Failure to Identify and Address Resident's Visual Impairment
Penalty
Summary
The facility failed to identify, assess, or address the visual impairment of a resident, despite multiple observations and staff confirmations that the resident was blind. The resident was seen bumping into walls and objects while attempting to navigate the facility, and required verbal directions and physical guidance from staff and his roommate to move safely. Interviews with the DON, CNAs, and an LPN confirmed awareness of the resident's blindness and his frequent collisions with objects. However, the facility's records did not reflect any formal identification, assessment, or care planning for his visual impairment. A review of the resident's medical record showed a history of Parkinson's Disease and Schizophrenia, and a recent MDS assessment inaccurately documented his vision as adequate, despite a fall assessment indicating inadequate vision and nursing notes describing his difficulty seeing and running into walls. The facility's policy required comprehensive assessment and ongoing monitoring of vision, but there was no documentation that these steps were taken for this resident. The deficiency was identified through observation, interviews, and record review.