F0656

D

Failure to Care Plan Droplet Precautions and UTI Interventions for a Cognitively Impaired Resident

Waco, Texas Survey Completed on 02-06-2026

Penalty

No penalty information released

Summary

Surveyors identified a deficiency in the facility’s failure to develop and implement a comprehensive, person-centered care plan with measurable objectives and timeframes for a resident with multiple acute and chronic conditions. The resident was an elderly female with diagnoses including Alzheimer’s disease, anemia, osteoporosis, influenza, and a urinary tract infection (UTI). A Quarterly MDS assessment documented that she was severely cognitively impaired with a BIMS score of 00, required supervision or touching assistance with eating, was dependent for toileting, needed substantial to maximum assistance with showering and personal hygiene, and was always incontinent of bowel and bladder. Physician’s orders dated 01/30/26 showed that the resident was on antibiotic therapy for UTI/flu, was receiving levofloxacin 750 mg orally with an end date of 02/06/26, and was ordered to be on droplet isolation with specific PPE and equipment handling requirements.

Record review showed that the resident’s care plan dated 01/31/26 addressed Influenza A with a goal that the resident would be free from signs and symptoms of dehydration, and included interventions such as encouraging fluid intake, offering favorite beverages, administering antipyretics and analgesics as ordered, and monitoring for side effects and signs of dehydration. However, despite the physician’s order for droplet isolation, the comprehensive care plan did not include that the resident was on droplet precautions. Additionally, a care plan dated 02/04/26 documented that the resident had a UTI with a goal that the infection would resolve without complications by the review date, but this UTI care plan contained no interventions. Observations on 02/04/26 confirmed that droplet precaution signage and a PPE cart were present outside the resident’s room, and the resident was observed sitting in a wheelchair in her room, pleasantly confused, clean, groomed, and with her call light in reach.

Interviews with facility staff further clarified the deficiency. The MDS nurse stated she was responsible for care plans, had been trained on completing them, and that droplet precautions should be care planned; she believed she had care planned droplet precautions for this resident but was not aware they were missing, and she also was not aware that no interventions had been added for the UTI care plan. The DON confirmed that she, the MDS nurse, the ADON, and the care plan nurse were responsible for completing care plans, that staff were regularly in-serviced on following care plans, and that droplet precautions should be part of a resident’s care plan when applicable. She acknowledged that she had care planned the resident for the flu but failed to include droplet precautions, and that she had entered the UTI care plan but had not added interventions. Multiple CNAs and LVNs reported they had been in-serviced on following residents’ care plans, knew where to find them in the electronic record, and relied on them to provide care. The facility’s written policy on comprehensive person-centered care plans required measurable objectives, timeframes, and interventions derived from comprehensive assessment data, and stated that care plans must be revised as residents’ conditions change, which was not fully carried out for this resident’s droplet precautions and UTI.

The facility’s own policy, revised in March 2022, specified that the IDT, in conjunction with the resident and representative, must develop and implement a comprehensive, person-centered care plan that includes measurable objectives and timetables to meet physical, psychosocial, and functional needs. It further required that care plan interventions be based on thorough assessment, reflect recognized standards of practice, and be revised as resident conditions change. In this case, despite clear physician orders and observable implementation of droplet precautions at the room level, the omission of droplet precautions from the written care plan and the absence of any documented interventions for the resident’s UTI demonstrated a failure to follow the facility’s own care planning policy and to ensure that all necessary care and services were captured in the comprehensive care plan.