Failure to Complete Timely MDS Assessments for Multiple Residents
Penalty
Summary
The facility failed to complete Minimum Data Set (MDS) assessments in a timely manner for four out of eight sampled residents. For one resident with reduced mobility and muscle wasting, the Discharge Return Not Anticipated MDS assessment was overdue by nine days. The MDS Coordinator confirmed being behind on work due to a busy schedule, resulting in the late assessment. Another resident with kidney disease and heart failure had an Annual MDS assessment overdue by thirteen days, with the same explanation provided by the MDS Coordinator. Additionally, a resident with Multiple Sclerosis had a Quarterly MDS assessment completed three days late. Another resident with schizoaffective disorder had both an Annual MDS and a Quarterly MDS completed late, with the Annual MDS overdue by over two weeks and the Quarterly MDS overdue by several days. The MDS Coordinator acknowledged the delays in all cases, and facility leadership confirmed that the expectation was for MDS assessments to be completed on time.