Incomplete DNR Authorization Form Lacks Resident Identification
Penalty
No penalty information released
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 ensure that a do not resuscitate (DNR) authorization form was properly completed for a resident with multiple diagnoses, including congestive heart failure, chronic obstructive pulmonary disease, acute kidney failure, and major depressive disorder. Upon review of the resident's electronic health record, the DNR form was found to be missing essential identifying information such as the patient's name, address, birthdate, and gender. Additionally, the signature on the form was illegible, and there was no clear indication as to whom the authorization pertained. During an interview, the Administrator confirmed the absence of identifying information and was unable to determine which resident the form was intended for.