Failure to Ensure Interdisciplinary Team Participation in Care Planning
Penalty
Summary
The facility failed to ensure that residents and/or their representatives were given the opportunity to participate in the development and implementation of their person-centered care plans with the full interdisciplinary team (IDT) present, as required. Record review and staff interviews revealed that for two sampled residents, care plan meetings were routinely attended only by social services and activities staff, with other required IDT members such as clinical representatives, dietary, and therapy staff not present. The facility's own policy specified that these team members should be present at care plan meetings, and that meeting notes should document all attendees. A complaint was received indicating that a resident's representative was contacted by the social worker for a care plan meeting, but only the social worker was present during the meeting, which was conducted by phone. Review of care plan meeting records for both residents showed a consistent pattern of limited staff attendance, with meetings often lacking nursing, dietary, and therapy input. Interviews with the Nursing Home Administrator and DON confirmed that the IDT was not participating as required, and that only social services and activities staff were regularly involved in these meetings.