Failure to Employ Full-Time Social Worker and Complete Discharge Planning
Penalty
Summary
The facility failed to employ a qualified full-time social worker as required for facilities with more than 120 beds. According to interviews and record reviews, the facility had not had a full-time social worker since December 11, 2025. The Director of Nursing (DON) and Administrator confirmed that the responsibilities of the social worker, including addressing grievances and initiating discharge plans, were being handled by themselves and Assistant Directors of Nursing (ADONs) in the absence of a social worker. The Administrator stated that although a new social worker was hired on November 24, 2025, this individual was terminated on December 11, 2025, and the position remained vacant at the time of the survey. A specific case involved a resident with complex medical needs, including a persistent vegetative state, ventilator dependence, multiple chronic conditions (such as CAD, DM, heart failure, COPD, PVD, HTN, prior CVA, CKD 3, and anoxic encephalopathy), and multiple stage IV pressure ulcers. The resident was bedbound, non-responsive, and required extensive care, including wound management, nutritional support, and mechanical ventilation. The resident's family desired all life-sustaining measures, and the care plan required ongoing monitoring and adjustment. Despite the issuance of a discharge notice due to non-payment, there was no active discharge planning or documentation of a discharge plan in the resident's care plan, and scheduled discharge planning orientation was not conducted as planned. Staff interviews revealed that grievances and discharge planning were not consistently managed according to facility policy during the period without a social worker. The DON and Administrator acknowledged lapses in grievance documentation and communication with families. The MDS nurses confirmed that the social worker would typically initiate interdisciplinary discharge planning, but this was not done for the resident in question. The facility was unable to provide a copy of the social worker job description when requested by the surveyor, and evidence of ongoing recruitment for the position was provided.