Failure to Communicate and Follow Up on Resident Transfer Request
Penalty
Summary
The facility failed to ensure timely follow-up and communication regarding a resident's request to transfer to another facility. The resident, who had diagnoses including heart failure, obesity, and reduced mobility, was cognitively intact and required maximal to total assistance with most activities of daily living. Despite the resident's request for assistance with transferring, there was no documented follow-up or communication from the Social Services Worker (SSW) for approximately one month. The resident expressed frustration and dissatisfaction due to the lack of updates and support for his care preferences, and even stopped participating in physical therapy sessions in anticipation of the transfer. Interviews revealed that the SSW acknowledged not contacting the requested receiving facility or providing the resident with updates about the status of the transfer request. Record review confirmed the absence of documentation regarding any actions taken to facilitate the transfer or communicate progress to the resident. The Director of Nursing (DON) confirmed that it was the SSW's responsibility to assist residents with grievances and requests, including providing updates. The facility's policy also indicated that social services staff are responsible for assisting with transitions of care and advocating for residents' rights.