Health inspection·May 16, 2024

F679 §483.24(c) Activities. §483.24(c)(1) The facility must provide, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community. § 483.25 Quality of care Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice. 22 CCR § 72311. Nursing Service--General. (a) Nursing service shall include, but not be limited to, the following: (1) Planning of patient care, which shall include at least the following: (A) Identification of care needs based upon an initial written and continuing assessment of the patient's needs with input, as necessary, from health professionals involved in the care of the patient. Initial assessments shall commence at the time of admission of the patient and be completed within seven days after admission. §72379. Activity Program -General. An activity program means a program which is staffed and equipped to encourage the participation of each patient, to meet the needs and interests of each patient and to encourage self-care and resumption of normal activities. 22 CCR §72523. Patient Care Policies and Procedures. (a)Written patient care policies and procedures shall be established and implemented to ensure that patient-related goals and facility objectives are achieved. The facility failed to ensure Resident 42, who was identified with visual impairment, functional limitation and required one to one (1:1) with activity staff, was provided with activities that stimulated the resident's senses. The facility failed to: 1. Provide a resident centered Activities Program that incorporated Resident 42’s interests. 2. Develop a care plan for Activities, with person centered interventions for Resident 42. 3. Maintain an optimal quality of life using the appropriate visual devices to promote participation in Activities of Daily Living for Resident 42, per the Impaired Visual Function care plan. 4. Perform a quarterly Activity Participation Review for Resident 42. 5. Conduct and maintain an Activity Evaluation for each resident, per the facility policy Activity Evaluation. As a result, on 4/1/2024, Resident 42 experienced emotional distress verbalizing she felt her days were empty; and indicating she was frustrated and uncomfortable because she was bored, as the resident did not receive any 1:1 with activity staff for approximately 45 days. A review of Resident 42's Admission Record indicated the facility originally admitted the resident on 11/6/2020 and re-admitted the resident on 10/27/2021 with diagnoses including adult failure to thrive (a decline in older adults that manifests as a downward spiral of health and ability), cachexia (a general state of ill health involving great weight loss and muscle loss), muscle weakness, dysphagia (difficulty swallowing), difficulty in walking, dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities), and schizophrenia (a disorder that affects a person's ability to think, feel, and behave clearly). A review of Resident 42's Physician's Order dated 10/27/2021, indicated the resident was to receive activity as tolerated and not in conflict with their treatment plan. A review of Resident 42's Minimum Data Set (MDS, a standardized assessment and care screening tool) dated 12/26/2023, indicated the resident had severely impaired cognition (ability to make decisions, understand, learn). The MDS further indicated the Resident 42 was dependent on assistance for oral hygiene, toileting hygiene, showering/bathing self, upper/lower body dressing, and personal hygiene. According to a review of Resident 42's Activities Participation Review dated 12/26/2023 at 1:43 PM, the resident was one on one (1:1) with activity staff. The review indicated Resident 42 enjoyed sensory stimulation, nail care, listening to music and watching television (TV). The review further indicated Resident 42 needed assistance to and from the activity room. There was no indication an Activities Participation Review was conducted after 12/26/2023. A review of Resident 42's Resident Care Conference Review dated 12/28/2023, indicated the resident was alert with periods of forgetfulness, verbally responsive, and able to make their needs known. The review further indicated the resident enjoyed nail care, hand massage, and relaxing in their room. A review of Resident 42's Care Plan revised on 1/2/2024, indicated the resident had impaired visual function related to cataracts (clouding of the normally clear lens of the eye, causing blurred vision). The care plan indicated goals for Resident 42 that included maintaining optimal quality of life within limitation imposed by visual function and using the appropriate visual devices to promote participation in Activities of Daily Living (ADLs, activities related to personal care that include bathing or showering, dressing, getting in and out of bed, walking, using the toilet, and