§483.24(c) Activities.
§483.24(c)(1) The facility must provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community.
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Observations:
Based on observations, review of activity log and staff interview, it was determined that the facility failed to provide an activity program that met the needs and interests of all residents and in accordance with care planned interventions for three of three residents reviewed (Resident #28, # 67, and Resident #75).
Findings Include:
Observation on October 1, 2019 approximately 1:20 p.m. to 2:30 p.m. of the Garden West unit revealed residents in living room with the television turned on or in their rooms resting. Further observation of Garden West unit (skilled nursing memory supportive unit) on October 2, 2019 approximately 9:00-10:30 p.m. revealed residents in the living room observing television programming.
Review of Resident #28's Quarterly MDS (minimum Data Set -periodic assessment of resident needs) dated July 26, 2019 identified the resident with a BIMS (Brief interview of mental status) score of 5 which places the resident as cognitively impaired.
Review of Resident #28's care plan, initiated November 2018, revealed areas of interest identified for resident as one to one visits, crafts, cooking, entertainment, exercise, spiritual activities, and sensory stimulation activities.
Review of Resident #28's activity logs from August 1, 2019 to September 30, 2019 revealed that the resident participated in watching television/newspaper twenty-two times in the month of August 2019 and twenty times in the month of September 2019. Further review of activity logs revealed resident attended bible study/hymn sing 11 times in the month of August and 6 times in the month of September 2019. Additional activities of Bingo/Movies/Music programs that resident attended were noted to be twelve times in August 2019 and twenty-six times during the month of September 2019.
Further review of Resident #28's activity logs revealed that from August 1, 2019 through September 30, 2019 there were sixteen days without any documented activities.
Review of Resident #67's clinical record revealed diagnoses including but not limited to following: Dementia (Irreversible, progressive degenerative disease of the brain, resulting in loss of reality contact and functioning ability); and Sensorineural hearing loss (damage caused to the nerve fibers in the inner ear; characterized by difficulty picking out words against background noise).
Review of Resident's Admission MDS assessment dated August 8, 2019 identified the resident with a BIMS (Brief interview of mental status) score of 3 which places the resident as cognitively impaired.
Review of Resident #67's care plan goal for activities, initiated August 2019, revealed activities of choice noted areas of interest as exercise, musical entertainment, spiritual programs, romance novels, and being off unit with supervision.
Review of Resident #67's activity logs from August 2019 through September 2019 revealed eight days without activity participation or refusal from admission of August 8, through August 31, 2019 and nine days without activity participation or refusal from September 1, through September 30, 2019.
Further review of Resident #67's activity logs revealed twelve times the only activity documented was Newspaper/Television during the month of August and thirteen times during the month of September 2019.
Review of Resident #75's Quarterly MDS Assessment dated August 27, 2019 revealed in Section C (Cognitive Patterns) revealed resident is severely cognitively impaired.
Review of Resident #75's activity care plan, initiated March 2019, revealed
activities of choice were entertainment, spiritual groups, live piano music, exercise, and volunteers for visits as tolerated/desired.
Review of Resident #75's activity logs from August 2019 through September 31, 2019 revealed that there were nine days without any documented activity participation in August 2019 and eight days in September 2019 without any documented activity participation.
Further review of Resident #75's activity logs revealed that for the month of August 2019 there were twelve days that television/newspaper activity was identified as only documented activity and six times in September 2019 that television/newspaper activity noted as only activity recorded.
Interview on October 3, 2019 at approximately 2:50 p.m. with the Nursing Home Administrator and non-licensed employee E3 when the above information was presented and indicated the activities were not representative of individual preferences or areas of interest.
28 Pa Code 201.29(j) Resident Rights
28 Pa Code 211.10(d) Resident care policies
| | Plan of Correction - To be completed: 11/30/2019
Activities admission assessment has been changed to capture a broader range of activities and interests of the residents prior to admission into the facility, so that an activities program can be designed specific to each resident's likes and interests. The electronic health record, Matrix Care, has been reformatted to assist staff with documentation on resident activities. The staff can now indicate when activities were offered and if those activities were performed or declined. A more personalized range of activities has been added to the activities schedule and available to residents on both one on one and in group settings. Staff will be in-serviced on documenting all aspects of resident activities to ensure residents are engaged with their needs and interests. The activities director and/ or designee will reassess all residents to ensure their care plan reflects a personalized activities program. The activities director will randomly audit resident charts to ensure residents likes, interests, and personalized activities are being offered and residents are engaged to meet their psychosocial needs until three months or compliance are met. The results of these audits will be shared and discussed during the QAPI committee meeting.
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