|§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 review of facility policy and clinical records and staff interviews, it was determined that the facility failed to make certain the facility developed and implemented a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs for two of 24 residents (Resident R12 and R52 )
A review of the facility policy "MDS/RAI/Care Planning" dated 1/6/20, indicated that residents will have an individualized written plan of care that identifies the resident's problems and needs.
A review of the clinical record reveled that Resident R12 was admitted to the facility on 10/30/19, with diagnoses that include diabetes, bipolar disorder (a mental condition marked by alternating periods of elation and depression), and homelessness.
A review of a smoking screening assessment dated 10/30/19, indicated Resident R12 smokes 10 cigarettes a day.
A review of a nurse progress note dated 11/12/19, indicated Resident R12 was "bumming cigarettes."
A review of the care plan dated 11/7/19, did not include smoking for Resident R12
A review of a nurse progress not dated 12/1/19, indicated Resident R12 had a deep tissue injury (DTI) noted to the right heel.
A review of the non-pressure skin condition record, dated 1/7/20, indicated DTI to right heel with no changes.
A review of a physician order dated 1/8/20, indicated to apply skin prep (a protective barrier) to right heel daily.
A review of the care plan initiated 11/7/19, did not include the DTI to the right heel for Resident R12.
During an interview on 1/30/20 at 1:30 p.m., the Director of Nursing confirmed the above findings and that the facility failed to develop and implement a comprehensive person-centered care plan that includes measurable objectives and timeframes to meet the resident's medical, nursing, and mental and psychosocial needs for smoking and injury to the right heel for Resident R12.
A review of the clinical record indicated that Resident R52 was admitted to the facility on 5/8/19, and Minimum Data Set (MDS-periodic assessment of care needs) dated 12/7/19, revealed diagnoses that included hypertension (high blood pressure), dwarfism (short stature of less than 4 feet 10 inches and can also be characterized by short limbs and/or short torso) lymphedema (localized swelling caused by a compromised lymphatic system which is responsible for returning fluid within organs or tissues to the bloodstream), diabetes (a chronic condition resulting in too much sugar in the blood), morbid obesity (body fat that increases the risk of health problems), and difficulty walking.
A review of the physical therapy delivery ticket dated 9/26/19, confirmed delivery of a loaner electric wheelchair for trial use for Resident R52.
A review of the physician order dated 10/30/19, indicated out of bed to loaner power wheelchair with bilateral non-elevating leg rests and tilt function.
During observations of the survey from 1/27/20 through 1/30/20, revealed Resident R52 seated in a tilted back power electric wheelchair with a seatbelt.
During an interview on 1/27/19, at 10:45 a.m. Resident R52 indicated that the seatbelt is for support in the wheelchair and that he can release it.
A review of the care plan last updated on 12/7/19, did not include use of a power electric wheelchair with seatbelt for support.
During an interview on 1/30/20, at 12:14 p. m. the Director of Nursing confirmed that the facility failed to to develop and implement a comprehensive person-centered care plan that includes measurable objectives and time frames to meet the resident's medical, nursing, and mental and psychosocial needs for wheelchair positioning and safety for Resident R52.
28 Pa. Code: 211.12(d)(1)(5) Nursing services.
| ||Plan of Correction - To be completed: 02/21/2020|
F656 Develop/Implement Comprehensive Care Plan
1. Resident R12 careplan has been updated to include smoking and the deep tissue injury to the right heel. Resident R 52 careplan has been updated to include the power wheelchair and the seatbelt used for support that he can self release.
2. The DON/designee will audit current resident care plans for residents who smoke, have skin impairment, and positioning devices to ensure that comprehensive, person centered care plans are in place for those residents.
3. The DON/designee will educate the nursing staff on developing and updating resident care plans to ensure they are comprehensive, person centered, with measureable objectives.
4. The DON/designee will audit 5 care plans a week x 2 weeks then monthly x 2 months to ensure that residents care plans have been updated to reflect the resident's current medical, physical, and psychosocial needs. The results of these audits will be reported to the monthly Quality Performance Improvement Committee for review