Deficiency in Admission Documentation and Resident Rights Review
Penalty
Summary
The facility failed to maintain proper admission documentation and provide a comprehensive review of resident admission rights, policies, and payment requirements for several residents. Specifically, the facility did not have admission records for two residents, Resident R32 and Resident R57, who were admitted in late March 2025. Both residents' clinical records lacked signed admissions records and did not include an admissions packet or discussion upon admission that covered essential information such as patient portion liability, daily rate cost structure, resident rights, and other critical details. Additionally, the facility did not provide a comprehensive review of admission rights and payment requirements for two other residents, Resident R62 and Resident R66. The admissions packet information was incomplete, missing details about per diem costs, Medicaid pending portion payment information, and a description of fees for services. Interviews with the residents revealed that they were not informed about their payment responsibilities or the billing schedule, and they had not received any bills while staying at the facility. Interviews with facility staff, including the Regional Business Office Manager and the Admissions Coordinator, highlighted a lack of clarity and communication regarding the Medicaid pending portion bill and the admissions process. The Admissions Coordinator, who works from home, did not review the admissions packet with residents and was unaware of the Medicaid pending portion bill, leaving the financial department to handle these matters. The Registered Nurse confirmed the facility's failure to provide a comprehensive review of resident admission rights and maintain admission documentation as required.
Plan Of Correction
1. A whole house audit was completed on admission documents and providing a comprehensive review of resident admission rights, policies, and payment requirements. 2. Future Residents will not be charged a $1000 monthly fee while awaiting Medicaid approval. 3. NHA/designee to educate Business Office Manager on the need to cease charging Medicaid pending residents the $1000 fee while waiting to be approved for Medicaid. 4. BOM/designee to audit resident statements monthly x3 months to ensure the issue does not recur. 5. NHA/designee to educate Social Services on the need to complete Admissions documents and providing a comprehensive review of resident admission rights, policies, and payment requirements. 6. Social Services/designee to audit admissions documents and resident admission rights, policies, and payment requirements 2x/week for 2 weeks, then monthly x 2 months. 7. Results to be submitted to QAPI for review and approval.