Failure to Update Care Plan for Resident's Toileting Needs
Penalty
Summary
The facility failed to ensure that the comprehensive care plan for a resident was reviewed and revised to meet the resident's current needs. Specifically, the care plan for a resident who required assistance with toileting was not updated to include interventions for monitoring the resident's noncompliance with toileting assistance. The resident, who had moderately impaired cognition and an ostomy, was observed toileting themselves without staff assistance, contrary to the care plan that indicated they required staff assistance for toileting transfer and hygiene. The resident's care plan, developed in 2023, documented that the resident was resistive to Activities of Daily Living assistance, but it did not include specific interventions to address the resident's noncompliance with toileting. Despite ongoing education and encouragement from staff, the resident continued to be adamant about their choices and often did not ask for help. The facility's policy required the care plan to be revised quarterly, annually, and as needed, but no new interventions had been developed since April 2023. Interviews with staff revealed that they were aware of the resident's attempts to be independent and did not call for help, yet the care plan was not updated to reflect this behavior. The Director of Nursing Services acknowledged that the care plan should have been evaluated for effectiveness and revised to include additional interventions to ensure the resident's safety during toileting. The lack of updated interventions in the care plan led to the resident not receiving the necessary assistance, as documented in the Certified Nursing Assistant Accountability records.
Plan Of Correction
Plan of Correction: Approved January 28, 2025 Plan of Correction FTAG 657 SS:D I. Immediate Action a. Resident #21 is still residing in the facility. Resident #21 was affected by this deficient practice. All residents requiring staff assistance with activities of daily living including toileting transfer and toileting hygiene and are non-compliant with activities of daily living have the potential to be affected by this practice. No other residents were affected. b. Certified Nurse’s Aide #1 was educated on 1/16/25 by the Assistant Director of Nursing on following all the instructions for providing care to the residents as documented on the Nursing Assistant Accountability Records with emphasis on reporting all non-compliance observed by the resident to the Nurse and rendering the level of assistance as instructed on the residents Accountability Records. Emphasis also reinforcing that a resident noncompliance does not remove the responsibility from the staff member to render the level of assistance documented on the Accountability record to provide the resident care. c. The resident’s noncompliance care plan was reviewed by the ADNS on 1/15/25 and updated with interventions including staff member offering toileting q 2 hours and prn and must always remain with the resident during toileting hygiene and toileting transfer task to maintain the safety of the resident at all times and to ensure any non-compliance with care is addressed. d. The Residents Activity of Daily Living Care plan was reviewed by the ADNS on 1/15/25 and updated with interventions including offering toileting q2 and prn. Staff member must remain with the resident at all times for all ADL care requiring staff assistance to monitor and provide assistance and maintain the resident’s safety at all times. Also updated to include minimal assistance of one person for toileting hygiene and moderate assist of one person for toilet transfer. e. The Nursing Aide Accountability record was reviewed by the ADNS on 1/15/25 and updated to include staff member must render the level of assistance as documented on the residents’ instructions. Also updated to include offer resident toileting q2 hrs. and prn, minimal assistance of one person for toileting hygiene and moderate assistance of one person for toilet transfer and to report all residents refusal of care and noncompliance to the nurse. f. RN #1 was provided with 1:1 education by the ADNS on 1/16/2025 on updating the Accountability record for the resident care to include intervention for monitoring residents with noncompliance. Ensuring noncompliance behavior has an intervention including interventions for offering toileting to the resident q2 and prn and for staff members to remain with the resident during all tasks requiring assistance and to ensure residents safety is maintained and also to follow up and reevaluate the effectiveness of these interventions with the IDT Team to ensure compliance. g. All LPNs who worked on unit (NAME) on 12/26/24 were provided with 1:1 education by the ADNS on 1/17/25 on following all instructions for care for the residents and reinforcing and ensuring the Aides are following the resident’s plan of care. If a resident demonstrates non-compliance the RN should be notified and the necessary follow up be done with the MD and the IDT team. The resident’s non-compliance does not remove the staff responsibility for rendering the level of care documented on the care instructions. II. Identification of Others a. An audit was conducted on 1/15/25 by the ADNS for all residents in house with noncompliance care plans related to ADL care including toileting self and requiring staff assistance. There were no negative findings of this audit. III. System Changes a. The Facility’s Policy and Procedure Titled Comprehensive Care Plan and Resident Meeting dated (MONTH) 2024 was reviewed on 1/16/25 by the Medical Director, Director of Nursing, and the Administrator with no changes made. b. All Licensed Nurses will be re-educated by the Inservice Coordinator/designee on the Policy and Procedure Titled Comprehensive Care Plan and Resident/Patient Meeting with emphasis on reviewing and revising the comprehensive care plan with interventions to meet the resident’s current needs. IV. Quality Assurance a. An audit tool was created by the Director of Nursing to review all residents with new episodes of non-compliance with Activities of Daily Living to ensure there are appropriate interventions to address the resident’s non-compliance and ensure the Aides accountability record and the residents noncompliance care plan is updated with these instructions and interventions. b. Audits will be completed by the ADNS/Designee on 25% of all residents on each unit weekly x 4, then monthly x 2 months and quarterly thereafter until 100% compliance is achieved. c. All negative findings will be brought to the attention of the Director of Nursing immediately. All negative findings will be immediately addressed by the DNS/designee with an onsite teaching/Inservice and disciplinary action as needed. d. All results of the audits will be brought to the QAPI committee quarterly x 4 (to review and discuss any unfavorable patterns that may prevent achieving 100% compliance). V. Person Responsible Director of Nursing