Failure to Update Behavioral Care Plans and Conduct Timely Quarterly Reviews
Penalty
Summary
The deficiency involves the facility’s failure to develop, update, and revise comprehensive, individualized care plans to address residents’ aggressive and behavioral symptoms, and to review and update care plans at least quarterly in conjunction with the MDS. Facility policy required an individualized comprehensive care plan with measurable goals and time frames, ongoing assessment with revisions as changes occur, and periodic review and updating by the interdisciplinary team when significant changes or other care-impacting changes occur. Despite this, three residents with severe cognitive impairment had documented aggressive or disruptive behaviors that were not reflected in their care plans, and two residents’ care plans were not updated on a quarterly basis as required. One resident, assessed on a quarterly MDS as severely cognitively impaired and without physical behavioral symptoms toward others during the look-back period, had no care plan directions or interventions for aggressive behaviors despite three documented altercations with other residents, including threats with a knife and hitting and slapping peers. A second resident, also severely cognitively impaired and assessed on a quarterly MDS as not exhibiting physical behavioral symptoms toward others, had no care plan guidance for aggressive behavior after kicking another resident in the dining room, and the care plan was not updated quarterly. A third severely cognitively impaired resident had a care plan listing multiple behaviors such as attempting to hit peers and staff, rummaging, making sexual comments, shouting, and refusing care, but no new intervention was added after an altercation involving yelling and cursing at another resident. In interviews, an LPN, the DON, and the MDS Coordinator each stated that new interventions should be added after behavioral incidents and that care plans should be updated quarterly, annually, and after significant changes, but acknowledged that care plans were not consistently updated, in part because the MDS Coordinator was the only person revising care plans and had been out sick for an extended period.
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