Failure to Arrange Transportation for Nephrology Appointments
Penalty
Summary
The deficiency involves the facility’s failure to arrange and provide transportation for multiple residents’ scheduled nephrology appointments, resulting in the cancellation of all six residents’ visits on the same day. Review of the appointment calendar showed that six residents had nephrology appointments scheduled for 11:15 AM that were canceled. The DON reported that all residents were supposed to travel together by facility bus, but the bus was not available because it had been in a repair shop since late January for a fuel pump failure. A repair receipt documented that the bus had very low fuel pressure, could not be repaired at the initial shop, and required transfer to a heavy truck repair facility. The DON further stated that transportation was supposed to be arranged 72 hours before the appointment, but the records staff responsible for scheduling were out due to vacation and sickness, and no designee was assigned to complete the arrangements. Resident interviews and record reviews confirmed the impact of this failure on six residents with significant renal and related comorbidities. One cognitively intact female resident with hypertensive kidney disease, type 2 diabetes, UTI, and anxiety disorder reported being upset that her kidney appointment was canceled due to lack of transportation; her appointment had been scheduled two months earlier. A cognitively intact male resident with chronic kidney disease, hypertensive heart failure, anemia, and BPH stated he canceled his quarterly kidney follow-up because the bus had been in the repair shop for a while. Another cognitively intact male resident with chronic kidney disease, type 2 diabetes, hypertensive heart disease, and peripheral vascular disease reported his kidney appointment was canceled because the bus was not available. Three additional residents with severely impaired cognition and extensive ADL assistance needs, including diagnoses such as obstructive and reflux uropathy, urinary retention, dementia, transplant kidney status, and Alzheimer’s disease, also had nephrology appointments scheduled and then canceled. The Administrator acknowledged the failure to arrange transportation, either through family or an outside transportation company, when the bus was unavailable and the responsible staff were absent.
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