§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. §483.21(b)(3) The services provided or arranged by the facility, as outlined by the comprehensive care plan, must- (iii) Be culturally-competent and trauma-informed.
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Observations:
Based on review of policies and clinical records, as well as staff interviews, it was determined that the facility failed to develop comprehensive care plans that included specific and individualized interventions to address resident care needs for one of five residents reviewed (Resident 2).
Findings include:
The facility's policy regarding behaviors, dated April 13, 2023, revealed that facility staff will attempt to implement person-centered care approaches designed to meet the individual goals and needs of each resident, which includes non-pharmacological interventions.
An admission Minimum Data Set (MDS) assessment (a mandatory assessment of a resident's abilities and care needs) for Resident 2, dated November 16, 2023, revealed that the resident was understood, understands, and had a diagnosis which included Parkinson's disease, anxiety, and depression.
A nursing note for Resident 2, dated January 18, 2024, revealed that the nurse and the nurse aide attempted to get the resident into the bath multiple times. The resident refused and became combative and kept stating she will tomorrow, or she will let them know when she wants a shower.
A nursing note for Resident 2, dated January 21, 2024, revealed that the resident was hitting, pinching, and cursing at staff with morning care. Even with attempts of calming talk and redirecting, she was attempting to get out of bed by herself and did not want staff to assist her.
A statement completed by Licensed Practical Nurse 1, dated January 29, 2024, at 2:00 p.m., revealed that on January 29, 2024, at 7:30 a.m. she was assisting Nurse Aide 2 with Resident 2. They were getting the resident out of bed by Hoyer lift (a mobile floor lift system that rolls on wheels and is intended to help lift, suspend, and transfer a medically-dependent person) and placing her in her wheelchair for breakfast. After the resident was safely placed in her wheelchair, Nurse Aide 2 put the footrests on the wheelchair and attempted to place the resident's feet onto the footrests. The resident then removed her feet and in response to this Nurse Aide 2 grabbed hold of the resident's ankles to place them back onto the footrests. Every time Nurse Aide 2 continued to grab hold of the resident's ankles, the resident would holler out and place her feet back on the ground. Based on these actions the nurse knew that the resident did not want her feet on the footrests. Nurse Aide 2 attempted to place her feet on the footrests again. When Nurse Aide 2 was bent over grabbing hold of the resident's ankles again, the resident hit Nurse Aide 2 with her open hand on Nurse Aide 2's back.
A statement completed by Nurse Aide 2, undated, (referring to the incident of January 29, 2024, at 7:30 a.m.) revealed that while doing care on Resident 2, "she started hitting me. I told her to stop it. I put my hand in front of hers to stop her from hitting me. She then started to yell at me. She was yelling and hitting me while the nurse was just standing there. The resident then started kicking and would not keep her feet on the wheelchair footrests."
There was no documented evidence that a comprehensive care plan that included specific and individualized interventions was developed for Resident 2 regarding her behaviors until February 15, 2024.
Interview with the Nursing Home Administrator on February 16, 2024, at 9:35 a.m. revealed that they felt Resident 2 did not have any behaviors, so a care plan was not developed regarding behaviors until February 15, 2024.
28 Pa. Code 211.12(d)(5) Nursing Services.
| | Plan of Correction - To be completed: 03/18/2024
F656 1.ComprehensiveCare plan of the resident #2 was reviewed and updated to include behaviors, and interventions to manage behaviors. 2.The facility has determined that residents residing in the facility have the potential to be affected by the deficient practice. An audit was conducted of current residents comprehensive care plans to identify residents' current behaviors, and interventions for managing behaviors. 3.All interdisciplinary care plan team members responsible for writing behavior care plans will be re-educated on the facility's policy for Comprehensive Care Plans. Team members responsible for providing care to residents will be re-educated on the facility policy for Behaviors. 4.The Director of Nursing or designee will conduct audits of comprehensive care plans for behaviors and interventions to manage behaviors weekly x4 weeks, Biweekly x4 weeks, and monthly x1 month. A summary of the audits will be presented at the Quality Assurance and Performance Improvement meetings for 3 months for further review and recommendations.
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