Failure to Coordinate Eye Care for Resident
Penalty
Summary
The facility failed to coordinate necessary eye care for a resident with quadriplegia, slurred speech, polyneuropathy, and mild vascular dementia. The resident had a medical order for vision consults as needed, starting from June 2022, and was experiencing eye irritation, for which artificial tears were prescribed. Despite the resident's ongoing complaints of eye discomfort and the ineffectiveness of the artificial tears, the facility did not arrange for an eye specialist consultation. The resident's condition included watering eyes and reddened conjunctivas, and the resident reported significant pain in the right eye. The Assistant Director of Nursing had requested an eye specialist appointment for the resident in January 2025, but the Social Services Director did not follow through with the coordination of care. The in-house eye specialist was out of network for the resident's insurance, and the resident could not afford to pay out of pocket. Despite being aware of these issues, the Social Services Director did not seek alternative arrangements or request facility assistance to cover the cost, resulting in the resident not receiving the necessary specialist care.
Plan Of Correction
Resident #45 was seen by the optometrist on and new orders received. An audit was completed on by Social services of current residents and any additional resident referrals were followed up on. The facility has contacted an outside to ensure that the resident's new insurance was covered by an optometrist for any future needs completed by. On Social services was educated on the process for ensuring that all referrals are submitted on a timely basis by the Administrator. The Social service team has been educated on the importance of documenting each step of the referral and any roadblocks that they are trying to overcome. Social services will perform weekly audits of residents' referral orders to ensure are obtained and follow up on timely. Audits will continue weekly for a minimum of 3 months or until significant compliance has been met after. The results of the audits will be submitted to the Administrator for review and discussed at the monthly QAPI committee meeting. The committee will direct improvement to the plan when necessary to achieve and maintain compliance.