Failure to Provide IV Antibiotic Therapy Due to Lack of RN
Summary
The facility failed to implement its admissions policy and procedure when it admitted a resident from a general acute care hospital for intravenous (IV) antibiotic therapy without having a registered nurse (RN) on duty to administer the medication. This resulted in the resident not receiving the prescribed IV antibiotic medication and necessitated the resident's return to the hospital just three hours after admission. The resident was admitted with diagnoses including bacteremia, dementia, major depressive disorder, and anxiety, and required IV vancomycin every 12 hours for MRSA bacteremia. Interviews and record reviews revealed that the facility's staff, including the Licensed Vocational Nurse (LVN) and the Director of Nursing (DON), were aware of the resident's need for IV antibiotics but were unable to provide the necessary care due to the absence of an RN. The LVN, who was the charge nurse at the time, informed the DON and the resident's responsible party about the situation, leading to the decision to send the resident back to the hospital. The facility's Marketing Director/Admissions also acknowledged that the resident should not have been transferred to the facility without the availability of an RN to administer the medication. The facility's policy and procedure for admissions, which aims to ensure that residents who can be adequately cared for are admitted, was not followed in this instance. The failure to coordinate and ensure the availability of appropriate nursing staff to administer the required IV medication directly led to the deficiency. The facility's job description for the Admissions Director emphasizes the need to coordinate with the Director of Nursing to assure the appropriateness of facility admissions, which was not effectively executed in this case.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
A resident admitted with multiple medical conditions did not have a signed admission Agreement on file, as required by facility policy. The omission was discovered during an audit, and the responsible party was later contacted to complete the paperwork, confirming that the admission coordinator had not generated the document at the time of admission.
A resident admitted with multiple medical conditions did not have required admission paperwork completed and signed until 28 days after admission, contrary to facility policy that mandates completion within 48 hours. The Administrator confirmed the delay and attributed it to the lack of a full-time admissions coordinator.
A resident with impaired cognition and a history of traumatic brain injury was placed on a secured behavioral unit without a physician order, signed consent, or a determination of incompetence, contrary to facility policy requiring such authorizations for secured unit placement.
The facility failed to ensure timely signing of consent to treat and admission agreements for two residents. One resident, with severe cognitive impairment, had their consent signed only on the day of their death. Another resident, who was cognitively intact, signed their admission agreement 11 days after admission due to the Director of Public Relations' absence and the resident's initial reluctance.
The facility failed to provide written Admission Agreements to new residents upon admission, affecting four residents with various medical conditions. The Business Office Manager could not provide evidence of these agreements, and the Administrator confirmed their absence. This deficiency was investigated under a specific complaint number.
The facility failed to ensure timely provision and signing of admission agreements for three residents, all of whom had significant medical conditions. Admission agreements were signed seven to nine days after admission, contrary to the facility's policy.
Failure to Obtain Signed Admission Paperwork at Admission
Penalty
Summary
The facility failed to ensure that required admission paperwork was signed for a resident upon admission. Record review showed that a resident was admitted with multiple diagnoses, including transient cerebral ischemic attack, heart failure, atrial fibrillation, hypertension, obstructive sleep apnea, peripheral autonomic neuropathy, anxiety disorder, abnormalities of gait and mobility, dysphagia, insomnia, muscle weakness, essential tremor, and foot drop. The resident was assessed as having intact cognition. During the investigation, it was found that the facility did not have a signed admission Agreement for this resident, and the responsible party was contacted to complete the paperwork after the fact. Interviews with the administrator confirmed that the admission Agreement was not completed at the time of admission, and the omission was discovered during an audit of admission Agreements. The administrator acknowledged that the document was not lost but had never been generated or signed. The facility's policy required a completed admission application, including financial disclosure and supporting documents, before review by the admissions team. The responsible party for the resident confirmed being contacted by the facility to sign the admission Agreement, as it had not been provided during the admission process.
