Failure to Hold Care Plan Meeting After Resident's Return from Hospitalization
Penalty
Summary
The facility failed to hold a care plan meeting following the completion of a comprehensive MDS assessment for a resident who had recently returned from a six-week hospital stay. After the resident experienced a change in condition and was transferred to an acute care hospital, they returned to the facility, and an MDS assessment was completed. However, there was no documentation in the medical record indicating that a care plan meeting was held after this assessment. During an interview, the Social Work Director confirmed that a care plan meeting should have been conducted in the month following the resident's return but acknowledged that it was not held. The absence of this meeting was attributed to an oversight, as it "fell through the cracks." This deficiency was identified during a complaint survey and was substantiated by both medical record review and staff interview.