Failure to Notify POA of Resident Health Changes
Penalty
Summary
The facility failed to notify a resident's responsible party or power of attorney (POA) of significant health changes, as required by facility policy. Medical record review for a resident with diagnoses including Parkinson's disease, anxiety, hypertension, and glaucoma, and with severely impaired cognition, showed two separate incidents where the resident experienced notable changes in condition: one involving low oxygen saturation and wheezing, and another where the resident was lethargic and unresponsive after medication administration. In both cases, while the physician was notified and interventions were initiated, there was no documented evidence that the resident's POA was informed of these changes. Staff interviews confirmed that no notification was made to the POA during these events, despite facility policy mandating such communication.