Ashford of Mount Washington The

Based on medical record review, observation of video recording, review of a facility Self-Reported Incident (SRI) and investigation, staff, family and law enforcement interviews, review of employee termination documentation, review of the facility policy, review of facility staff training documents, review of the Resident Handout, and review of the Employee Handbook, the facility failed to ensure residents were free from physical, verbal, mental and emotional abuse and mistreatment by a facility staff member while in the resident's room providing care, and not in accordance with the facility policy. This resulted in Real and Present Danger and the potential for serious physical and/or psychological harm for one resident (#88) who was cognitively impaired when Personal Care Assistant (PCA) #105 engaged in acts of aggression and acts meant to humiliate and dehumanize the resident. PCA #105 was captured on video physically throwing items at the resident's body and face and being verbally abusive to the resident during the provision of care. This affected one (Resident #88) of three residents reviewed for abuse. The facility census was 90.

On 09/01/23 at 3:16 P.M., the Executive Director (ED) and Regional Vice President of Operations (RVPO) #405 were notified Real and Present Danger began on 08/30/23 at 6:01 A.M. when Resident #88 experienced verbal and physical abuse/mistreatment per PCA #105. Review of the video recording dated 08/30/23 timed at 6:01 A.M. revealed PCA #105 entered Resident #88's room and told the resident it was time to wake up. Resident #88 was in her bed with her eyes open. When Resident #88 didn't respond to PCA #105's admonition to wake up, PCA #105 said, Why are just sitting there with that [explicit term] look on your face? You either gonna get up or you're not. Hear? As PCA #105 said Hear?, she threw an incontinence pad at the resident, hitting the resident in the torso. PCA #105 then threw a second incontinence pad at Resident #88, and it struck the resident in the face. Resident #88 said, Ouch and kicked at PCA #105 with her left foot and said [explicit term] to the aide. PCA #105 then threw a third incontinence pad at the resident striking her in the chest. Resident #88 then sat up in bed and looked at PCA #105 and said, Okay, okay. PCA #105 was approximately two feet away from Resident #88's face and then said, Get your [explicit term] up.

The Real and Present danger was abated on 09/05/23 when the facility implemented the following corrective actions:

On 08/30/23 at approximately 1:45 P.M., the ED was made aware by the local police of an allegation of abuse by PCA #105 towards Resident #88 which occurred on 08/30/23 at 6:01 A.M.

On 08/30/23 at approximately 1:50 P.M., the ED asked floor staff to do a safety check on Resident #88 and staff reported the resident had a visitor and was in no distress.

On 08/30/23 at 4:16 P.M., Assistant Director of Care (ADOC) #350 assessed Resident #88 for injury and found no injuries.

On 08/30/23, the ED suspended PCA #105 and obtained a written statement from her.

On 08/30/23, the ED initiated an SRI regarding an allegation of abuse towards Resident #88.

On 08/30/23 and 08/31/23, Activities Director (AD) #120, Executive Chef (EC) #125, Business Office Manager (BOM) #130, Director of Care (DOC), Maintenance Director (MD) #195, Senior Living Advisor (SLA) #300, and ADOC #350, interviewed all residents in the facility regarding abuse concerns with no negative findings reported.

On 08/30/23 and 08/31/23, the DOC and ADOC #350 completed head to toe skin assessments on all residents with no concerns noted.

On 08/30/23, RVPO #405 in-serviced the ED on the abuse policy and care of residents with dementia.

On 08/30/23, the ED in-serviced all department heads (AD #120, EC #125, BOM #130, DOC, MD #195, SLA #300, and ADOC #350) on the abuse policy and care of residents with dementia.

On 08/30/23 and 08/31/23, AD #120, EC #125, BOM #130, DOC, MD #195, SLA #300, and ADOC #350 in-serviced all staff on the abuse policy and care of the resident with dementia. Any staff on leave or vacation will be in-serviced immediately upon their return to work and prior to working with residents.

Starting on 08/30/23 on the 3:00 P.M. to 11:00 P.M. shift and every shift thereafter all licensed nurses will make rounds on their assigned units to ensure compliance with the abuse policy. The facility staffs one to three nurses per shift.

On 08/31/23, Physician Assistant (PA) #415 completed a physical examination of Resident #88 with no negative findings noted.

