Failure to Notify Correct State Ombudsman of Involuntary Discharge
Penalty
Summary
The facility failed to provide a copy of the planned Involuntary Discharge Notice to the correct State Long-Term Care Ombudsman for two of three residents reviewed. For both residents, record review showed that the Involuntary Discharge Notices were sent to the Ombudsman in another state rather than to the New Mexico Long-Term Care Ombudsman. Interviews with the New Mexico Ombudsman confirmed that she did not receive the discharge notices for either resident. The Social Services Director (SSD) stated during interviews that she sent the notices to the wrong state’s Ombudsman, following instructions from the Corporate SSD and using a template that included incorrect contact information. As a result, the required notifications were not provided to the appropriate state entity, as confirmed by both documentation and staff interviews.