Failure to Address Resident's Psychosocial Distress Due to Environmental Noise
Penalty
Summary
The facility failed to adequately assess and address a resident's expressions of distress, leading to decreased social interaction and increased withdrawn, angry, and depressive behaviors. The resident, a cognitively intact female with a history of major depression and anxiety disorder, expressed frustration due to the constant yelling of other residents in her hall. Despite reporting these frustrations to staff, no effective measures were taken to alleviate the situation, resulting in the resident's increased distress and uncharacteristic behavior. Observations revealed that the resident preferred to keep her door closed and use ear buds to block out the noise, yet she continued to experience frustration and anxiety. The facility's psychiatric consults noted the resident's sleep disturbances and recommended non-pharmaceutical interventions, but these were not effectively implemented. The resident's mood assessments were incomplete, further indicating a lack of comprehensive evaluation and intervention by the facility. Interviews with staff confirmed that the issue of residents yelling was well-known, yet no grievance forms were completed, and the problem persisted. The facility's decision to place several residents who frequently yelled in the same area exacerbated the situation, affecting the resident's mental well-being. The Social Service Director acknowledged the resident's recent behavioral changes, which were uncharacteristic and linked to the ongoing disturbances.
Plan Of Correction
Element 1: Resident 52 no longer resides in facility. Element 2: Residents on C hall with a Brief Interview of Mental Status of 9 or greater had a Patient Health Questionnaire-9 completed to ensure residents have had no expressions of distress, developed decreased social interaction, increased withdrawal, anger, and depressive behaviors. Any changes in Patient Health Questionnaire-9 have had referrals made to psychology services. Element 3: CNAs and Nurses were re-educated on proper documentation of behaviors including depression, agitation, withdrawal, distress, anger, etc. Interdisciplinary Team will review clinical documentation M-F to ensure any changes in behaviors are followed up on. Element 4: The Administrator will complete an audit reviewing 6 residents per week to evaluate Patient Health Questionnaire-9 scores and ensure appropriate interventions are in place if eligible. Audit findings will be presented to the facility QAPI Committee and will only be discontinued with substantial compliance and with approval of the facility QAPI Committee. Any instances of noncompliance that are identified will be addressed per company policy concerning education and disciplinary action when necessary. The Administrator is responsible for achieving and sustaining compliance.