Failure to Notify Residents of Physician Change
Summary
The facility failed to honor the residents' right to choose their attending physician, affecting five residents. This issue arose after the facility terminated the agreement with their Medical Director and changed the attending physician without notifying the residents or their representatives. The change was effective on July 4, 2024, and the lack of communication regarding this change was evident in the interviews and record reviews conducted during the survey. Resident #1, a female with intact cognition, was not informed about the change in her primary physician. She noticed the change when a new doctor visited her, but she was not officially notified. Similarly, Resident #2's responsible party was not informed about the change in the medical director, although they were notified about the facility's change in ownership. Resident #3's responsible party also did not receive any notification about the change in the medical director or the primary physician. The facility's administration acknowledged the oversight in communication. The new administrator and other staff members, including the Director of Operations and the Director of Nursing, admitted that residents and their responsible parties should have been notified 30 days in advance of the change. However, there was no evidence that such notifications were distributed, leading to confusion and a lack of choice for the residents regarding their attending 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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