Failure to Revise Care Plan for Resident-Centered Behavioral Interventions
Penalty
Summary
The facility failed to revise the care plan to include resident-centered functional abilities for a resident with a history of cerebrovascular accident (CVA), hemiplegia, hemiparesis, muscle weakness, and severely impaired cognition. The resident's care plan directed staff to reassure her and to leave and return later if she was resistive with activities of daily living (ADLs), but did not include other person-centered interventions despite ongoing behavioral issues. Multiple behavior and event notes documented that the resident was frequently verbally and physically aggressive toward staff during assistance with ADLs, transfers, and medication administration. Incidents included hitting, pinching, kicking, biting, and grabbing staff, as well as verbal refusals and threats. Staff attempts to redirect the resident were minimally effective, and the resident continued to display aggressive behaviors during care. There were also documented instances of the resident sustaining skin tears during these episodes. Interviews with staff revealed uncertainty about the availability of person-centered interventions in the care plan and a reliance on reapproaching the resident later. The facility's policy required timely, person-centered, comprehensive care plans that are reviewed and revised by an interdisciplinary team, with updates made when changes in the resident's condition occur. Despite ongoing behavioral challenges and injuries, the care plan was not revised to include additional person-centered interventions.