Failure to Provide Ongoing, Individualized Activity Program for Residents
Summary
The deficiency involves the facility’s failure to provide an ongoing, comprehensive activity program that met residents’ individual preferences and needs, as required by facility policy. Surveyors found that activity assessments and care plans identified specific interests and the importance of various activities for residents, but the facility did not implement or document activities consistent with those plans. Activity calendars lacked scheduled one-on-one activities for certain months, and there was little variety in daily activities from week to week. The facility’s own policy required admission activity assessments, ongoing updates, and individualized activity plans, including one-on-one activities to be completed per the activity calendar, but these were not carried out as written. One resident, identified as Resident #28, had multiple medical diagnoses including encephalopathy, heart failure, anemia, diabetes, and a fractured hip, and was cognitively intact per the MDS. The activity assessment for this resident documented numerous current interests and their importance, including one-on-one activities with animals/pets, beauty/barber services, exercise, family/friend visits, gardening, movies/TV, cooking, and current events, as well as small group interests such as bingo, cards, resident council, volunteering, walking, arts/crafts, community outings, and social parties. The care plan stated the resident was involved with activities little of the time and included interventions such as assisting the resident to activities, encouraging participation, inviting to resident council, breaking activities into manageable tasks, and providing an activity calendar. However, review of the medical record showed no evidence that the resident was offered or participated in the identified one-on-one or group activities during the review period. For Resident #28, the activity calendars for a specific month showed scheduled one-on-one visits on several dates and listed group activities such as weekly bingo, multiple weekly card/game sessions, weekly pet therapy, weekly outings, and a monthly spa day. Yet, the record of one-on-one activities contained only a few brief contacts, such as staff visiting while the resident’s husband was present, offering popsicles or snacks, and one instance of offering a word search that was declined by the husband when the resident was sleeping. The Activity Supervisor confirmed that these few documented contacts were all that had been provided since the resident’s admission. There was no documentation that the resident’s stated preferences for activities like bingo, pool, happy hour music, or other listed interests were implemented. Another resident, identified as Resident #2, had extensive medical conditions including CVA with hemiplegia, encephalopathy, chronic systolic CHF, respiratory failure, altered cognitive function, insomnia, sleep apnea, hypertension, atrial fibrillation, abdominal aortic aneurysm, and a prosthetic heart valve, and was severely impaired for daily decision-making per the MDS. The activity assessment documented current interests in individual activities such as animals/pets, current events, exercise, movies, music, and family/friend visits, as well as interests in religious studies, shopping, sing-alongs, social parties, volunteering, walking, and arts/crafts. Past interests included bingo, cards, cooking, creative writing, dominoes, educational programs, and reading. The care plan indicated the resident was involved with activities some of the time, with goals to participate in activities of choice and remain active with individual activities, and interventions similar to those for Resident #28, including assistance to activities, encouragement, and provision of an activity calendar. Despite these documented interests and care plan interventions, the record for Resident #2 showed only a few one-on-one activities, such as two visits where staff sat and talked with the resident for 10–15 minutes and one in-room manicure. There were documented gaps with no evidence of any activities provided over extended periods between specified dates. Observations showed the resident frequently lying in bed with no activities present in the room, and the resident stated she did not go out of her room much and did not know what she was going to do that day. The Activity Supervisor acknowledged that only a few one-on-one activities were documented since admission and stated the resident had cognitive impairment, did not want to join other activities, and only came out of her room for meals. The Administrator confirmed there were no documented activities in the electronic medical record for these residents beyond the few noted, that the calendars for several months did not include scheduled one-on-one activities, and that there was little variety in daily activities. Additional information from Social Services indicated that a separate Medicaid "Quality Moments" program provided emotional/behavioral support to certain qualifying residents, but this service was not provided by facility staff, was not available to all residents, and was not part of the residents’ activity care plans. Observations also showed that an activity calendar for Resident #2 was posted on the wall but not within the resident’s view. Overall, surveyors determined that, based on observation, record review, policy review, and interviews, the facility did not ensure that residents were provided with an ongoing, individualized activity program consistent with their assessed preferences and the facility’s own Resident Activities policy.
Penalty
Resources
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Failure to Provide Resident-Centered Activities Three residents did not receive an ongoing activities program matched to their needs and preferences. A resident with severe visual impairment was bored on weekends and could not participate in bingo because he was not given a large-print card. Another resident said she was never asked about activity preferences, did not get an activity calendar until later, and was not offered in-room activities. A third resident with significant neurologic and physical impairments said preferred activities were unavailable and he was bored; the acting AD reported activities often started late and many residents could not participate.
Failure to Provide Individualized Activities: A resident with anxiety, depression, and weakness was cognitively intact but said they could not attend group activities because of leg problems and wanted more in-room activities. The resident mostly stayed in bed watching TV, and staff documentation showed only limited room visits with no consistent activity documentation despite a care plan goal for participation two to three times per week.
