Deficiencies in Comprehensive Care Plans for Residents
Penalty
Summary
The facility failed to develop and implement comprehensive care plans for three residents, leading to deficiencies in their care. Resident #291 was observed with a floor mat on one side of the bed, but there was no care plan intervention for the use of floor mats. The MDS Coordinator confirmed that the floor mats had not been care planned until the day of the survey. Additionally, there were no physician orders for the floor mats, although the facility's policy did not require such orders. The lack of a comprehensive care plan for Resident #291's floor mat intervention was a clear deficiency. Resident #74 was observed with a floor mat on the right side of the bed, but the care plan did not initially reflect this intervention. The MDS Coordinator later revised the care plan to include the floor mat intervention, which had been implemented over the weekend. Despite the revision, the initial absence of a care plan for the floor mat intervention constituted a deficiency. The facility's policy allowed for the use of floor mats without a physician's order, but the care plan should have been updated to reflect the intervention. Resident #43 required a C-collar as per physician's orders, but there was no care plan for its use. Interviews with staff revealed that the resident was supposed to wear the C-collar constantly, but it was not always in place, and the resident was not compliant with wearing it during sleep or in the dining room. The C-collar was found in the laundry, wet and not ready for use. The absence of a care plan for the C-collar and the lack of consistent application of the physician's orders were significant deficiencies in the resident's care.
Plan Of Correction
N072-Comprehensive Care Plans Identify patients that were at risk and what did: Ref Resident #43 Regarding Resident #43 the brace with appropriate interventions was added to Care Plan. How will you identify other residents that are at risk: 100 % audit was completed to identify residents with brace. Any residents with brace were reviewed to ensure appropriate Care Plan was completed. Measures put in place: Upon admissions residents are assessed for devices. Any Devices such as braces or other devices are reviewed upon admission and reviewed in our morning meeting. During morning meeting the MDS Coordinator will update and validate to the team when this is completed. Restorative Nursing will be maintaining a weekly checklist of all new devices and will be addressed on care plan. Also training was completed on for care plan team members regarding Floor mats, C-Collar Devices and Following Physician Orders. Nursing staff to communicate and document anytime a resident refuses treatment such as the C-Collar to update care plan. This will be reported and presented to the QAPI committee to ensure compliance. All nursing staff were in-serviced on assistive devices (brace and floor mats). How will you monitor: The Director of Nursing, MDS Coordinators, Restorative Nurse and or Designee will be responsible for bringing the findings and summary to the QAPI Committee. This will occur Monthly for 3 months, then quarterly and or if any variances are reported ongoing. Regarding Resident #74 the Care Plan was completed with appropriate interventions to address. How will you identify other residents that are at risk: 100% audit was completed to identify residents at risk for and Care Plan with appropriate interventions. Measures put in place: Upon admissions residents are assessed for risk. Any residents at risk for a Care Plan will be completed with appropriate interventions to address. This will be reported and presented to the QAPI committee to ensure compliance. All nursing staff were in-serviced on precautions and floor mats. How will you monitor: Through the continuous quality improvement program (Gang tackling) we will monitor compliance. The Director of Nursing, MDS Coordinators, Restorative Nurse and our Designee will be responsible for bringing the findings and summary to the QAPI Committee. This will occur Monthly for 3 months, then quarterly and or if any variances are reported ongoing. Ref Resident #291 Regarding Resident #291 the Care Plan was completed with appropriate interventions to address floor mats. How will you identify other residents that are at risk: 100% audit was completed to identify residents with floor mats and Care Plan in place with appropriate interventions. Measures put in place: Upon admissions residents are assessed for floor mats. Any residents found to need a floor mat a Care Plan will be completed with appropriate interventions to address. This will be reported and presented to the QAPI committee to ensure compliance. All nursing staff were in-serviced on floor mats. (risk for) How will you monitor: Through the continuous quality improvement program (Gang tackling) we will monitor compliance. The Director of Nursing, MDS Coordinators, Restorative Nurse and our Designee will be responsible for bringing the findings and summary to the QAPI Committee. This will occur Monthly for 3 months, then quarterly and or if any variances are reported ongoing.