Failure to Revise Care Plan for Resident with Escalating Aggressive Behaviors
Penalty
Summary
The facility failed to revise the care plan for a resident who exhibited recent increases in violent and aggressive behaviors towards other residents and staff. The resident, who had a history of major depressive disorder, mood disorder, adjustment disorder with mixed anxiety and depressive mood, bipolar disorder, and HIV disease, demonstrated behaviors such as spitting at and kicking staff, hitting others with her wheelchair, and refusing medications. Despite these significant behavioral changes, the care plan was not updated to address the new or escalating behaviors, and interventions continued to focus only on medication refusal. Documentation showed that the resident had multiple behavioral incidents, including spitting on a nurse, kicking staff, and being combative during morning care. Psychiatry progress notes indicated increased symptoms of bipolar disorder, including mania, psychosis, and refusal to follow staff recommendations. The resident was also noted to have been agitated, aggressive toward her roommate, and required a room change. Despite these documented changes, the last interdisciplinary team meeting and care plan revision occurred prior to the escalation of these behaviors, and the care plan did not reflect the resident's current needs or interventions for the aggressive behaviors. Interviews with facility staff revealed that although behavioral changes were discussed in daily clinical meetings, the care plan was not revised to address the resident's increased aggression. The MDS coordinator and regional nurse both acknowledged that the care plan should have been updated, with the social services director identified as responsible for ensuring care plan revisions. However, no updates were made to the care plan to reflect the resident's behavioral changes and required interventions.