Failure to Arrange Timely Outside Professional Services
Penalty
Summary
The facility failed to arrange for timely outside professional services for two residents who required them. One resident, with multiple diagnoses including Parkinson's disease, schizoaffective disorder, and dementia, was identified as needing dental care after an in-room dental exam revealed decay causing injury to her lip and a need for fillings. Despite a care plan intervention to coordinate dental care and transportation, there was no documentation that an outside dental appointment was scheduled or that the resident refused or canceled such appointments. Interviews with nursing staff and the former unit manager revealed confusion about who was responsible for scheduling and documenting these appointments, and a lack of clarity regarding insurance coverage and the current process for arranging outside services. Another resident, with diagnoses including hemiplegia, chronic respiratory failure, morbid obesity, major depressive disorder, type 1 diabetes, and epilepsy, was referred multiple times to an endocrinologist due to poorly controlled diabetes, as evidenced by elevated Hemoglobin A1c levels. Although the need for an endocrinology referral was documented in several provider notes and discussed in an interdisciplinary team meeting, there was a significant delay in arranging the appointment. The resident's family specifically requested a preferred endocrinologist, and while a referral was eventually made and an assessment conducted, staff interviews indicated uncertainty about when or if previous referrals were acted upon, and the responsible unit manager was unavailable for clarification. In both cases, the facility did not ensure that required outside professional services were arranged in a timely manner, as evidenced by the lack of documentation and follow-through on referrals and appointments. The deficiencies were identified through interviews with residents, staff, and review of medical records, which showed gaps in the process for coordinating and documenting outside care.