Failure to Involve Resident and Representative in Person-Centered Care Planning
Penalty
Summary
The deficiency involves the facility’s failure to provide a resident the opportunity to participate in the development and implementation of a person-centered care plan. The resident had diagnoses of heart failure and respiratory failure, severe cognitive impairment, spoke Hmong, and was dependent for all cares and transfers. Her care plan identified her as a fall risk with a fall mat at the bedside and required assistance with eating, bed mobility, and transfers using two staff and a full body mechanical lift. However, the electronic medical record lacked documentation of any care conference since her admission, despite facility policies and staff statements indicating that care conferences should occur within 5–21 days of admission and then quarterly, with resident and/or representative participation. Surveyors observed the resident seated on the edge of a floor mattress with her breakfast tray placed on the mattress to her left. She was leaning on her left elbow and using her right hand to eat, with food falling onto the mattress as she tried to eat. Nursing assistants reported that the resident frequently crawled off her bed onto the floor mattress and that staff only placed her in a wheelchair when family were present to watch her. They also stated that she received bed baths instead of showers because it would take up to three staff to shower her, and one nursing assistant commented that some cultures, like Hmong, like to be on the floor, and was unsure whether eating on the floor bothered the resident. The social services director, clinical leader/LPN, DON, and administrator each confirmed that care conferences are intended to elicit resident preferences, discuss medications, cares, comfort, complaints, and ensure needs are met, and that such a conference should have been held for this resident within the required timeframe. They acknowledged that no care conference had been held and no documentation could be located. The resident’s family member stated she was never offered a care conference and, while agreeing with the use of a floor mattress for safety, expressed dissatisfaction that the resident was left on the floor mattress for hours, preferred that the resident be offered the toilet or commode, preferred showers instead of bed baths, and stated it was not their culture to eat on the floor. Facility policies on Resident Rights and Care Planning required that residents be informed of and supported in their right to participate in person-centered care planning, including incorporating personal and cultural preferences, which did not occur for this resident.
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