Failure to Provide Residents with Choice of Attending Physician
Summary
The facility failed to honor residents' rights to choose their attending physician, as evidenced by the switch to a new provider group without notifying all residents or providing them with options. The Director of Nursing (DON) was unable to provide the facility's policy on resident choice of attending physician when requested. Interviews with residents revealed that they were not informed about the change in providers and were not given a choice. One resident expressed dissatisfaction with the new provider, citing issues with medication management and lack of communication. Record reviews showed no documentation of resident notification or choice regarding the change in providers. The DON confirmed that the provider group switch affected almost all residents and acknowledged the lack of written notice to residents. The Regional Director of Quality Assurance also confirmed that it was the facility's responsibility to inform residents and provide them with a choice, but no documentation of such notification was available.
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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