Failure to Address Resident-to-Resident Aggression and Discharge Planning in Care Plan
Penalty
Summary
A deficiency occurred when the facility failed to develop and implement a comprehensive care plan that addressed all of a resident's needs, specifically regarding aggressive and inappropriate behaviors toward other residents and discharge planning. The resident, admitted for a short-term stay with diagnoses including congestive heart failure, diabetes mellitus, and bipolar disorder, exhibited both physical and verbal behavioral symptoms directed at others, as documented in the Minimum Data Set (MDS) assessments and nursing notes. Despite multiple incidents of inappropriate comments, derogatory language, and physical altercations with other residents, the care plan did not include interventions or goals specific to these behaviors toward fellow residents. Facility records and staff interviews revealed that the resident frequently disrupted common areas and mealtimes with aggressive verbal behavior, which was difficult for staff to redirect and often led to other residents avoiding communal activities. A significant incident involved the resident physically striking another resident with a remote control, resulting in injury and necessitating behavioral health evaluation. The care plan, however, only addressed interactions with staff and did not reflect the resident's history of resident-to-resident altercations or the need for targeted interventions to manage these behaviors. Additionally, the care plan lacked documentation of discharge planning, despite the resident's stated goal to return to the community and ongoing efforts by social services and case management to identify appropriate placement. Staff interviews confirmed that no formal discharge plan was in place, and the care plan was not updated to reflect the resident's preferences or potential for discharge. The Director of Nursing acknowledged that the care plan should have included both behavioral interventions for resident-to-resident issues and a plan for transitioning the resident out of the facility.