Failure to Provide Adequate Behavioral Health Services and Supervision for Resident With PICA
Penalty
Summary
The deficiency involves the facility’s failure to provide person-centered, interdisciplinary behavioral health services and appropriate supervision to a resident with significant psychiatric and cognitive impairments and known PICA behaviors. The resident was admitted with diagnoses including brief psychotic disorder, other specified eating disorder, delusional disorders, depression, malnutrition, and a psychotic disorder, and had a BIMS score of 3 indicating severe cognitive impairment. The care plan identified risks for psychosocial issues, physical and verbal aggression, wandering, PICA behavior (including eating cigarette butts, plastic, Styrofoam, and pages from books), chronic pain, and the need for psychotropic medications, as well as the need for 1:1 supervision and supervised smoking due to unsafe habits. Despite these identified risks, behavior tracking records from September through December documented repeated episodes where the resident attempted to ingest non-food items on numerous dates, yet there were no corresponding detailed notes describing the specific behaviors or circumstances. Progress notes show that on one occasion the resident had three loose stools and was reported to be putting the stool in her mouth, and on another occasion the resident was found rummaging through a desk drawer behind the nurse’s station, where she located a package of cigarettes and bit into one before staff intervened. Another progress note documents that the resident was inappropriately handling her own bowel movement during a night shift bed check, and this was reported to nursing and the NP. Interviews revealed discrepancies between staff perceptions and the documented behavior tracking. The administrator and DON stated the resident was not on 1:1 supervision from mid-September to early December because they believed she was not exhibiting PICA behaviors and was instead on 15-minute safety checks. However, the CNA reported that when she marked “yes” for putting non-food items in the resident’s mouth, the behavior was occurring and that the resident would put anything she could get her hands on into her mouth, including hair, hair ties, cigarettes, paper towels, and toilet paper. The NP stated she was not informed of the PICA behaviors or feces ingestion until December and that she had not received earlier reports. The DON stated she reviewed behavior tracking and progress notes every 72 hours and discussed results in IDT, but also stated the resident was not having PICA behaviors during the period when behavior tracking showed repeated entries for putting non-food items in the resident’s mouth. The facility’s Behavior Management Policy requires monitoring for behavioral changes and appropriate interventions, but the lack of detailed documentation and communication about the resident’s ongoing PICA behaviors and ingestion of feces led to a failure to provide necessary behavioral health services and appropriate supervision.
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