§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 facility policy, review of clinical records, observations, and staff interviews, it was determined that the facility did not complete a comprehensive care plan for four of eighteen residents reviewed. (Residents R1, R11, R12, R24)
Findings include:
Interview held with Nursing Home Administrator Employee E1 on March 11, 2024 at 1:00 p.m. The Nursing Home Administrator, Employee E1 revealed the facility was having an issue with accomdating staffing preferences for several females at the facility requesting male nurses aide. The facility stated that they are trying to accomodate preferences but have been unable to accomdate in some cases. When asked how many residents are preferring males caregivers the Nursing Home Administrator Employee E1 stated "alot".
Interview with Resident R1 on March 11, 2024 at 10:20 a.m. indicated that she prefers female nurse aide over male nurse aide, stating "I don't feel as clean" when hygiene care is provided by male nurse aide.
Review of Resident R1's MDS Minimum Data Set revealed a BIMS Brief Interview for Mental Status of 14.
Observations of R1 during morning medication administration on March 11, 2024 at 10:25 am, revealed R1 voicing her concern regarding male nurse aides to licensed nurse, Employee E3. E3 replied that she will bring resident's concern again to administration.
Resident Council meeting was held on March 11, 2024 at 1:00 p.m. with eight awake, alert and oriented residents. During the resident council discussion the topic was brought up regarding male caregivers. Residents R11, R12, and R24 all stated that they prefer to have a female nurse aide give personal care such as bathing or toileting but sometimes are given a male nurses aid. The group discussed how this was brought up to the Nursing Home Administrator Employee E1 during previous Resident Council meetings and and Nursing Home Administrator "reiterated that this is what it is and we need to get more comfortable with having males as aides because that is who is applying and qualified."
Review of R1, R11, R12 and R24's care plan show no description of the resident's preferring a female caregiver over a male caregiver.
Review of Resident Council Meeting Minutes from February 2024 described having males as aides as being a concerned discussed.
28 Pa Code 211.10( c)(d) Resident care policies
28 Pa Code 211.12 (d)(1)(3)(5) Nursing services
| | Plan of Correction - To be completed: 04/04/2024
Residents who have informed the facility of a specific caregiver preference have had their care plans updated with that information. Any resident in the future, who verbalizes a caregiver preference to staff, will have that preference added to their care plans.
On April 3 and April 4, 2024, we will be conducting mandatory in-services with the Certified Nursing Assistants and the Professional Nursing Staff to review approaches for residents whose plans of care have been updated with caregiver preferences.
Going forward, all residents and their legal representatives, upon admission to the facility, will be informed that we employ both male and female caregivers. A trauma assessment will be performed on all new residents to evaluate for any potential past trauma that would potentially affect their need for a specific caregiver. If a need is identified, it will be added to the resident's care plan and the staff will be made aware of that need.
The Social Service Director and the RNAC will be responsible for monitoring the care plan development for the resident's caregiver preferences or any trauma related issues that would affect the resident's care.
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