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F0578
D

Failure to Follow Advance Directive and POLST Procedures

Sunnyvale, California Survey Completed on 04-11-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to follow its own policies and procedures regarding advance directives (AD) and Physician Orders for Life-Sustaining Treatment (POLST) forms for three residents. For two residents, the POLST forms had incomplete sections regarding advance directives, and there was no documented evidence that the facility verified, offered, or assisted these residents in executing an AD. For the third resident, the POLST form indicated no advance directive, and again, there was no documentation that the facility offered or assisted with executing an AD. These findings were confirmed by both the social service director and the director of nursing, who acknowledged that staff should have completed the relevant sections and provided assistance as required. Record reviews showed that upon admission, the facility did not consistently ask residents about existing advance directives, nor did they ensure that copies were obtained and placed in the clinical record as outlined in their policy. Additionally, the admitting nurse did not always review the POLST form for completeness. The lack of documentation and incomplete forms demonstrate that the facility did not adhere to its established procedures for ensuring residents' rights regarding advance directives and life-sustaining treatment preferences.

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