§483.10(f) Self-determination.
The resident has the right to and the facility must promote and facilitate resident self-determination through support of resident choice, including but not limited to the rights specified in paragraphs (f)(1) through (11) of this section.
§483.10(f)(1) The resident has a right to choose activities, schedules (including sleeping and waking times), health care and providers of health care services consistent with his or her interests, assessments, and plan of care and other applicable provisions of this part.
§483.10(f)(2) The resident has a right to make choices about aspects of his or her life in the facility that are significant to the resident.
§483.10(f)(3) The resident has a right to interact with members of the community and participate in community activities both inside and outside the facility.
§483.10(f)(8) The resident has a right to participate in other activities, including social, religious, and community activities that do not interfere with the rights of other residents in the facility.
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Observations:
Based on the review of clinical records, interviews with resident and staff, it was determined that the facility failed to ensure that the resident had the right to choose healthcare and providers of healthcare consistent with resident's interests and plan of care for one of three residents reviewed. (Resident R1)
Findings Include:
Interview with Resident R1 on May 30, 2024, at 10:00 a.m. stated he did not want Employee E4, Licensed Nurse, to provide care for him. He stated after the last survey by the State Survey Agency in September 2023, he did not want her to provide him care and administer medications. Resident also stated she made mistakes with his medication administration, and he was told by the facility staff that Employee E3 would not administer him his medications. Resident R1 stated Employee E4 prepared and administered his medications numerous times even after he requested not to have Employee E4 as his nurse.
Interview with Employee E3, Unit Manager on May 30, 2024, at 10:00 a.m. stated Licesed nurse, Employee E4 should not administer medication to Resident R1. She stated there was some concern with Employee E4 and Resident R1, and Resident R1 requested not to have Employee E4 administer him the medication since January 2024. Employee E3 stated Resident R1's medication was administered by other nurses.
Review of care plan for Resident R1 dated July 13, 2021, stated to allow Resident R1 to make safe independent decisions regarding plan of care, maintain compliance with resident's rights, and empower resident by involving in all aspects of care.
Review of Medication Administration Record for Resident R1 for the month of March 2024 revealed that Licensed nurse, Employee E4 administered medications to Resident R1 on March 2, 5, 7, 8, 11, 12, 13, 14, 17, 18, 19, 21, 22, 25, 26, 27 and 28. A total of 17 days.
Review of Medication Administration Record for Resident R1 for the month of April 2024 revealed that Licensed nurse, Employee E4 administered medications to Resident R1 on April 1, 2, 4, 14, 15, 16, 26, 29 and 30. A total of 9 days.
Review of Medication Administration Record for Resident R1 for the month of May 2024 revealed that Employee Licensed nurse, E4 administered medications to Resident R1 on May 2, 5, 7, 8 ,11, 12, 13, 14, 17, 18, 19 ,21, 22, 24, 25, 26, 27 and 28. A total of 18 days.
28 Pa. Code 201.29 (a) Resident rights
28 Pa. Code 201.18 (b)(2) Management
| | Plan of Correction - To be completed: 07/12/2024
1) Employee E4 will not provide any care or administer any medications to Resident R1. Employee E4 will receive re-education regarding respecting resident rights/preferences.
2)The facility will interview other residents to ensure that their resident preferences are being met.
3) Facility staff will receive in-service regarding respecting resident rights/preferences.
4) The Director of Nursing and/or designee will conduct an interview of five residents per week for four weeks and five per month for two months to ensure that their preferences are being respected.
The DON and/or designee will report the findings of these audits to the Performance Improvement Committee each month for three months.
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