Failure to Complete Timely Comprehensive Assessment for Pain Management
Penalty
Summary
A deficiency occurred when the facility failed to complete a comprehensive assessment for a resident in a timely manner. The resident, who was cognitively intact and had diagnoses including unilateral primary osteoarthritis, an artificial right knee, and lower back pain, was admitted and had a care plan identifying pain management interventions, including medication and ice packs for the right knee. Despite these interventions, the Minimum Data Set (MDS) assessment, which should have been completed within 14 days of admission, was not completed on time. The MDS coordinator confirmed the assessment was late and could not provide a reason for the delay. Facility policy required a comprehensive and individualized plan of care but did not address the MDS completion process.