On 08/31/23, the ED sent a letter via e-mail to all resident(s) and/or their representatives regarding the abuse concern and steps the facility took as a result of the incident.

On 09/02/23, 09/03/23 and 09/04/23, the Manager on Duty (MOD), who is one of the department heads and/or managers who rotate as the MOD and is identified on a schedule, was physically present in the facility for a minimum of four hours and made management/quality of care rounds with no abuse concerns noted. The MOD will continue to audit on weekends and holidays to ensure compliance with the abuse policy.

On 09/05/23, Regional Director of Care (RDOC) #410 made a list of residents likely to be affected by the deficient practice identifying all residents with diagnoses of dementia with behavioral disturbance. The facility will arrange for a third-party psychiatric services vendor with family consent to complete a baseline emotional assessment on like residents (#01, #14, #35, #75 and #81) on or before 12/05/23. The third-party vendor will determine the need for ongoing psychiatric care. All newly admitted residents with diagnosis of dementia with behavioral disturbance or similar diagnosis/presentation will be referred for an evaluation with the psychiatric services vendor with family consent.

Starting on 09/05/23, ED and/or designee will interview ten resident's weekly times 30 days at random to determine if residents have witnessed verbal or physical resident abuse and if residents feel safe in their home. Concerns will be addressed immediately. Trends will be reported in the Quality Assurance and Performance Improvement (QAPI) committee meeting, and the QAPI committee will determine the need for further monitoring.

Starting on 09/05/23, the ED will ensure all newly hired staff receive training on the abuse policy upon hire, monthly for six months, and annually thereafter. The ED will monitor for compliance.

Starting on 09/05/23, BOM #130 will audit 10 current employee files weekly to ensure completion of abuse training. The audits will be completed weekly times 30 days and randomly thereafter. BOM #130 to report negative findings to the ED immediately for immediate action. Concerns will be reported to the QAPI Committee.

On 09/05/23, the DOC or designee will complete and document head to toe assessments on all identified residents with diagnosis of dementia with behavioral disturbance to monitor for signs of physical abuse weekly for the next 30 days. DOC or designee will report negative findings to the ED immediately for appropriate next steps. Documentation will be included in the progress notes and on an audit tool.

On or before 09/29/23, all nurses and PCA's will complete CARES (Connect with the Person, Assess Behavior, Respond Appropriately, Evaluate what works, Share with Others) dementia care training program, a 16-hour program which consists of four modules of four hours each computerized based training. ADOC #350 or designee will ensure completion of program. Newly hired direct care staff will complete CARES program before working with residents. Additionally, all newly hired staff will complete computerized training on the following topics: Alzheimer's Disease and Related Disorders, Dementia Care: Managing Challenging Behaviors, Dementia Care: Preventing Catastrophic Reactions, Behavioral Health and Older Adults, and Depression and Suicide in Older Adults.

On 09/05/23 between 9:00 A.M. and 2:46 P.M., DOC, SLA #300, Licensed Practical Nurse (LPN) #230, MD #195, PCA's #150 and #250, and Server #205, verified they were educated on the facility abuse policy and communication with residents with dementia. All staff members interviewed were knowledgeable of the content of each education provided by the facility.

On 09/05/23, surveyor completed review of the medical records for residents (#35, #75, #81) identified as being at increased risk for abuse related to dementia diagnosis and revealed no concerns related to abuse.

Although the Real and Present danger was abated on 09/05/23, the violation continues as the facility is still in the process of implementing their corrective action plan and monitoring to ensure ongoing compliance.

Findings include:

Review of the medical record for Resident #88 revealed an admission date of 06/27/22 with diagnoses including vascular dementia with behavioral disturbance, asthma, diabetes mellitus (DM), and hypertension (HTN).

Review of the cognitive assessment, the Mini-Mental Status Exam (MMSE) for Resident #88 dated 07/30/23 revealed the resident scored seven out of 30 which indicated the resident had severe cognitive impairment.

Review of the health assessment for Resident #88 dated 08/08/23 revealed the resident had difficulty communicating needs verbally, required reminders and cueing with dressing and hygiene, resisted dressing and hygiene tasks at times, and needed assistance with bathing. Resident #88 was independent with mobility but was forgetful and needed reminders to find areas within the community and needed safety checks every shift.

Review of an undated PCA assignment sheet for Resident #88 revealed the resident required hands-on assistance with activities of daily living (ADL) including toileting, resident was to be check and changed, and could be combative with care.

