Surveyors found that the facility failed to provide a varied, resident-centered activity program, relying heavily on repetitive schedules, TV viewing, and faith-based activities with no offerings later in the day. The posted activity calendar was outdated and partially updated, and a scheduled craft activity did not occur. Multiple residents reported boredom, lack of non-spiritual activities on Sundays, canceled or unfulfilled events such as karaoke, and no community outings despite interest. One resident who wished to participate in cards, current events, nail care, and getting out of bed had no documented activities for a month aside from a few room visits. Staff oversight was limited, with the administrator acknowledging the program did not engage residents and the corporate activity coordinator confirming inconsistent implementation and awareness of days with no activities.
Failure to provide life enrichment activities and care plan interventions for two residents. One resident with aphasia, mood disorder, and stroke was repeatedly observed in bed without activity support, despite documented preferences for TV and in-room activities and no life enrichment care plan. Another resident with head injury, dementia, and psychotic disturbance had documented interests in sports, golf, TV, movies, news, and pet visits, but activity notes showed no activities provided since admission.
Surveyors found that the facility did not consistently provide meaningful, person-centered activities as posted on the activity calendar. Two residents reported that scheduled activities such as BINGO and brain games, especially on weekends, were frequently missed or started very late, that music did not match their preferences, that room visits were not occurring, and that they were often not included in community outings. Observations confirmed that a scheduled BINGO session did not begin at the posted time, leaving residents waiting without explanation, and that some weekend and Sunday activities were not occurring despite being listed. Activity logs showed gaps in documented activities, no refusals, and minimal Sunday programming, while the Activity Director acknowledged late and missed activities and difficulty covering simultaneous activities on multiple floors with limited staff.
A resident with severe cognitive and visual impairments did not receive individualized, meaningful activities to support leisure needs. Documentation inaccurately reflected participation in activities that the resident was unable to perform, and staff did not consult the resident's DPOA for past interests. Interviews confirmed the resident required one-on-one support and was not engaged in appropriate activities, highlighting a lack of resident-centered programming in the memory care unit.
The facility did not provide a meaningful activity program for cognitively impaired residents on the locked unit, leaving many unengaged and without posted activity schedules. Two residents with significant behavioral and cognitive needs were not provided with appropriate activities, leading to increased agitation and a physical altercation. Staff interviews confirmed that activities were often not conducted due to staffing shortages, and documentation of interventions was incomplete.
Two residents with severe cognitive impairment and high dependency were not provided with meaningful activities, despite documented preferences and care plans indicating the importance of such engagement. Both were observed in bed without any form of stimulation, and activity records showed no evidence of independent, intellectual, physical, social, or spiritual activities being offered or documented. Facility staff confirmed the lack of activity provision and documentation, contrary to facility policy.
A resident with depression and intact cognition reported that the facility did not support her preferred activities, including pet therapy, evening programs, and opportunities to serve others. Activity calendars confirmed a lack of evening activities, pet therapy, and community outings, and the resident described the available activities as unfulfilling. Facility leadership acknowledged that activity needs assessments were limited and had not recently evaluated the need for evening or community-based activities.
A resident with dementia, dysphagia, and depression, who required assistance with ADLs and had impaired cognition, was repeatedly found in bed with no accessible activities and expressed ongoing boredom. Despite a care plan indicating preferences for independent activities, board games, and music, only limited group activities were documented, and there was no activity cart or consistent provision of materials of interest. The resident's environment lacked accessible engagement, and basic needs such as access to the TV and glasses were not met.
A resident with moderate cognitive impairment and multiple medical conditions was not provided with meaningful, individualized activities. The resident reported boredom, was unaware of any activity calendar, and had not been invited to participate in activities. Review of records showed no care plan for activity preferences and only solitary activities documented, with no evidence of group activities being offered.
A resident with severe cognitive impairment and major depressive disorder was left without meaningful engagement, as scheduled activities were not consistently implemented and activity staff failed to interact with residents. Observations showed the resident sitting unengaged for extended periods, while staff were seen using personal phones or working alone. Staff interviews confirmed that scheduled activities did not occur as planned and that inconsistent staffing contributed to the lack of engagement.
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