Failure to Involve Residents and Representatives in Care Plan Development
Penalty
Summary
The facility failed to ensure that care plans were developed in consultation with residents and their representatives for four out of six residents reviewed. Specifically, there was no evidence that residents or their family members were invited to participate in care plan meetings. Documentation for care plan meetings was incomplete, lacking information on the date, time, attendees, and invitations for the meetings. Residents and their family members reported not being aware of or involved in care plan meetings, and some were unfamiliar with the concept of a care plan meeting altogether. For example, one resident with paraplegia and multiple medical conditions, who was cognitively intact, stated he had not been invited to a care plan meeting and was unaware of such meetings. His family member also confirmed not being involved or informed about care planning, despite recent acute health events. Another resident with moderate cognitive impairment and complex medical needs, as well as her family member, reported not being informed or involved in care plan meetings, with the family member expressing a desire to participate. Additional residents with moderate cognitive impairment and significant medical diagnoses, including those requiring oxygen therapy and those with Parkinson's disease, also indicated they had not participated in or been informed about care plan meetings. Staff interviews confirmed that care plan meetings were the responsibility of the MDS Coordinator, who stated that invitations were sent via mail or email but could not provide evidence of such communication. The facility's policy required that residents and their representatives be invited to care plan meetings at least quarterly, but there was no documentation to support that this occurred.