Failure to Provide Appropriate Dementia Care and Behavioral Interventions
Penalty
Summary
The facility failed to provide appropriate treatment and services to a resident diagnosed with dementia, resulting in the resident not attaining or maintaining their highest practicable physical, mental, and psychosocial well-being. The resident, who had a history of vascular dementia with mood disturbance, recurrent depressive disorder, generalized anxiety disorder, and impulse disorder, frequently refused care, including showers and laboratory tests, and exhibited physically and verbally aggressive behaviors toward staff and other residents. Despite these ongoing behaviors, the facility did not adequately address the resident's customary routines, preferences, or choices, nor did it implement or document effective non-pharmacological interventions to manage the resident's dementia-related behaviors. The resident was observed propelling himself in a wheelchair throughout the facility, entering other residents' rooms, and becoming aggressive when redirected. On one occasion, the resident entered another resident's room, punched the resident in the arm, and attempted to strike her after being told he was in the wrong room. Staff interviews and record reviews revealed that the care plan did not reflect the need for close supervision, redirection, or specific interventions to prevent such incidents. Documentation was lacking regarding the identification and monitoring of behavioral triggers, the use of non-pharmacological interventions, and the effectiveness of care plan strategies. The care plan also failed to address the resident's preference for solitude and his tendency to become anxious and agitated around others. Additionally, the facility's documentation practices were insufficient, as the Treatment Administration Records did not record specific behaviors, non-pharmacological interventions, or the resident's aggressive episodes. Staff were unable to provide evidence of in-service training on dementia care and behavior management, and there was no clear process for communicating care plan changes to staff. The lack of comprehensive and updated care planning, documentation, and staff training contributed to the facility's failure to provide appropriate dementia care and to prevent further incidents of aggression and behavioral disturbances.