Failure to Develop and Implement Comprehensive Care Plan for Geri Chair Use
Penalty
Summary
The facility failed to develop and implement a comprehensive, person-centered care plan with measurable objectives and timeframes for a resident who required the use of a Geri chair for mobility. Despite multiple observations of the resident using a Geri chair throughout the facility, the care plan did not include any documented focus, goals, or interventions related to the use of this equipment. The resident's electronic records indicated significant medical needs, including nontraumatic intracranial hemorrhage, right side hemiplegia, muscle weakness, and severe cognitive impairment, all of which necessitated specialized mobility support. Interviews with facility staff, including the Director of Rehab, Regional Nurse Consultant, LVN, MDS Coordinator, and DON, confirmed that the resident regularly used a Geri chair due to poor trunk control and a history of falls from bed and wheelchair. Staff acknowledged that the Geri chair was essential for the resident's mobility and safety, and that its use should have been included in the care plan. The Director of Rehab noted that attempts to use a standard wheelchair were unsuccessful due to the resident's physical limitations, and the Regional Nurse Consultant stated that Geri chairs should be care planned as part of the resident's mobility needs. The facility's own policy required the development and implementation of a comprehensive, person-centered care plan for each resident, including measurable objectives and timeframes to address identified needs. However, the care plan for this resident did not reflect the use of the Geri chair, and staff interviews revealed a lack of clarity regarding responsibility for updating care plans. This omission could result in staff not being aware of the resident's mobility needs and the equipment required for their care.