Deficiency in Emergency Preparedness Communication Plan
Penalty
Summary
The facility's emergency preparedness communication plan was found to be deficient as it did not include a method for sharing information and medical documentation for patients with other health care providers. This deficiency was identified during a document review conducted on January 13, 2025, at 8:00 a.m. The absence of this critical component in the communication plan affects the entire facility, as it is essential for maintaining the continuity of care during emergencies. During an exit interview with the Administrator and the Maintenance Director on the same day at 10:30 a.m., it was confirmed that the facility lacked the necessary documentation to support the sharing of patient information and medical documentation. This oversight in the emergency preparedness communication plan indicates a failure to comply with the regulatory requirements, which mandate the inclusion of such methods to ensure effective communication and continuity of care in emergency situations.
Plan Of Correction
The facility established policy to share appropriate information from the facility's emergency plan with residents and their representatives. The Senior Director of Property and Facilities will ensure the Emergency Operations Manual and related policies are reviewed on an annual basis. Results of the review will be submitted by the Senior Director of Property and Facilities to the Quality Assurance and Performance Improvement Committee on an annual basis.