Wingate Healthcare PATIENT ABUSE Policy and Procedure

Wingate Healthcare
PATIENT ABUSE
Policy and Procedure

POLICY:

It is the policy of the facility that each resident has the right to be free from verbal, sexual,
physical and mental abuse, corporal punishment and involuntary seclusion. Further, each
resident at the facility will be treated with respect and dignity at all times.

PROCEDURE:

To foster an environment that recognizes the worth, specialness, and uniqueness of all
individuals, to promote respect and set standards of care.

Definitions:

 Abuse The willful infliction of injury, unreasonable confinement, intimidation, or
punishment with resulting physical hurt or pain or mental anguish to a resident. Abuse is
also the deprivation by an individual, including a caretaker, of goods or services that is
necessary to attain or maintain, physical, mental and psychosocial well being of a
resident. This definition presumes that instances of abuse to any resident, even one in a
coma, causes physical harm or pain or mental anguish.

 Verbal Abuse Any use of oral, written, or gestured language, that includes disparaging
and derogatory terms to residents of their families, or within their hearing distance, to
describe residents, regardless of a resident's age, ability to comprehend or mental and/or
physical disability.

 Sexual Abuse Includes, but is not limited to, sexual harassment, sexual coercion or
sexual assault of a resident.

 Physical Abuse Includes, but is not limited to, hitting, slapping, pinching, kicking,
etc. Physical Abuse also includes controlling behavior through corporal punishment
of a resident.

 Mental Abuse Includes, but is not limited to, humiliation, harassment, threats of
punishment or depravation of a resident.

 Involuntary Seclusion The separation of a resident from other residents or from
his/her room or confinement to his/her room (with or without roommates) against the

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resident's will, or the will of the resident's legal representative. Emergency or short term
monitored separation from other residents will not be considered involuntary seclusion
and may be permitted if used for a limited period of time as a therapeutic intervention
to reduce agitation until professional staff can develop a plan of care to meet the
resident's needs.

 Misappropriation of Resident Property The deliberate misplacement, exploitation of
wrongful, temporary or permanent use of a resident's belongings or money without the
resident's consent.

 At Risk Residents most at risk of neglect and abuse, i.e., residents who have
dementia, none or infrequent visitors, psychosocial disruptions, interactive without
behavioral dysfunction, or residents who are bedfast and totally dependent on care.

GOOD PRACTICE STANDARDS

1. Residents of the facility will not be subjected to abuse by anyone, including but not
limited to, facility staff, other residents, consultants, volunteer staff, family members,
friends and other individuals.

2. Prior to their employment, employees will be screened in accordance with Human
Resource policies for hiring.

3. The facility will not employ individuals who have been found guilty of abusing,
mistreating or neglecting residents by a court of law. The facility will not hire
individuals who have had a finding(s) entered into a State Nurse Aide Registry
concerning abuse, mistreatment, or neglect.

4. Under the Administrator’s direction, this facility will thoroughly investigate any
alleged violation involving mistreatment, abuse or neglect, according to state law.

5. Each facility will follow individual state reporting requirements. The facility will report
the results of its investigation to appropriate regulatory offices within the time
established at the state level. An investigation report should not exceed seventy-two
hours in being transmitted to the state agency.

6. Considering the results of the facility's investigation, appropriate disciplinary action
will be taken, up to and including termination of an employee. The Human Resources
Department reviews all disciplinary action.

7. All bruising or injuries of unknown etiology shall be investigated as patient abuse,
neglect or mistreatment.

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STAFF RESPONSIBILITIES
1. Staff will be knowledgeable in the definition of abuse, mistreatment, neglect and

in the particular laws governing their state, as well as the policy and
procedure for abuse. Staff will attend in-services at least annually. At the
time of the Abuse in-service staff will sign a Resident Abuse Certification.

2. Staff will maintain a manner of courtesy and respect toward residents and their
families.

3. Staff will refrain from all actions that could be considered abuse, mistreatment,
and/or neglect.

4. Any employee who has reasonable cause to believe a resident has been abused,
mistreated or neglected shall (after ensuring the safety of the resident if necessary)
immediately report alleged incident to their Supervisor, Director of Nursing
and/or Administrator.

