Failure to Provide Resident-Centered Activities for Cognitively Impaired Resident
Penalty
Summary
The facility failed to provide meaningful, resident-centered activities for a resident with significant cognitive impairment and physical dependency. The resident, admitted with diagnoses including metabolic encephalopathy, malnutrition, dysphagia, and diabetes, was rarely able to communicate or make needs known and required extensive assistance for mobility and personal care. The activities care plan indicated a preference for activities related to the resident's prior lifestyle, with goals for satisfaction in daily routines and leisure, and interventions such as allowing expression of feelings and peer interaction. However, documentation showed inconsistent and infrequent one-on-one activity visits, with several refusals and limited engagement, such as eye contact or brief verbal sounds. There was no evidence of anxiety or restlessness in the medical record, and activity assessments were inconsistently documented and not always signed or dated. Observations revealed the resident was often left in bed for extended periods without repositioning devices or support, and staff were not observed entering the room for long stretches of time. The resident was not on bed rest, but staff interviews indicated she was rarely gotten out of bed, with no clear reason provided. The resident required a mechanical lift for transfers and was expected to be dressed and out of bed per her wishes, but this was not consistently implemented. Activity staff reported difficulty assessing preferences due to the resident's cognitive status and noted that refusals were sometimes based on the resident being asleep, without clear evidence of re-approaching when awake. Documentation of one-on-one activities was incomplete, with visitation records unsigned and inconsistent with assessment requirements. The Life Enrichment Director acknowledged challenges in assessing and providing appropriate activities for the resident and could not verify the accuracy or timing of assessments. The lack of consistent, meaningful engagement and incomplete documentation led to the finding that the facility did not meet the resident's needs for individualized activities.