Failure to Provide Required Written Notice of Room Change and New Roommate
Penalty
Summary
The deficiency involves the facility’s failure to provide required written notice of a room change and new roommate assignment for two residents. One resident with Alzheimer’s disease and unspecified dementia, documented in a history and physical as not having the capacity to understand and make decisions, was admitted with a responsible party designated as the decision maker. Facility census records showed this resident was in one room and another resident was in a different room on the same date. A progress note later documented that the cognitively impaired resident was moved into the other resident’s room. During interview and record review, the ADON confirmed that the responsible party should have been notified prior to the room change and that there was no documentation that this notification occurred. The second resident, who was already occupying the room into which the first resident was moved, did not receive written notice that a new roommate would be assigned. The ADON stated that residents should be notified about getting a roommate and that it was the Social Worker’s responsibility to notify the responsible party and the potential roommate of a room change and to document that conversation. The Social Service Assistant confirmed that the room change should have been documented on a room change form and in a progress note, and that written notification should have been provided to both residents, but acknowledged this was missed. The facility’s policy on room change/roommate assignment required advance notice to all parties and their representatives and documentation of the room change in the medical record, which was not followed in these instances.
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