Failure to provide individualized activities for a resident with dementia. The resident's representative said the resident had not received activities and needed to stay busy, while survey observations showed the resident wandering in the halls and sitting in the lobby without participating in facility activities. The DON reported there was no record of activity participation, and an activity staff member said she only talked with the resident occasionally and was the only activity staff member, so she did not have time.
Failure to provide activities for a resident with Parkinson’s disease, cerebrovascular disease, moderate cognitive impairment, and dependence in ADLs/transfers. The resident was repeatedly observed in bed in a quiet room without stimulation while music, art, and worship activities were available, and records showed only limited 1:1 visits with no documentation of activity attendance or refusal. The AD noted the resident liked music and art and had not been out of the room for an activity since March.
A resident with dementia, severe cognitive impairment, depression, visual and hearing impairments, and other comorbidities had documented preferences on the MDS for reading materials, music, and being around animals, but the activity assessment was completed only with the resident, not family, and concluded the resident could not identify preferred activities. The care plan inconsistently described the resident as sociable with interests in arts and crafts, bingo, and music, yet noted no current activities of interest, and a later activity participation review was left incomplete. Activity records listed daily relaxation and media-based activities and one-on-one reading, but staff later clarified that relaxation meant the resident was simply resting in bed and that recorded one-on-one sessions did not actually occur because the resident was asleep. Surveyors repeatedly observed the resident awake in a dark room with no television, music, reading materials, or other entertainment, and staff were unable to state the resident’s specific activity preferences, demonstrating a failure to adequately assess and implement individualized activity services.
A resident with stroke, vascular dementia, and kidney failure was non-verbal and unable to make needs known, yet the facility did not develop or implement an individualized activity plan. The care plan had incomplete activity focus, goals, and interventions, and activity flow sheets showed the resident was not offered or participated in any individual or group activities. Observations showed the resident lying in bed awake looking at the ceiling or wall, with the TV in the room not on during the observations.
Failure to Provide Resident-Centered Activities
Penalty
Summary
The facility failed to provide an ongoing activities program that supported residents’ choices of facility-sponsored group activities, individual activities, and independent activities for three residents reviewed for activities. The deficiency involved Resident #27, Resident #73, and Resident #85, and the report states that the failure could place residents at risk for boredom, depression, and diminished quality of life. Resident #27 was an older male with diagnoses including blindness in both eyes and a BIMS score of 6, indicating severe cognitive impairment. His MDS reflected that vision was highly impaired and that books, newspapers, and magazines were very important to him. His care plan addressed visual impairment and legal blindness, but there was no activities focus. During interview, he said he got bored on weekends because there were not enough activities, especially activities that accommodated blindness. He also said he was taken to bingo but was not given a large-print bingo card, so he could not participate. Resident #73 was a female with diagnoses including a displaced comminuted fracture of the shaft of the right femur, atrial fibrillation, and morbid obesity, and her BIMS score was 15. Her baseline care plan had no activities focus. She stated she was not asked about activity preferences on admission, did not receive an activity calendar until later, and no one had come to her room to offer activities such as coloring materials or puzzles. Resident #85 was a male with diagnoses including central cord syndrome at C3, occlusion and stenosis of an unspecified middle cerebral artery, and a cerebral aneurysm, with a BIMS score of 9. His care plan noted dependence on staff for activities and cognitive stimulation/social interaction related to physical limitations. He said the facility had asked what activities he liked, but the toss game they used to play outside could not be located, popcorn was no longer available during movies, and he was currently bored. The acting AD stated activities did not always start on time, there was not much resident involvement because many residents lacked physical ability or stamina, and she had no training in being an activities director or direction from the facility regarding activities.
Failure to Provide Individualized Activities
Penalty
Summary
The facility failed to provide individualized activities for Resident 5, who was admitted with diagnoses including anxiety disorder, depression, and weakness. The admission MDS dated 01/14/2026 showed the resident was cognitively intact. During interviews on 05/03/2026 and 05/06/2026, Resident 5 stated they could not attend in-person activities because of their legs, wanted more activities to occupy them, mostly stayed in bed watching TV, and did not remember the last time activities staff visited to offer activities. The resident also stated activities staff would need to offer something they were able to do because they had difficulty doing some activities. The activities care plan dated 12/26/2026 showed a goal for Resident 5 to participate in activities two to three times per week. Progress notes documented one visit on 12/22/2026 to provide a welcome packet and encourage participation in daily activities, but no further activity documentation was found in the progress notes. Staff H stated room visits should include puzzles, arts and crafts, visiting, and chatting, and that documentation was placed in tasks, but the task record showed no documentation of activities for the past 30 days. Staff J stated paper documentation existed for room visits and that Resident 5 was on a list for room visits every Monday and Wednesday, while the room visit documentation showed only four visits on 01/26/2026, 02/06/2026, 03/10/2026, and 04/08/2026.
