Failure to Accurately Identify and Use Resident’s Legal Representative
Penalty
Summary
The deficiency involves the facility’s failure to maintain an accurate designation of a legal representative for a resident with developmental delay, as required by its advance directives policy. The policy states that during admission the facility must identify the resident’s primary decision maker or legal representative and invoke this person when the resident is unable to make relevant health care decisions. The resident was re-admitted with a diagnosis of developmental delay and was documented in the medical record as their own responsible party, with an outside agency case manager listed as the first emergency contact and identified as family. No Durable Power of Attorney (DPOA) documentation was located in the record. The resident’s care plan noted impaired cognition related to developmental delay, directing staff to use yes/no questions and one-step instructions, and a provider note described the resident as an intermittently poor historian who communicated more by body language, with family assisting. Despite this, the facility’s records showed the resident signed their own POLST and other consents. Social services documented contacting the outside agency case manager to schedule a care conference, and an admission note recorded that this case manager approved a room move. In interviews, the case manager stated the resident had a DPOA and that the facility sought questions and updates from the case manager even though they were not the DPOA and had no right to make decisions. The LPN/Resident Care Manager reported concern at admission and again when reviewing the POLST, noting that the case manager told them the resident could sign for themself and that admissions and the business office should verify any DPOA. The Interim DON stated they were unaware of any DPOA and believed social services should confirm DPOA status. The identified DPOA reported having served in that role for a couple of months, never receiving calls from the facility, and learning of the resident’s catheter incident and hospital transfer only through the case manager, rather than directly from the facility.
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