Failure to Develop and Implement Comprehensive Care Plans for Behavior, ADLs, Communication, Oral Care, and ROM
Penalty
Summary
The deficiency involves the facility’s failure to develop and implement comprehensive, person-centered care plans with measurable objectives and timetables for multiple residents. One resident with paranoid schizophrenia and bipolar disorder had a behavior management care plan that included one-on-one precautions, but during an observation the staff member assigned to provide continuous supervision was found asleep in a chair and did not respond when his name was called three times. The resident, who was cognitively intact, stated that the person in the chair was supposed to be watching him, indicating that the one-on-one supervision intervention was not being carried out as planned. Another cognitively intact resident with a history of CVA with left-sided weakness/hemiplegia, right hand contracture, incontinence, liver and colon cancer, and Crohn’s disease had a care plan requiring assistance with ADLs, including showers every other day and as needed. The resident reported not receiving a scheduled shower, wearing the same clothes for four days, and not having her hair combed since two days before Thanksgiving. Observations confirmed that her hair was disheveled and unkempt and that her gown had dried liquid stains, demonstrating that the ADL care plan, including grooming and hair care associated with showering, was not implemented as written. The facility also failed to develop and implement appropriate care plans for communication, oral care, and ROM. A cognitively intact resident whose preferred language was Spanish and who did not speak English had no care plan addressing his language or communication barrier, despite using a phone translator to communicate with staff. Another resident, dependent on staff for oral hygiene and receiving nutrition via PEG tube due to dysphagia, was observed with a yellowish-tan substance along the gum line and between the teeth and reported that staff did not brush his teeth, contrary to his care plan specifying daily and PRN oral care. A further resident with type 2 diabetes and hand contractures had a care plan calling for nail care by a nurse and ROM to upper and lower extremities with AM and PM care, yet was observed with contracted hands, no positioning devices, and fingernails approximately one inch long; a CNA confirmed that no ROM was being performed on the hands and that nails had not been trimmed, indicating the ROM and nail care interventions were not implemented.
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