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Based on interview, record review, and review of the facility's policy, it was determined the facility failed to ensure one (1) of ten (10) sampled patients (#1) was free from all forms of abuse or harassment from staff. The facility failed to identify, investigate, and report an allegation of abuse to appropriate agencies per facility policy.

The findings include:

Review of the facility's policy titled, "Suspected Patient Abuse/Neglect", dated December 2018, revealed the hospital supports the patient's right to receive care in a safe setting and will act to protect vulnerable patients, including protection of the patient's emotional and physical health and safety. Definition of Verbal Abuse is any derogatory, threatening, derisive, or demeaning language, whether in writing, oral, or with gestures, including that which reasonably should be known as being derogatory, threatening, derisive, or demeaning; or profane or obscene language directed toward a patient.

Suspected Abuse: First Responder/Supervisor Responsibilities
1. The employee who first becomes aware of a patient is said to be abused, neglected, mistreated must take all appropriate steps necessary to protect the patient including but not limited to reassignment of staff, removal of staff from patient care, and restriction of visitors.
3. Notify the CEO or designee (Administrator On Call) immediately in any instance of reported, observed, or suspected patient abuse, neglect, mistreatment and/or exploitation.
4. Notify the patient's attending physician.
5. Document the allegations on a complaint form and enter as an event report. Forward immediately to the Director of Quality Management (DQM) for investigation.
7. The DQM will be notified immediately in all cases of suspected child abuse and/or neglect. any suspected adult/elder abuse, neglect, mistreatment and/or exploitation.
All investigation and resulting action documentation will be maintained in the Administrative office.

Record review revealed the facility admitted Patient #1 on 11/06/19 with diagnoses which included Toxic Metabolic Encephalopathy and Acute Renal Failure.

Interview with Licensed Practical Nurse (LPN) #1 revealed former Certified Nursing Assistant (CNA) #1 told Patient #1 to "shut the hell up" while providing his/her care on 11/19/19.

Interview with CNA #2, on 12/27/19 at 1:30 PM, revealed Patient #1 told her CNA #1 told him/her to "shut the hell up" during the PM shift on 11/19/19 while providing his/her care. CNA #2 stated she reported the allegation to LPN #1 during AM shift of 11/20/19 when the patient reported the allegation.

Interview with LPN #1, on 12/27/19 at 1:08 PM, revealed on 11/20/19 in the morning (unsure of specific time), CNA #2 informed her Patient #1 reported CNA #1 said
"shut the hell up" during the shift while providing his/her care. LPN #1 stated she reported the allegation to Registered Nurse (RN) #1/Nursing Supervisor.

Interview with RN #1/Nursing Supervisor, on 12/26/19 at 4:00 PM, revealed she was informed by a staff member that CNA #1 told Patient #1 "shut the hell up". RN #1 stated she did not remember who the staff member was that reported information to her and she did not remember date and/or time she received the information. RN #1 revealed she contacted staff who worked the PM shift on 11/19/19 (date of allegation) to obtain statements in an attempt to validate whether or not former CNA #1 made comment to Patient #1. RN #1 stated, "I do not have any documentation of the information I obtained from the staff. I'm sure I wrote statements although, I'm unable to locate them". Further interview revealed RN #1 did not report the allegation per facility policy on 11/20/19 to any Administrative staff (DQM, Human Resource Director (HRD), Chief Nursing Officer (CNO), or Administrator) when allegation was reported to her and CNA #1 was allowed to work the PM shift on 11/20/19.

Interview with the HRD, on 12/26/19 at 4:25 PM, revealed he did not recall the specific date RN #1 made him/her aware of the allegation. The HRD stated he did recall RN #1 made him aware CNA #1 told Patient #1 "shut the hell up" and the allegation occurred during the night shift but a specific date/time was not given. The HRD stated he did not report the allegation to any reportable agencies because "I did not feel it was necessarily abuse", even though the facility policy stated verbal abuse was defined as any derogatory, threatening, derisive, or demeaning language, toward a patient. The HRD further stated it was his understanding "Patient #1 was a difficult patient. The CNA made a comment to the patient that was inappropriate, but it was one (1) incident, I did not feel it was a reportable event. If it happened more that once, I would have thought verbal abuse". The HRD stated CNA #1 was terminated in the AM of 11/21/19 after completing assigned shift night of 11/20/19. The HRD further stated the alleged comment made to Patient #1 was not the reason CNA #1 was terminated. Further interview revealed the HRD did not have any documentation the facility conducted an investigation to the allegation.

Review of CNA #1's Personnel Record revealed a Termination Form, dated 11/21/19, which revealed the reason for termination was "Performance".

Interview with the Chief Nursing Officer (CNO), on 12/26/19 at 4:55 PM, revealed she became aware of the allegation on the morning of 11/21/19 when the HRD and RN #1 were meeting with CNA #1 to terminate her employment. The CNO stated he/she was not aware CNA #1 told Patient #1 "shut the hell up". The CNO further stated, "I would have to be present for the situation to understand the intent and/or if the incident warranted an investigation. The staff member responsible to investigate such allegation would be the Nursing Manager/Supervisor. If the allegation was thought to be Customer Service related, it should have been reported to the HRD. If allegation was considered abuse of a patient, I would be the person to complete the investigation which would be forwarded to the Administrator, which would include our Chief Executive Officer (CEO). However, even if the comment "shut the hell up" to a patient was made, I would expect an investigation by the Nursing Manager/Supervisor. I would not want a staff member to tell any patient or human "shut the hell up".