5. Staff will follow the facility’s Policy and Procedure on investigation of abuse,
mistreatment or neglect.

Addendum:

All bruising or injuries of unknown etiology shall be investigated in a manner similar to
patient abuse or neglect. Notification of state agencies will occur per state and OBRA
regulatory requirements.

REMINDERS
 When leaving a message for Human Resources, please explain that you need an

immediate return call, because it involves an important employee issue.

 Continue the employee on suspension until you are able to reach Human Resources.
Explain to the employee.

 Suspend the employee, pending investigation at the time of the incident.

 Have statements taken immediately.

 Train staff on the Abuse Policy.

 Train all Department Heads on how to complete an Accident/Incident Report.
 If the employee refused to write and sign a statement, then write what they said and

make a note that they refused to write their own statement.

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• If an employee has been suspended, they should not be allowed in the facility.

 If the employee who has been suspended does not contact the facility and the facility
is unable to reach them by phone, a certified letter with a return receipt requested should be
sent.

 Take statements from people who were on that unit even if they say that they don't have
any information.

 Nurses notes should include notification of MD, family, and description of the incident.
The notes should not include State, police, Ombudsman, etc. notification. That
information should be on the Accident/Incident Report.

 We must review all investigations at the quarterly Medical Staff Meetings.

HUMAN RESOURCE REMINDERS:

 We are temporarily able to move an employee to the day shift.

 We can provide more inservices.

 Families and residents should not be shown statements that were given during the
investigation. These are confidential.

 We should explain the general outcome of the investigation to the family and resident,
i.e., "the employee no longer works here, or we will be evaluating their performance on
a regular basis."

REVIEW, DISCIPLINE AND MONITORING OF EMPLOYEE

Pull personnel file for all implicated staff and witnesses and check on the following:

 Appropriate licensure or certification for CNA (verification from registry, as well as
certificate).

 Orientation checklist: specific to patient abuse or related to issue at hand.
 Any work related performance issues and/or disciplinary actions.
 Yearly performance evaluation present.
 Copy of any and all inservices attended by the employee. Ensure that the five

federal mandated inservices are present:
1) Abuse
2) Right to Know
3) Patient Rights

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4) Infection Control
5) Fire Safety

EMPLOYEE DISCIPLINE

After investigation, the appropriate disciplinary action is taken. Counseling occurs at the
time of discipline. If termination is not warranted, the following is implemented for thirty
(30) days:

 Inservice determined by incident.
 If employee is on an alternate shift, the employee will work the day shift or

Administrative Designee will be assigned to the employee's shift to preceptor.
 Weekly monitoring report by the Administrative Designee will be given to the

Administrator and Director of Nursing.
 Interview the residents regularly who are being cared for by the employee and

document all findings.

After 30 days, monthly reports from the Administrative Designee will be presented to the
Administrator or Director of Nursing for up to 12 calendar months.

Any further infraction will result in immediate termination.

SUMMARY OF INVESTIGATION

Assemble the results of any in-house investigations of mistreatment, neglect, or abuse of
residents, misappropriation of their property, or injuries of unknown source. The summary
should include but not be limited to:

 Brief summary of incident (do not use inflammatory quotes) and assessment of what did or
did not happen, i.e., allegation validated or invalidated based on the facility investigation.

 Was the Administrator notified of the incident and when?

 Did investigations begin promptly after the report of the problem?

 Is there a record of statements or interviews of the resident, suspect (if one is
identified), any eyewitness and any circumstantial witnesses?

 Was relevant documentation reviewed and preserved (e.g., dated dressing which was not
changed when treatment record recorded change?)

 Was the alleged victim examined promptly (if injury was suspected), and the finding
documented in the report?

 What steps were taken to protect the alleged victim from further abuse (particularly when
no suspect has been identified?) i.e., two staff members assigned to provide care.

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 What actions were taken as a result of the investigation?
 What corrective action was taken, including informing the physician, resident's family

members, police, ombudsman, State licensure authorities, Regional Manager, Regional
Nurse, and Human Resources?
 Personnel file review of suspect(s).
 Family and resident updated on outcome of investigation.

