Failure to Provide Necessary Dental Services for Resident with Dental Abscess
Penalty
Summary
The facility failed to provide necessary dental services for a resident who had a documented dental abscess and was awaiting Medicaid approval for insurance coverage. Upon admission, the resident had a known dental infection and was prescribed antibiotics, with a follow-up dental appointment scheduled prior to hospital discharge. Staff interviews and record reviews revealed that the social services assessment identified dental needs, but no dental visit request was filed, and staff were unaware of the abscessed tooth. When the dental office contacted the facility regarding payment for the scheduled extraction, staff found that the resident lacked dental insurance and was unable to pay the $1200 fee. The appointment was subsequently canceled after discussing the cost with the resident, and staff were not aware of available facility resources or the resident's pending Medicaid status. Further review of the resident's records showed ongoing dental infection, difficulty chewing, and significant weight loss since admission. The care plan included a focus on dental care, but no arrangements were made for the necessary procedure due to the perceived lack of payment options. Communication breakdowns between nursing, social services, and the business office contributed to the failure to secure dental care, despite the resident's Medicaid approval being effective shortly after admission. The deficiency resulted in the resident experiencing pain, difficulty eating, and severe weight loss.