The Tennessee Department of Health has lifted a suspension of admissions at Appalachian Christian Village. The suspension was imposed earlier this month following an investigation of abuse of a patient that revealed deficiencies the department said placed all the nursing home’s residents with dementia in immediate jeopardy.
The DOH suspended admissions at the nursing home Feb. 8 based on a federal surveyors’ report that the nursing home was aware of alleged incidents of abuse of a resident with dementia by three nursing assistants and placed all its residents with dementia in jeopardy by failing to stop and immediately report the abuse.
In a news release issued on Tuesday, the DOH said the deficiencies discovered in the investigation have been corrected and the suspension was lifted effective Feb. 22.
According to the federal surveyors, evidence gathered from interviews with ACV employees and reviews of time cards, video surveillance, medical records and other documents showed the three CNA’s worked night shifts together on the second floor of the nursing home and initiated the abuse in December because they thought the patient’s reaction “would be comical.”
The surveyors’ report states the three initially filled a syringe with tap water that they sprayed above the patient’s bed and allowed to drip down on her shoulder. When the patient woke up and pulled covers up over her shoulder, the CNAs laughed and in subsequent visits to her room took turns spaying water from ice coolers and from a toilet directly on her head, face and hands, causing her to wake up, curse and call out to her spouse.
According to the surveyors, the CNAs also used a cell phone to record a video of the patient in an agitated state and to take photographs of her with a breast and buttocks exposed that they showed to other AVC employees and in one instance, to a CNA at another facility. The three CNAs also sprayed water on a second patient with dementia on at least two occasions but stopped when the patient did not react.
In reporting the abuse, the surveyors found that at 4 a.m. on Jan. 14, a CNA told a registered nurse about the abuse. At 4.45 p.m. on Jan. 15, the RN told the director of nursing about the incident. And at 9 p.m. on Jan. 15 the director of nursing told the nursing home administrator.
According to the Department of Health, corrective actions taken by the nursing home began on the night of Jan. 14 when a nursing supervisor prohibited the three CNAs allegedly involved in the abuse from entering the first patient’s room or from performing any care that was not attended by an RN. On Jan. 17, the three CNAs were placed on leave without pay and on Jan. 19, “after further investigation,” the three were fired and their actions reported to local law enforcement.
On Jan. 22, two other CNAs were terminated for providing misleading information during the investigation. And on Jan. 24, the CNA who initially told a nurse about the abuse received a written warning and a one-day suspension for failing to “timely report” the alleged abuse and violations of the ACV’s cell phone policy. A seventh CNA and an RN were also disciplined with written warnings and one day suspensions.
On the night of Jan. 14, all ACV residents were assessed and no similar evidence of abuse was discovered. Patients with dementia and those who could not be interviewed were subsequently evaluated for any changes that might indicate abuse and 33 alert patients and 55 family members were interviewed about any inappropriate behavior or suspected abuse, harm or neglect.
While no evidence of abuse was discovered or voiced in the patient evaluations and interviews, concerns expressed by family members were forwarded for follow up and corrective action.
ACV’s policies on abuse prevention, cell phone use and crime reporting were revised to mandate employees “immediately report to their supervisor” any abuse or suspected abuse they are aware of to prohibit employee’s use of cameras at the facility and to impose disciplinary action for failing to report that may include termination. The nursing home provided “each and every employee” at ACV with in-service instruction on the revised policies, adopted new mandates for in-service training requirements for its supervisory nursing staff and also provided instruction and counseling to the nursing home’s administrator and director of nursing on how to timely report allegations of abuse.
The nursing home also implemented new policies for resident interviews and observation of staff and resident interaction to be conducted by supervisory staff during clinical rounds, an additional resident monitoring program to be conducted by management, and a new grievance and patient care complaint program that includes the provision of reporting forms on public bulletin boards accessible to all ACV employees, residents and visitors.
ACV hired an independent nurse consultant to help implement and maintain compliance with corrective actions and also developed a new process to enhance communication on activities that occur at the nursing home after business hours and on weekends.