Failure to Follow Behavioral Health Care Plan for Resident
Summary
The facility failed to provide appropriate behavioral health care for a resident, identified as R19, who exhibited combative behaviors during care. R19, diagnosed with dementia, anxiety, and pain, had a care plan that directed staff to ensure her safety, leave her alone, and reapproach her later if she became agitated or combative. However, the care plan lacked specific instructions on preventing skin tears and bruises related to her resistance or combativeness. Despite the care plan's directives, staff did not consistently follow these guidelines, leading to multiple instances where R19 sustained bruises and skin tears during care. Observations and nurse's notes documented several incidents where R19 became combative, resulting in injuries. For instance, on multiple occasions, R19 was noted to have bruises on her arms and hands, and skin tears on her forearms, often due to hitting walls or during physical interactions with staff. The notes indicated that R19 was combative during personal care, hitting, kicking, and screaming, which led to injuries such as bruises and skin tears. Staff interventions during these episodes were not aligned with the care plan, as they involved multiple staff members attempting to manage R19's care simultaneously, which was overwhelming for her. Interviews with staff revealed a lack of adherence to the care plan. A licensed nurse and a certified nurse aide acknowledged R19's aggressive behaviors and the need to reapproach her later, yet staff often attempted to expedite care by having multiple caregivers present, contrary to the care plan's guidance. An administrative nurse confirmed that having three staff members in the room could be overwhelming for R19 and stated that education would be provided to staff on how to approach her. The facility's behavioral health services policy emphasized the need for qualified staff to provide mental and behavioral health services, but the failure to follow the care plan during R19's combative episodes resulted in her sustaining injuries and placed her at risk for impaired quality of life.
Penalty
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A resident with paraplegia and a history of trauma was involved in an incident where an LPN physically restrained him by blocking his wheelchair, leading to the resident punching the LPN. The resident had grabbed his medication and attempted to leave, contrary to physician orders. This action violated the facility's Resident Rights policy, which ensures residents are free from restraints. The incident was witnessed by staff, and authorities were notified.
The facility failed to ensure sufficient staffing to meet the behavioral health needs of residents, affecting two residents and potentially impacting all 31 residents on a nursing unit. The inadequate staffing led to delays in care and supervision, resulting in falls and hospitalizations for residents with complex behavioral health needs.
Failure to Ensure Resident Rights and Appropriate Behavioral Health Management
Penalty
Summary
The facility failed to ensure appropriate nursing services to maintain the highest practicable physical, mental, and psychosocial well-being of Resident #115, particularly in relation to mobility and behavioral health needs. Resident #115, who had diagnoses including paraplegia and a chronic ulcer, was cognitively intact and required varying levels of assistance for daily activities. The care plan highlighted the resident's risk for impaired psychosocial well-being due to a history of trauma, emphasizing the need for respectful and compassionate communication. However, an incident occurred where the resident grabbed his crushed pain medication from the medication cart and attempted to leave, leading to a confrontation with LPN #402. During the incident, LPN #402 blocked the resident's path and physically restrained him by placing her foot in the wheel of his wheelchair, as the resident was required to take his medication in front of the nurse. This action led to the resident punching the LPN in the hands. The facility's Resident Rights policy, which states that residents have the right to be free from restraints, was not adhered to in this situation. The incident was witnessed by other staff members, and the police, DON, and Administrator were notified. This deficiency highlights a failure in ensuring the resident's rights and appropriate handling of behavioral health needs.
Insufficient Staffing for Behavioral Health Needs
Penalty
Summary
The facility failed to ensure sufficient staffing to meet the behavioral health needs of the residents, specifically affecting two residents and potentially impacting all 31 residents on the Rosepointe B nursing unit. Resident #101, who had vascular dementia, hemiplegia, hemiparesis, and schizophrenia, exhibited socially inappropriate behaviors and required substantial assistance for daily activities. On multiple occasions, Resident #101 was found on the floor or attempting to remove his incontinence brief and clothing, indicating a need for constant supervision. The staffing on the unit was insufficient, with only two STNAs assigned to care for 31 residents, leading to delays in care and supervision for Resident #101, who eventually fell and was sent to the hospital for evaluation. The staff, including the RN and STNAs, reported difficulties in managing their workload and ensuring timely care for all residents due to the inadequate staffing levels. Resident #76, who had vascular dementia, psychotic disturbance, and other cognitive impairments, also required significant assistance and supervision. This resident frequently removed his incontinence brief and consumed feces, necessitating constant monitoring and care. On one occasion, Resident #76 was found on the floor next to his bed and was later admitted to the hospital for a possible cranial bleed. The staff reported that the unit was challenging to manage with only two STNAs, as many residents required mechanical lifts for transfers and had complex behavioral health needs. The lack of sufficient staff led to delays in providing care and addressing the residents' needs promptly. Interviews with the nursing staff revealed that the workload was overwhelming, and they often had to forgo breaks to ensure residents received care. The DON and Administrator determined the staffing levels, but the assigned staff was not adequate to meet the needs of the residents on the Rosepointe B unit. The staff's inability to provide timely and appropriate care due to insufficient staffing levels directly contributed to the deficiencies observed in the care of Residents #101 and #76.
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