Failure to Provide and Follow Through on Dental Services and Recommendations
Penalty
Summary
The deficiency involves the facility’s failure to ensure that routine and 24-hour emergency dental services were provided and that dental recommendations were implemented for three residents. For one resident with dementia and progressive multiple sclerosis, a care plan meeting note documented that the resident wished to be seen by a dentist for possible dentures. A subsequent dental consultation recommended use of Prevident 5000 Dry Mouth gel and referral to an oral surgeon for extraction of all non-restorable teeth. The consultation lacked any review signature by nursing staff or the resident’s physician, and the physician orders contained no orders for the oral surgeon consultation or the Prevident gel. For a second resident with vascular dementia and generalized muscle weakness, a dental consultation documented that the resident had lost upper and lower dentures and that Step 1 of the denture replacement process had been completed, with a follow-up visit scheduled for Step 2. Facility-provided information from the contracted dental services provider indicated the resident was seen for Step 1 and scheduled for Step 2, but the clinical record contained no additional dental consultations or visit notes over several months. Progress notes showed that the resident’s representative repeatedly inquired about the status of the denture replacement, and was told the resident was in Step 2, while the DON later confirmed the resident had not been seen by the dentist since the initial consultation. For a third resident with a neurocognitive disorder with Lewy bodies and heart failure, a dental consultation documented a periodic oral exam and scheduled a prophylaxis visit for a later date. The clinical record contained no further dental consultations after that exam. The NHA confirmed there was no additional information in the record regarding the scheduled prophylaxis visit and reported contacting the contracted dental services provider to investigate what had happened with that visit. Overall, the records and staff interviews showed that scheduled dental services and dentist recommendations were not carried out or documented for all three residents.
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