|§483.24(a) Based on the comprehensive assessment of a resident and consistent with the resident's needs and choices, the facility must provide the necessary care and services to ensure that a resident's abilities in activities of daily living do not diminish unless circumstances of the individual's clinical condition demonstrate that such diminution was unavoidable. This includes the facility ensuring that:|
§483.24(a)(1) A resident is given the appropriate treatment and services to maintain or improve his or her ability to carry out the activities of daily living, including those specified in paragraph (b) of this section ...
§483.24(b) Activities of daily living.
The facility must provide care and services in accordance with paragraph (a) for the following activities of daily living:
§483.24(b)(1) Hygiene -bathing, dressing, grooming, and oral care,
§483.24(b)(2) Mobility-transfer and ambulation, including walking,
§483.24(b)(4) Dining-eating, including meals and snacks,
§483.24(b)(5) Communication, including
(iii) Other functional communication systems.
Based on clinical record review, observation, and resident interview, it was determined that the facility failed to provide services to maintain personal hygiene (bathing,dressing) for one of four sampled residents. (Resident 42)
Clinical record review revealed that Resident 42 had diagnoses that included heart disease and difficulty walking. According to the Minimum Data Set (MDS) assessment dated March 5, 2019, the resident had no memory problems and required supervision, or assistance from staff for personal hygiene. The ongoing care plan dated November 19, 2018 revealed that the resident had activities of daily living self-care deficits and that staff would provide assistance to meet those needs.
Observations from June 4, 2019, at 10:30 a.m., and again on June 6, 2019, at 2:00 p.m., revealed Resident 42 was wearing the same soiled clothing. Review of the resident's bathing report from May 9, 2019 through June 6, 2019, and the activities of daily living task for dressing from June 4, 2019 to June 6, 2019, did not indicate the resident refused supervision or assistance from staff. In an interview on June 4, 2019 at 10:30 a.m., the resident stated staff assist her with bathing and dressing.
28 Pa. Code 211.12(d)(5) Nursing Services.
| ||Plan of Correction - To be completed: 07/02/2019|
1. R42 was encouraged to change their clothing. R42's Care Plan, Care Delivery Guide, and Behavior Flow Record were reviewed to ensure they capture resident's target behavior for refusal of care.
2. All residents who behaviorally refuse Activity of Daily Living (ADL) care; as it relates to dressing, have the potential to be affected. The DON and/or delegate reviewed the Care Plan, Care Delivery Guide, and Behavior Flow Record for all residents who are known to refuse ADL care. Updates were made as needed to reflect this behavior.
3. To prevent this from reoccurring the DON and/or delegate educated all nursing staff on the procedure for identifying residents who refuse ADLs through their plan of care. Nursing staff was also educated on how to document refusals.
4. To monitor and maintain ongoing compliance the DON and/or delegate will audit resident refusal records 5 times weekly for 1 month and the 1 time weekly for 2 months. Results of audit will be presented to QAPI committee for further review and recommendation.