Failure to Develop Comprehensive Care Plans for Residents with Behavioral and Skin Integrity Needs
Penalty
Summary
The facility failed to develop and implement comprehensive care plans that addressed all identified needs for two residents. For one resident with severe cognitive impairment and a history of heart disease, kidney disease, hearing loss, anxiety, and Alzheimer's disease, the care plan did not address her physical and verbal behavioral symptoms, including hitting, kicking, pushing, scratching, threatening, screaming, and frequent rejection of care. Interviews with LPNs and a CNA confirmed awareness of these behaviors and the use of interventions such as one-to-one attention or contacting the resident's daughter, but there was no documentation of these interventions in the care plan, nor were staff given specific instructions for managing the behaviors. Another resident with multiple diagnoses, including dementia with behavioral disturbance, anxiety disorder, congestive heart failure, chronic kidney disease, and chronic obstructive pulmonary disease, developed unstageable pressure ulcers on both heels. Although medical records and wound care notes documented the presence of these wounds and recommended interventions such as repositioning every two hours, offloading pressure, and using heel protectors, the care plan only addressed the potential for skin breakdown and did not include interventions for the resident's actual impaired skin integrity. Additionally, there was no care plan addressing the resident's non-compliance with offloading pressure from the heels, despite staff being aware of this issue. Facility policy required that care plans be reviewed and revised after each comprehensive and quarterly MDS assessment, and that all identified care area needs be included in the person-centered comprehensive care plan. However, the care plans for both residents failed to include measurable objectives and appropriate interventions for their specific needs, as confirmed by staff interviews and record review.