Failure to Provide Resident-Centered Activities for Cognitively Impaired Resident
Penalty
Summary
The facility failed to provide resident-centered activities designed to support the leisure needs of a resident with severe cognitive and visual impairments. The resident, who had diagnoses including vascular dementia with behavioral disturbances, adjustment disorder, and sequelae of cerebral infarction, was assessed as severely cognitively impaired and highly visually impaired. Documentation indicated that the resident was dependent on staff for mobility and unable to participate in traditional leisure activities due to these deficits. Despite this, the activity attendance log showed minimal participation in sensory stimulation and inaccurately documented independent engagement in activities such as religious study and jigsaw puzzles, which the resident's durable power of attorney (DPOA) and staff interviews confirmed were not possible due to the resident's limitations and lack of interest. Interviews with the DPOA revealed that staff never consulted her regarding the resident's past leisure interests, and she stated the resident could not accurately express his preferences. The DPOA also reported that the resident could not engage in activities like reading, puzzles, or watching television, and that religion was not important to him, contradicting the activity records. Staff interviews further confirmed that the resident required one-on-one assistance for any leisure activity and was rarely observed participating in any activities. The activity assistant reported not being informed of the resident's preferences and resorted to placing various supplies in front of the resident to gauge interest, but noted the resident appeared emotionally distressed and unable to participate in group activities. Additional interviews with facility staff, including the activity director and former social services director, highlighted concerns about the quality and quantity of individualized activities offered in the memory care unit. The activity director acknowledged that documentation of self-propelling a wheelchair or looking out the window was inaccurately recorded as leisure activity participation. The nursing home administrator confirmed awareness of the need for more individualized activities in the memory care setting, as current practices did not adequately address the resident's needs for meaningful engagement.