Failure to Provide Resident-Centered Activities to Meet Psychosocial Needs
Penalty
Summary
The deficiency involves the facility’s failure to provide an ongoing program of activities designed to meet residents’ interests and their physical, mental, and psychosocial well-being, as required by facility policy. The policy stated that the Life Enhancement/Activity Director would coordinate comprehensive assessments, identify residents’ likes and dislikes, post activity calendars on each unit, and ensure daily documentation of resident participation in activities. Surveyors found that activity calendars were not posted, resident-specific activity interests were not consistently identified or documented, and daily participation records were incomplete or missing. Staff interviews revealed that CNAs and nurses did not know where to find information on residents’ preferred activities and had not been educated on those preferences. For one resident with schizophrenia, anxiety, and bipolar disorder, who was documented as cognitively intact and had a legal guardian, the care plan referenced behavior problems and risk for anxiety, with instructions for staff to provide a program of activities of interest and to offer activities to prevent boredom and provide healthy outlets for energy. However, the care plan did not specify which activities the resident enjoyed. The resident had been sent to the ER after expressing suicidal and self-harm threats; the facility’s investigation documented that the resident later stated he was bored and wanted to get out of the building, and the conclusion of the investigation was that the resident was not engaged in meaningful activities. The resident reported hearing voices telling him to do something bad to himself and stated he would have liked to do something besides coloring or bingo and to do something outside the building. Multiple staff, including CNAs, an LPN, the SSD, and the Activity Director, acknowledged that there were limited activities, especially at night and on weekends, and that the resident had not been specifically asked what types of activities he would like. For another resident with psychosis and bipolar disorder, who had a legal guardian and a BIMS score indicating moderate cognitive impairment, the care plan stated that staff should offer activities to prevent boredom, ensure activities were compatible with the resident’s capabilities and interests, adapt activities as needed, and invite the resident to scheduled activities. The care plan did not identify specific activities of interest. A PASRR Level II evaluation required provision of a structured environment and a schedule of daily tasks or activities. The resident reported that there was nothing to do, that staff had never asked what activities he would like, that he preferred 1:1 activities rather than large noisy groups, and that he wanted more than bingo and more activities on weekends. Activity documentation showed the resident attended activities on only two dates over more than two months, with no documented participation after the second date. The Activity Director stated not knowing what the resident liked to do and admitted not always documenting attendance. Overall, interviews with the Activity Director, Administrator, DON, and other staff confirmed that residents were not consistently assessed for activity preferences, calendars were not consistently posted, and there were few structured activities in the evenings and on weekends, contributing to residents’ reports of boredom and lack of engagement.
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