Failure to Care Plan for Resident’s Refusal of Personal Care and Meals
Penalty
Summary
Surveyors identified a failure to develop and implement care plan interventions for a male resident with dementia, protein calorie malnutrition, depression, anxiety disorder, and anorexia who was admitted on 10/21/2024 and was known to refuse personal care and meals. On multiple observations in early January 2026, the resident was found lying in bed wearing a gown, with extremely oily hair and a thick layer of white flakes on the front of his shirt, which a CNA identified as likely dandruff. A CNA reported she had not seen the resident shower during her three months of employment, and an LPN stated the resident consistently refused showers. Review of point-of-care bathing documentation from 12/10/2025 to 01/06/2026 showed missing bathing information on most days and only two refusals documented. Despite this pattern, the resident’s current care plan did not include any interventions addressing refusal of bathing or showering. The resident was also observed repeatedly refusing or minimally consuming meals. On one occasion, he did not eat his lunch and stated he might eat later, but his tray was removed with most of the meal untouched, and the CNA did not offer alternative choices, explaining that he was a picky eater with a poor appetite and usually asked if he wanted something different. On another observation, the resident ate only a piece of bread and declined the rest of a full meal; his tray was again removed by a CNA without offering alternative foods or providing cueing or prompting, with the CNA stating he did not eat much and mainly drank fluids. The resident’s nutritional risk assessment documented that he was underweight with increased nutritional needs and would benefit from gradual weight gain, and the dietitian’s notes indicated he was at high risk for malnutrition, averaging 50–75% meal intake with 25% of the time less than 50% intake. Nonetheless, his care plan did not include interventions for refusing meals, despite facility leadership acknowledging that refusals of bathing, grooming, and meals should be care planned with personalized interventions, as required by the facility’s Care Planning Policy.
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