Failure to Notify Responsible Party of Significant Changes and Care Refusals
Penalty
Summary
The deficiency involves the facility’s failure to notify a resident’s responsible party (RP) of significant changes in the resident’s condition and refusals of care, despite the RP being identified in the admission record as the contact person for care conferences. The resident was admitted with chronic kidney disease stage 3B and type 2 diabetes mellitus, and the care plan indicated a preference for having family involved in discussions about care. The resident’s physical therapy evaluation documented refusal of any skilled services and identified a risk for falls. Progress notes showed that over a period of several weeks the resident repeatedly refused morning medications, requested not to be disturbed for care, refused a blood draw, and refused to attend a care conference. The interdisciplinary team also discussed the resident’s significant weight loss during this time. During interviews, a licensed nurse confirmed that the RP was not notified of the resident’s refusals of prescribed morning medications, refusal of a blood draw, request not to be disturbed, refusal to participate in a care conference, or the significant weight loss, and that the RP was not invited to the care conference. The DON stated that the RP had the right to be informed of changes in the resident’s condition, such as significant weight loss or refusal of care or treatment, and acknowledged that the RP was not given the opportunity to participate in care planning and decision-making. Review of facility policies showed requirements to inform the resident/representative regarding refusal or discontinuation of treatment, to notify the physician and RP of significant weight changes, and to develop a comprehensive person-centered care plan in conjunction with the resident and family or legal representative. These documented policies were not followed in this case.
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