FITZGERALD, GA-LIFE CARE CENTER

Review of the facility policy titled, Behavior Management Standard, dated September 2021 revealed the following on page 11: Violent Behavior Management: At times, resident behavior may become violent in nature. These behaviors may spill over onto other residents and staff. In these cases, the disruption must be controlled before further assessment can be done. #4: Stay at a safe distance from the resident and respect his/her need for personal space, but do not LEAVE the RESIDENT ALONE. #10: Place the resident in a One-to-One situation with a staff member until the situation is resolved either through transfer to an acute care setting or a psychiatric setting. Care planning should address the immediate interventions put into place as well as a long-term plan to address behavior management.

Review of the electronic medical record (EMR) for R#44 revealed she was admitted to the facility on [DATE] with diagnoses to include history of traumatic brain injury (TBI), schizoaffective disorder-bipolar type, aphasia, depressive episodes, anxiety disorder, cognitive communication deficit.

Review of the Annual Minimum Data Set (MDS) assessment for R#44, dated 2/16/2023, documented the following: Section C/Cognitive Patterns: documented short-term and long-term memory problems, inattention, and disorganized thinking. Section D/Mood: Mood score of five (5), indicating mild depression.

Section E/Behavior: verbal behaviors, behaviors towards others, and rejection of care.
Review of the Care Plan, last revised on 3/7/2023 documented the following, including but not limited to: R#44 is at risk for psychosocial problems related to behaviors, resident to resident event of physical, mental abuse and sexual abuse.

5/23/2022, Focus: Inappropriate sexual activity with another resident Intervention: 5/23/2022 Notify state of incident, notify family and MD. Resident to be examined by crisis nurse. Resident placed on one on one. Screened by CHE. File police report.

6/20/2022, Focus: R#44 entered another resident’s room and an incident occurred of resident on resident, no injury.

Intervention: 6/20/2022, Resident was placed one on one, reported to Admin and state, family was notified. R#44 was moved to another hall.

8/9/2022, Focus: became aggressive, kicked bedside table, broke table, shook fist at staff.

Intervention: 9/8/2022 Give medication as ordered. Resident placed back on one on one upon admission to facility.

8/20/2022, Focus: aggressive behavior toward staff, scratched a CNA on neck.

8/22/2022, Focus: making aggressive gestures and yelling at other residents.

Intervention: 8/23/2022 Attempting to find placement for stabilization of resident, family notified.

8/24/2022, Focus: sent out and admitted in house for stabilization

9/8/2022, Focus: facility issued a 30-day discharge; returned to the facility with new orders; R#44 hit another resident in the chest/no injury noted.

Intervention: 9/8/2022 Give medication as ordered. Resident placed back on one on one upon admission to facility.

9/19/2022, Focus: grunting and hollering at other residents.

Intervention: 9/20/2022, Resident continues one on one care. R#44 continues to have multiple outbursts.

Resident shaking her fist at other residents. Resident went back to her room and slammed the door.

Resident then threw chair trying to hit one on one sitter. Sitter continues redirecting resident behavior but at this time unsuccessful. CHE NP notified and order for antipsychotic injection given. Medication was effective and no more behaviors noted throughout shift.

12/8/2022, Focus: Behaviors continued: 12/8/2022 R#44 spit meds out. Yelling and pacing hallway.

12/9/2022 R#44 continues physical aggressive toward other residents, went toward another resident in hallway attempting to put her hands around her throat.

Intervention: 12/9/2022 Continue resident on one on one.

4/18/2023, Focus: resident to resident with minor injury.

Intervention: 4/18/2023 resident separated and continues one on one, appropriate agencies notified, CHE notified for medication review, SSD to visit PRN, Activities to take resident outside PRN

In an interview with Licensed Practical Nurse (LPN) YY on 5/17/2023 at 10:41 a.m. she stated today was her first day working in the facility. She stated R#44 received 1:1 monitoring 24 hours/day. She stated staff kept a monitoring log and documented every hour.

In an interview with the DON on 5/18/2023 at 2:30 p.m., she stated she was only recently hired at the facility and confirmed the missing days and shifts from the monitoring log. She stated she had identified the concern when she came to the facility and had since put a Performance Improvement Plan in place to address the issue.