Failure to Provide Nonpharmacological Dementia Care and Services
Penalty
Summary
The facility failed to provide appropriate nonpharmacological dementia care and services to a resident diagnosed with dementia, depression, and anxiety. The resident had severely impaired cognition, as evidenced by low BIMS scores, and required total dependence for activities of daily living such as toileting, personal hygiene, and footwear. The resident also exhibited fluctuating behaviors, disorganized thinking, and frequent rejection of care. Despite these needs, the resident's care plan lacked specific interventions to address dementia care, and there was no facility policy provided for dementia care. The resident was prescribed multiple psychotropic medications, including antipsychotics, antidepressants, and antianxiety agents, and was monitored for behavioral symptoms. However, the Medication Administration Records for April and May did not document occurrences of behavioral symptoms or the use of nonpharmacological interventions, despite the resident displaying frequent crying, repetitive movements, yelling, aggression, and resistance to care. Progress notes indicated that the resident had difficulty participating in activities, was not easily redirected, and sometimes became aggressive during care, requiring staff intervention and medication administration. Observations and staff interviews confirmed that the resident engaged in aggressive and disruptive behaviors, such as attempting to slap a surveyor, grabbing another resident's walker, and self-transferring, which required frequent staff redirection. Staff reported that care plans typically guide interventions, but in this case, the care plan did not address the resident's dementia needs. Administrative staff acknowledged the omission, and the facility did not provide a policy for dementia care when requested.