Failure to Verify Resident Representative for Cognitively Impaired Resident Admission
Penalty
Summary
The facility failed to determine whether a resident with advanced dementia had a designated Resident Representative before allowing the resident to sign admission paperwork. The resident, who had a diagnosis of advanced dementia as documented in a hospital discharge summary, was admitted to the facility and subsequently discharged to another skilled nursing facility. The resident's face sheet listed her as the primary contact for financial matters, with a family member as the emergency contact and another family member as the Resident Representative. Despite this, the admission paperwork was signed by the resident herself and witnessed by the former Admission Coordinator. Interviews revealed that the resident's family member, who was her legal representative, was not involved in the admission paperwork process and only became aware of the issue after the resident was transferred to another facility. The family member expressed concern that the resident, due to her dementia, would not have understood the documents she signed. The family member also noted that the resident's spouse, who was present during the signing, was overwhelmed and would not have understood the paperwork either. The family member stated she was available and could have signed the paperwork if contacted. The former Admission Coordinator acknowledged being aware of the resident's dementia diagnosis but stated she was not aware of its severity. She reported that both the resident and her spouse denied having a power of attorney at the time of admission. The Admission Coordinator allowed the resident to sign the paperwork based on her own assessment and the spouse's suggestion. It was only near the time of discharge that the facility received documentation of the legal representative's authority. Both the DON and the Administrator confirmed that the admission paperwork should have been signed by the resident's legal representative due to the resident's cognitive impairment.