Failure to Designate Resident Representation for Cognitively Impaired Resident
Penalty
Summary
The facility failed to attempt to designate a representative for a resident with moderate cognitive impairment and intellectual disability, resulting in the absence of a surrogate to make informed medical and financial decisions on the resident's behalf. The resident, who had a BIMS score of 9 indicating moderate cognitive impairment, was diagnosed with mild intellectual disabilities, mood disorder, psychotic disorder, anxiety disorder, and depression. The resident's care plan identified the need to determine if an appropriate family member, friend, or support person could serve as Power of Attorney (POA), conservator, or guardian, and if not, to refer to the Office of Substitute Decision Maker. However, the admission record listed only the resident as a contact, and there was no documentation of attempts to identify or designate a representative. Staff interviews confirmed that the resident was often disoriented, unable to make complex decisions, and required assistance with medical and financial matters. Despite this, the Director of Social Services denied making any attempts to designate a conservator, guardian, or POA, and the facility administrator confirmed there was no record of such efforts. The facility's policy required assessment of decision-making capacity and identification of a primary decision-maker if the resident lacked capacity, but this process was not followed for the resident in question.