Failure to Notify Ombudsman and Resident's Representative of Emergency Transfers
Penalty
Summary
Monumental Post Acute Care at Woodside Park was found to be non-compliant with the requirements of 42 CFR part 483, Subpart B, specifically regarding the notice requirements before transfer or discharge of residents. The facility failed to notify the Office of the State Long-Term Care Ombudsman about facility-initiated emergency transfers to the hospital for a resident. Additionally, the facility did not inform the resident's representative of the transfer and the reasons for the move in writing and in a language and manner they understand. The deficiency was identified through a review of nursing notes and clinical records for a resident who experienced a seizure and was transferred to a local hospital for evaluation. Further documentation revealed another instance where the resident was admitted to the hospital for altered mental status. Despite these transfers, there was no documentation available to indicate that the Ombudsman was notified, as required. Interviews with staff confirmed the lack of notification to both the Ombudsman and the resident's representative.
Plan Of Correction
State Long Term Care Ombudsmen have been notified of Transfers/discharge for R136. The Social Services team have been educated on the importance of adherence to regulations re: F623. All discharges, transfers, and discharges have been reviewed for the past three months. There were no further discrepancies in notification. State Long Term Care Ombudsmen will be notified of emergency transfers in writing by Social Services or designee monthly. Notification of State Long Term Care Ombudsmen will be reviewed/audited monthly for accuracy by Social Services, and the results will be reported in monthly QAPI.