Failure to Update and Implement Fall Prevention Interventions on Care Plan
Penalty
No penalty information released
The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.
Summary
The facility failed to ensure that fall prevention interventions on a resident's care plan were reviewed and revised for accuracy. A resident with diagnoses including PTSD, insomnia, and Parkinson's disease was identified as being at risk for falls, with a care plan intervention specifying the use of a commode or urinal at bedside. During observation, it was noted that neither a commode nor a urinal was present at the resident's bedside. This was confirmed by an LPN, who acknowledged the absence of the intervention. The DON later confirmed that the intervention was no longer appropriate and had been removed from the care plan, but this update was not reflected in the care plan at the time of the survey.