Failure to Honor Residents' Right to Choose Attending Physician
Summary
The facility failed to honor the residents' right to choose their attending physician when it changed medical provider groups. This deficiency was identified through interviews and record reviews, revealing that residents across five hallways were not informed or given the opportunity to consent to the change in their primary care provider (PCP). The facility's policy, which mandates informing residents in writing about their attending physician during admission, upon changes, and upon request, was not followed. Interviews with several cognitively intact residents indicated that they were unaware of the change and had not been consulted or informed about the new physician assigned to them. The facility's administration, including the Nursing Home Administrator (NHA) and the Regional Clinical Consultant (RCC), confirmed that the change in the medical provider group was a corporate decision made on June 1, 2024, and that they were not given a choice in the matter. The NHA admitted that no meetings or letters were provided to inform residents or obtain their consent. Additionally, a group interview with alert and oriented residents corroborated that they were not informed about the change in medical provider groups, nor were they asked for their permission. The facility was unable to provide documentation proving that residents and their responsible parties had been informed or that consent was obtained for the change in physicians.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
A resident with severe cognitive impairment and multiple diagnoses was admitted without a signed consent for treatment by facility providers, as the legal guardian insisted on exclusive care by VA providers. Despite this, staff obtained or attempted to obtain medical orders from facility providers on several occasions, contrary to the guardian's directives and without proper authorization.
Failure to Ensure Resident Received Care Only from Approved Physicians
Penalty
Summary
This facility failed to ensure that a resident received care and services only from approved physicians, as required. The resident in question was admitted with diagnoses including Alzheimer's disease, heart disease, and obstructive sleep apnea, and had a severely impaired cognitive status as indicated by a BIMS score of 3 out of 15. The resident's legal guardian, who was also the daughter, refused to sign the facility's consent for treatment and insisted that all medical care be provided exclusively by VA providers. The guardian also took responsibility for scheduling and notifying the VA for all appointments, declining involvement from the facility's medical director or related providers. Despite the lack of consent for treatment by facility providers, there were multiple instances where facility staff either attempted to obtain or did obtain medical orders for the resident. These included a new order for Depakote from a CNP for increased agitation, notification of a provider regarding leg swelling, and a treatment order for a skin injury after the medical director's group was contacted. Interviews with the Administrator and DON confirmed that the facility did not have a signed consent on file and that staff actions were taken without the required authorization from the resident's legal guardian.
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