Failure to Review and Revise Care Plans Quarterly and With Significant Changes
Penalty
Summary
The deficiency involves the facility’s failure to review and revise resident care plans at least quarterly and as needed, as required by its own Care Planning-Interdisciplinary Team policy and federal regulations. The policy, revised in 09/2013, states that assessments are ongoing and care plans must be updated with significant changes, unmet outcomes, readmissions, and at least quarterly with the MDS. Surveyors found multiple examples where this did not occur. One resident with schizophrenia, cognitively intact per a recent quarterly assessment, had a care plan last revised more than a year earlier. Another resident, severely cognitively impaired and admitted to hospice for senile degeneration of the brain, had a care plan last revised over a year prior and with no hospice-related concern documented. The DON, who oversees the MDS coordinator, repeatedly stated they did not know why these care plans had not been updated. Additional residents also had outdated or incomplete care plans despite significant changes in condition or services. One resident with documented poor intake, significant weight loss over several months, dietician interventions including supplements, high-calorie snacks, and an appetite stimulant, and a quarterly assessment noting weight loss, had a care plan last revised months earlier that did not address nutrition or weight loss and still reflected an outdated fluid restriction. Another cognitively intact resident with emphysema and COPD was newly admitted to hospice, but the care plan, last reviewed over a year earlier, did not include hospice services. A further resident on hospice with a prognosis of less than six months had a care plan last revised more than a year earlier and lacking documentation of hospice services or repeated unsafe smoking behaviors, including placing a cigarette in a pocket and later igniting a cigarette while on oxygen, which resulted in a burn treated with Silvadene. The DON acknowledged that care plans were supposed to be updated quarterly and that this had not been done for these residents.
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