Failure to Provide Medically Related Social Services and Individualized Behavior Management
Penalty
Summary
The facility failed to provide medically related social services to support the mental and psychosocial health of two residents. One resident with dementia and severe cognitive impairment was subject to a transfer process initiated by the facility's interdisciplinary team due to concerns about his interactions with other residents. The resident's care plan did not include interventions related to wandering or maintaining his safety around other residents who were frustrated by him. Documentation showed no social work interventions, and the resident's representative was not informed of the right to appeal the discharge or that the discharge was voluntary. Staff interviews revealed that interventions to address the resident's behaviors and safety were limited to increased supervision, with no evidence of individualized behavior management or documentation of these actions. Another resident, who was cognitively intact but had a history of borderline intellectual functioning, bipolar disorder, and anxiety, expressed difficulty managing anger and reported making verbal threats toward the first resident. The care plan for this resident included general interventions for suspiciousness and coping but did not address the specific issue of threatening or harassing other residents. Staff interviews indicated that interventions were limited to attempts to keep the residents separated and verbal communication among staff, with no clear documentation or care plan updates regarding these behaviors. During the period in question, the facility did not have a dedicated social worker, and social work responsibilities were handled by nursing staff and a corporate-level social worker who was not involved in the care planning or discharge planning for the affected residents. The lack of social work involvement resulted in insufficient advocacy for residents' rights, inadequate individualized behavior management interventions, and incomplete discharge planning, as evidenced by the absence of documented interventions and care plan updates.