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Based on observation, interview and record review, the facility failed to produce and/or follow appropriate policies and procedures for Occupational therapy aide services. Job description (JD) for occupational aide (OA) which delineate the scope, organization, and method for implementation of services was provided and reviewed and the facility was not following the JD.

Findings include:
Observation and concurrent interview were made on 03/28/23 at 10:51 AM. Three residents were noted in the activity/recreational room. OA was noted assisting a resident with coloring. Tour of rooms revealed 9 residents in rooms in beds. Queried with OA how long he/she has been in this position. OA stated that she started on January 1st, 2023.

Record review (RR) on 03/28/23 at 11:00 AM was done. Census was 19. Of the 19 residents for the critical access facility (CAH), 5 residents were marked for physical therapy/occupational therapy (PT/OT). Census report revealed that there are 6 residents with an admitting date of 07/01/2020 and chief complaint of long-term care (LTC).

RR of the job description of occupational therapy aide was provided. Position #59835. No Policy and/or procedure was provided for position # 59835. Experience and essential knowledge and abilities: (One (1) year of work experience which involved participation in the provision of occupational therapeutic services within prescribed treatment plans; planning and conducting adjunctive activities of a diversional, recreational nature of individuals and groups and must have demonstrated knowledge and application of various treatment procedures and therapeutic techniques pertinent to occupational therapy; structure and function of the human body; human growth and development; physical and psycho-social dysfunctional conditions; common medical terminology used in occupational therapy treatment and programs; theories, methods, media, therapeutic activities and adaptive equipment used in occupational theory; applicable hospital/facility/program policies and procedures; and the ability to assist and participate in the activities of the treatment team.

Interview was done on 03/29/23 at 03:10 PM with staff member (SM)2. Queried with S2 regarding activity schedule and OA schedule. S2 stated that the OA was currently working four days a week from approximately 8:30 AM and hours will change because of appointments. OA was also not expected to do heavy lifting. We do not offer activities on the weekends. Before January 1, 2023, it was just me. There were seven days that people were not getting out of bed and it's always short staffed. We do not have activities on the weekends. It is a grab and go, i.e., word searches, puzzles, books, reading material and nursing staff have access to these materials. As far as documentation, our department only does a weekly note for activities. Not everyone gets seen every day. Nursing is short staffed every day. I do not know where the clinical nurses' aides or nurses are documenting for the patients in the rooms. I only have one OA and she is being pulled for feeding, pickng up trays and do peri-care by nursing.

In summary, there is only one OA who is on light duty, not full-time and does not work weekends OA does not have 1 year of experience as an occupational therapeutic aide and does not fulfill the experience and knowledge of the job description. OA is being pulled into nursing aide duties while activity department is trying to maintain activity program and there is no schedule or insight of when this may or may not occur. Documentation is not organized amongst the activity staff and/or the nursing staff, so documentation is not easily found.

This deficient practice has the potential to affect all the patients in the CAH who cannot get out of bed and/or are vulnerable and are totally dependent on the CAH for a consistent activity program. (Refer 11-93-31(b))

Based on observation, interviews and record reviews, the facility failed to provide documentation of social work plans, assessments, measurable goals, objectives, treatment plans to meet the needs of the patients in the swing beds of the critical access hospital (CAH). In addition, no written agreement was obtained for social work consultation with sister facility.

Findings include:
On 03/30/23 at 08:00 AM, interviewed patient (P)1 who was in her room. P1 stated "yesterday was the first time I've been up for three months. I have also been trying to talk with a social worker, but my social worker died. I called Medicare and they said I had to have my card."

On 03/30/23 at 09:42 AM, interviewed assistant hospital administrator. Assistant hospital administrator stated that the facility had been without a social worker since November. We get resources from our sister facility.

On 03/31/23 at 1:12 PM, interviewed social worker(SW)1 from sister facility. SW1 stated that "I have not been out there since the last social worker." Queried regarding arrangement to cover the patients in the facility. SW1 stated that the last time I collaborated with them was about a month ago on a patient who was going to the facility from this facility. SW1 stated it is mostly resource connection and referrals.

