Lakeland Nursing Home and Rehabilitation was cited after the facility failed to provide supervision for a resident who was known for being sexually inappropriate with other residents. According to the citation, the male resident committed “unsafe and sexually inappropriate behaviors” toward other female residents.
Failure to Implement Behavioral Medicine Recommendations
Additionally, the facility was cited because it failed to ensure “behavioral medicine recommendations were implemented” and didn’t develop and implement “meaningful care plan interventions related to behaviors and sexually inappropriate behaviors.” The facility also did not “alert and educate staff on specific interventions to prevent continued unsafe and sexually inappropriate behaviors.”
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Incidents of Unsafe Behavior
One of the unsafe incidents in this citation occurred when the resident tried to feed cookies to another cognitively impaired resident who had strict instructions to only receive food through a feeding tube. A nurse approached the resident to intervene and told him he couldn’t feed other residents.
The residents were then separated, and social services said they would contact the resident’s family so they could reinforce the rule of not feeding other residents. The facility, however, did not contact the family of the cognitively impaired resident to notify them of the incident. Further review of the impaired resident’s record revealed that facility did not document the incident in their reporting log.
A second incident occurred when the resident in this citation was caught groping a female resident by sticking his hand under her blouse and touching her breast. When asked about the incident, the resident said he didn’t recall the event but “wished he did.” The only documentation found related to this incident of sexual abuse was the female resident’s behavioral medicine note, written and signed by a psychiatrist.
The note revealed that the female resident suffers from late onset dementia with “behavioral disturbance” and is often confused. Since she did not appear to be traumatized by the event, the psychiatrist did not make any adjustments to her medications. However, the resident’s care plan revealed she was still at risk from the male resident discussed in this citation because of her “cognitive impairment, poor judgment/insight, and her propensity to wander.”
The investigator of this citation dug further into the facility’s grievance reports and found a third incident of sexual misconduct. This time, the resident exposed his genitals to a female resident sitting in her room. When interviewed, the female resident said she was sitting in her room watching TV when the resident came in her room and exposed his genital area. She stated she was “shocked” and asked what he thought he was doing. She went down to the hall and told the nurses and certified nursing assistants. She was distressed by the incident , saying it was “terrible” and that he “shouldn’t be doing that.”
A progress note revealed that a few days after the incident, the male resident tried to go back to her room, but staff redirected him. She stated she was “disgusted” by the resident and wanted him to stay away from her. There was no other documentation of the incident in the medical record other than the follow-up notes from social service.
Importance of Monitoring Residents with Unsafe Behaviors
Residents who pose a risk to fellow residents in nursing home facilities need to be carefully monitored. Their care plan should include interventions such as how to deescalate a situation, calmly engage in conversation, and reinforce positive behaviors with the resident. When the resident in this citation displayed unsafe and inappropriate behaviors multiple times, the facility should have responded by revising his care plan and following the updated care plan to prevent future harm to himself and others. However, according to this citation, the facility did not provide any follow-up training or education following the “unsafe and sexually inappropriate” behaviors toward a vulnerable resident.
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