Failure to Provide Ongoing, Individualized Activities Program for a Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide an ongoing program of activities designed to meet the interests and physical, mental, and psychosocial well-being of a resident. The resident was admitted with COPD, unspecified dementia of moderate severity, bipolar disorder, anxiety, and was receiving scheduled antipsychotic and psychotropic medications. The comprehensive care plan identified that the resident participated in activities such as bingo and ice cream socials, and included interventions such as inviting the resident to scheduled activities, providing a monthly activities calendar, and establishing and recording prior activity involvement and interests. Additional care plan focuses included elopement risk/wandering, with interventions such as structured activities (toileting, walking inside and outside, reorientation strategies), and psychotropic medication use with non-pharmacological interventions including back rubs, redirection, calm approach, repositioning, providing a quiet environment, and taking the resident to activities. Review of the most recent quarterly MDS showed the resident had a BIMS score of 9 (moderate cognitive impairment) and a Resident Mood Interview score of 13, indicating moderate depression and that the resident sometimes felt socially isolated. The MDS also documented that the resident required maximum assistance with toileting, bathing, and transfers. Review of the social activity task log for a 30-day period showed the resident participated in activities on only two days. Paper activity participation logs for two consecutive months showed the resident had no documented attendance for one month and only one documented activity for the prior month. Activity calendars for both the secured and non-secured units listed only a limited set of group activities (bingo, coffee social, woodworking, table games, open activities) and were identical for both units, without individualized or unit-specific programming for residents on the secured unit. Multiple observations showed a lack of structured or documented activities and minimal staff engagement. The resident was observed alone in a hallway in a wheelchair with no staff nearby while other residents sat in a common area with a loud television and some staring at the wall. During a scheduled ice cream social, no activities were occurring and the resident was not present in the common area. On another occasion, several residents were in the common area while staff sat in a secluded nursing desk area conversing, with the television on but no staff interaction, structured activities, or resident socialization observed; later, the resident was found in bed with covers drawn and lights off. The Activity Director reported having only one light-duty CNA to assist on limited days, no activities staff on weekends, and reliance on CNAs to provide activities when they had time, without consistent documentation of refusals or non-applicability. CNAs confirmed there was no set time for activities on the secured unit, that they provided activities only if time allowed, and that they did not document these activities. The facility’s policy stated that residents have the right to choose activities and that reasons for inability to participate should be documented in the medical record, but such documentation was not described in the findings.
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