§483.10(a) Resident Rights. The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section.
§483.10(a)(1) A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident.
§483.10(a)(2) The facility must provide equal access to quality care regardless of diagnosis, severity of condition, or payment source. A facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the State plan for all residents regardless of payment source.
§483.10(b) Exercise of Rights. The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States.
§483.10(b)(1) The facility must ensure that the resident can exercise his or her rights without interference, coercion, discrimination, or reprisal from the facility.
§483.10(b)(2) The resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his or her rights and to be supported by the facility in the exercise of his or her rights as required under this subpart.
|
Observations:
Based on review of facility records and policy, review of clinical records, and the Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual 2019 (RAI-assessment guide use to plan the provision of care for residents), observations, and resident and staff interviews, it was determined that the facility failed to ensure that a resident's dignity was maintained for nine of 24 residents reviewed (Residents R1, R11, R13, R26, R36, R44, R48, R66, and R78).
Findings include:
Review of "Resident Rights Inservice" provided by the Registered Nurse (RN) Regional Director on 2/07/24, at approximately 11:00 a.m. revealed "The Residents' Bill of Rights, The Nursing Home Reform Act established the following rights for nursing home residents: The right to be treated with dignity; The right to exercise self-determination; The right to communicate freely; Receive adequate and appropriate care; To be treated with consideration, respect, and dignity; and Participate in community activities, both inside and outside the nursing home."
Review of the facility policy, "Resident Communication System and Call Light Policy" dated 1/17/24, revealed "It is the policy of the facility to provide residents with a means of communicating with staff. A call system is installed in each resident room and toilet/bath areas. The facility responds to resident needs and requests. Procedure: 3. Staff will respond to call lights promptly. Answering Call Lights - General Guidelines: 1. Upon entering a resident room, turn off the call light. 6. Some residents may not be able to use their call light. Staff will check these residents more frequently. 8. Answer the resident's call light as soon as possible. 9. Be courteous when answering call lights. Steps in Procedure: 1. Turn off the call light. 2. Identify yourself and call the resident by his/her name (use Mr. or Mrs.) and ask 'how may I help you?' 3. Listen to the resident's request. 4. Do what the resident requests, if capable/allowed. Otherwise seek assistance of charge nurse or someone who can assist. If you have promised the resident you will return with an item or information, do so promptly."
Resident R78's clinical record revealed an admission date of 9/12/22, with diagnoses that included urinary tract infection, sepsis (a life-threatening complication of an infection), diabetes mellitus (a group of diseases that result in too much sugar in the blood), and gastro-esophageal reflux disease (a digestive disease in which the stomach acid irritates the food pipe lining.)
Review of the RAI manual instructions for Section C0500 "Brief Interview for Mental Status (BIMS)" revealed that a score of 13-15 identified a resident as cognitively intact and a score of 8-12 identified a resident as moderately impaired, and a score of 0-7 as severely impaired.
Revies of the Minimum Data Set (MDS-a periodic assessment of resident care needs) Section C0500 dated 1/23/24, revealed Resident R78 with a BIMS score of 12. Resident R78's Section GG0170 dated 1/23/24, Functional Abilities and Goals for Mobility, indicated that Resident R78's ability to transfer to and from a bed to a chair/wheelchair is independent (resident completes the activity by themselves with no assistance from a helper).
During an interview on 2/05/24, at 11:45 a.m. Resident R78 indicated he/she is frustrated over the way staff talk to him/her. Resident R78 verbalized, "When I do need help with something, the staff are very rude to me. They tell me I am selfish."
During an interview on 2/05/24, at 1:30 p.m., Resident R1 revealed that when staff respond to call light activation and the resident requests assistance, the responding staff act very irritated and make the resident feel as though they are a nuisance.
During an interview on 2/05/24, at 2:20 p.m., Resident R11 revealed that they don't like to use their call bell or ask for assistance because the staff talk down to them and belittle them for interrupting them.
Interviews during a Resident Council meeting on 2/06/24, at 10:30 a.m. revealed four of five residents (R13, R48, R66, and R78) in attendance with concerns of when they put their call bells on, staff will come into their room, turn the call bell off and not return. The residents further indicated after they turn their call bells back on, it could take an hour for staff to respond.
Resident R36's clinical record revealed an admission date of 7/12/23, with diagnoses that included diabetes mellitus, interstitial cystitis (a chronic painful bladder condition), unsteadiness on feet, and muscle weakness.
The MDS Section C0500 dated 11/08/23, indicated Resident R36 is alert and oriented with a BIMS score of 15. The Point of Care ADL Category Report (MDS 3.0) dated 2/07/24, indicated that Resident R36 for Transfers and Toilet use, was identified as limited assistance (one-person physical assist) and eating as supervision (set up assistance). During an interview on 2/06/24, at 12:10 p.m. Resident R36 indicated that staff are rude and do not answer his/her call bell timely. Resident R36 further indicated his/her roommate will often have to go get staff to assist in his/her needs due to being blind. On 2/08/24, at 10:45 a.m. Resident R36 verbalized, "it took an hour for someone to answer my call bell last night."
