Failure to Provide Adequate Activities Program for Resident
Summary
The facility failed to provide an ongoing activities program to meet the needs of a resident, identified as Resident #49. This resident was initially admitted with diagnoses including rheumatoid arthritis, spinal stenosis, and anxiety disorder, and had intact cognition according to the Minimum Data Set (MDS) 3.0 assessment. The resident's activity care plan, dated 11/17/23, indicated a need for a variety of activity types and locations to maintain interest. However, a review of the activity logs from 01/07/25 to 02/12/25 showed that the resident only received two one-to-one activity visits from the activity staff during this period. Interviews revealed that the resident had not received activities because she was unable to get into a wheelchair to attend them and was not provided with activities in her room. The Activity Director confirmed that the lack of one-to-one activities was due to the termination of two activity staff members in the prior month. The facility's activity policy, revised in 01/2020, stated that activity programming should promote the physical, mental, and psychosocial well-being of each resident, but this was not adhered to in the case of Resident #49.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
A facility failed to ensure a resident with severe cognitive impairment and multiple diagnoses participated in activities that met their needs. Despite a care plan requiring one-on-one interventions for sensory and social stimuli, the resident was not observed in any activities over several days, and records showed participation in only one activity over two months. This was confirmed by activity personnel.
The facility failed to provide therapeutic activities for its residents, affecting three individuals. A resident with severe cognitive impairment was observed lying in bed with minimal engagement, despite a care plan for daily socialization. Another resident, mostly bed-bound, reported a lack of activity staff visits and exclusion from outings, leading to boredom. A third resident, who is cognitively intact, stated that the activity calendar was not followed, and he had to buy his own puzzle books for entertainment. The facility did not adhere to its policy of providing activities based on residents' preferences and needs.
A resident with depression and other health issues was not assessed for activity preferences, and the facility failed to offer activities that met his interests. The resident's medical record lacked an activity assessment and comprehensive plan of care. Staff interviews confirmed the absence of communication regarding the resident's preferences, and the facility's policy on activity programs was not followed.
The facility failed to schedule activities for memory care residents, affecting all 21 residents in the unit and one outside of it. Observations showed no activities on weekends and delays during scheduled times due to staff being occupied with meal duties. Interviews confirmed activities were often late or not conducted as planned, causing frustration for residents.
The facility failed to conduct scheduled group activities due to the absence of activity staff, who were escorting a resident to an appointment. This affected 22 residents who regularly attend these activities. Interviews confirmed that activities are sometimes canceled when staff are unavailable, contrary to the facility's policy to promote residents' well-being through activity programming.
The facility did not provide structured activities for residents in the memory care unit, affecting all 27 residents. Activity calendars lacked specific activities for the unit, and scheduled activities were often not conducted. Observations and interviews confirmed the absence of activities, with only the Activity Director and an assistant responsible for conducting them. The facility's policy to meet residents' interests and well-being was not fulfilled.
Failure to Meet Resident's Activity Needs
Penalty
Summary
The facility failed to ensure that a resident attended activities that met their needs, affecting one resident out of the 80 in the facility. The resident, who was admitted with multiple diagnoses including hereditary ataxia, vascular dementia, and major depressive disorder, was severely cognitively impaired and dependent on assistance for activities of daily living. The resident's activity plan of care required one-on-one interventions to promote sensory and social stimuli, with goals including eye contact and response to sensory items. However, observations over three days revealed that the resident did not participate in any group or one-on-one activities. A review of the activity log showed that the resident attended only one activity over a two-month period, which was confirmed by an interview with activity personnel.
Failure to Provide Therapeutic Activities for Residents
Penalty
Summary
The facility failed to provide therapeutic activities to meet the needs and preferences of its residents, affecting three residents. Resident #47, who has severe cognitive impairment and is dependent on staff for mobility, was observed lying in bed with a flat affect and watching television during multiple observations. The care plan for Resident #47 included daily visits for encouragement and socialization, but the Activity Director admitted that one-on-one activities occurred only once a week and were not documented on the activity calendar. The resident's participation in group activities was minimal, and the facility did not adhere to the care plan's interventions. Resident #2, who has intact cognition but is mostly bed-bound, reported that activity staff did not visit her room for activities and that she was not included in outings. The resident expressed boredom and a desire for more engagement, stating that the activities documented were due to a CNA sneaking her treats from activities. The activity documentation showed limited participation, and the resident felt neglected in terms of being offered activities or outings. Resident #10, who is cognitively intact and dependent on staff for mobility, also reported a lack of engagement from the activity department. The resident stated that the monthly activity calendar was not followed, and he had to purchase his own puzzle books for entertainment. The Activity Director confirmed that one-on-one activities were brief and infrequent, and the resident's care plan for daily visits was not implemented. The facility's policy to provide activities based on residents' preferences and needs was not followed, as evidenced by the limited participation and lack of individualized attention for these residents.
