|§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 observations, clinical record review and staff interview, it was revealed that the facility failed to assess residents for the placement of beds against the wall for two of two residents (Resident R7 and Resident R10).
During an observation on 12/11/19, at 12:50 p.m. it was revealed that Resident R10 bed was flush against the wall, limiting the ability to exit one side of the bed.
During an observation on 12/12/19, at 12:06 p.m. it was revealed that Resident R7 was in bed with the side of the bed flush against the wall, limiting the ability to exit one side of the bed.
A review of the clinical record indicated Resident R10 was admitted to the facility on 10/16/14, with diagnoses of pain in right hip, muscle weakness, and spinal stenosis. The quarterly MDS (Minimum Data Set - a periodic assessment of resident needs) dated 10/3/19, indicated these diagnoses remained current.
A review of the clinical record for Resident R10 did not include an assessment for safety or to determine if the bed placement was a restraint. The clinical record also failed to include a physician's order to place the resident's bed against the wall, inhibiting the ability of the resident to get out of the bed from either side.
A review of the clinical record indicated Resident R7 was admitted to the facility on 9/6/19, with diagnoses that included spinal stenosis (progressive narrowing of the opening in the spinal canal), legal blindness, and anxiety.
A review of the clinical records for Resident R7 and R10 did not include an assessment for safety or to determine if the placement of the bed against the wall was a restraint. The clinical record also failed to include a physician's order to place the resident's bed against the wall, inhibiting the ability of the resident to get out of the bed from either side.
During an interview 12/13/19, 2:35 p.m. Director of Nursing confirmed that Resident R7 and R10 did not have an assessment ot determine the safety of bed placement against the wall.
28 Pa. Code:211.10(c)(d) Resident care policies.
28 Pa. Code: 211.12(d)(1)(5) Nursing services.
Previously cited 1/12/18 and 8/1/19.
| ||Plan of Correction - To be completed: 01/17/2020|
The Bed Safety Policy was updated to include that "Bed may be placed against the wall, not as a restraint but to enhance the room size and the Resident's safe mobility. A physician's order will be obtained for bed placement against the wall." Care plans and orders will be updated to include bed placement against the wall for Resident R 10 and R 7 and for any other Residents who have their beds against the wall. At care plan meetings, the DON will audit where the bed is placed and that the necessary documentation in place. This information will be reported to the CQI committee monthly x 3 and with 100 % compliance. All new admissions will be have the necessary documentation in place if their bed is against the wall. This will be audited by the DON and reported to CQI monthly x3. Nurses will be educated on bed placement documentation on January 16, 2020