Initial Comments:
A focused fundamental survey was conducted April 25 and 26, 2023, to determine compliance with the Requirements of the 42 CFR Part 483, Subpart I, Requirements for Intermediate Care Facilities. The census during the survey was four and the sample consisted of two individuals. Two deficiencies were identified as a result of the survey.
Plan of Correction:
483.450(b)(4) STANDARD
MGMT OF INAPPROPRIATE CLIENT BEHAVIOR
Name - Component - 00
The use of systematic interventions to manage inappropriate client behavior must be incorporated into the client's individual program plan, in accordance with §483.440(c)(4) and (5) of this subpart.
Observations:
Based on staff interview and documentation review, it was determined that the facility failed to provide an effective and consistent behavior support plan to address one individual's inappropriate behavior.
The findings included:
Individual #1
A. Pre-admission documentation, incident reports. daily staff notes, and the record of Individual #1 were reviewed on April 25 and 26, 2023. The review revealed that this individual was admitted to the facility on November 4, 2022. Individual #1 diagnoses included Impulse control disorder, Bipolar disorder, Autism spectrum disorder, Moderate intellectual disability, Clostridioides difficile- C-Diff., and seizure disorder.
B. Staff interview with the Program supervisor and facility nurse on April 26, 2023 at 10:00 a.m. and facility documentation revealed that from November 4, 2022 to April 26, 2023, Individual #1 has exhibited the following maladaptive behaviors:
1. Hitting others - 109 incidents
2. Kicking others - 68 incidents
3. Self-induced vomiting - 31 incidents
4. Crawling out of bed / wheelchair - 92 incidents
5. Smearing feces - 56 incidents (Individual #1 has Clostridioides difficile- C-Diff)
6. Screaming - 103 incidents
7. Throwing objects - 18 incidents
8. Scratching others - 38 incidents
9. Refusing to eat - 61 incidents
C. Staff interview with the House Supervisor and facility nurse on April 26, 2023 at 10:00 a.m. further revealed and confirmed that Individual #1 did not have a behavioral support plan with interventions in place addressing the above-mentioned inappropriate behaviors.
Plan of Correction:1. The facility will ensure an effective and consistent behavior support plan is in place.
2. In reference to this violation, the facility is working with outside agencies in an effort to identify and secure resources to provide behavior supports. Meetings are being held every 2 weeks to identify current needs of the consumer with the intent to identify a Provider who can meet those needs. It is the facility's ultimate goal to not have him be discharged from the hospital back to the facility, but rather find alternative placement. Should he return to the facility, the QIDP will secure behavior supports through a contract with an outside agency.
3. To prevent recurrence, admission will not occur until all resources are secured to provide appropriate support.
4. The QIDP and DON will monitor for compliance during the admission process.
483.460(a)(3) STANDARD
PHYSICIAN SERVICES
Name - Component - 00
The facility must provide or obtain preventive and general medical care.
Observations:
Based on record review and staff interview it was determined that the facility failed to obtain and provide preventative and general medical care in the provision of psychiatric/psychological services for one individual residing in the facility. (Individual #1)
Findings included:
Individual #1
A. Individual #1 was admitted to the facility on November 4, 2022. Individual #1 has the following diagnoses: Impulse control disorder, Bipolar disorder, Autism spectrum disorder, Moderate intellectual disability, Clostridioides difficile- C-Diff., and seizure disorder.
B. Staff interview with the House Supervisor and facility nurse on April 26, 2023 at 10:00 a.m. and facility documentation revealed that from November 4, 2022 to April 26, 2023, Individual #1 has exhibited the maladaptive behaviors of hitting others; kicking others; self-induced vomiting; crawling out of bed/wheelchair; smearing feces; screaming; throwing objects; scratching others and refusing to eat.
C. Staff interview with the House Supervisor and facility nurse on April 26, 2023 at 10:00 a.m. further revealed and confirmed that Individual #1 has not been seen and evaluated by a psychiatrist or psychologist since being admitted to the facility.
Plan of Correction:
1. The facility will provide preventative and general medical care in the provision of psychiatric/psychological services.
2. In reference to this violation, the facility LPN is working with local resources to identify and secure psychiatric services.
3. To prevent recurrence, admission will not occur until all resources are secured to provide appropriate support.
4. The QIDP and DON will monitor for compliance during the admission process.
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