Failure to Honor Residents' Outdoor Activity Preferences
Summary
The facility failed to honor the outdoor activity preferences of two residents, as evidenced by interviews and record reviews. One resident's family member reported that after admission, she was told the resident could only go outside with the smokers, who went out five times a day, but also stated that residents could go months without going outside. Another resident stated she had not been outside except for appointments and expressed a desire to go outside when the weather was comfortable, but staff had not taken her out, citing being busy. The Minimum Data Set (MDS) assessments for both residents indicated that going outside for fresh air was either 'somewhat important' or 'very important' to them. Staff interviews revealed that the activities staff member had not conducted any outside activities or used the facility's courtyard since starting in July, only feeling comfortable to do so months later. A review of the facility's activities calendars for several months showed no scheduled outside activities. The facility's policy requires the activity program to meet residents' interests and promote their well-being, but the lack of outdoor activities did not align with these stated procedures.
Penalty
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The facility failed to properly position residents during meals, affecting three individuals on the secured unit. Observations showed residents in tilt wheelchairs at inappropriate angles and one resident in a low wheelchair without leg rests, unable to reach their meal. Staff did not intervene to reposition the residents, and interviews confirmed the improper positioning. The facility's policy on dignity and respect was not followed.
Improper Positioning of Residents During Meals
Penalty
Summary
The facility failed to ensure proper positioning of residents during meals on the secured unit, affecting three residents. Observations revealed that two residents were seated in specialty tilt wheelchairs at angles between 60 to 75 degrees, with one resident's table height reaching their chin throughout the meal. The staff did not intervene or reposition the residents during the meal observation. Another resident was observed sitting in a low wheelchair without leg rests, with their feet dangling, and was not positioned properly at the table during breakfast. Despite staff presence, no intervention was made to reposition the resident to allow proper access to their meal. Interviews with staff confirmed the improper positioning of residents during meals. One staff member acknowledged that a resident was not positioned correctly at the table, citing concerns about the resident grabbing items off the table. The Director of Nursing verified that residents should be upright and properly positioned at an appropriate table height during meals. The facility's policy on Quality of Life - Dignity emphasizes care that promotes dignity, respect, and individuality, which was not adhered to in these instances.
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