Failure to Honor Resident Preferences, Privacy, and Anxiety Related to Care and Pet Visits
Penalty
Summary
The deficiency involves the facility’s failure to honor resident rights to dignity, preferences, and privacy during care for two residents. One resident, admitted with muscle weakness and osteoarthritis and care planned as dependent for ADLs including rolling in bed, reported that a nursing assistant was rude, did not follow the resident’s expressed preferences for how to be safely rolled, and refused to close the privacy curtain during care. The resident, who had a BIMS score of 11 indicating moderately impaired cognition but was alert and oriented, stated that because the nursing assistant did not follow the resident’s instructions on how to be turned, the resident’s head struck the bed side rail. The DNS’s assessment documented a faint bruise above the resident’s left eyebrow, approximately the size of a quarter, and the MAR showed the resident received acetaminophen for head pain following the incident. The same incident included a failure to provide privacy during personal care. The resident reported that the nursing assistant refused to close the privacy curtain despite the resident’s roommate needing to walk past the bed to access the bathroom. The roommate confirmed being present in the room, hearing the nursing assistant speak rudely to the resident, hearing the resident yell “ouch,” and observing that the privacy curtain remained open while care was being provided. The facility’s own policy on resident rights requires that each resident be treated with respect and dignity and that resident goals, preferences, and choices be incorporated into care, but the DNS could not provide evidence that these rights were protected and promoted for this resident. A second deficiency involved the facility’s handling of a resident’s anxiety and panic related to dogs in a common area. A cognitively intact resident with a BIMS score of 15 reported having extreme anxiety and panic around dogs since childhood. The resident stated that another resident’s wife brought a dog into a common area without prior notice, which caused the resident to panic, and that when the resident requested removal of the dog, the visitor initially did not remove it. The resident further reported that the Director of Social Services told the resident to leave the common area if uncomfortable with the dog and refused to continue the discussion. In an interview, the Director of Social Services confirmed telling the resident to leave the common area because other residents had the right to enjoy the dogs and acknowledged not allowing the conversation to continue. The DNS stated that if only one resident was uncomfortable with a dog, that resident would be removed rather than the dog, and could not provide evidence that the facility protected and promoted this resident’s rights, despite a facility policy requiring that patients be asked if they would like to visit or interact with animals.
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