Review of the nurse progress note for Resident #88 dated 08/30/23 timed at 4:15 P.M. per ADOC #350 revealed the nurse completed a head-to-toe skin assessment of the resident with no new issues noted. Vital signs were taken and were within normal limits. Resident #88 was in a pleasant mood and denied any pain.

Review of the facility SRI initiated 08/30/23 revealed the facility investigated an allegation of physical abuse towards Resident #88 by PCA #105 and the facility substantiated that abuse had occurred verified by evidence gathered during the investigation.

Review of the written statement by PCA #105 dated 08/30/23 revealed the aide worked with Resident #88 from 08/29/23 at 11:00 P.M. to 08/30/23 at 7:00 A.M. PCA #105 confirmed the last time she saw Resident #88 was at 6:40 A.M. when she went into the resident's room and the resident let the aide get her dressed. Review of the statement revealed prior to 6:40 A.M., PCA #105 had approached Resident #88 to give care, but the resident would not allow care, and the resident kicked the aide. Review of the statement revealed Resident #88 is combative and does not allow care and further noted, I did not do anything to that lady.

Review of the termination notice dated 08/31/23 for PCA #105 revealed the aide was terminated effective immediately due to misconduct.

Observation on 09/01/23 at 11:40 A.M. of a video recording dated 08/30/23 timed at 6:01 A.M. revealed PCA #105 entered Resident #88's room and told the resident it was time to wake up. Resident #88 was in her bed with her eyes open. When Resident #88 didn't respond to PCA's admonition to wake up, PCA #105 said, Why are just sitting there with that [explicit term] look on your face? You either gonna get up or you're not. Hear? As PCA #105 said Hear? she threw an incontinence pad at the resident hitting the resident in the torso. PCA #105 then threw a second incontinence pad at the resident, and it struck the resident in the face. Resident #88 said, Ouch and kicked at PCA #105 with her left foot and said [explicit term] to the aide. PCA #105 then threw a third incontinence pad at Resident #88 striking her in the chest. Resident #88 then sat up in bed and looked at PCA #105 and said, Okay, okay. PCA #105 was approximately two feet away from Resident #88's face and then said, Get your [explicit term] up. The video footage ended at that point.

Interview on 09/01/23 at 9:51 A.M. with the ED and RVPO #405 confirmed on 08/30/23 at approximately 1:45 P.M., Resident #88's representative came to the ED's office and said, I've got you. You stay right here. The police are on their way. ED confirmed that Police Officers (PO) #425 and #430 came to her office and told her Resident #88's representative had video footage of PCA #105 abusing the resident. ED confirmed that after the nurse had confirmed Resident #88's immediate safety, she viewed the video footage with police and Resident #88's family member. The ED confirmed the video showed PCA #105 enter Resident #88's room and said, Are you going to get up or not? The ED confirmed PCA #105's voice was raised, and she had a sarcastic tone to her voice. The ED confirmed PCA #105 said to Resident #88, Why are you just sitting there looking stupid? The ED confirmed Resident #88 did not respond but she was awake and alert and looking at PCA #105. The ED confirmed Resident #88 is cognitively impaired and has a diagnosis of dementia with behavioral disturbance and frequently resists care. The ED confirmed the video showed PCA #105 throwing incontinence pads at Resident #88 with intent and hitting her in the torso. The ED confirmed the incontinence pads were provided by Resident #88's family. The ED confirmed the video then showed PCA #105 throwing a second incontinence pad at Resident #88, and it hit her in the face. The ED confirmed Resident #88 then kicks at PCA #105 and called her a [explicit term]. The ED confirmed PCA #105 then threw another incontinence pad at the resident hitting her body. The ED confirmed the facility immediately suspended PCA #105 and reported the allegation of abuse to the Ohio Department of Health (ODH). The ED confirmed Resident #88 was not able to recall the incident due to dementia. The ED confirmed the facility's investigation confirmed that physical and verbal abuse had occurred by PCA #105 towards Resident #88 on 08/30/23 at 6:01 A.M.

Interview on 09/01/23 at 11:23 A.M. with PO #425 confirmed he had observed the video footage of PCA #105 and Resident #88 dated 08/30/23 at 6:01 A.M. PO #425 confirmed the video was disturbing to watch and he thought the aide should be arrested based on what he saw in the video.

