Failure to Provide Timely Dental Services and Specialty Referrals
Penalty
Summary
The facility failed to provide or obtain timely dental services for two residents, resulting in unaddressed dental issues and progression of oral health problems. For one resident with a history of stroke and hemiplegia, repeated recommendations for extraction of a broken tooth (#18) were not acted upon over a period of 17 months. Despite multiple dental consultations, nursing notes, and provider recommendations indicating the need for extraction and referral to an oral surgeon, the necessary appointment was not scheduled. This inaction led to the development of a fistula and abscess at the site of the affected tooth. Interviews with staff revealed ongoing communication breakdowns and lack of follow-through in scheduling and documenting specialty dental care, despite the issue being previously identified and discussed among nursing leadership. Another resident, admitted with hypertension and peripheral vascular disease, was identified as needing an oral surgeon evaluation for removal of excess tissue and biopsy of a growth in the mouth. Although a referral was made following a dental assessment, there was no documentation that the appointment was scheduled or that the resident or representative refused the consultation. The resident reported that the dental appointment was never completed, and staff interviews confirmed that the required oral surgeon consultation had not been scheduled due to oversight and lack of communication between the scheduler and nursing staff. Facility policy required that ancillary services, including dental care, be provided or coordinated and that all services and outcomes be documented. The policy also directed that outside medical appointments be arranged, documented, and communicated effectively. However, the facility failed to ensure timely follow-up on dental recommendations, proper scheduling of specialty appointments, and adequate documentation of actions taken, resulting in prolonged resident discomfort and progression of dental conditions.