Failure to Complete Admission Paperwork Within Required Timeframe
Penalty
Summary
The facility failed to ensure that admission paperwork was completed and signed as required for one resident out of five reviewed for admission. Specifically, a resident with diagnoses including type two diabetes mellitus, obstructive sleep apnea, respiratory failure with hypoxia, anxiety disorder, and hypertension was admitted, and the admission Minimum Data Set (MDS) assessment indicated no cognitive impairment. However, review of the resident's admissions packet revealed that all required documents, such as the admissions agreement, responsible party agreement, assignment of benefits, and various consents, were signed 28 days after the resident's admission rather than at the time of admission. During an interview, the Administrator confirmed that the admissions paperwork was not completed at the time of admission and acknowledged that it should have been. The facility's policy requires that all admission paperwork be completed and signed within 48 hours of admission, with the Administrator signing off on the completed packet within the same timeframe. The Administrator also noted the absence of a full-time admissions coordinator, stating that the responsibility for completing admissions paperwork fell to either the Mobile Admissions Coordinator or the Administrator.
Resident Placed on Secured Unit Without Required Authorization or Consent
Penalty
Summary
The facility failed to ensure that a resident placed on a secured behavioral unit met the established criteria for admission to that unit. Specifically, the resident had diagnoses including subdural hemorrhage, intracranial injury, hypotension, generalized anxiety disorder, and impaired cognition, and was identified as being at risk for elopement and wandering. The care plan indicated the resident resided on the secure unit for safety, with interventions to manage wandering behaviors. However, there was no physician order authorizing the resident's placement on the secured unit, and the resident had not signed a consent form for this placement. Further review revealed that the resident had not been declared incompetent, nor did they have a power of attorney or guardian. The facility's policy required that residents admitted to the secure behavioral unit must have a current mental health diagnosis, psychosocial or behavioral disturbance, be deemed incompetent by a physician, and have a current or active power of attorney or guardian. These requirements were not met in this case, as confirmed by staff interview and medical record review.
Delayed Consent and Admission Agreement Signing
Penalty
Summary
The facility failed to ensure timely signing of consent to treat and admission agreements for residents. For Resident #89, who was admitted with severe cognitive impairment and multiple medical conditions, the consent to treat was not signed until the day of the resident's death, despite the resident being dependent for all activities of daily living and having a Power of Attorney present shortly after admission. The Director of Nursing confirmed that the nursing staff were responsible for obtaining the consent to treat upon admission, but this was not done in a timely manner. For Resident #51, who was cognitively intact and admitted with conditions such as cerebral infarction and diabetes, the consent to treat was signed two days after admission, but the admission agreement was not signed until 11 days post-admission. The Director of Public Relations acknowledged the delay, attributing it to the resident's initial reluctance to complete paperwork and her own absence from the facility due to marketing duties. This deficiency was investigated under Complaint Number OH00163843.
Failure to Provide Admission Agreements to New Residents
Penalty
Summary
The facility failed to provide written Admission Agreements to new residents at the time of their admission, affecting four out of five residents reviewed for admission procedures. This deficiency was identified through a review of medical records and staff interviews. The residents involved had various medical conditions, including diabetes mellitus type II, lumbar disc degeneration, congestive heart failure, acute myocardial infarction, adult failure to thrive, non-pressure chronic ulcer, morbid obesity, acute kidney failure, depression, acute osteomyelitis, partial traumatic amputation, polyneuropathy, bilateral osteoarthritis, and edema. Despite these conditions, the facility did not have evidence of providing the necessary Admission Agreements to these residents. The Business Office Manager was unable to provide the requested evidence of written Admission Agreements for the residents in question. Subsequent interviews with the Administrator confirmed that the facility had no evidence of signed Admission Agreements for the affected residents. This deficiency was investigated under Complaint Number OH00154443, highlighting a lapse in the facility's admission procedures and documentation practices.
Failure to Provide Timely Admission Agreements
Penalty
Summary
The facility failed to ensure that admission agreements were provided and signed timely for newly admitted residents. This deficiency affected three residents, all of whom had significant medical conditions. Resident #10, diagnosed with sepsis, prostate cancer, type II diabetes, and other conditions, was admitted on [DATE] but did not sign the admission agreement until nine days later. Similarly, Resident #11, with diagnoses including a fractured clavicle and heart disease, signed the admission agreement nine days after admission and just three days before discharge. Resident #12, who had undergone joint replacement surgery and had other medical issues, signed the agreement seven days after admission and one day before discharge. The Admissions Director confirmed that admission packets are typically signed within 72 hours, although there is no defined timeframe for signature. The facility's policy requires that potential residents sign the admission agreement and receive a copy of the facility's description of services, payment options, and resident rights prior to signing. However, this policy was not followed for the three residents in question. The deficiency was investigated under Complaint Number OH00152165.
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