Failure to Provide Trauma-Informed, Culturally Competent Care for a Resident With Severe Cognitive Impairment
Penalty
Summary
The deficiency involves the facility’s failure to provide trauma-informed, culturally competent care to a resident with a known history of trauma and severe cognitive impairment. The resident was an elderly male with dementia and altered mental status, with a Brief Interview for Mental Status (BIMS) score of 3 indicating severe cognitive impairment. His Minimum Data Set (MDS) assessment documented that he felt down, depressed, or hopeless nearly every day and that he was receiving an antidepressant. Despite these indicators of psychological vulnerability, review of his electronic medical record showed that no trauma screening assessment had been completed, and his care plan contained no focus area or interventions related to trauma history, behaviors, or triggers. Nursing and social services documentation reflected ongoing behavioral and psychological concerns that were not incorporated into the care plan. A nursing progress note described the resident making inappropriate verbal comments after medication administration and an episode where he accused a nurse of withholding medications, ranted at her, and threw a medication cup against the wall after taking his medication. A social services note documented that the resident believed other residents were out to get him, thought someone had a gun and was following him, and accused staff of showing him naked elderly women. The note indicated that he truly believed these allegations, that a psychologist had been notified, and that he refused to speak with the psychologist and was mean to her. None of these behaviors, beliefs, or potential triggers were reflected in the resident’s care plan. During interviews, the resident reported multiple distressing experiences and allegations involving his former roommate and various staff members, including threats from the roommate, seeing another resident unclothed, being pushed on the bed by an LVN, having his walker kicked by a male staff member, and having a male staff member run a finger across his back and put a finger in his ear. He also reported a background as an assistant warden in a prison and expressed strong feelings about men who hurt or kill women and children. The Social Services Director identified his family member as a trigger, described family conflict and restrictions on his visiting another family member before her death, and noted that the former roommate was large, bossy, and that the resident feared people having guns and believed the roommate had a gun. The Social Services Director, MDS Coordinators, and DON all stated that resident behaviors, fears, and triggers should be on the care plan so staff would know how to respond and monitor progress, and the DON specifically stated that this resident’s history of making allegations, fears, and triggers should absolutely be in his care plan. Despite this, the resident’s care plan and Kardex did not contain trauma history, behaviors, or triggers, and no trauma screening was present in the record, resulting in a failure to provide trauma-informed care in accordance with professional standards and the facility’s own care planning policy.
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