Interview on 09/05/23 at 1:56 P.M. with Resident #88's family member confirmed they had installed a video camera in Resident #88's apartment approximately a week ago. Resident #88's family member stated the video captured an aide being verbally abusive to the resident and throwing incontinence pads at her body and her face. Resident #88's family member confirmed the video of the incident was recorded on 08/30/23 at 6:01 A.M. and was shared with the facility administration and local police. Resident #88's family member confirmed he felt the aide in the video had been verbally and physically abusive to the resident.

Review of the facility policy titled Abuse, Neglect Reporting and Investigation dated 03/31/23 revealed the facility was committed to maintaining a safe environment for each resident, and instances or allegations of abuse should be treated seriously and must be reported to the ED or the supervisor on duty for investigation and appropriate follow-up. Verbal abuse was defined as the use of oral, written or gestured language that willfully included disparaging and derogatory terms to resident/patients or their families, or within their hearing distance, regardless of their age, ability to comprehend, or disability.

Review of the facility training document titled Understanding Abuse dated 2020 revealed acts of abuse are still considered abusive even if the individual does not have the ability to understand what has occurred and is unable to express distress related to the act. Mental abuse was the use of verbal or nonverbal acts which caused the individual to experience humiliation, intimidation, fear, shame, or anxiety. Mental abuse could be very subtle and difficult to recognize. Verbal abuse included yelling, talking disrespectfully and scolding.

Review of the Resident Rights Handbook dated 06/26/22 with signed receipt by Resident #88's family member revealed the residents had the right to be free from physical, verbal, mental, and emotional abuse and to be treated at all times with courtesy, respect, and full recognition of dignity and individuality.

Review of the Employee Handbook dated 06/24/20 on page 10 revealed abuse of a resident was a serious infraction and would result in termination of employment.

This violation represents non-compliance investigated under Complaint Numbers OH00146102, OH00146034 and OH00146006.

Based on record review, observation of video footage, staff interview, review of personnel records, and review of facility resident rights document, the facility failed to ensure residents were provided with adequate and appropriate nursing care. This affected one (Residents #88) of three residents reviewed for resident rights. The facility census was 90.

Findings include:

Review of the medical record for Resident #88 revealed an admission date of 06/27/22 with diagnoses including vascular dementia with behavioral disturbance, asthma, diabetes mellitus (DM), and hypertension (HTN).

Review of resident agreement for Resident #88 dated 06/26/22 revealed resident's representative had signed the agreement on the resident's behalf and there was a section on page 10 which indicated the facility prohibited the use of any video or audio recording on the premises. No cameras, including cell phone cameras, recorders, or other types of recording devices were permitted to be installed by the resident or resident's family. Violators were subject to eviction.

Review of the cognitive assessment, the Mini-Mental Status Exam (MMSE) for Resident #88 dated 07/30/23 revealed resident scored seven out of 30 which indicated severe cognitive impairment.

Review of the health assessment for Resident #88 dated 08/08/23 revealed the resident had difficulty communicating needs verbally, required reminders and cueing with dressing and hygiene, resisted dressing and hygiene tasks at times, and needed assistance with bathing. Resident #88 was independent with mobility but was forgetful and needed reminders to find areas within the community and needed safety checks every shift.

Review of the undated Personal Care Assistant (PCA) assignment sheet for Resident #88 revealed the resident required hands-on assistance with activities of daily living (ADL) including toileting, the resident was to be check and changed, and could be combative with care.

Observation on 09/05/23 at 9:05 A.M. with the Director of Care (DOC) revealed there was a video camera which appeared to be functioning mounted onto the wall of the resident's room. There was a sign in the room indicating there was a video camera in place.

Interview on 09/05/23 at 1:56 P.M. with Resident #88's family member confirmed they had installed a video camera in Resident #88's apartment approximately a week ago due to concerns the resident was being mistreated.

Interview on 09/06/23 at 3:37 P.M. of the Executive Director (ED) confirmed Resident #88's representative sent the facility a copy of video taken in the resident's room on 09/06/23 at approximately 5:30 A.M.. The video included Medication Aide (MA) #295 providing care in Resident #88's room. MA #295 was working as a Personal Care Assistant (PCA) on 09/06/23. ED confirmed the facility viewed the video and immediately suspended MA #295. The facility took a statement from MA #295 and determined the aide's behavior was inappropriate and unprofessional. MA #295 spoke to the camera in the room and did not interact with the resident in a respectful manner. ED confirmed that in the video MA #295 was talking to the camera and talking at the resident and she would send a copy of the video to the Surveyor for review.