INVESTIGATION FILE
A Completed file on investigation should contain:

1. A copy of the Incident/Accident Report
2. Resident/witness Statement
3. Employee Statement
4. Investigation Statements from Shift Supervisor, Director of Nursing, Social Worker

and Administrator
5. Staffing assignment for the past 24 hours
6. Copies of Nurse's and Social Services Notes
7. Copy of Care Plan
8. Copy of Disciplinary Action taken, if any
9. Copy of monitoring program, if appropriate
10. Copy of Police Report
11. Copy of the report sent to the State
12. Copy of Ombudsman Report
13. Copy of consent for photograph from admission packet 14.*

Photograph
15. Summary of investigation
 Decision to obtain photograph to be made by the Director of Nursing or

Administrator only.

Revised October,2007

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Wingate Healthcare
ABUSE PREVENTION PLAN

Policy and Procedure

SCREENING:
 Criminal background checks are to be done on every new employee.
 Prior to employment, The Nurse Aide Registry is checked for all facility hires.
 If the applicant indicates employment in another state, that Nurse Aide Registry is to be

checked.
 Previous employment references are obtained.
 All professional and certified licenses are verified for expiration date and any

outstanding complaints prior to hire and at the time of each renewal.

TRAINING:
 Residents and family members/responsible party will be informed upon

admission and at least annually thereafter, in a language they understand, of their
rights and responsibilities. Such rights include the right to be free from verbal,
sexual, physical and mental abuse, corporal punishment, involuntary seclusion,
misappropriation of property and to be identified upon admission as a "Resident
at Risk". Every resident at a nursing facility will be treated with respect and
dignity at all times.

 Staff will be knowledgeable in the definition of abuse, mistreatment, neglect,
involuntary seclusion, misappropriation of resident property, and those residents
most at risk and in the particular laws governing their state. Staff will also
understand and be familiar with the policy and procedure describing patient
abuse. Staff must attend inservice education related to patient abuse at least
annually.

Training will include, but not be limited to:

 Appropriate intervention to deal with aggressive and/or catastrophic actions of
residents.

 Staff reporting their knowledge related to allegations without fear of reprisal.
 How to recognize signs of burnout, frustration, and stress that may lead to abuse.
 Staff will maintain a manner of courtesy and respect toward residents and their

families.
 Staff must refrain from all actions that could be considered a form of abuse,

mistreatment and/or neglect.
 Any employee who has reasonable cause to believe a resident has been abused,

mistreated or neglected shall (after ensuring the safety of the resident if
necessary) immediately report alleged incident to their supervisor, director of
nursing or administrator.
 Staff will follow this policy to investigate any allegation of abuse,
mistreatment or neglect.

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PREVENTION:

 The Abuse Hotline phone number is posted on each nursing unit for anyone to access.
Resident Council convenes monthly and provides an opportunity for residents to share
concerns about care, treatment, or staff attitudes. Concerns are immediately addressed.

 A grievance program is available to residents, families and visitors. See facility
Grievance Policy.

 Daily nursing patterns are in place to meet the needs of the residents. Specific
resident care plans/care cards are available to identify resident care needs.

 Licensed and supervisory staff are available on each shift and responsible for
intervening with any inappropriate behavior from staff such as swearing, rough
handling and/or not attending to care needs of residents.

 Residents who are identified through the care planning process as in need of additional
supervision are addressed through increased resident supervision. Refer to the
"Supervision and Monitoring Policy."

 Monthly staff meetings are held with the Administrator and/or Director of Nursing to
provide a forum for staff to discuss areas of concern and identify resolution. Staff who
have a decline in performance of daily duties, or an increase in absenteeism will be
contacted by the Administrator/Director of Nursing or appropriate Department Head for
a review of any personal issues that are impacting their performance. Please see the
"Supervision and Monitoring Policy."

IDENTIFICATION:
Bruises or injures of unknown origin are fully investigated to determine cause. Results of
accident/incident monitoring is reviewed at the Quality Assurance Committee to identify any
patterns and/or trends.

Protection of Residents during Investigation:
Staff members implicated in a potential abuse/neglect situation are suspended pending the
results of that investigation. Based on the results of the investigation appropriate disciplinary
measures are determined in conjunction with the Human Resources Department. Staff
implicated in abuse/neglect/mistreatment or misappropriation are terminated. Individual
residents involved or other potential resident victims are interviewed by the social worker to
determine any specific or safety concerns. The psychosocial needs of each resident are
addressed.

