Failure to Provide Timely Medical Appointments and Hospice Services Due to Transportation and Administrative Delays
Penalty
Summary
The facility failed to provide treatment and care in accordance with professional standards, the comprehensive person-centered care plan, and residents' choices for several residents. Specifically, three residents did not attend their scheduled doctor appointments for follow-up and other medical needs due to the facility van being unavailable. The van was not used because its registration had expired and the insurance policy had been canceled, as confirmed by interviews with the Human Resource Director, DON, CNA, and the insurance company. Staff reported that the lack of van insurance prevented them from transporting residents to critical medical appointments, and there was no log of van usage during this period. One resident with multiple chronic conditions, including heart failure, diabetes, and kidney disease, missed nephrology and cardiology appointments that were not rescheduled in a timely manner. Another resident experiencing light vaginal bleeding was unable to be transported to her physician as requested, and although the physician offered to come to the facility, this did not occur. The resident was eventually transferred to the emergency room by ambulance. A third resident missed a primary care appointment for the same reason. Documentation and interviews confirmed that these missed appointments were directly related to the facility's inability to provide transportation due to the lack of van insurance and registration. Additionally, the facility failed to provide hospice services to a resident who requested them for uncontrolled pain, despite a physician's order and the resident's expressed preferences. The process was delayed because corporate approval was required before ancillary services could be initiated, resulting in an eight-day delay before hospice services were arranged. The resident, her POA, and the facility physician all expressed concern about the delay, and documentation showed that the resident continued to experience pain while waiting for hospice care. The facility's policy required communication with and access to services, but this was not followed in these cases.