Failure to Implement Resident Care Plan Preferences for CNA Assignment
Penalty
Summary
A deficiency occurred when the facility failed to implement care plan interventions developed by the Interdisciplinary Team (IDT) for a resident with quadriplegia, spinal stenosis, spastic diplegic cerebral palsy, muscle weakness, and anxiety. The resident was entirely dependent on staff for activities of daily living and had intact cognitive skills, with the capacity to make and understand medical decisions. The resident had previously experienced a traumatic incident during care provided by a specific CNA and had clearly expressed a preference not to be assigned to that CNA again, providing a preference list to facility staff. Despite these documented preferences and care plan interventions, the resident was assigned to the same CNA on multiple occasions, including a recent incident where the CNA was assigned to provide care and entered the resident's room to perform tasks. The care plan required communication among nursing staff and scheduling coordinators regarding the resident's CNA preferences, review of assignments before each shift, daily monitoring of the resident's satisfaction, and immediate documentation of any deviations from the preference. However, these interventions were not followed, and the resident's preferences were not honored, resulting in repeated assignments of the CNA to the resident. Interviews with facility staff, including the QAN, MDS nurse, and DON, confirmed that the care plan interventions were not effectively implemented. The QAN acknowledged assigning the CNA to the resident due to staffing limitations and did not notify the resident beforehand. The MDS nurse and DON both stated that the interventions identified in the IDT meeting were not followed, which led to the resident's dissatisfaction and distress. The facility's policy required the development and implementation of a comprehensive, person-centered care plan, which was not adhered to in this case.