Facility Investigation and Reporting Response:
Any report of abuse or suspected abuse is thoroughly investigated. Suspected employees are
suspended during investigation and terminated if proven, with a complaint lodged against their
license if a professional nurse or nursing assistant. Staff retraining is to be done according to
Nursing Home Guidelines. The State Hotline, Regional Manager and Regional Nurse are to be
notified.

• Refer to the Policy & Procedure on Reporting and Investigating Abuse.

Revised November, 2007

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Wingate Healthcare
REPORTING & INVESTIGATING ABUSE

Policy and Procedure

POLICY:
Any complaint, observation, or suspicion of resident abuse, mistreatment, neglect,
involuntary seclusion, misappropriation of property, and those residents most at risk will be
thoroughly investigated and reported. The investigation and report will be done in a uniform
manner as detailed below. Refer to the Patient Abuse Policy & Procedure for clarification on
what constitutes abuse, mistreatment or neglect of residents.

Purpose:
To provide on-going safety of all residents.

To complete a thorough investigation of an alleged incident of patient/resident abuse,
mistreatment, and/or neglect, and to ensure completion of this process by the appropriate
staff.

To ensure that proper notification of nursing facility Administrative staff, corporate
staff and all appropriate regulatory agencies occurs.

Procedural Guidelines

When abuse, mistreatment, neglect, involuntary seclusion, or misappropriation of resident
property is observed by, reported to, or suspected by any employee at the facility, staff
immediately notifies the Administrative or Nursing Supervisor on duty. The Administrative
or Nursing Supervisor assumes responsibility for taking the following steps during the
investigation:

1) Immediately notify the Director of Nurses and the Administrator (by telephone, if
necessary.)

2) Notify the appropriate Department Head.

3) Immediately investigate the alleged incident during the shift on which the alleged
abuse occurred.

4) Interview the resident and other resident witnesses. Conduct at least three resident
interviews. These interviews are to be dated, documented and signed by the
supervisor. See: Sample Questions To Include During an Investigation/
Interview.

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Three resident interviews will be conducted. The purpose of these separate interviews is
to determine if the employee's account of the alleged incident is consistent. A resident
with cognitive dementia will not be discounted.

The interviews are conducted by:
1. The shift supervisor who was on duty when the incident was reported;
2. The Director of Nursing;
3. The Social Worker or Administrator.

5) Interview the staff member implicated. Have the employee document, in writing, their
knowledge/version of the incident. Ensure the employee's written narrative is signed and
dated. If employee refuses to sign statement, the Administrator will document the event.

6) Interview any staff witnesses or other available witnesses. Have the witnesses
document their knowledge/version of the incident in writing. Ensure the witnesses sign
and date their written narrative. Interview all staff on that unit at the time of the alleged
abuse to m a k e sure that all information is gathered promptly. Obtain written
statements. Use Interview Questions... Form.

7) When a staff member is implicated in a potential resident abuse situation, the employee
is to be removed from all patient care areas and sent home after the written narrative is
obtained from the employee. The employee is instructed to contact the Director of
Nursing or Administrator the next day.

8) The Social Worker will notify the Resident Care Plan Coordinator of potential Care
Plan needs.

9) The Administrator will notify the Regional Manager and Human Resources
Department.

10) The Director of Nursing will notify the Regional Nurse Manager.

11) The Administrator, Director of Nursing or their designee will assemble the
investigation file.

12) The Administrator or his/her designee will complete the summary of the
investigation.

September 2004

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REPORTING/DOCUMENTATION REQUIREMENTS

1) The Administrator, Director of Nursing or their designee assumes responsibility for
notification of the incident and preliminary internal investigative results to the following:

a) Immediate notification of regional office (Monday-Friday) if incident is of a serious
nature. Call to be placed to appropriate individuals immediately. These incidents
are to be reported to:
1) Regional Manager
2) Regional Nurse Manager
3) Human Resource Department

b) Oral or faxed notification to the Department of Public Health
immediately.

c) Written reports are to be sent to the Department of Public Health
summarizing the incident, individuals involved, investigation results and
facility action. This is to be completed within 48 hours of initial
notification of the Department. NOTE: All written reports are to be
reviewed by the Regional Nurse prior to submission.