Resident R26's clinical record revealed an admission date of 11/29/23, with diagnoses that included end stage renal disease (kidneys are not functioning properly), anemia (deficiency of healthy red blood cells), and muscle weakness.
The MDS Section C0500 dated 1/14/24, indicated Resident R26 is alert and oriented with a BIMS score of 15. Resident R26's Section GG0130 dated 1/14/24, Functional Abilities and Goals for Self-Care indicated Resident R26's ability to shower/bathe self requires partial/moderate assistance.
During a interview on 2/07/24, at approximately 12:00 p.m. Resident R26 indicated that he/she was placed in the shower room and the Nursing Assistant (NA) threw a washcloth at him/her and said, "wash yourself." The NA then left him/her unassisted in the shower room for an extended period of time.
Resident R44's clinical record revealed an admission date of 2/26/23, with diagnoses that included intestinal obstruction, anxiety, malignant neoplasm of the bronchus or lung (cancer), and hyperlipidemia (high cholesterol).
The MDS Section C0500 dated 11/15/23, indicated Resident R44 is alert and oriented with a BIMS score of 15. The Point of Care ADL Category Report (MDS 3.0) dated 11/15/23, indicated that Resident R44 for Transfers and Toilet hygiene was identified as dependent (helper does all of the effort. Resident does none of the effort to complete the activity).
During an interview on 2/06/24, at 9:45 a.m. Resident R44 indicated he/she placed his/her call bell on at 9:00 a.m. due to being incontinent of stool. Resident R44 verbalized, "They just came in and turned my call bell off and left. They do this all the time. They call me selfish and that I think I am a princess. They told me they are going to teach me to be patient." Resident R44 turned his/her call bell back on at 9:50 a.m. awaiting staff to return to his/her room. A further interview and observation at 10:10 a.m. revealed Resident R44 resting in bed still incontinent of stool. Resident R44 indicated staff came back into his/her room and turned the call bell off and left.
During an interview with RN Supervisor Employee E7 on 2/06/24, at 10:15 a.m. Resident R44 revealed to the RN Supervisor that staff were turning his/her call bell off for the past hour and he/she needed incontinence care. RN Supervisor Employee E7 further confirmed that Resident R44's call bell was not on and Resident 44's needs were not addressed in a dignified timely manner.
Observations on 2/07/24, at approximately 10:45 a.m. revealed Licensed Practical Nurse (LPN) Employee E8 speaking loudly with a harsh tone to Resident R44 regarding care being provided during a meal. LPN Employee E8 was overheard speaking loudly to Resident R44 stating, "It is a state regulation that care cannot be provided during a meal." The Infection Control RN interrupted LPN Employee E8 and requested him/her to step out of Resident R44's room and stop talking. The Infection Control RN further confirmed that LPN Employee E8 was not speaking to Resident R44 in a dignified manner.
An interview with the RN Regional Director on 12/07/24, at 12:20 p.m. confirmed that staff should always respond to resident call bells and needs in a dignified and timely manner.
28 Pa. Code 201.29(a) Resident Rights
| | Plan of Correction - To be completed: 03/12/2024
The facility completed the following corrective actions; interviews were completed for residents R1, R11, R13, R26, R36, R44, R48, R66, R78 to determine if they have any additional concerns. Any concerns noted have been logged according to facility policy and appropriate follow up is being provided. All residents have the potential to be affected and the administrator and department leaders will interview all residents with respect call lights being answered timely and if they are being treated with dignity and respect by 3-5-2024. Any concerns noted will be logged according to facility policy and appropriate follow up will be provided. For residents who are non-interviewable the residents' primary contact will be interviewed. To prevent this from reoccurring all staff will have completed assigned education on "Respect and Dignity in The Healthcare Setting" and "Communication and Customer Service Principles" to be completed by 3-12-2024. Furthermore, an all staff in service was conducted on 2-28-2024 by the administrator for all staff regarding resident rights, treating everyone with respect and dignity and expectations regarding answering call lights. To monitor and maintain ongoing compliance the following actions will be taken: The administrator/or designee will complete a call light audit of 5 residents 3 times weekly for 4 weeks then monthly for 2 months to ensure call lights as being answered as expected. Furthermore, The administrator/or designee will complete review of 5 resident interviews 3 times weekly for 4 weeks then monthly for 2 months to learn if residents are being treated with dignity and respect. Results of these audits will be reviewed by the facilities QAPI committee for further review, action and monitoring.
|
|