Failure to Administer Medications Timely and Lack of Palliative Care Procedures
Penalty
Summary
The facility failed to provide quality care by not administering medication according to physician orders and not developing appropriate procedures for palliative care. For one resident with Parkinson's disease, there were multiple documented instances where Carbidopa-Levodopa was administered significantly later than the prescribed times, ranging from over one hour to more than three hours late, despite facility policy requiring administration within one hour of the scheduled time. The Nursing Home Administrator confirmed that medications should be administered timely in accordance with physician orders and professional standards of practice. Additionally, the facility did not establish or follow proper procedures for implementing palliative care for two residents with dementia. In one case, after a resident's representative requested a transition to palliative care, there was no documented palliative care plan, no signed consent, and no supporting notes from a physician or social worker. In another case, a resident's representative requested palliative care with specific directives, but the clinical record lacked documentation of a clinical diagnosis or rationale for palliative care, as well as a comprehensive care plan, signed consent, and interdisciplinary progress notes. Interviews with facility leadership confirmed the absence of documentation outlining the clinical rationale or medical necessity for palliative care orders and the lack of a facility policy or established criteria for determining eligibility for palliative care services. These deficiencies were cited under relevant state codes for resident care policies and nursing services.