Failure to Notify Resident Representative Prior to Hospital Transfer
Penalty
Summary
The facility failed to ensure that a resident or their representative received adequate preparation and notification prior to a hospital transfer. Specifically, a resident with a diagnosis of cerebral infarction and severe cognitive impairment was transferred to the hospital without the knowledge or consent of her designated healthcare power of attorney, her daughter. The daughter reported that she was not informed of the transfer, and the resident was unable to speak or make decisions for herself due to her condition. Review of the resident's records, including the face sheet, MDS, and nurse progress notes, revealed no documentation that either the resident or her representative was prepared for or notified about the hospital transfer. The facility's policy requires that all discharge decisions, including reasons for discharge and discussions with the resident and family, be documented, and that required notices and appeals information be provided. This policy was not followed in this instance, resulting in a lack of proper documentation and notification.