Failure to Provide Individualized Behavioral Health Interventions and Hygiene Care
Penalty
Summary
The deficiency involves the facility’s failure to provide necessary behavioral health care and services, including individualized behavioral interventions, for a resident with significant behavioral-emotional issues. Surveyors repeatedly observed the resident and her room with a very strong odor of urine on multiple days and at various times, including in her room and in the dining room. The resident was also observed hoarding paper towels from a dispenser in the dining room, folding them, and placing them under her arm while staff present did not intervene. Over several days, the resident was seen wearing the same ill-fitting, oversized clothing that dragged on the ground, hung off her buttocks, and became visibly stained, with a strong urine odor detectable from several feet away. Record review showed the resident had diagnoses including Alzheimer’s disease, dementia, generalized anxiety, and schizophrenia, with a recent MDS indicating moderate cognitive impairment, occasional bladder incontinence, and a need for assistance or supervision with toileting, personal hygiene, dressing, and showering. A nurse practitioner note documented that the resident was co-managed with psychiatry, was not taking medications for schizophrenia, and was receiving supportive care only due to non-compliance related to psychosis. The resident’s care plans listed multiple behavioral concerns such as difficulty adjusting to changes, self-hitting while talking to imaginary persons, refusing showers and facial hair trimming, rummaging through others’ belongings, refusing assessments, refusing to wear incontinence briefs and using textured bath towels instead, carrying plastic bags with belongings, and episodes of verbal and combative agitation. However, the care plans lacked personalized interventions specifically aimed at preventing or managing these behavioral issues. Interviews further demonstrated a lack of coordinated behavioral health intervention and documentation. The resident’s guardian reported that the resident would not use the toilet, instead stacking towels under herself to urinate on, and stated that the facility allowed these behaviors to continue without doing anything for her situation or discussing her behavioral health. The guardian also reported not being contacted by the psychiatric NP about the resident’s behavioral issues and being told that nothing could be done because the resident would not take medication. The floating SSD acknowledged that refusals to change clothing and shower should have been charted as behaviors and became tearful after noting the strong urine odor in the resident’s room. Nursing staff stated they tried different staff and times to approach the resident but acknowledged that care plan interventions were not specific to her needs. The psychiatric NP reported not being informed of behavioral complaints, refusals of care, or documented behaviors, and the Executive Director stated that the resident had rights, had refused clothing changes, and was content and at baseline. When requested, the facility did not provide a behavioral health program policy prior to survey exit.
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