Failure to Address and Care Plan for Repeated Refusals of Hygiene and Nail Care
Penalty
Summary
The facility failed to develop and implement a comprehensive, person-centered care plan addressing a resident's repeated refusals of hygiene and nail care. Record reviews showed that the resident, who had diagnoses including schizoaffective disorder, unspecified dementia, anxiety disorder, and major depressive disorder, consistently refused hygiene care daily over a two-month period and refused nail care on multiple occasions. Hospice aide visit notes also documented refusals of nail care, with notifications made to nursing staff. Despite these ongoing refusals, the resident's care plan did not include any identification of the refusal of care or interventions to address it. Interviews with facility staff, including LPNs and the nurse responsible for MDS and care plan updates, confirmed that the refusals were known and occurred frequently, yet were not reflected in the care plan. The staff acknowledged that the care plan should have included these issues and interventions but did not.