Failure to Provide Routine Dental Care for Resident
Penalty
Summary
The facility failed to provide routine dental services to meet the needs of Resident #101, who had complaints of tooth pain while chewing but was not evaluated by a dentist. The facility's policy required that within 14 days of admission, a comprehensive oral assessment should be completed by a dentist or dental hygienist unless refused by the resident. However, Resident #101, who was admitted with conditions including dorsalgia, hemiplegia, and hypertension, did not receive the necessary dental care despite documented complaints of mouth or facial pain and difficulty with chewing. The nursing admission assessment noted Resident #101's complaints of mouth or facial pain, but there was no evidence in the nursing progress notes that the resident was seen by a dentist or that a medical provider was notified of the tooth pain. Although the resident consented to dental services, they were not included in the schedule of residents to be seen by the dentist. Interviews with nursing staff revealed a lack of communication and follow-up regarding the resident's dental complaints, and the Health Information Management Clerk did not keep track of referral forms for dental issues. The facility's dental contractor stated that the dentist was not informed of Resident #101's pain, and the resident was not seen during the dentist's visits to the facility. The Director of Nursing and the Administrator both expressed expectations that the resident should have been seen by the dentist, and that communication regarding dental complaints should have been made to ensure the resident's comfort and care. The deficiency highlights a breakdown in communication and adherence to the facility's dental care policy, resulting in unmet dental needs for Resident #101.
Plan Of Correction
Plan of Correction: Approved February 4, 2025 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** **F790 Routine/Emergency Dental Services in SNF’s** 1. What corrective action will be accomplished for those residents found to have been affected by the deficient practice? a. For Resident 101, Dent Serv was immediately notified of need for patient to be seen for dental pain while chewing, patient was in isolation for COVID and an appointment was made for patient when out of quarantine. Patient was seen by dental service on 1/27/25. 2. How you will identify other residents having the potential to be affected by the same deficient practice and what corrective action will be taken? a. All residents have the potential to be affected by the same deficient practice. b. An MDS report was run on the most recent MDS completed on all in house residents questioning L0200F Mouth or facial pain, discomfort or difficulty with chewing. A look back period went from (MONTH) 2024 to [DATE]. No other resident’s triggered for this question. 3. What measures will be put in place or what systemic changes you will make to ensure that the deficient practice does not reoccur? a. All RN’s who complete admission assessments will be in-serviced on P&P CBC-NUR-402 community based dental care and notifying the medical provider immediately of any resident complaints related to mouth or facial pain, discomfort or difficulty with chewing. They will also be in-serviced on placing a call to our dental service to schedule a visit and fill out the Dental visit form with concern for visit and fax to the Dent Serv. b. C.N.A’s and nursing staff will be in serviced to notify the patients primary nurse and or nurse manager if any resident complains of any mouth or facial pain, discomfort or difficulty with chewing. c. All RN’s will be in-serviced to ensure all new admissions sign the dental consent service form, those who wish to receive dental services will be scheduled to have a comprehensive oral assessment by the dentist or dental hygienist within 14 days of admission. d. All nursing staff will be in-serviced to add any resident complaints related to mouth or facial pain, discomfort or difficulty with chewing to 24 hour report for Nurse Manager to bring to am report. This will also include the follow up to the medical and dental provider notification. 4. How the corrective action will be monitored to ensure the deficient practice will not reoccur? a. All new admissions and readmissions will be audited within 72 hrs. of admission by nurse manager or designee to see if dental service consent form is completed, signed and also to see if any resident complains of mouth or facial pain, discomfort or difficulty chewing. b. The DON will run the MDS analyzer report each week to see if there is any resident with any complaints of mouth or facial pain, discomfort or difficulty chewing for appropriate follow up. Any deficient findings would be corrected immediately. c. The ADON will complete an audit to be filled in after am huddle with the name of each resident who is on 24 hour report with complaints of oral pain and note that medical provider and dental provider were notified and follow up visit and care is documented. Any deficient findings would be corrected immediately. d. The results of these audits will be reported by the Director of Nursing at our quarterly Quality and Resident Safety committee for review. These audits will continue until we achieve 100% compliance for 8 consecutive weeks. 5. The date of the correction and the title of the person responsible for the correction of the deficiency Date of corrections: (MONTH) 5, 2025 Person Responsible: Director of Nursing