Failure to Respect Resident's Right to Refuse Care
Penalty
Summary
The facility failed to respect and facilitate a resident's right to self-determination, specifically regarding the refusal of care by Resident #43. The resident, who had intact cognition and was dependent on staff for personal hygiene and other activities of daily living, reported an incident where their choice to refuse care was not respected. On one occasion, Certified Nursing Assistant #2 forcefully provided care despite the resident's refusal, which included removing the resident's covers and incontinence briefs against their will. This incident was reported by the resident to the administration, highlighting a breach in respecting the resident's autonomy and choice. The facility's policy on resident rights emphasizes the importance of self-determination and respect for resident choices. However, during the survey, it was found that the staff did not adhere to this policy. Certified Nursing Assistant #2 admitted to forcing care due to concerns about the resident's skin integrity but failed to report the resident's refusal to the nursing staff. Interviews with other staff members, including a Licensed Practical Nurse and a Registered Nurse, indicated that the proper protocol would have been to report the refusal and attempt to offer care later. The Director of Nursing and the Administrator acknowledged the grievance filed by the resident and reiterated the importance of respecting residents' rights to refuse care.
Plan Of Correction
Plan of Correction: Approved January 3, 2025 Immediate Corrective Action: - The Administrator held an audio conference with the Director of Nursing, Assistant Director of Nursing, and Compliance Officer on 12/06/2024 to review the current facility's policy titled Resident's Bill of Rights dated 10/2022; and strategize on maintaining fidelity during residents’ refusal of care to assure that all residents are guaranteed the right to a dignified existence, self-determination, respect, full recognition of their individuality, consideration, and privacy in treatment and care while at the facility. The policy remains intact. - The Facility Administrator and Director of Nursing issued a memorandum on 12/06/2024 to resident #43, and all other residents and care unit representatives to reassure their bill of rights while at the facility in accordance with CFR(s): 483.10(f)(1)-(3)(8). Identification of Others Potentially Affected: - The facility respectfully submits all residents were potentially affected by this practice. System Changes to Prevent Recurrence: - Resident #43 was interviewed on 12/09/2024 by the Director of Social Services to identify/address any additional grievances. Resident #43 did not have any additional grievances and requested to remain at the facility. - RN #2, LPN #2, CNA #2, and all other direct resident care nursing staff including the Interdisciplinary team were re-in-serviced on Resident Bill of Rights and Refusal of Care & Non-Adherence to Care Plan from 12/09/2024 to 12/12/2024 by the ADON. - From 12/09/2024 to 12/21/2024, the DON and RN Managers reviewed the nursing notes in Sigma care for all residents during the period of 08.2024 – 12.2024 to identify any refusal of care and reconciliation outline. No additional defective practice was identified. RN Managers and DON will observe ADLs (change of linens, grooming, etc.) for residents 2x per week over the next eight weeks. Quality Assurance Monitoring: - An audit tool has been created and implemented for ongoing monitoring. - The Director of Nursing Services will perform weekly audits for randomized resident(s) for the next 4 months, then quarterly thereafter to sustain 100% compliance. Defective Practices will be reported to the compliance team and findings presented to the quarterly QAPI team meetings. Responsible Party: Director of Nursing