Involuntary Seclusion of Resident During Meals Due to Behavioral Issues
Penalty
Summary
A deficiency occurred when a resident was involuntarily secluded from other residents during meal times. The resident, who is cognitively intact with a BIMS score of 15 and has diagnoses including lymphedema, dementia with agitation, depression, epilepsy, type 2 diabetes, and asthma, was observed eating alone at a table facing the wall in the day room, away from other residents. The resident reported being told by the administrator that they had to eat alone in the day room to avoid disturbing others, and expressed feeling like a child being chastised, preferring to eat in the dining room instead. Staff interviews revealed that the resident had a history of outbursts and causing disturbances in the dining room, leading to the decision to move the resident to a separate room for meals. The administrator and nursing staff acknowledged that the resident was disruptive during meal times and stated that the move was intended to find a compromise for all involved. However, the action resulted in the resident being separated from others without their consent, constituting involuntary seclusion.
Removal Plan
- The DON and Care plan coordinator met with resident #1 and advised her that she would be offered 3 locations for her meals: main dining room, smaller dining room, or her room.
- An alert has been added to the EMR for resident #1 that she will be able to choose where she would like to take meals.
- Staff will ask resident #1 prior to each meal where she would like her meal served.
- Care plan will be updated to reflect that resident is able to choose her dining locations.
- Resident #1's dietary card has been updated to reflect that meals may be taken at the location of resident's choice.
- Facility will not ask any other resident to receive meals in the small dining room unless the resident requests to do so.
- The facility has reviewed all current residents and no other residents were identified as being secluded in any manner.
- In the future, the facility will not seclude a resident exhibiting behavior problems that may be detrimental to other residents.
- If resident #1 or any other resident exhibits disruptive behaviors, staff will attempt to de-escalate the situation.
- If a resident is removed from an area, a staff member will remain with them until behaviors have resolved.
- All nursing staff will receive in-service training on the above.
- If any nursing staff is unable to be present in person, they will receive in-service via phone.