eating) through the review date. The care plan indicated interventions that included arranging a consultation with an eye care practitioner, identifying, and recording factors affecting visual function, and telling the resident where items are placed. Further review of Resident 42's care plan did not indicate there was a care plan that addressed activities. A review of Resident 42's Activity Attendance Record indicated the resident did not receive a room visit from activities on 1/3/2024 and 1/12/2024. The Activity Attendance Record did not indicate Resident 42 participated in an independent activity on 1/1 and 1/2/2024. The Activity Attendance Record further indicated on 1/4, 1/6 - 1/11, 1/13 - 1/17, 1/20 - 1/22, 1/24 and 1/27 - 1/31/2024 Resident 42 was in bed relaxing. A review of Resident 42's Activity Attendance Record indicated the resident did not receive a room visit from activities on 2/1, 2/2, 2/7, 2/8, 2/14, 2/16, 2/23 and 2/29/2024. The Activity Attendance Record indicated Resident 42 listened to music on 2/9, 2/15, 2/17, and 2/20/2024. The Activity Attendance Record indicated Resident 42 performed other independent activity on 2/3 - 2/6, 2/10 - 2/13, 2/18, 2/19, 2/21, 2/22, and 2/24 - 2/28/2024. The Activity Attendance Record did not specify what other independent activity represented. According to a review of Resident 42's Activity Attendance Record, the resident did not receive a room visit from activities on 3/31/2024 and the resident performed other independent activity on 3/5, 3/6, 3/9 - 3/14, 3/18 - 3/20, 3/22 - 3/27, 3/29 and 3/30/2024. The Activity Attendance Record did not specify what other independent activity represented. A review of Resident 42's Activity Attendance Record indicated the resident performed other independent activity on 4/1 - 4/3/2024. The Activity Attendance Record did not specify what other independent activity represented. During a concurrent observation and interview on 4/1/2024 at 8:34 AM, Resident 42 was observed lying in bed with a blank stare. Resident stated she could not see well, and indicated she only saw shadows. Resident 42 stated she spends her days in her room, because she could not get up to go to activities. Resident 42 stated she would rather stay in her room than go to the activities room. Resident 42 stated she had asked for a radio a few weeks ago because she thought it would be a great way to pass the time. Resident 42 stated she could not remember who she told, but indicated she was informed the staff were working on it. Resident 42 was observed without a radio or television in her room. Resident 42 stated she felt uncomfortable and frustrated because she was bored and did not have anything to listen to. Resident 42 stated she would also like to listen to the TV sometimes. Resident 42 stated she felt her days were empty. During a concurrent interview and record review on 4/2/2024 at 1:55 PM, Resident 42's Activity Participation Review, Care Plan, and Activity Attendance Records were reviewed with the Activities Director (AD). The AD stated Resident 42 was bed bound and visually impaired. The AD stated Resident 42 had 1:1 visits with activities in her room and enjoyed listening to music, having someone read to her, and a hand massage. The AD stated activities did room rounds around 1 PM to 2 PM and indicated they try to visit Resident 42 every day. The AD stated they try not to do more than 10 minutes with Resident 42 because of all the other residents’ activities had to see. The AD verified Resident 42's last Activity Participation Review was on 12/26/2023 which should have been done in 3/2024 and indicated it should be done quarterly. The AD stated the purpose of the Activity Participation Review was to evaluate a resident's preferences for the types of activity and participation they prefer. The AD further verified Resident 42 did not have a care plan for activities. The AD stated every resident should have a care plan for their activity preferences, so staff know what activities to provide the resident with. The AD stated the activities department was responsible for developing a care plan for activities. The AD verified Resident 42 did not have a TV in the room, and stated she was not aware Resident 42 had asked for a radio. During a concurrent observation and interview on 4/2/2024 at 2:20 PM, Certified Nursing Assistant (CNA) 4 stated Resident 42 had a difficult time seeing. CNA 4 verified Resident 4 did not have a radio or TV in their room. CNA 4 did not know how long Resident 4 did not have a TV or radio. CNA 4 stated she was not aware Resident 42 had asked for a radio. On 4/2/2024 at 2:30 PM, during an interview, Licensed Vocational Nurse (LVN) 4 stated she was not sure how often activities come to Resident 42's room. LVN 4 stated Resident 42 did not have a TV or radio. LVN 4 stated he was not