Failure to Develop Person-Centered Care Plan for Resident Hand-Rubbing Behavior
Penalty
Summary
Surveyors identified a deficiency in the facility’s failure to develop a comprehensive, person-centered care plan addressing a resident’s known behavior of tightly holding and rubbing her hands when upset. The resident was admitted with Parkinson’s disease and an anxiety disorder, and staff interviews revealed that she had a tendency to tightly hold and rub her hands when distressed or when spoken to. The DON demonstrated this behavior and acknowledged that there was no documentation or care plan reflecting it. The facility’s own policy on comprehensive, person-centered care plans requires the IDT, in conjunction with the resident and/or representative, to develop a care plan that describes services to attain or maintain the resident’s highest practicable physical, mental, and psychosocial well-being. The deficiency came to light after the resident complained about a CNA and was observed with a quarter-sized, dark purplish discoloration on the top of her right hand between the forefinger and thumb. LN 1 and the ADON both observed this discoloration and confirmed the resident had reported the issue to the ADON. Despite these observations and the known behavior of the resident squeezing and rubbing her hands when upset, there was no corresponding care plan or documentation to guide staff in monitoring or managing this behavior. In a subsequent interview, the DON stated there should have been a care plan regarding the resident squeezing her hand when upset or when spoken to and that it was important to have a care plan to observe and monitor the resident, confirming that the required person-centered care planning had not been completed for this need.
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