Reports to be sent to: (In New York) 1
(In Massachusetts) Complaint Investigation Unit 0
Patient Complaint Unit 8
145 Huguenot Street 0
Division of Health Care Quality Sixth Floor 1
99 Chauncy Street 2nd Fl New Rochelle, New York 10801
Boston, Massachusetts 02111

d) Documentation in the Medical Record is to reflect direct observable facts (i.e.,
if resident complained of being hit, document redness, swelling, etc.).

2) Social Service should document the resident's psychosocial status assessment of
feelings re: safety. Documentation should continue as required.

3) Report to the State nurse aide registry or licensing authorities any knowledge of any
actions by a court of law which would indicate an employee is unfit for service.

SUMMARY OF THE INVESTIGATION

Assemble the results of any in-house investigations of mistreatment, neglect, or abuse of
residents, misappropriation of their property, or injuries of unknown source. The summary
should include, but is not be limited to, the following information:

1. A brief summary of the incident using the INVESTIGATION STATEMENT form. Do not
use inflammatory quotations. An assessment of what happened, such as: can the allegation
be validated or invalidated based on the facility investigation.

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2. The SUSPECTED/ACTUAL RESIDENT ABUSE NOTIFICATION
CHECKLIST is completed.

3. Verify that investigations began promptly after the report of the problem.

4. Assemble records of statements or interviews with the resident, suspect (if one is
identified), any eyewitnesses and any circumstantial witnesses.

5. Assure that relevant documentation was reviewed and preserved, for example: a
dated dressing that was not changed when treatment record recorded a change.

6. If an injury was suspected, verify the alleged victim was examined promptly. Be sure
the finding is documented in the report.

7. Verify the personnel file of the suspect(s) was reviewed.

8. Verify steps were taken to protect the alleged victim from further abuse, particularly if
no suspect was identified. Appropriate action here might be for two staff members to
be assigned to provide care for the alleged victim..

9. Review actions that were taken as a result of the investigation.

10. Verify that corrective action was taken.

11. Verify the resident and resident's family was updated on the outcome of the
investigation.

INSTRUCTIONS FOR COMPLETING INTERVIEWS

Complete Accident/Incident Report Form
1) Obtain written narrative statements from employees, the resident and witnesses.

Include the following information:

 Date
 Time of day or night
 Identification of staff member implicated
 Any witnesses
 Who the resident or staff member reported incident to and when
 What the response was of the person to whom the incident was reported

Also, note if this is the first time the resident/witness reported such an incident. If this is not
the first time, clarify when else this type of incident occurred. Written statements should be
in the individual's own handwriting and taken as soon after the reported allegation as
possible.

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2) The Director of Nurses or other appropriate Department Head will review the
employee's written statement to determine if the employee's story is consistent. The
Director of Nurses will review the written statements within 24 hours of the alleged
incident.

3) The Social Worker(s) interviews other potential victims within 24-48 hours of the
alleged incident. Use the investigation questionnaire.

4) The appropriate Department Head pulls the employee personnel file that is implicated in
the alleged incident and reviews it for the following:

1) Appropriate licensure or certification.

2) Evidence that Registry checks and CORI checks were done.

3) Orientation checklist: specific to patient abuse or related to issue at hand.

4) Any work related performance issues and/or disciplinary actions.

5) Yearly performance evaluation present.

6) Copy of any and all inservices attended by the employee. Ensure that the five
federal mandated inservices are present:

1) Abuse
2) Right to Know
3) Patient Rights
4) Infection Control
5) Fire Safety

FOLLOW-UP ACTION

Disciplinary action can be taken against the staff involved when indicated. Alternatively,
the employee will be retrained. With guidance from the Human Resources Department, the
employee can be:

1) Suspended pending internal facility investigation. Do not wait for the State to
investigate.

2) Given a written warning. Set up a monitoring program for the employee, if
appropriate.

3) Terminated or reinstated, depending on the finding of the investigation.

A facility Social Worker will provide counseling and support to the resident(s) involved. It
will be communicated to the resident that either "the employee is no longer working here",
or "the facility is evaluating this employee's performance on a regular basis".

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Documentation of psychosocial interventions must be placed in the resident's medical
record. Continue psychosocial intervention for up to three (3) days as needed. Nursing will
document intervention as needed for follow-up x 72 hours.

