Failure to Protect Bedbound Resident’s Privacy on Memory Care Unit
Penalty
Summary
The facility failed to maintain privacy for a resident with dementia and severe cognitive impairment who was dependent on staff for all ADLs while she was in bed in her room. The resident’s EMR and MDS assessments documented severe cognitive impairment and total dependence for ADLs, and her care plan reflected this dependence. During observation, the resident was resting in bed covered with blankets, with her room door open to the hallway, when another resident wandered into the room and began moving the blankets covering her. A licensed nurse removed the wandering resident from the room after being informed of the incident. Staff interviews revealed that on the memory care unit residents were allowed to wander wherever they wanted, with no boundaries for wandering, including going into and out of other residents’ rooms, despite a facility policy stating that resident dignity and privacy are to be respected. This failure to provide privacy occurred in the context of a memory care unit practice that permitted unrestricted wandering into other residents’ rooms, including the room of a cognitively impaired, fully dependent resident who was in bed at the time.
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