Lack of Evidence for Resident Care Plan Meetings
Penalty
Summary
The facility failed to provide evidence of conducting resident care plan conference meetings or inviting residents to these meetings, as required by regulations. Specifically, for one resident, identified as Resident R106, there was no documentation indicating that the resident or their representative had been invited to or attended a care plan conference meeting. This deficiency was identified through a review of clinical records, facility policies, and staff interviews. Resident R106, who was admitted to the facility with diagnoses including chronic obstructive pulmonary disease, anxiety, and hypertension, reported not having attended or been invited to a care plan conference meeting. This was confirmed by interviews with the Social Services Coordinator and the Director of Nursing, who acknowledged the lack of evidence for such meetings or invitations in the resident's records since their admission.
Plan Of Correction
A care plan conference has been scheduled for R106. The facility will ensure that residents and/or resident representatives are invited to attend care plan conference meetings to discuss their goals and plan of care. Documentation of attendance/refusal will be noted in the clinical record. The Administrator will educate the Resident Services Coordinator regarding the importance of inviting and documenting attendance/refusal of residents and/or resident representatives to care plan conference meetings. The RSC will review documentation of resident care conferences held within the past 30 days to ensure appropriate individuals were invited to care conferences. The Assistant Director of Nursing will conduct a weekly audit of care conferences for 4 weeks to ensure that appropriate individuals were invited to care conferences with supportive documentation. The results of the audits will be reviewed at the monthly Quality Assurance and Performance Improvement meeting.