Failure to Involve Resident Representative in Care Planning and Notification of Changes
Penalty
Summary
The facility failed to involve a resident's designated representative in the development and ongoing review of the resident's person-centered plan of care. The resident, who had diagnoses of dementia, bipolar disorder, and diabetes, was admitted with moderate cognitive impairment and a Durable Power of Attorney for Health Care (DPOA-HC) in place. Despite the DPOA-HC being documented in the electronic medical record, the representative (CC1) was not informed of significant changes to the resident's care, including the discontinuation of medications for diabetes and bipolar disorder, and the initiation of IV fluids and lab orders following the resident's episodes of nausea, vomiting, and somnolence. CC1 reported not being notified about the discontinuation of critical medications or changes in the resident's condition, and expressed concern that these changes led to instability in the resident's health, which affected discharge planning. Multiple emails from CC1 to facility staff show repeated requests for the care plan, medication lists, and updates on the resident's condition, which were not adequately addressed. Progress notes and staff interviews confirmed that there was no documentation of timely notification to CC1 regarding medication changes or care plan updates, and that the first substantial care conference with CC1 occurred weeks after admission. Staff interviews revealed that the responsibility for notifying representatives of changes in care was not consistently followed, and facility leadership acknowledged that the representative should have been involved from admission and kept informed of all significant changes. The lack of communication and collaboration with the resident's representative resulted in ongoing frustration and unanswered questions regarding the resident's care and discharge planning.