|§483.21(b) Comprehensive Care Plans|
§483.21(b)(1) The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at §483.10(c)(2) and §483.10(c)(3), that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following -
(i) The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required under §483.24, §483.25 or §483.40; and
(ii) Any services that would otherwise be required under §483.24, §483.25 or §483.40 but are not provided due to the resident's exercise of rights under §483.10, including the right to refuse treatment under §483.10(c)(6).
(iii) Any specialized services or specialized rehabilitative services the nursing facility will provide as a result of PASARR recommendations. If a facility disagrees with the findings of the PASARR, it must indicate its rationale in the resident's medical record.
(iv)In consultation with the resident and the resident's representative(s)-
(A) The resident's goals for admission and desired outcomes.
(B) The resident's preference and potential for future discharge. Facilities must document whether the resident's desire to return to the community was assessed and any referrals to local contact agencies and/or other appropriate entities, for this purpose.
(C) Discharge plans in the comprehensive care plan, as appropriate, in accordance with the requirements set forth in paragraph (c) of this section.
Based on clinical record review and staff interview, it was determined the facility failed to develop a comprehensive person-centered care plan to address one resident's inappropriate sexual behavior (Resident 41) and a resident requiring protection from another resident's behavioral symptoms (Resident 26) for two of 28 sampled residents.
A review of the clinical record revealed that Resident 26 was admitted to the facility on May 21, 2016, with diagnoses which include heart failure, dementia (a condition in which a person loses the ability to think, remember, learn, make decisions, and solve problems) without behavioral disturbance, anxiety and Alzheimer's disease (decline in brain function which causes memory loss and causes brain tissue to breakdown).
A quarterly MDS Assessment (minimum data set- a federally mandated standardized assessment conducted at specific intervals to plan resident care) dated February 16, 2019, indicated that the resident was moderately cognitively impaired with a BIMS score of 10 (brief interview for mental status, a tool to assess the resident's attention, orientation and ability to register and recall new information, a score of 8-12 equates to being moderately cognitively impaired).
Clinical record review revealed that Resident 41 was admitted to the facility on July 25, 2018 with diagnoses, which included encephalopathy (a disease in which some functioning of the brain is affected by some agent or condition) and bipolar disease (a serious mental illness characterized by extreme mood swings, a mood disorder that causes radical emotional changes and mood swings and personal history of other mental and behavioral issues). A quarterly MDS Assessment dated February 1, 2019, indicated that the resident was moderately cognitively impaired with a BIMS score of 11.
Nursing documentation dated May 3, 2019, at 4:38 PM revealed that Resident 41 "pecked" Resident 26 on the lips. The facility implemented direct observation of Resident 41.
Nursing documentation dated May 5, 2019 at 6:15 PM revealed that Resident 41 was walking in the hallway when he stopped to talk to Resident 26 and as he was talking, Resident 41 bent down to try to kiss Resident 26 again. Staff intervened and no contact was made.
Resident 41 was then placed on a 1 to 1 constant supervision.
Resident 26's care plan updated May 3, 2019, indicated that the facility will discuss coping strategies with her after being kissed by another resident and providing her the ability to discuss her feelings.
Resident 41's care plan updated May 3, 2019, indicated that he would be on 1 to 1 supervision, be distracted if possible and have supervision when in a social gathering.
A review of the care plans of Resident 26 and Resident 41 revealed no documented evidence that the facility had identified the specific need to prevent inappropriate physical contact between Resident 41 and Resident 26 (i.e., keeping the residents separated).
28 Pa. Code 211.11(d) Resident care plan
28 Pa. Code 211.12 (d)(3)(5) Nursing services.
| ||Plan of Correction - To be completed: 05/27/2019|
1. R26 and R 41 had their behavioral care plans updated.
2. New admissions and current residents with documented inappropriate sexual behaviors have the potential to be affected by the deficient practice. Utilizing the "Behavior" QAPI tool the DON/designee will audit any residents with documented inappropriate sexual behaviors from 5.10.2019 – current to ensure appropriate interventions are in place.
3. To ensure the deficient practice does not recur, the DON/designee will educate the licensed staff on the "Behavior Practice Guide – comprehensive care plans" on or before the date of compliance.
4. Utilizing the "Behavior" QAPI tool the DON/designee will audit 5 residents/week who display inappropriate sexual behavior to ensure that care plans are updated with appropriate interventions. Results will be reviewed with QA&A.