Violation of Resident's Right to Refuse Care
Penalty
Summary
The facility failed to uphold a resident's right to self-determination and choice, leading to a deficiency. A resident, who had diagnoses including impaired hearing and full cognition, refused incontinence care during the night shift. Despite the resident's clear refusal and statement that they were not incontinent, Certified Nurse Aide #4 proceeded to provide incontinence care, rolling the resident in bed and pulling down their incontinence brief. This action was against the resident's wishes and violated their rights. The resident's care plan, updated prior to the incident, indicated that the resident preferred not to be disturbed during the night unless they requested assistance. The aide's rationale for providing care was based on the resident's previous incontinence during the night and prior acceptance of care. However, the resident explicitly stated they did not need incontinence care at the time of the incident, and the aide's actions were not in alignment with the resident's expressed wishes or the care plan. The incident was documented in an incident report, and the facility's investigation confirmed that the aide violated the resident's rights by not respecting their refusal of care. The resident expressed initial upset and anger over the situation, although there were no psychological concerns noted post-incident. The facility's policies and staff expectations clearly outlined the importance of respecting resident rights and documenting refusals, which were not adhered to in this case.
Plan Of Correction
Plan of Correction: Approved April 15, 2025 Resident #1’s care plan has been reviewed and was found to be accurate. There is a care plan intervention under “Self – Care Deficit” that states “Allow to make choices in care, i.e., clothing, ADL routine, etc.” All other residents' care plans will be audited to ensure that there is a care plan intervention under “Self – Care Deficit” that states “Allow to make choices in care, i.e., clothing, ADL routine, etc.” The following policies will be reviewed and revised as deemed necessary to ensure that residents’ choices and preferences regarding their care are carefully planned for as well as followed by the staff members when providing care: - Comprehensive Care Plan Policy - Resident Right to Refusal Policy Clinical Staff will be inserviced on the previously mentioned policies including any revisions and/or policy changes implemented after reviewing such policies. Staff will also be inserviced on “Promoting Resident’s Independence, Resident Rights and Abuse.” The “Promoting Resident Rights and Independence Questionnaire,” which will include components of the ADL Critical Element Pathway, will be conducted weekly and the results of the audits will be compiled and reported monthly to the QAA Committee. The audit will be completed monthly until we achieve 100% for three consecutive months. The Director of Nursing will be responsible for overseeing this process.