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- Plan Of CareCare planning
Inspectors found that a resident's plan of care did not include fall prevention interventions, even though staff members confirmed these interventions should have been documented there. The resident had sustained an injury from a fall that was reported as a critical incident.
- Plan Of CareCare planning
Inspectors found that a resident's written plan of care did not include clear directions to staff about how to safely transfer and move the resident. A nurse confirmed that the instructions in the care plan did not match the transfer method signs posted in the resident's room, which could confuse staff about the correct procedure.
- Plan Of CareCare planning
Inspectors found that a resident had a fall, and their care plan specified equipment to prevent injuries, but the home did not provide this equipment to the resident as documented.
- Plan Of CareCare planning
Inspectors found that a resident was using a fall prevention device that was not documented in the resident's plan of care. After the resident was injured in a fall, staff acknowledged that this device should have been recorded in the resident's clinical record.