Observation on 09/06/23 at 3:59 P.M. of the video dated 09/06/23 timed at approximately 5:30 A.M. revealed the video showed an interaction between MA #295 and Resident #88 which occurred in resident's room and was captured on a video camera which had been recently installed by resident's representative in the resident's room. Resident #88 was in the bathroom with the door open and MA #295 spoke loudly expressing frustration regarding resident's combativeness, I mean I don't know what people want you do to if the residents don't want you to touch them. What do you do? Seriously, I don't know. Resident #88 exited the bathroom and aide handed her an article of clothing and told resident to put it on. Then MA #295 continued talking out loud as if she was speaking to the camera, But I'm not gonna get hit. I'm not gonna to get hit by a by a resident. You're not gonna hit me, (addresses resident by first name). So, I'm gonna go ahead and let you do what you do. I'm doing my best, and that's all I can do for real. As MA #295 is making the bed she said, Put me on camera? This is really petty. MA #295 then handed Resident #88 a pair of pants and tells her to put them on. MA #295 then pulls her mask up over her mouth and said, I don't know what kind of germs is in here and as she continued working on straightening the room, MA #295 then said, I got a family at home. Not playing no games. I'm a grown woman. No one is playing with my life. Resident #88 did not respond verbally to any of the MA #295's statements and looked bewildered throughout the video which was two minutes and 59 seconds in length.

Review of the written statement per MA #295 dated 09/06/23 regarding video recording of her providing care to Resident #88 on 09/06/23 at 5:30 A.M. revealed prior to the recording Resident #88 was being combative with MA #295. MA #295 confirmed she was not aware that she was on camera and she thought the camera in the resident's room was distorted. Review of statement revealed MA #295 was upset because Resident #88 kept hitting her and confirmed it was terrible that I was acting like that in response to the resident. MA #295 confirmed she thought to get another staff person to assist her with the resident's care but she didn't do it this time. MA #295 confirmed she remembered the training and inservice's the facility had on how to deal with resident and residents with dementia but she just didn't do it.

Review of the termination notice for MA #295 dated 09/06/23 revealed employee was terminated due to misconduct.

Review of the undated Resident Rights handout page four revealed the residents have the right to be free from physical, verbal, mental, and emotional abuse and to be treated at all times with courtesy, respect, and full recognition of dignity and individuality.

This violation represents non-compliance investigated under Complaint Number OH00145751.

Based on record review, observation of video footage, staff and family member interviews, review of resident agreement, and review of facility resident rights document, the facility failed to ensure residents were able to freely exercise their right to retain and use personal possessions without fear of retribution. This affected one (Residents #88) of three residents reviewed for resident rights. The facility census was 90.

Findings include:

Review of the medical record for Resident #88 revealed an admission date of 06/27/22 with diagnoses including vascular dementia with behavioral disturbance, asthma, diabetes mellitus (DM), and hypertension (HTN).

Review of resident agreement for Resident #88 dated 06/26/22 revealed the resident's representative had signed the agreement on the resident's behalf and there was a section on page 10 which indicated the facility prohibited the use of any video or audio recording on the premises. No cameras, including cell phone cameras, recorders, or other types of recording devices were permitted to be installed by the resident or resident's family. Violators were subject to eviction.

Review of the cognitive assessment, the Mini-Mental Status Exam (MMSE) for Resident #88 dated 07/30/23 revealed resident scored seven out of 30 which indicated severe cognitive impairment.

Review of the health assessment for Resident #88 dated 08/08/23 revealed the resident had difficulty communicating needs verbally, required reminders and cueing with dressing and hygiene, resisted dressing and hygiene tasks at times, and needed assistance with bathing. Resident #88 was independent with mobility but was forgetful and needed reminders to find areas within the community and needed safety checks every shift.

Review of an undated Personal Care Assistant (PCA) assignment sheet for Resident #88 revealed the resident required hands-on assistance with activities of daily living (ADL) including toileting, resident was to be check and changed, and could be combative with care.

