Failure to Submit Timely MDS Assessments
Penalty
Summary
The facility failed to ensure accurate and timely completion of resident assessments for two residents. Resident #27 was admitted to the facility and later died there. An MDS assessment for death in the facility was completed but not submitted. Resident #82 was admitted and later discharged to the hospital. The last MDS assessment submitted for this resident was an admission assessment, and the discharge assessment was not submitted until a later date. Staff E, a Resident Care Specialist I RN, confirmed that Resident #27's MDS assessment should have been submitted and acknowledged that the discharge MDS assessment for Resident #82 was delayed. The staff member attributed these issues to a switch in electronic medical records systems, which caused them to work in two systems simultaneously.
Plan Of Correction
1. Residents #27 & #82's assessments were transmitted on. 2. Minimum Data Set (MDS) Coordinator/Designee has completed a review of facility resident Minimum Data Set assessments completed over the last 30 days to verify completed & transmitted timely. Follow up based on findings. 3. Staff Development Coordinator/Designee has completed education with current facility Minimum Data Set employees related to timely Minimum Data Set completion/submission. 4. Minimum Data Set Coordinator/Designee to complete monitoring to verify assessments completed/transmitted timely weekly x 3 months or until substantial compliance is achieved. Findings to be reviewed during the monthly Quality Assurance and Performance Improvement Committee Meeting. Modifications implemented as indicated.