Failure to Provide Routine and Emergency Dental Services Due to Missed Appointments and Incomplete Paperwork
Penalty
Summary
The facility failed to provide or obtain routine and 24-hour emergency dental services for a resident who had a broken tooth and oversized dentures. The resident, who was cognitively intact but had mild memory/recall difficulties, had a history of depressive disorder, anxiety, diabetes, and heart disease. She required only set-up or clean-up assistance for oral hygiene. Dental records showed that she received new dentures, but subsequent scheduled follow-up and annual dental appointments were missed, with documentation indicating she was unavailable for treatment on two occasions. No further attempts or appointments were documented for several months. The resident reported ongoing issues with her dentures, stating they did not fit, looked unnatural, and made it difficult to eat and talk, leading her to stop wearing them. She also reported breaking a tooth while eating, which she attributed to not being able to wear her dentures. She communicated these concerns to the Social Worker and her nurse, but no adjustments, repairs, or replacements were offered, and she had not seen the dentist since receiving the dentures. Staff interviews revealed a lack of awareness or follow-up regarding her dental issues, with the Social Worker and Medical Records Custodian both acknowledging the resident's requests but unable to explain the lack of action or missed appointments. Further investigation revealed that the contracted dental provider had placed a 'do not treat' status on the resident's account due to incomplete re-enrollment paperwork, specifically a missing physician-signed form. The dental company representative stated that all necessary forms were sent to the Social Worker, but the required documentation was not returned, preventing the resident from receiving dental services. The Social Worker was unaware of the missing paperwork until the day of the survey and stated that forms were sent to her at different times, which may have contributed to the oversight. The facility's policy required Social Services to assist with dental appointments and maintain complete records, but these procedures were not followed in this case.