Interview on 09/01/23 at 9:51 A.M. of Executive Director (ED) confirmed on 08/30/23 at approximately 1:45 P.M. Resident #88's family member came to the ED's office and informed ED the police were coming to speak with her. ED confirmed that Police Officers (PO) #425 and #430 came to her office and told her Resident #88's representative had video footage of PCA #105 abusing resident on 08/30/23 at 6:01 A.M. ED confirmed that after nurse had confirmed resident's immediate safety, she viewed the video footage with police and Resident #88's family member. ED confirmed video showed an interaction between PCA #105 and Resident #88. ED further confirmed the facility did not permit residents to have cameras even in their private apartments, and this was addressed in the resident agreement. ED further confirmed that residents were subject to eviction if they were found to have installed a camera in the room. ED confirmed Resident #88 had not been issued an eviction notice, and she was unsure if she would be required to issue one. ED confirmed she would follow the direction of the corporate office for the facility.

Observation on 09/01/23 at 11:40 A.M. of the video dated 08/30/23 timed at 6:01 A.M. revealed the video showed an interaction between PCA #105 and Resident #88 which occurred in resident's room and was captured on a video camera which had been recently installed by resident's representative in the resident's room.

Observation on 09/05/23 at 9:05 A.M. with the Director of Care (DOC) revealed there was a video camera which appeared to be functioning and the camera was mounted onto the wall of the resident's room. There was a sign in the room indicating there was a video camera in place.

Interview on 09/05/23 at 1:56 P.M. with Resident #88's family member confirmed the family had installed a video camera in Resident #88's apartment approximately a week ago due to concerns the resident was being mistreated. Resident #88's family member confirmed he was told upon admission that residents could be evicted for having a camera in her room, but he installed the camera anyway due to concerns for her safety.

Review of the undated Resident Rights handout on page four revealed the residents had the right to retain and use personal clothing and a reasonable amount of possessions, in a reasonably secure manner, unless to do so would infringe on the rights of other residents or would not be medically advisable as documented in the resident's medical record by the attending physician.

Review of the undated Resident Handbook on page four revealed Your apartment is your castle - your home. Inside your home, you are welcome to read, watch television, make your bed, entertain guests in privacy and enjoy activities as you always have.

This violations is based on incidental findings discovered during the course of this complaint investigation.

Based on record review, staff interview, review of facility documents, review of electronic mail (email) communication, review of facility policies, and review of Self-Reported Incidents (SRI's), the facility failed to thoroughly investigate an incident involving an allegation of staff to resident abuse. This affected one (#66) of three residents reviewed for abuse. The census was 65.

Findings include:

Review of the medical record for Resident #66 revealed an admission date of 06/17/19 with a diagnosis of dementia.

Review of the annual functional assessment for Resident #66 dated 04/05/22 revealed resident required staff assistance with activities of daily living (ADL's.)

Review of the cognitive assessment for Resident #66 dated 06/09/22 revealed resident had severe cognitive impairment.

Review of the nurse progress notes for Resident #66 dated 07/01/22 through 08/01/22 revealed the notes did not include any documentation related to staff to resident abuse or mistreatment.

Review of the nurse progress note for Resident #66 dated 08/01/22 revealed resident was sent to the hospital for psychiatric evaluation due being combative with the staff and using racial slurs towards staff and peers. Resident #66 was still in the hospital at the time of the survey.

Review of the facility SRI's dated 07/01/22 through 08/05/22 revealed there were no SRI's regarding abuse allegations involving Resident #66.

Review of written statement per Housekeeper #210 dated 08/02/22 revealed he witnessed Personal Care Assistant (PCA) #375 get into an altercation with Resident #66 in front of the facility. Review of the statement revealed Resident #66 called PCA #375 a racial slur and PCA #375 told the resident to shut up and they began yelling back and forth at each other. Further review revealed PCA #375 told Resident #66 she was not going to do anything for her anymore and that she was done with her.

Review of written statement per PCA #115 undated revealed she witnessed PCA #375 get into a verbal altercation in front of the facility with Resident #66. Review of statement revealed Housekeeper #210 also witnessed the altercation and they were calling each other racial slurs.

Review of email communication dated 07/22/22 from Employee Relations Director (ERD) #380 to PCA #375 revealed the employee was being placed immediately on a paid administrative leave due to allegations of bullying and racist comments to coworkers.

