Failure to Ensure Healthcare Decisions Made by Legally Authorized Representative
Penalty
Summary
The facility failed to ensure that the right to make healthcare decisions for a resident was extended only to those legally authorized, as required by state law. A resident with severe cognitive impairment, as indicated by a BIMS score of 6 out of 15, was admitted with a court-ordered temporary guardianship that expired after a set period. Despite the expiration of the temporary guardianship and the absence of documentation for permanent guardianship, the facility continued to allow the former temporary guardian to make healthcare decisions for the resident. Medical records and social services notes confirmed that the temporary guardian was involved in signing admission agreements, vaccine consents, and making referral requests after the guardianship had lapsed. Staff interviews and record reviews revealed that the facility was aware the temporary guardianship had expired and that the resident was legally their own decision maker at that time. However, the facility did not obtain updated guardianship paperwork or ensure that only a legally authorized representative made healthcare decisions for the resident. The social services director acknowledged that the former temporary guardian continued to act as the resident's legal representative and decision maker after the expiration of the guardianship, contrary to legal requirements.