State Findings:
Based on observation, record review, review of facility policies titled Abuse Prevention Policy, Resident-to-Resident Altercations, and Behavioral Assessment, Intervention, and Monitoring, and interviews, the facility failed to provide adequate supervision for two identified vulnerable residents (R) (R#1 and R#6) from a sample of 20 residents, to protect from actual sexual abuse. This failure resulted in R#6 being raped by R#17 and R#1 was exposed to sexually inappropriate behavior by R#16. The facility failed to follow up with psychiatric services for R#16 and failed to put interventions in place to prevent other residents from potential sexually inappropriate behaviors. In addition, the facility failed to assess other residents who were at risk for sexual abuse.
On [DATE] a determination was made that a situation in which the facility’s noncompliance with one or more requirements of participation caused or had the likelihood to cause serious injury, harm, impairment, or death to residents.
The facility’s Administrator and Director of Nursing (DON) were informed of the Immediate Jeopardy (IJ) for F600 and F609 on [DATE] at 2:50 p.m. The noncompliance related to the IJ was identified to have existed on [DATE].
Review of the Hospital Note dated [DATE] revealed that R#6 was brought in for alleged sexual abuse. Continued review revealed that R#6 was refusing any medications, she was alert and orientated to self only, and having visual hallucinations, stating that she sees a man outside trying to kill them and he had a gun, with actively pointing in the direction of the visual hallucination. Also, per review revealed that nursing home staff said that R#6 was alert and orientated x1 and was at baseline. Further review revealed that the night of [DATE] at 4:00 a.m., nursing home staff walked into R#6’s room and found another resident (R#17) sexually assaulting R#6 with witnessed penetration and blood on bedsheets. The assailant (R#17) is [CONDITION(S)] positive and has a history of syphilis which remains seropositive (positive result in blood test) despite treatment. Family member agreed to an exam for sexual assault victims along with agreeing for R#6 to receive all medical prophylactic treatment due to R#17’s medical history. Laboratory testing was completed, including an [CONDITION(S)] test, which came back negative, but recommended future testing; however, newly detected [CONDITION(S)] C was found, and family member unaware of any prior history.
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...and we want to hear it.
NHAA is here to assist families, residents, and the community by sounding the alarm on issues like those found above. This nursing home and many others across the country are cited for abuse and neglect.
If you have or had a loved one living in this nursing home or any other nursing home where you suspect any form of abuse or neglect, contact us immediately.
We have helped many already and we can help you and your loved one as well by filing a state complaint, hiring a specialized nursing home attorney or helping you find a more suitable location for your loved one.
You can make a difference, even if your loved one has already passed away.
Please give us a call at 1-800-645-5262 or fill out our form detailing your experience.
Personal Note from NHA-Advocates
NHAA shares with all the families of loved ones who are confined to nursing homes the pain and anguish of putting them in the care of someone else. We expect our loved ones to be treated with dignity and honor in the homes we place them. We cannot emphasize enough to family members of nursing home residents; frequent visits are essential to our loved ones’ well-being and safety.
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