Failure to Develop and Implement Comprehensive Care Plans for Hospice and Enteral Feeding
Penalty
Summary
The facility failed to develop and implement comprehensive, person-centered care plans for two residents, as identified through observation, interview, and record review. One resident, a female with moderate cognitive impairment, traumatic brain injury, anxiety disorder, and depression, was receiving hospice services. Despite documentation of her hospice admission and ongoing care, her care plan did not address her hospice services. Interviews with nursing staff and the MDS Coordinator confirmed that the omission was not identified or corrected, and responsibility for updating the care plan was unclear among staff. Another resident, a female with severe cognitive impairment and total dependence for eating, was receiving enteral nutrition via a feeding tube. Her physician orders specified continuous tube feeding and water flushes, but her care plan did not reflect her need for tube feeding. Nursing staff were aware of her feeding regimen through shift reports and direct care experience, but had not reviewed or updated the care plan to include this critical information. The MDS Coordinator and other staff acknowledged that the care plan should have included tube feeding and that its absence could lead to miscommunication about her care needs. Facility policy required that comprehensive, person-centered care plans describe all services to be provided and assign responsibility for each element of care. However, the care plans for both residents lacked essential information about their hospice and enteral feeding needs, as confirmed by staff interviews and record reviews. This failure to update and implement care plans as required placed the residents at risk of not receiving appropriate care.