Failure to Care Plan Behavioral Symptoms and Hygiene Refusals
Penalty
Summary
The deficiency involves the facility’s failure to develop and implement a comprehensive care plan with measurable interventions addressing behavioral symptoms for a resident with dementia and depression. On observation, the resident was noted sitting in a chair beside the bed with a strong urine odor in the room. The admission form documented diagnoses of dementia and depression, and a quarterly assessment showed the resident was moderately impaired in cognition with a BIMS score of 11. Despite this, the care plan dated 05/28/25 did not include interventions for behaviors, including agitation and refusal of showers. Behavior documentation dated 02/26/26 described the resident as aggressive when asked about showers, with behavior worsening when asked to get up from sleep. The note indicated non-pharmacological attempts such as explaining the importance of a shower, but listed no results or interventions to prevent recurrence, and showed that the physician and family were not notified. Multiple CNAs and an LPN reported that the resident frequently refused showers, became agitated or hateful when asked, sometimes would not get out of bed or allow staff to change briefs, and that refusals were reported to the charge nurse and documented in progress notes. The MDS coordinator acknowledged that the resident’s agitation and refusal of showers were not reflected in the care plan and stated that these behaviors should have been care planned.
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