Upon completion of the regulatory investigation, verbal and written copies of the external
investigation results are forwarded to the Regional Manager and Regional Nurse.

September 2004

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SAMPLE QUESTIONS TO INCLUDE DURING AN
INVESTIGATION/INTERVIEW OF THE RESIDENT REPORTING

ABUSE

Begin with general questioning. Continue probing to identify specifics.

 Please tell me what happened to you yesterday, earlier, later, and so forth.

 I understand there was some difficulty or problem. Please explain what happened.

Determine if and when the resident has received and understands their rights, i.e. to be
free from verbal, sexual, physical and mental abuse, corporal punishment, involuntary
seclusion, misappropriation of their property and to be identified upon admission as a
"Resident at Risk". Every resident will be treated with respect and dignity at all
times.

 Has any resident or staff member ever physically harmed you? If yes, please describe
what happened.

 Has a staff member ever yelled or sworn at you? If yes, please describe
what happened.

 Can you tell me who did this? Did you report this to someone? If yes, what was their
response? If no, do you understand why not?

 Are you aware of any instances in which a resident was abused or neglected? If yes,
please describe what happened.

 Do you feel you get help when you need it?

 Have you ever refused care or treatment such as a bath or certain medication? If yes,
what happened?

 Are you satisfied with the care provided by your caregivers, like your Nursing
Assistant, Registered Nurse or Therapist? If no, tell me more about that.

 Is there enough staff to take care of everyone? If no, tell me more about that.

 Do you feel the staff members listen to your requests and respond appropriately?

 If the staff is unable to accommodate one of your requests, do they provide a
reasonable explanation of why they cannot honor the request?

September 2004

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Wingate Healthcare
Reporting and Investigating

Suspected / Actual Resident Abuse
Notification Checklist

Person Notified: ___________________________ Date: ______Time: ______ By Whom:
Administrative or
Nursing Supervisor on Duty:
Director of Nurses:
Administrator:
Attending Physician:
Family:
Police - Per local law
enforcement statute:
Ombudsman (form completed):
Social Worker:

Care Plan Coordinator:
Regional Manager:
Regional Nurse:

Human Resources Representative:

September 2004

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Wingate Healthcare
Reporting and Investigating
Interview Questions for the Supervisor, Director of Nursing and
Social Worker to Ask of the Resident/Family Reporting Abuse ________

Can you tell me what happened?

When did the alleged incident take place? The date and time of day or night?

Who was involved? Can you name and/or descripe the individual or individuals
involved?
Were there any witnesses? Do you know their names?

Whom did you report this incident to and when?

What was the response of the person to whom you reported the incident?

Is this the first time this incident or a similar incident has occurred? If no, explain.

Name of resident or family member being interviewed:

Date and Time:
Signature of person conducting the interview:_________________Title:_________

September 2004

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Wingate Healthcare

Reporting & Investigating
INVESTIGATION STATEMENT

Resident's Name: Time:
Witness Name:
Date:

General Statement of Knowledge / Version of the Incident;

Signature and Dates:
Resident/Witness:____________________________
Shift Supervisor: ___________________________
Director of Nurses:
Administrator:

September 2004

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Annual Resident Abuse Certification

I, __________________________________ am aware of and fully understand the
Wingate Healthcare Resident Abuse Policy and Procedure. I understand that each resident
has the right to be free from verbal, sexual, physical and mental abuse, corporal
punishment and involuntary seclusion. Further, each resident at the facility will be treated
with respect and dignity at all times.

I understand that my responsibilities as an employee of Wingate include:

1. Understanding the definition of abuse, mistreatment and neglect and in particular,
understanding the State laws pertaining to Resident Abuse.

2. Maintaining a manner of courtesy and respect toward residents and their families.

3. Refraining from all actions that could be considered abuse, mistreatment or neglect.

4. Reporting an alleged incident of abuse to my Supervisor, DON and/or
Administrator if there is reasonable cause to believe a resident has been abused,
mistreated or neglected.

5. Following the facility’s P&P on investigation of abuse, mistreatment or neglect.

I certify that I have fulfilled the above responsibilities and will continue to do so, and
verify that I have not witnessed or have knowledge of any incident of abuse in the past
twelve months that has not been reported and investigated.

____________________________________ ________________________
Employee Signature Date

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