Failure to Assess and Offer Resident-Centered Activities
Penalty
Summary
The facility failed to assess and offer activities that met the interests of a resident, who was admitted with diagnoses including depression, cerebral infarction, diabetes type one, and difficulty walking. The resident's medical record lacked evidence of an activity assessment, and there was no comprehensive activity plan of care. Progress notes and task documentation did not reflect the resident's participation in activities, and the resident was often marked as passive or observed only. Interviews with the resident revealed that he was not offered activities of interest, such as working on model cars or planes, and no one had discussed his activity preferences with him. Interviews with facility staff, including the social service/activity director and the activity assistant, confirmed that the resident did not have an activity assessment or individualized plan of care for activities. The staff were unclear about the documentation of activities and had not spoken to the resident about his preferences. The facility's policy on activity programs emphasized the importance of meeting residents' interests and supporting their well-being, but this was not reflected in the care provided to the resident. The lack of a structured activity program and communication with the resident contributed to the deficiency in meeting his needs.
Failure to Schedule Activities for Memory Care Residents
Penalty
Summary
The facility failed to schedule activities to meet the needs of residents in the memory care unit, affecting all 21 residents in that unit and one resident outside of it. Observations and reviews of the activity calendars from November 2024 to January 2025 revealed that no activities were scheduled for weekends in the memory care unit. On January 15, 2025, no activities were observed in the memory care unit during scheduled times, and staff were occupied with breakfast and morning hygiene routines instead. Similarly, in the non-memory care unit, activities were not occurring as scheduled, with staff assisting with meal duties instead. Interviews with activity assistants and the activities director confirmed that activities were delayed or not conducted as scheduled due to staff being overwhelmed with meal duties and other responsibilities. The activities director admitted to prioritizing activities in other parts of the building due to limited staff and confirmed that activities were often late because of the time taken to serve meals. A resident expressed frustration over activity delays, which sometimes required her to wait in her wheelchair for extended periods, causing discomfort. The deficiency was investigated under Complaint Number OH00161522.
Failure to Conduct Scheduled Group Activities
Penalty
Summary
The facility failed to conduct scheduled group activities, as observed on January 21, 2025. The activity calendar indicated a group activity, 'coffee time,' was scheduled for 9:00 A.M. in the activity room, followed by an exercise session at 10:30 A.M. in the dining room. However, observations at 9:07 A.M. and 9:23 A.M. revealed that the activity room was closed and locked, and no group activities were taking place in the common areas or dining room. Interviews with the Assistant Director of Nursing and the Activity Director confirmed that the 9:00 A.M. activity did not occur as planned because the activity staff were out of the facility, escorting a resident to an appointment. Consequently, the exercise session scheduled for 10:30 A.M. was also not conducted as residents were having coffee at that time. The deficiency affected 22 residents who regularly attend group activities, while 17 residents either chose not to attend or were not physically able to participate. Interviews with a Licensed Practical Nurse and a resident confirmed that group activities are sometimes canceled due to the absence of activity staff, who are occupied with transporting residents to appointments. The facility's policy, reviewed in August 2023, mandates providing activity programming to promote the physical, mental, and psychosocial well-being of each resident, which was not adhered to in this instance.
Lack of Structured Activities in Memory Care Unit
Penalty
Summary
The facility failed to provide structured and routine activities for residents in the memory care unit, affecting all 27 residents in that unit. The activity calendars from January 2024 through January 2025 did not include specific activities for the memory care unit, and there were significant gaps in scheduled activities, particularly on Tuesdays, Wednesdays, and after 3:00 PM on Saturdays. Observations on multiple dates revealed that scheduled activities were not conducted, and interviews with residents and staff confirmed the lack of activities. A resident expressed that activities were rarely held, and a CNA reported that activities were not prioritized in the memory care unit. The Activity Director and an activity assistant were the only staff responsible for activities, with the director covering weekdays and the assistant on weekends. The Activity Director admitted to conducting only two activities in the memory care unit and two upstairs, with room visits in between when possible. Most residents in the memory care unit required one-on-one activities, which were not consistently provided. The facility's policy stated that activities should meet the interests of each resident and support their well-being, but this was not being fulfilled in the memory care unit.
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