Failure to Ensure Physician Conducted Initial Visits
Penalty
Summary
The facility failed to ensure that a physician completed the initial visit for three residents, as required by regulations. According to the clinical records, Resident R116 was admitted on June 6, 2024, and their initial visit was conducted by a Certified Registered Nurse Practitioner (CRNP) on June 7, 2024, instead of a physician. Similarly, Resident R229, admitted on December 5, 2024, had their initial visit conducted by a CRNP on December 6, 2024. Resident R422, admitted on December 10, 2024, also had their initial visit conducted by a CRNP on December 11, 2024. These actions were not in compliance with the requirement that the initial visit must be conducted by a physician. The deficiency was confirmed during an interview with the Director of Nursing, who acknowledged that the facility did not ensure a physician completed the initial visits for the three residents. The residents involved had various medical conditions, including dementia, hypertension, depression, osteomyelitis, spina bifida occulta, lymphedema, traumatic brain injury, and anxiety. The failure to have a physician conduct the initial visits was a deviation from the regulatory requirements outlined in §483.30(c).
Plan Of Correction
1. R116, R229 and R422 were seen by a physician and had history and physical completed. 2. An audit was done of admissions for the previous 30 days to ensure residents were seen by a physician for a full history and physical; no issues identified. Verbiage for NP visits needed prior to initial physician visit has been changed to "medical stabilization visit." 3. Director of nursing will meet with medical director to review regulatory requirements related to physician visits. 4. Director of nursing or designee will audit 2 new admissions weekly for 4 weeks to ensure initial history and physical is completed by a physician. Audit findings will be shared with QAPI committee.