Failure to Care Plan Resident’s Refusal of Restorative Nursing Services
Penalty
Summary
The deficiency involves the facility’s failure to develop and implement a comprehensive, person-centered care plan to address a resident’s refusal of Restorative Nursing Assistance (RNA) services. The resident was admitted with diagnoses including unspecified acute kidney failure, difficulty in walking, and generalized weakness. A History and Physical and a Minimum Data Set assessment documented that the resident had intact cognitive skills and the capacity to understand and make decisions, and required moderate assistance for transfers and walking. An order was in place for RNA ambulation with a front wheeled walker five times per week. Record review of the resident’s Documentation Survey Report for December showed that on two consecutive days, RNA for ambulation with a front wheeled walker was documented as “not applicable.” One RNA staff member stated that “NA” is used when a resident is in the hospital or not in the facility. However, another RNA staff member reported that on those same two days the resident was present, refused RNA while waiting to be discharged, and that the resident refused RNA three times on one of those days. This RNA staff member acknowledged that no RNA was provided on those days and that the refusals were not reported to the Charge Nurse as required. The DON stated that when a resident refuses RNA services three times, the RNA staff should report this to the Charge Nurse so the Charge Nurse can speak with the resident, determine the reason for refusal, and encourage participation. The DON further stated that a care plan should have been developed to address the resident’s refusal of RNA services, and acknowledged that nurses did not have a guide on how to proceed with the plan of care for this refusal. The facility’s policy on Comprehensive Person-Centered Care Plans requires development and implementation of a comprehensive, person-centered care plan with measurable objectives and timeframes, including services not provided due to the resident’s exercise of the right to refuse treatment, and specifies that assessments are ongoing and care plans are revised as residents’ conditions change. This was not done for the resident’s RNA refusals.
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