Failure to Honor Residents' Right to Choose Physician
Summary
The facility failed to honor the residents' right to choose their attending physician, affecting three sampled residents. Resident #2 expressed dissatisfaction with being assigned to staff member C as his physician, despite his preference for NF1. Staff member C claimed that as a VA resident, Resident #2 was required to see her, although the VA contract did not support this claim. Staff members D and B confirmed that all residents were automatically assigned to staff member C upon admission, regardless of their preferences. Resident #3 and Resident #4 also reported not being given a choice of physician upon admission, with Resident #4 unaware of his right to choose. Staff members A, F, and G acknowledged that residents were routinely switched to staff member C as their primary care physician, despite the facility's policy stating residents have the right to choose their medical service providers. Staff member F noted that in her years of employment, no resident had chosen a physician outside the facility's employed providers. The facility's practice of assigning staff member C as the primary care physician for all residents, including VA residents, contradicted the documented resident rights, leading to the deficiency.
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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