Failure to Provide Routine Dental Care Due to Payor Source Uncertainty
Penalty
Summary
A deficiency occurred when the facility failed to provide routine dental care services to a resident who was admitted with multiple medical conditions, including bipolar disorder, major depressive disorder, dysphagia, hypotension, hypertension, and abdominal tenderness. The resident was cognitively intact and did not refuse care. Upon admission and subsequent assessments, the resident was noted to have obvious or likely cavities or broken natural teeth, and her care plan included coordination for dental care and transportation as needed. Despite these documented needs, the resident reported that arrangements for dental care had not been made, and observation confirmed she had only six remaining teeth, with multiple missing and discolored teeth. Interviews with facility staff revealed that the Social Services Director was aware of the resident's need for dental services but had not arranged care due to uncertainty about payment, as the resident was in a private pay/Medicaid pending status. The contracted dental provider's records showed the resident was listed but had not received or been scheduled for an annual assessment. The DON stated that all residents should have access to dental services regardless of payor source, and the facility was responsible for providing these services. However, the necessary dental care was not provided in a timely manner, resulting in a failure to meet the resident's dental care needs.