Failure to Provide Timely Dental Services and Assess Oral Health
Penalty
Summary
The facility failed to ensure timely dental services for two out of three sampled residents, resulting in deficiencies related to both the identification and referral for dental care. In the first case, a resident with moderate cognitive impairment and multiple physical diagnoses lost her left upper canine tooth while eating. Although she reported the incident to staff and her daughter, there was no documentation in her electronic medical record regarding the missing tooth, despite staff assisting her with oral care. Staff interviews revealed that none of the CNAs or nurses were aware of the missing tooth until the time of the survey, and no assessment or referral for dental services was made at the time of the incident. In the second case, another resident with severe cognitive impairment and total dependence on staff for activities of daily living, including oral care, was found by her representative to have a broken tooth. The representative reported the issue to the facility, which led to the resident being placed on antibiotics and eventually having the tooth extracted. However, prior to this, the resident had not been offered routine dental care or seen by the dental hygienist during scheduled visits. Documentation inconsistencies were noted, with the care plan indicating poor dental condition but no evidence of routine dental assessments or offers for dental services. Staff interviews and record reviews indicated a lack of consistent processes for tracking and offering dental services, with reliance on resident or representative requests rather than proactive scheduling. The facility's own policy required emergency dental care to be available and for staff to notify the dental consultant in cases of acute dental issues, but this was not followed in either case. The deficiencies were further compounded by staff turnover and inadequate communication regarding changes in residents' oral health conditions.