Failure to Honor Resident's Discharge Preferences and Goals
Penalty
Summary
The facility failed to ensure that the discharge process for a resident with diagnoses including Wernicke's Encephalopathy, alcohol-induced psychotic disorder, alcoholic cirrhosis, and nicotine dependence honored the resident's preferences and goals. The resident, who was cognitively intact, expressed a clear desire to be transferred to a local skilled nursing facility that permitted smoking. Documentation showed that the social worker communicated this preference to the resident's guardian, who authorized the release of records to two local facilities. However, the resident was ultimately transferred to a facility several hours away, contrary to his stated wishes. There was no documentation provided to justify why a local placement was not pursued or why the facility could no longer meet the resident's needs. The social worker was unable to explain the decision to transfer the resident to a distant facility and there was no evidence that the resident was meaningfully involved in the discharge decision-making process. Additionally, the facility could not produce documentation confirming the resident's guardianship status during the survey.