Failure to Revise Care Plans for Changing Resident Needs
Penalty
Summary
The facility failed to ensure that comprehensive care plans were revised to address the changing needs of three residents. For one resident with vascular dementia and bone disorders, a foot cradle was observed in use for several weeks to protect the toes from blanket contact due to hammertoes and an arterial ulcer, but this intervention was not included in the resident's care plan. Staff interviews confirmed the use of the foot cradle and acknowledged it should have been care planned, but it was omitted. Another resident with dementia, congestive heart failure, and ischemic cardiomyopathy experienced a decline in cognition and ability to perform activities of daily living (ADLs), including increased dependence on staff for oral hygiene, feeding, and dressing. Despite these changes, the care plan had not been updated since the previous year and continued to state the resident was independent in most ADLs. The MDS nurse and DON confirmed awareness of the resident's decline and that the care plan did not reflect the current needs for assistance with ADLs and oral hygiene. A third resident with cellulitis, peripheral vascular disease, and under palliative care was placed on enhanced barrier precautions (EBP) due to infection, as indicated by signage and staff interviews. However, the use of EBP was not documented in the resident's care plan, despite being active in the electronic medical record. The ADON confirmed that EBP should have been included in the care plan. The facility's policy requires care plans to be revised as residents' conditions change, but this was not done for these residents.