Failure to Maintain Guardianship Documentation and Offer Advance Directives
Penalty
Summary
The facility failed to obtain and/or renew guardianship papers and did not offer or document assistance in formulating advance directives for three of four residents reviewed. For one resident with a diagnosis of unspecified intellectual disabilities, guardianship papers were found to be expired, and there was no clear assignment of responsibility among staff for ensuring these documents were current and available in the electronic health record (EHR). Interviews with staff revealed confusion about who was responsible for maintaining up-to-date guardianship documentation, and the administrator was unaware of the process. Another resident with intact cognition had no documentation in their EHR regarding advance directives, nor was there evidence that the topic was discussed or that assistance was offered. Staff confirmed that there was no record of such a discussion, despite facility policy requiring that residents be offered information and assistance with advance directives upon admission. A third resident, who was their own decision-maker, expressed interest in designating a Durable Power of Attorney (DPOA) for health care but reported that the facility did not request a copy of an advance directive or offer the option to establish one. The social worker acknowledged that a conversation with the resident’s contact about DPOA was not documented. The administrator confirmed that residents should be given the opportunity to delegate DPOA and that these directives should be documented and accessible, but this was not done for the resident in question.