F0656

D

Non-individualized Care Plan for Resident With Liver Disease and Alcohol Dependence

Olympia, Washington Survey Completed on 03-02-2026

Penalty

No penalty information released

Summary

Surveyors identified a failure to develop a comprehensive, person-centered care plan for one resident with alcoholic cirrhosis, esophageal varices, and alcohol dependence. The resident’s quarterly MDS showed no cognitive impairment and partial to moderate dependence for ADLs. The existing care plan, initiated on 10/24/2025, addressed cirrhosis only generally by directing staff to monitor for yellowing of the eyes/skin, abdominal ascites, and changes in mental status, and to obtain labs and diagnostics as ordered. A subsequent care plan entry dated 12/13/2025 instructed staff to monitor for alcohol withdrawal and check vitals as needed. The care plan did not include more specific interventions such as monitoring daily weights, monitoring abdominal girth, or addressing medications used to manage the resident’s liver disease and alcohol dependence.

During interview, the resident reported that staff did not always understand the tasks needed to manage liver disease and alcohol dependence and stated, "I don't think they understand liver disease." The resident described inconsistent performance of key tasks, including obtaining weights and vitals, passing medications on time or at all, drawing laboratory samples correctly, and applying prescribed skin creams, all of which the resident identified as part of managing her condition. The resident felt the care plan lacked the detail staff needed to care for her health conditions. A nursing assistant reported that staff had inconsistent assignments and therefore did not always know if the resident needed vitals or weights and that staff did not always know residents well. The DON acknowledged that the resident’s care plan should be more personalized to address the resident’s health conditions.