Failure to Support Resident's Choice to Transfer
Penalty
Summary
A deficiency occurred when the facility failed to honor a resident's right to self-determination by not supporting her expressed choice to transfer to another facility. The resident, who had a history of protein-calorie malnutrition, bipolar disorder, mood disorder, opioid dependence, and generalized anxiety disorder, communicated her desire to move to another facility but reported that her requests were ignored and not acted upon. The resident had a moderate cognitive impairment, as indicated by a BIMS score of 10 out of 15. There was no documentation in her progress notes or the facility's grievance log regarding her request or any follow-up actions taken by staff. Interviews with the Social Services Assistant revealed that although she was aware of the resident's wish to transfer and had discussed it with her, she did not document the conversation or any change in the resident's wishes. The facility's policy requires informing residents of their rights and documenting relevant information, but there was no evidence that the resident's request or subsequent discussions were recorded. This lack of documentation and follow-up resulted in the facility failing to promote and facilitate the resident's right to make choices about her care and living arrangements.