Failure to Involve Cognitively Intact Resident in Room Change and Phone Restriction
Penalty
Summary
The deficiency involves the facility’s failure to ensure a cognitively intact resident was informed of and involved in decisions about his care, specifically a room change to a secured memory care unit and the temporary removal of his cell phone from his possession. Resident B had diagnoses including end stage renal disease, major depressive disorder, bipolar disorder, and anxiety, but his quarterly MDS assessment documented intact cognition. His care plan noted that he enjoyed independent activities, walking, and being outdoors. Despite this, he was moved from his prior location to the secured memory care unit and had his cell phone removed from his possession without his consent. According to the resident’s account, he had gone outside to the front porch for fresh air, as he had done multiple times before, without being aware of any rule requiring him to ask permission. Staff brought him back inside, later placed a monitor on his ankle, and about a week later moved him to the memory care unit and took his phone, all without asking him or obtaining his permission. He reported feeling like he had no freedom, felt like a prisoner, and stated he would prefer to be around higher functioning people. At the time of surveyor observation, he was well groomed and alert and oriented to person, place, time, and situation, and he continued to express that he did not know why he had been placed on the secured unit. Facility documentation showed that staff and the IDT discussed the resident’s exit seeking, impulsive, anxious, pacing, and manic behaviors with his spouse and other family members, and that the family agreed to the room change and to having his cell phone kept at the nurse’s station. However, behavior tracking logs for the months reviewed lacked documentation of exit seeking, impulsive behaviors, anxiousness, pacing, restlessness, or manic behaviors, and progress notes did not document any conversations with the resident about the room move or his permission for removal of his phone. The Social Services Designee confirmed she had not spoken with the resident about the move or his phone and was unsure if any other IDT members had done so, and acknowledged that nursing staff did not document behaviors as they should. The facility’s Resident Rights policy stated that each resident has the right to be treated with dignity and respect, but the record lacked evidence that this resident was informed of or involved in these significant care decisions.
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