Interview on 08/05/22 at 11:27 A.M. with the Director of Care (DOC) confirmed sometime in July 2022, PCA #115 told her she and Housekeeper #210 had witnessed PCA #375 get into a verbal confrontation in front of the building with Resident #66. DOC confirmed PCA #115 told her the PCA #375 and Resident #66 were yelling at each other and using racial slurs. DOC confirmed she told PCA #115 and Housekeeper #210 to leave statements for her in her mailbox. DOC confirmed she reported the incident to ERD #380 and PCA #375 was placed on an administrative leave. DOC confirmed she had no additional information regarding the alleged incident between PCA #375 and Resident #66. DOC confirmed Resident #66's record contained no information regarding the incident. DOC confirmed the facility had not interviewed PCA #375 regarding the incident.

Interview on 08/05/22 at 11:45 A.M. with the Executive Director (ED) confirmed she was not involved in the investigation of the incident between PCA #375 and Resident #66. ED confirmed ERD #380 had placed PCA #375 on leave on 07/22/22 and the employee had not returned to work. ED confirmed Resident #66 was out of the facility at the hospital unrelated to the incident between PCA #375 and resident. ED confirmed the facility had not completed an SRI and had no further investigative information regarding the incident besides the written statements from PCA #115 and Housekeeper #210.

Interview on 08/05/22 at 12:28 P.M. with ERD #38 confirmed the facility had notified her that PCA #375 had made some racial slurs to coworkers, so she placed the employee on an administrative leave. ERD #38 confirmed after she read statements from PCA #115 and Housekeeper #210 she realized the concerns were actually involving PCA #375 making improper comments to a resident which she felt was a more serious concern. ERD #38 confirmed she had not obtained a written statement yet from PCA #375 but when she spoke to her on the phone the aide denied making any inappropriate comments to coworkers.

Interview on 08/05/22 at 1:02 P.M. with the ED confirmed PCA #375 was placed on leave on 07/22/22 and had not worked since that time. ED confirmed PCA #375 worked the following days in July: 07/05/22, 07/06/22, 07/09/22, 07/10/22, 07/12/22, 07/14/22. ED confirmed she wasn't sure of the exact date of the incident between PCA #375 and Resident #66, but it occurred on one of the dates in July 2022.

Interview on 08/05/22 at 1:43 P.M. with PCA #375 confirmed she was notified by email on 07/22/22 that she was being place on administrative leave for bullying and racist comments. PCA #375 confirmed she had not made racist comments to any residents, had never been in an argument with a resident, and wasn't exactly sure what prompted to facility to place her on leave.

Attempted to interview Housekeeper #210 on 08/05/22 at 12:53 P.M. and 4:09 P.M. but was unable to reach employee by phone.

Interview on 08/05/22 at 4:10 P.M. with PCA #115 confirmed she wasn't sure of the exact date but sometime in early July 2022 she and Housekeeper #210 were out in front of the facility, and they witnessed Resident #66 call PCA #375 a racial slur. PCA #115 confirmed PCA #375, and Resident #66 then began yelling at each other. PCA #115 confirmed she heard PCA #375 call Resident #66 a racial slur and that she also cursed at the resident, told her to shut up, and when the resident threatened to kick the aide, PCA #375 threatened to kick the resident back. PCA #375 confirmed she reported the incident immediately to the DOC who told her to put a written statement in the DOC mailbox.

Review of the facility policy titled Abuse, Neglect Reporting and Investigation dated 03/31/20 revealed instances or allegations of abuse should be treated seriously and must be reported to the ED or the supervisor on duty for investigation and appropriate follow-up. Abuse included verbal abuse which was defined as the use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to resident/patients or their families, or within their hearing distance, regardless of their age, ability to comprehend, or disability. Examples of verbal abuse include but are not limited to threats of harm; saying things to frighten a resident/patient, such as telling a resident/patient that he/she will never be able to see his/her family again. Upon learning of alleged abuse, the ED or designee should attempt to take necessary steps to ensure that residents are protected from subsequent episodes of abuse while a determination on the matter is pending. The resident's representative and attending physician should be notified of allegations of abuse. The facility should maintain a written record of the investigation which should include interviews with potential witnesses including the alleged perpetrator, the alleged victim, staff, other residents, and visitors to the community.

This violation substantiates Complaint Number OH00134651.