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F0679
D

Inadequate Activity Provision for Residents

Everett, Pennsylvania Survey Completed on 01-15-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide adequate and ongoing activities to meet the needs of seven residents, as identified through clinical record reviews and interviews. These residents, who were mostly cognitively intact and dependent on staff for daily care, expressed the importance of participating in activities such as reading, listening to music, engaging in group activities, and attending religious services. However, the activity calendars for December 2024 and January 2025 showed a reduction in the number of activities offered compared to previous months. This reduction was attributed to the termination of two activity aides and the cutback in hours for the Activity Director, leading to fewer activities being scheduled. Residents expressed dissatisfaction with the reduced activity schedule during a resident council meeting and in interviews, highlighting the importance of activities like bingo, music, and religious services. The reduction in bingo sessions was particularly concerning as it affected residents' ability to earn points to purchase items, which was crucial for those without family support. Observations of a Sunday Social activity revealed a lack of engagement, with residents sitting quietly without refreshments. The Activity Director acknowledged the residents' requests for more activities but cited staffing and scheduling constraints as barriers to meeting these needs.

Plan Of Correction

1. Minimum Data Set (MDS) department will conduct a thorough review of all resident assessments to accurately identify individual interests, abilities, and needs. Activities Director will update all activities care plans to reflect specific activity preferences and goals for each resident. 2. Activities Director will update all activities care plans to reflect specific activity preferences and goals for each resident. 3. Executive Director will educate the Activities Director to develop a diverse and engaging activities calendar that caters to a variety of interests, including physical, cognitive, social, and spiritual needs. Incorporate resident input through suggestion boxes, resident council meetings, and individual discussions. As well as to design activities with varying levels of intensity to accommodate different abilities. 4. Activities Director/Designee to conduct Quality Improvement (QI) monitoring of regulation deficiency of 679 to ensure residents engage in activities programs that involve with residents' interests and abilities 5X a week for 4 weeks, then monthly. Findings to be reported to the Quality Improvement Performance Improvement (QAPI) committee meeting and updated as indicated. QI schedule modified based on findings.

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