Failure to Initiate Dementia Care Plan for Resident
Penalty
Summary
Staff failed to initiate a care plan for a resident with a diagnosis of dementia, despite the admission Minimum Data Set (MDS) assessment indicating that dementia should be addressed in the care plan. The resident was admitted with dementia, and facility policy required that a comprehensive, person-centered care plan be developed within 7 days of the MDS assessment and no more than 21 days after admission. However, a review and interview with the Assistant Director of Nursing Services (ADNS) revealed that no dementia care plan had been initiated for the resident, and the omission was not identified or corrected until 177 days after admission. The facility's own policies emphasized the importance of individualized care planning for residents with dementia, including interventions for memory support, behavior management, safety, meaningful engagement, and consideration of resident routines and preferences.