Failure to Assist Resident in Obtaining Personal Belongings
Penalty
Summary
The facility failed to ensure that a resident was treated with respect and dignity by not assisting with obtaining personal belongings from the resident's previous facility. The resident, who was admitted with diagnoses including cerebral palsy, altered mental status, and quadriplegia, was documented as having no personal belongings upon admission. The resident's medical records indicated a lack of cognitive capacity and total dependence on staff for activities of daily living. Despite facility policy requiring efforts to retrieve personal property for new admissions, there was no documentation or evidence that staff attempted to contact the previous facility or retrieve the resident's belongings. Interviews with the Social Services Director and the Director of Nursing confirmed that the standard practice is to contact the previous facility or arrange for staff to collect a resident's belongings. However, both were unable to provide any documentation or recall any attempts made in this case. The facility's own policies emphasized the importance of residents retaining personal possessions to maintain a homelike environment, but these procedures were not followed for this resident.
Plan Of Correction
RESPECT, DIGNITY / RIGHT TO HAVE PERSONAL PROPERTY CFR(s): 483.10(e)(2) IMMEDIATE CORRECTIVE ACTION: Resident 1 was discharged on 1/3/2021. ACTION TAKEN TO IDENTIFY ALL OTHER RESIDENTS HAVING THE POTENTIAL TO BE AFFECTED BY THE DEFICIENT PRACTICE AND CORRECTIVE ACTION TAKEN: Residents admitted from other facilities had the potential to be affected by this deficient practice. The Social Services Director and Social Services Designee interviewed 10 residents admitted in the last two weeks if assistance is needed in retrieving any belongings from prior facility. No other residents were affected by this deficient practice. PROCESS AND ACTION TAKEN TO ENSURE DEFICIENT PRACTICE DOES NOT RECUR: The DON conducted an in-service education with licensed staff and social services staff on 6/30/25, regarding facility policy on Residents' Rights and Personal Property to ensure that assistance will be provided in securing belongings if the resident came from another facility. The Administrator conducted an in-service education with social services staff on 7/7/25, regarding facility policy on Residents' Rights and Personal Property to ensure that assistance will be provided in securing belongings if the resident came from another facility. Effective 7/7/25, the Social Services Director and the Social Services Designee will check newly admitted residents' inventory lists to ensure residents have personal belongings brought to the facility and provide assistance in obtaining personal belongings from the previous facility if needed. The DON and/or her designee will conduct random reviews of five (5) newly admitted residents weekly for the next four (4) weeks, then monthly for two (2) months of all new admissions to ensure the belongings checklist is completed and assistance is provided in securing and locating belongings from other facilities if needed. MONITORING PERFORMANCE TO ENSURE THAT CORRECTION IS ACHIEVED AND SUSTAINED: As part of the facility's Continuous Quality Improvement (CQI) program, the DON will report findings at the Quality Assessment and Assurance Committee (QAA) regarding weekly random checks at the next monthly meeting. The Administrator will monitor compliance through review of DON reports. CORRECTIVE ACTION COMPLETION: July 7, 2025