Failure to Notify Resident Representative of Discharge
Penalty
Summary
The facility failed to notify the resident's representative (RR) of a discharge for a resident with severely impaired cognition. The resident, who had diagnoses including follow-up care for a surgical procedure, heart failure, and dementia, was admitted with a cognitive assessment indicating severe impairment. According to the medical record, the resident was discharged to another facility, and the discharge documentation was signed by the resident. Staff A, an LPN, facilitated the discharge and assumed the RR had been notified, but did not confirm this. Later, the RR arrived at the facility and was informed by Staff A that the resident had already been transferred, leading to the RR expressing upset at not having been notified. Staff B, the DON, confirmed that the facility's process requires notification of representatives for residents with altered mental status, which was not followed in this case. The RR also verified during a telephone interview that they had not been notified of the transfer.