Failure to Assess and Support Resident Mobility and Independence
Penalty
Summary
The facility failed to assess and address the mobility needs of a resident with multiple complex medical diagnoses, including respiratory failure, diabetes mellitus, atrial fibrillation, congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease, and Raynaud's syndrome. Upon admission, the resident was documented as requiring assistance for most activities of daily living (ADLs) and was using a wheelchair for mobility. However, the initial evaluation was not a comprehensive assessment, and a required admission MDS was not completed by the deadline. The resident did not have a comprehensive, individualized care plan in place until well after admission, and the only care plan available was a generic, undated document with limited information. Observations and interviews revealed that the resident became totally dependent on staff for mobility and ADLs, resulting in a significant decline in functional status and psychosocial well-being. The resident reported feeling imprisoned, totally dependent, and expressed distress over the loss of independence. The resident was unable to maneuver the manual wheelchair due to multiple finger amputations and blackened fingertips, and staff did not provide or assess for appropriate adaptive equipment to promote independence. The resident's own mobility aids from home were not supplemented or replaced by the facility, and staff did not inquire about or provide interventions to support the resident's independence until prompted by surveyors. Staff interviews confirmed that care planning responsibilities were neglected due to the absence of a Director of Nursing, and no one had assumed those duties. The resident's psychosocial harm was compounded by missed opportunities to participate in activities due to lack of assistance and appropriate equipment. The facility also failed to communicate with the resident and their representative regarding available tools and interventions to improve mobility and independence, only reaching out after surveyor involvement. The lack of assessment, individualized care planning, and provision of necessary equipment led to a preventable decline in the resident's mobility and psychosocial health.
Removal Plan
- Provide in-service to Administrator by Nurse Consultant regarding preventing decline in residents' level of activities of daily living (ADL) functions, including providing necessary equipment appropriate for resident and facility.
- Administrator to provide in-service to DON regarding preventing decline in resident ADL functions, including providing necessary equipment and assessing for appropriate interventions to prevent declines.
- Administrator and Nurse Consultant to in-service nursing staff to identify and respond appropriately to a resident's decline in ADL functions, including assessing, monitoring and providing interventions. Nurses will be responsible for assessing and providing appropriate interventions.
- Contact Resident #184 family to bring specialized equipment (special belt for foot movement and trapeze bar) from home that is being requested by resident to facility so it can be used to assist with his independent transfer and repositioning.
- Administrator and DON to monitor care areas routinely to ensure equipment is in place.
- Notify Primary Care Physician of Resident #184 of mental health concerns and request further direction/orders. Contact family to bring personal items from home, notify Physician for any new orders and contact pharmacy for medication consult.
- Complete care plan and MDS for Resident #184.