Resident Not Informed of Physician Change
Summary
The facility failed to ensure that a resident was involved in the decision-making process and was notified of a change in their attending physician. This deficiency was identified for a resident who had the capacity to understand and make decisions, as indicated by their History and Physical and Minimum Data Set assessments. The resident was not informed about the change of physician, which was made due to a shift in their level of care from skilled to custodial care. The resident expressed that they were unaware of the change and emphasized their right to be informed and to choose their own physician. During an interview, the Director of Nursing confirmed that there was no documentation indicating the resident was notified about the change of physician. The facility's policy and procedure on the choice of attending physician and resident rights clearly state that residents have the right to choose their physician and must be informed of any changes. The failure to notify the resident and involve them in the decision-making process violated their rights as outlined in the facility's policies and federal and state laws.
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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