aware Resident 42 had asked for a radio, and stated he did not realize the resident had no TV in their room. During a concurrent interview and record review on 4/3/2024 at 3:36 PM, Resident 42's Activity Attendance Records were reviewed with the Activities Assistant (AA). The AA stated the other independent activity on the attendance records indicated Resident 42 was either asleep or getting changed/cleaned up when the room visit was attempted. The AA stated Resident 42 had difficulty seeing and did not like to go to the activities room. The AA stated Resident 42 liked to listen to music or have a hand massage. The AA stated she was not aware Resident 42 asked for a radio, and indicated she was not aware Resident 42 did not have a TV. The AA stated when doing room visits, she spends about 10 minutes with each resident, and if Resident 42 was sleeping or getting changed when she first attempted the visit, she did not come back to the room at a later time, because she had to see the other residents and had other activities scheduled for the day in the activity room. The AA stated activities would try to see the residents that required 1:1 activity every day but indicated there may be sometimes when it would not happen. During a concurrent interview and record review on 4/4/2024 at 1:16 PM, Resident 42's Activity Participation Review, Care Plan, and Activity Attendance Records were reviewed with the Director of Nursing (DON). The DON stated Resident 42 needed sensory activities because of their visual impairment. The DON stated if the resident would like a radio, one should be provided to them. The DON verified the last Activity Participation Review for Resident 42 was conducted on 12/26/2023, and stated it was due to be completed. The DON stated the Activity Participation Review should be done on admission, quarterly, annually, and with a change of condition. The DON further verified Resident 42 did not have an activity care plan. The DON stated the Activity Participation Review was conducted to determine activity preferences. The DON stated the care plan was used to guide care and provide the resident with what they would want for activities. The DON stated if a resident was not evaluated for their activity preferences and do not have a care plan for activity, the resident may not receive the activities they want which could lead to a decline to the resident's quality of life. A review of the facility's undated policy and procedure titled, "Activity Evaluation," indicated to promote the physical, mental, and psychosocial well-being of residents, an activity evaluation is conducted and maintained for each resident at least quarterly and with any change of condition that could affect his/her participation in planned activities. An activity evaluation is conducted as part of the comprehensive assessment to help develop an activity plan that reflects the choices and interests of the resident. The resident's activity evaluation was conducted by activity department personnel, in conjunction with other staff who evaluate related factors such as functional level, cognition, and medical conditions that may affect activities participation. The activity evaluation was used to develop individual activities care plan (separate from or as part of the comprehensive care plan) that would allow the resident to participate in activities of his/her choice and interest. Each resident's activities care plan related to his/her comprehensive assessment and reflects his/her individual needs. The completed activity evaluation was part of the resident's medical record and was updated as necessary, but at least quarterly. The facility failed to ensure Resident 42, who was identified with visual impairment, functional limitation and required one to one (1:1) with activity staff, was provided with activities that stimulated the resident's senses. The facility failed to: 1. Provide a resident centered Activities Program that incorporated Resident 42’s interests. 2. Develop a care plan for Activities, with person centered interventions for Resident 42. 3. Maintain an optimal quality of life using the appropriate visual devices to promote participation in Activities of Daily Living for Resident 42, per the Impaired Visual Function care plan. 4. Perform a quarterly Activity Participation Review for Resident 42. 5. Conduct and maintain an Activity Evaluation for each resident, per the facility policy Activity Evaluation. As a result, on 4/1/2024, Resident 42 experienced emotional distress verbalizing she felt her days were empty; and indicating she was frustrated and uncomfortable because she was bored, as the resident did not receive any 1:1 with activity staff for approximately 45 days. The above violations had a direct or immediate relationship to the health, safety, or security of Resident 42.