Failure to Timely Update Care Plan for Resident with Combative Behaviors
Penalty
Summary
The facility failed to develop and implement a comprehensive, person-centered care plan for a resident with severe cognitive impairment and a history of combative and resistant behaviors during care. Despite multiple documented incidents where the resident refused care, became aggressive, scratched, hit, and bit staff, and engaged in self-injurious behaviors, the care plan did not include specific focus areas or interventions addressing these behaviors. Progress notes and interviews confirmed repeated episodes of aggression and resistance, including refusal of showers, combative actions during nail care, and self-inflicted injuries, yet these issues were not incorporated into the resident's care plan in a timely manner. Staff interviews revealed that the care plan was not updated to reflect the resident's behavioral challenges until after several incidents had occurred. The social worker and MDS coordinator acknowledged that the care plan should have been revised to include interventions for resistance to care and combative behaviors, but this was delayed due to workload and oversight. The director of nursing also confirmed that the care plan should have been updated following a significant incident where the resident became combative and injured herself during nail care. The facility's own policy requires that comprehensive, person-centered care plans be developed and revised as residents' conditions change, incorporating identified problem areas and associated risk factors. However, the care plan for this resident did not meet these requirements, as it lacked measurable objectives, timeframes, and interventions to address the resident's medical, nursing, and psychosocial needs related to her aggressive and resistant behaviors.