Failure to Maintain Essential Services and Timely Vendor Payments
Penalty
Summary
The facility failed to administer its operations in a manner that enabled effective and efficient use of resources, resulting in widespread unpaid debts and disruption of essential services. Key services such as phone and internet were disconnected due to non-payment, forcing staff to use personal cell phones and prepaid devices to conduct facility business and allow residents to communicate with their families. The facility van lacked insurance and current registration, preventing residents from attending medical appointments. Staff members purchased essential supplies such as milk, coffee, laundry soap, bleach, and incontinent briefs out of their own pockets because the facility did not provide adequate funds or pay vendors. Maintenance and laundry services were also compromised, with the hot water heater for laundry out of service for over a month and washing machines lacking proper chemicals and servicing due to unpaid bills. Multiple interviews with staff, including the DON, dietary manager, maintenance director, and housekeeper, confirmed that the facility was unable to purchase necessary supplies or maintain equipment due to outstanding vendor balances. The dietary manager reported substituting menu items because the food budget was insufficient, and staff had to buy food items themselves. The maintenance director and laundry supervisor stated that they could not obtain needed repairs or chemicals for laundry sanitation, and staff had to use cold water and inadequate cleaning agents. The lack of phone and internet service also hindered communication with families, physicians, and pharmacies, impacting the ability to send or receive critical information and documentation. Residents were directly affected by these deficiencies. Several residents missed important medical appointments because the facility van was uninsured and unregistered. One resident's family had to transport her to the ER, and the facility used the uninsured van to pick her up. Residents and their families expressed concerns about communication barriers and missed care opportunities. Staff and department heads repeatedly reported the lack of response from facility leadership regarding supply needs and unpaid bills, and the absence of an administrator further exacerbated the situation. The cumulative effect of these failures resulted in an Immediate Jeopardy situation, as essential care and services required for residents' well-being were not reliably provided.
Removal Plan
- The CEO and Managing Partner re-educated the COO on the governing board responsibility to ensure management and operation of the facility, emphasizing oversight of facility care and services and vendor payments.
- The CEO and COO will review and make payments or payment arrangements for outstanding vendor invoices, including telephone/internet, van insurance, van registration, fire and security vendor, and others. Emergency plans for communication and documentation (hot spots, paper MARs/TARs) will be implemented as needed.
- The DON will complete a Medication Error Form for each of the identified residents with medication errors, including communication with providers, responsible parties, management, and pharmacist consultant, and corrective actions.
- The DON will re-educate nurses and certified medication aides on policies for administering medications and medication errors, using one-on-one meetings and memos, and will conduct Medication Pass Observations.
- The CEO and COO will post the facility administrator's vacant position and continue active recruitment, with a sign-on bonus. Until filled, supply needs will be communicated to the DON and HR Director, with conference calls to ensure vendor payments and resident services.
- Staff will be reimbursed for out-of-pocket expenses per usual procedures, and HR will instruct staff not to purchase items for the facility in the absence of the administrator; all purchases will be made by the administrator and/or HR Director after the conference call.
- Annual van registration and insurance will be added to the annual maintenance checklist, with the administrator reviewing the checklist during QAPI to ensure renewal.
- An ad-hoc QAPI meeting will be held, and the Medical Director will be notified of the deficient practice and removal plan. Action items will be reviewed during QAPI meetings, with meeting minutes maintained.