Reviewed the facility policy titled "Social Service" dated 03/17/2022 and it revealed: "The function of the Social Service Department is to provide the highest level of patient care services for patients in the Emergency Services, Critical Access Hospital, and the residents in the Long-Term Care section of the hospital. (D) (1) Social worker will perform social services assessment within 14 days of admission, all new admissions and annually thereafter (LTC). (4) Develops care plans to address any psycho-social issues (LTC), (11) Complete social work in-service as assigned or as needed.

Based on observation, record review and interviews, the facility failed to follow a comprehensive assessment and comprehensive care plan to include individualized therapeutic activities which include sensory stimulation and getting patient's out of bed (OOB )for activity pursuit on consistent schedule due to lack of staff and coordination with nursing and rehabilitative services.

Findings:

Observation and concurrent interview were made on 03/28/23 at 10:51 AM. Three residents were noted in the activity/recreational room. OA was noted assisting a resident with coloring. Tour of rooms revealed 9 residents in rooms in beds. Queried with OA how long he/she has been in this position. OA stated that she started on January 1st, 2023. (REF 1006)

Record review (RR) done on 03/28/23 at 11:00 AM revealed that the facility did not have a comprehensive assessment. The residents were reviewed quarterly by the interdisciplinary committee. Census was 19. Of the 19 residents for the critical access facility (CAH), 5 residents were marked for physical therapy/occupational therapy (PT/OT). Census report revealed that there are 6 residents with an admitting date of 07/01/2020 and chief complaint of long-term care (LTC). (REF 1006)

Interview was done on 03/28/2023 with SM2 at 02:50 PM. SM2 stated that it's getting better but there was a time where patients were not getting out of bed. We initially hired an occupational therapy aide who comes in 4 days a week at 08:30 AM and we have agency help. There are no activities on the weekends.

Interview with occupational aide (OA) on 03/29/23 at 09:30 AM was done. Queried with OA what she knew about stimulus therapy. OA stated that when P2 is at the bedside, I turn on his machine to hear the waves. In the activity room, I play acoustic guitar. Surveyor queried about stimulus when he is up in the hall at 0600 AM, by himself. OA stated she takes him to the activity room when she arrives to work.

Observation and RR was done concurrently on 03/30/23 at 07:30 AM. Patient (P)2 was in a Geri-chair in the hallway, 20' from the nursing station with no staff around. P2 was looking up at the ceiling. RR of plan of care (last review 03/07/2023) states resident will engage in therapeutic sensory based activities up to 5x/week to improve comfort and emotional wellbeing. Plan of care activity intolerance. Plan- elevate head of bed - once per shift and ensure resident is in upright position at least 45 degrees, when in bed/Geri chair. Plan - resident will be up in wheelchair as tolerated. Resident to be up in the Geri chair as tolerated from 0600-1000 Monday to Friday for sensory: Responsible: Nurse CNA Act/Rec Pt and OT.

Interview on 03/30/23 at 07:35 AM was done with staff member (SM)1. Queried with staff member (SM) 1 who stated that they get P2 up at 0600 am. He is placed in the hallway.

Interview with SM6 on 03/30/23 at 08:32 AM was done. SM6 stated "there was a point where people were not getting up. There is a schedule now and it's getting better but patients are still in bed for breakfast and dinner meals. SM6 verbalizes that "I put the long-term patients on the rehab schedule to assure they get up." P2 gets up and is in the hall for 2 hours until he may go to the activity room, and he is left there without anyone around. OA does not start until 8:00 AM or 8:30 AM.

RR of an assessment report was done on 03/30/23 at 09:00 AM dated 02/27/23 of occupational therapy discipline/ RR of res activity comments state patient's plan of care is to be out of bed (OOB)Monday-Friday with evening nursing staff assistance for Hoyer lift transfers. When OOB, patient enjoys mild massage with scented lotion, passive range of motion at bilateral upper extremities within tolerable range, listening to Hawaiian music, looking out the window towards the garden and ocean.

Daily activity schedule dated 2/20/23-2/29/23 shows that the patient received activity 3/7 times for the week. Documentation for the week of 02/13-02/17/23 was done 3/7 times for the week. No activities were recorded for the weekend.

This deficient practice has the potential to affect all vulnerable residents who are totally dependent on the facility and the patients are deemed at risk for outcomes related to not getting out of bed.