Failure to Provide Access to Dental Services
Penalty
Summary
The facility failed to provide access to oral surgery dental services for a Medicare resident, identified as Resident #26, who was reviewed for dental services. The resident was observed sitting in bed with missing top and bottom teeth and expressed a desire to see a dentist. The facility's Dental Services Policy and Procedure indicated that dental needs should be identified through assessments and addressed in the resident's care plan, with assistance provided for making dental appointments and arranging transportation. However, there was no dental care plan available for Resident #26. The resident's records showed a history of periodontal exams with recommendations for oral surgery to extract problematic teeth. Despite these recommendations, the facility did not make the necessary arrangements for the resident to receive oral surgery. Progress notes indicated attempts to schedule appointments and arrange transportation, but these efforts were unsuccessful due to issues with insurance coverage and transportation provider reimbursement. The resident was informed of the situation and expressed a desire to have her dental issues addressed. Interviews with facility staff, including a registered nurse and the Director of Social Services, confirmed that no further arrangements were made for the resident's oral surgery. The MDS Coordinator also confirmed the absence of a dental care plan for the resident. This deficiency highlights the facility's failure to comply with the statutory requirement to provide access to necessary health-related services, including dental care, for its residents.
Plan Of Correction
The corrective action accomplished for those residents affected include: Resident # 26 was reviewed and discussed with the resident's dentist on [date] for a secondary dental [procedure], and resident # 26 was seen by the dentist on [date]. Additional referral received and additional dental [procedure] scheduled at Nova Dental for [date] on [date]. Other residents having the potential to be affected were identified by: An audit was conducted by the Director of Social Services on [date] to identify if any other residents had missed their out-of-facility dental [appointments]. No other residents were identified as missing dental services by the audit. The measures of systematic changes made include: The Social Service Department reviewed the policy and procedure on Dental Services on [date]. Nursing Staff were reinserviced on [date] and [date] regarding scheduling and follow-ups. The corrective actions put in place include: The Director of Social Services or designee will perform random audits on a monthly basis for dental visits, recommendations, and compliance in follow-up and attendance. The Director of Nursing or designee will monitor ongoing compliance through random observations and chart reviews of nursing documentation and physician orders regarding dental updates. Findings will be reported to the QAPI Committee quarterly over the next six months with any necessary additional in-services.