 2024, at 4:24 p.m. confirmed that Resident 1 did hit Resident 4.
28 Pa. Code 201.14(a) Responsibility of Licensee.
28 Pa. Code 201.18(b)(1)(e)(1) Management.
28 Pa. Code 201.29(j) Resident Rights.
| | Plan of Correction - To be completed: 04/25/2024
Resident 1 met with the Director of Nursing to discuss recent behaviors towards other residents. Resident has a BIM score of 15 and is capable of understanding the consequences of his actions. The resident understands physical altercations are not appropriate and if this behavior and his inappropriate verbal behavior and threats towards other residents on his floor do not cease, he will be moved off the 2nd floor to another location in the building and a potential loss of his smoking privileges. All Nursing staff on 2nd floor will be re-educated to ensure timely reporting of resident 1 behaviors to the Registered Nurse Supervisor and updated care plan. Registered Nurse Supervisors will be re-educated to ensure timely reporting of resident behaviors to Director of Nursing or Nursing Home Administrator and updated behavior plan. Licensed Practical Nurse will be responsible for monitoring and documentation of noted behaviors on medication administration record per shift. The Social Worker or other designated manager will meet with the resident weekly x6 weeks to continue to stress the importance of his compliance.
Resident's care plan will be updated to reflect individualized interventions to include: resident cannot sit at the entrance to the activity room/dining room and block other residents from entering; Education for resident regarding inappropriate gestures towards others is inappropriate. Resident must refrain from hitting others and that there are consequences for his actions; Encourage resident to stay away from other residents when he is feeling frustrated or angry; Staff to monitor for signs/symptoms of escalating agitation or anger. Members of the Interdisciplinary team will review R1 progress notes daily (M-F) and identify any behaviors that may require interventions and update to care plan.
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