Failure to Provide Individualized Activities
Penalty
Summary
The facility failed to ensure individual activities of preference were provided to a resident with Alzheimer's disease who was identified in the care plan as being at risk for depression and impaired social interaction and who was expected to participate in social situations and activities of choice. The resident's representative stated the resident had not received activities at the facility and needed to stay busy because of dementia, and reported that attempts to speak with activity staff about appropriate activities were unsuccessful because staff were always on their way somewhere else. Survey observations showed the resident wandering in the halls and sitting in the front lobby, and the resident was not observed participating in facility activities. The DON stated there was no record of activity participation for the resident, and an activity staff member stated she only sat and talked with the resident once in a while and was the only activity staff member, so she did not have time. The facility policy also stated that special considerations would be made for developing meaningful activities for residents with dementia and/or special needs.
Failure to Provide Activities for a Resident with Cognitive and Physical Impairment
Penalty
Summary
The facility failed to provide activities designed to meet the interests of and support the physical, mental, and psychosocial well-being of Resident 22. The resident’s diagnoses included Parkinson’s disease and cerebrovascular disease. The Quarterly MDS dated 2/10/26 indicated moderate cognitive impairment and dependence in ADLs and transfers. The Activities Care Plan, revised 4/27/26, directed staff to invite the resident to groups of interest such as worship, music events, social groups, and cognitive groups. During random observations, Resident 22 was repeatedly found lying in bed in a quiet room without television, music, or other stimulation on multiple dates and times. On 5/1/26, while a live music activity was occurring in the main dining room, the resident remained awake in bed in his room. The May 2026 Activities Calendar listed music, art, and worship activities, but the Activities Participation 30-day documentation showed only three one-on-one visits per week, one friendly visit, and one people watching entry, with no documentation that the resident attended or refused activities. The Activities Director stated the resident liked music and art, had previously participated with assistance, had not been out of his room for an activity since March, and that the only activity interaction he was receiving was three 20-30 minute one-on-one visits per week.
Failure to Adequately Assess and Implement a Resident’s Activity Preferences
Penalty
Summary
The deficiency involves the facility’s failure to adequately assess and honor a resident’s activity preferences and to meet the resident’s identified needs for meaningful activities. The resident had dementia, severe cognitive impairment with a BIMS score of six, depression, age-related macular degeneration, osteoarthritis, and sensorineural hearing loss. The comprehensive MDS assessment documented that it was somewhat important to the resident to have books, newspapers, and magazines to read, to listen to music, and to be around animals such as pets. Despite this, the activity participation assessment dated 10/06/25 noted the resident was hard of hearing and hard to communicate with, was completed only with the resident and not the family, and concluded the resident was unable to identify preferred activities. The plan of care dated 11/06/25 described the resident as sociable, liking to participate in various activities, and willing to interact with others and participate in activities related to their interests as their condition allowed. It also stated the resident had no current activities of interest and was unable to pursue interests due to physical and/or cognitive condition, while listing arts and crafts, bingo, and music as important activities. Interventions included discussing the activity calendar, encouraging rest so the resident could attend preferred activities, and inviting the resident to music-related and scheduled activities. However, the subsequent activity participation review dated 12/15/25 was not completed, and the Activities Director reported trying to identify the resident’s preferred activities but could not refer to any documentation of this, and thought she had spoken to the family but acknowledged it might not be documented. Activity participation records from 04/01/26 to 04/19/26 showed daily participation in relaxation, television/radio/movies, and news events, and documented one-on-one and reading activities on two dates, although the Activities Assistant later stated the resident had been asleep during those one-on-one sessions and that relaxation meant the resident was simply resting in bed. Multiple observations on 04/20/26 and 04/21/26 found the resident awake in a dark room with no television, music, reading materials, or other entertainment, and an empty bedside table. A CNA confirmed the resident was sitting in the dark without any form of entertainment and was unsure of the resident’s music or television preferences. The RAI User’s Manual guidance cited in the report states that activity preference information should be obtained from the resident or, if not possible, from family or others, and used to create an individualized plan based on the resident’s preferences, underscoring that the facility did not adequately assess and implement the resident’s activity preferences as required.
Incomplete individualized activity plan and no documented activity participation
Penalty
Summary
Provide activities to meet all resident's needs. Based on observation, interview, and record review, the facility failed to develop and implement an individualized activity plan for Resident 61, who was admitted with diagnoses of stroke, vascular dementia, and kidney failure and was non-verbal and unable to make needs known. The resident's care plan had incomplete activity focus, goals, and intervention areas. Observations on 04/20/2026, 04/21/2026, and 04/22/2026 showed the resident lying in bed awake looking at the ceiling or wall, with a television present in the room but not observed on during any of the observations. Review of the March and April 2026 activity flow sheets showed the resident was not offered and did not participate in any individual or group activities. During interview, the Activity Director reviewed the record and stated staff should have contacted the resident's representative to assist with the activity care plan and that the resident had not been offered any independent or group activities, which did not meet expectations.
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