Failure to Ensure Accurate Completion of Advance Directives for Residents with Legal Representatives
Penalty
Summary
The facility failed to ensure that advance directive documentation was accurately completed for four residents who had legal representatives in place. In each case, the required (State)-POST (Physician Orders for Scope of Treatment) forms were either signed by the resident despite a legal guardian or DPOA being designated, or were acknowledged verbally by a guardian without proper witnessing or follow-up signatures. Specifically, one resident's POST form was signed by the resident instead of their legal guardian, another had a verbal order from a guardian documented by an LPN without witness signatures, and a third resident, deemed incapacitated by two physicians, signed their own POST form instead of their DPOA. For the fourth resident, the POST form was verbally acknowledged by the guardian, but the documentation did not meet the required standards for validity. Interviews and record reviews revealed that the facility lacked a social worker, resulting in a team approach to handling social services responsibilities, including advance directive completion. The facility's policy and state guidelines require that advance directives be signed by the appropriate legal representative when a resident lacks decision-making capacity, and that verbal or telephone orders be properly witnessed and signed by the attending health professional within a specified timeframe. These requirements were not met in the cases reviewed, leading to inaccurate and incomplete advance directive documentation.