Failure to Care Plan Psychosocial Needs After Verbal Abuse by Family Representative
Penalty
Summary
The deficiency involves the facility’s failure to develop and implement a comprehensive, person-centered care plan to assess and maintain the psychosocial well-being of a resident following an incident of verbal abuse by the resident’s family representative. The resident had a severely impaired cognitive status, with a BIMS score of 3/15, and required total assistance with food and fluid intake, with encouragement to self-feed with the left hand. The resident’s physician orders included a pureed diet with mildly thick liquids and 1:1 feeding. On the date of the incident, an acute change in mental status event record documented that the resident was seen tearing up around 6 p.m. while the family representative repeatedly yelled at the resident, expressing frustration that the resident could not feed herself, insisting she use her arms, and stating he was tired of helping her, before storming out of the room visibly angered. The acute change in mental status documentation indicated that the care plan was not reviewed. The DON stated that no care plan was initiated after the verbal abuse was observed because the abuse was not committed by staff or another resident, and acknowledged that there should have been a care plan initiated after the incident to serve as a blueprint for the resident’s care. Although the facility’s policy on the Interdisciplinary Team/Care Plan Process requires that an IDT develop and maintain a comprehensive care plan incorporating identified problem areas, risk factors, and changes in medical condition, the resident’s care plan addressing psychosocial well-being did not start until a later date and only generally stated that the resident had potential for psychosocial issues due to living in the facility. The record review and interviews showed that, despite documented emotional distress and verbal abuse, the facility did not review or revise the care plan at the time of the incident to address the resident’s psychosocial needs related to the event.
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