Failure to Complete Leave of Absence Documentation for Resident on Pass
Penalty
Summary
A deficiency occurred when the facility failed to ensure that a required Release of Responsibility for Leave of Absence Form was completed for a resident before allowing the resident to leave the premises on pass. The resident, who had a history of cerebral infarct and alcohol dependence, was permitted to leave the facility with his brother after an order was obtained for a pass not to exceed four hours. However, the resident did not return as expected, and the facility lacked documentation regarding his destination, contact information, and expected return time because the required form was not filled out. Staff interviews and record reviews confirmed that the established procedure required residents or their representatives to complete a form indicating the date and time of departure, expected return, destination, and contact information. In this case, staff acknowledged that the form was not completed, which resulted in the facility not having essential information to locate the resident when he did not return as planned. The resident later reported that he decided not to return to the facility and went home instead, without notifying the staff.