Failure to Provide Communication Tools for Resident with Speech Disabilities
Penalty
Summary
A resident with a history of intracerebral hemorrhage, seizures, gastrostomy with dysphagia, and severely impaired cognitive skills was admitted and readmitted to the facility. The resident's Minimum Data Set indicated unclear speech and dependence on staff for daily activities. During observation, the resident was unable to verbally express needs and could only respond to yes/no questions. Staff, including a CNA and an RN, confirmed that the resident could not communicate needs verbally and that no communication boards or assistive tools were available in the resident's room. The RN acknowledged that a communication board would be helpful but was not present at the time. The facility's policy required staff to assess communication barriers and provide appropriate aids or services for residents with speech disabilities. Despite this, the resident did not have access to any communication tools, and staff were unable to determine the resident's needs during the observed incident. The lack of communication aids was confirmed by both the staff and the DON, who stated that the resident's declining condition warranted such tools, but none were provided at the time of the survey.