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F0742
D

Failure to Initiate Speech Therapy Referral for Resident with Mental Health Needs

Great Falls, Montana Survey Completed on 06-19-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A deficiency occurred when the facility failed to ensure a referral was made for cognitive rehabilitation with a speech therapist for one resident who had been evaluated for depression, schizophrenia, and bipolar disorder. The resident's Behavioral Health Outpatient Psychosocial Evaluation indicated a need for cognitive rehabilitation with a speech therapist, and the plan included a referral for this service. However, interviews with facility staff revealed that no referral or speech therapy notes could be found for the resident, and there was confusion between the facility and the outpatient provider regarding responsibility for initiating the referral. This resulted in an almost six-month delay in implementing the recommended speech therapy treatment for the resident.

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