Failure to Timely Update Care Plan for Contractures and Infection Control
Penalty
Summary
The facility failed to ensure that a person-centered care plan was reviewed and revised in a timely manner for a resident with specific clinical needs. The resident, who had contractures in both hands and was participating in the Restorative Nursing Program, was observed with hand contractures and the use of bilateral hand splints. However, the care plan did not initially include any problem, goal, or intervention addressing the contractures or the use of splints, despite staff providing these interventions. The care plan was only revised to include these details after the surveyor's observation, rather than at the time the needs were identified by staff. Additionally, the same resident was placed on contact precautions due to the presence of a multidrug-resistant organism (MDRO) as indicated by a rectal screen. Although a sign was posted on the resident's door and staff were aware of the contact precautions, the care plan did not reflect the resident's infection control status or appropriate interventions until after the surveyor's review. The care plan was not updated to address the resident's MDRO status and required precautions until well after the laboratory results were available and the precautions were implemented.