Failure to Honor Residents' Right to Choose Attending Physician
Summary
The facility failed to honor the residents' right to choose their attending physician, affecting four out of six sampled residents. The deficiency arose when the facility changed medical provider groups without adequately assisting residents in making an informed choice about their attending physician. The facility's policy, which guarantees residents the right to be informed and choose their attending physician, was not followed. Interviews with residents revealed that they were either not offered a choice or not informed about their right to select a physician, nor were they informed about which physicians were covered by their insurance. The facility's electronic medical records contained unsigned and undated provider choice documents, indicating that the residents' consent was not properly obtained. Staff interviews revealed that the previous facility owner had restricted physician choices to a newly contracted medical group, and the new ownership continued this practice by offering only two new physicians for residents to choose from. The Social Services Director admitted to assisting residents in choosing a physician without providing complete information about insurance coverage, and the provider choice forms were completed without the residents' or their legal representatives' signatures.
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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