Failure to Provide Timely Therapy Evaluation for Communication Deficit
Penalty
Summary
The facility failed to ensure that a resident received appropriate treatment and services to maintain or improve her ability to carry out activities of daily living (ADLs), specifically regarding her communication abilities. The resident, a cognitively intact female with a history of stroke, hemiplegia, high blood pressure, diabetes, and non-Alzheimer's dementia, was admitted with a communication deficit. Her comprehensive MDS assessment and Care Area Assessment (CAA) indicated impaired expressive communication and triggered care planning for communication and ADL functional/rehabilitation potential. However, her care plan was incomplete and did not address her communication needs. Despite physician orders allowing for PT, OT, and ST evaluation and treatment as indicated, the resident was not evaluated by speech therapy (ST) upon admission or during her stay until after surveyor intervention. The SLP and DOR both stated that their process relied on nursing staff to notify therapy of a decline or need for therapy, and no such referral was made. Nursing staff were unaware of the need to communicate the presence of a communication board or the resident's ongoing communication difficulties to therapy. The resident herself reported frustration and emotional distress due to staff not taking the time to listen to her, and she expressed a desire for speech therapy services, which had not been offered. Interviews with facility staff revealed a lack of communication and coordination between nursing and therapy departments regarding the resident's needs. The SLP confirmed that she had not been informed about the communication board and had not screened the resident until prompted by the survey. The DOR and ADM acknowledged that the process for therapy screening was not followed for this resident, and that therapy services could have been authorized by the facility if payor source issues were present. The resident's family member also indicated that the resident could benefit from speech therapy and that her Medicaid status was in transition, which may have contributed to the lack of therapy services.